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Anesthesiology > Induction Agents > Flashcards

Induction Agents Flashcards

1
Q

Pretreatment with what medication can decrease etomidate-induced myoclonus?

A

Opioids or benzos (fast onset, not diazepam)

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2
Q

Prolonged infusions of what induction agent increases mortality in ICU patients?

A

Etomidate (likely secondary to adrenal suppression)

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3
Q

Effects of ketamine on the heart

A

Increased sympathetics (increased HR, CO, SV) which masks the direct myocardial depression associated with large doses of ketamine

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4
Q

Pretreatment with what medication can decreased ketamine-induced psychotomimetic effects?

A

Benzos

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5
Q

Mixing which induction agent and opioids or LR can cause precipitation?

A

Thiopental

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6
Q

Mechanism of action for thiopental?

A

Enhances action (increased duration) of GABA action at GABA-A receptor

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7
Q

Induction dose for thiopental

A

3-5mg/kg

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8
Q

What is the primary mechanism for prompt awakening after induction dose of thiopental?

A

Redistribution

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9
Q

Treatment of intra-arterial injection of thiopental

A

Dilution with NS + vasomotor relaxation (lidocaine, papaverine, or phenoxybenzamine) with sympathectomy (i.e. stellate ganglion block) if meds are ineffective

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10
Q

When do you worry about propofol infusion syndrome?

A

ICU patients, usually pediatric patients, when propofol used at 150-200 mcg/kg/min for hours to days

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11
Q

Signs and symptoms of propofol infusion syndrome?

A

Progressive bradyarrhythmias, metabolic acidosis, cardiac arrest

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12
Q

How does propofol work?

A

Stimulates GABA-A receptors

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13
Q

Does propofol injection affect NMB?

A

Increases depth but not duration

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14
Q

How is etomidate metabolized?

A

Ester hydrolysis (plasma and hepatic)

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15
Q

How is etomidate excreted?

A

Inactive metabolites renally

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16
Q

Induction dose of etomidate

A

0.3 mg/kg

17
Q

Etomidate has what EEG changes?

A

Can cause epileptiform activity and thus avoided with patients with seizures

18
Q

Which induction agents do not cause cardio depression?

A

Etomidate and Ketamine

19
Q

Which induction agents decrease ICP?

A

Propofol, thiopental, and etomidate

20
Q

Which induction agents do not cause respiratory depression?

A

Etomidate, Ketamine, Midazolam

21
Q

Which induction agents provide analgesia?

A

Ketamine

22
Q

Which induction agents cause porphyria?

A

Thiopental and etomidate

23
Q

Which induction agents cause bronchorelaxation?

A

Ketamine

24
Q

Which induction agents cause myoclonus?

A

Etomidate

25
Q

How does etomidate cause adrenal suppression?

A

Inhibits 11-beta-hydroxylase which decreases aldosterone and cortisol synthesis

26
Q

Which induction agents cause significant N/V?

A

Etomidate

27
Q

Which induction agents can cause post-op hiccups and sense of restlessness?

A

Etomidate

28
Q

Mechanism of action for ketamine

A

Non-competitive antagonism at NMDA receptors; also has local anesthetic properties; can bind mu-delta-kappa receptors, inhibits reuptake of epi, dopamine, serotonin, NE; blocks Ach receptors (anti-cholinergic symptoms)

29
Q

What neurotransmitter pairs with NMDA receptors?

A

Glutamine (excitatory)

30
Q

Which induction agent increases cerebral blood flow and ICP

A

Ketamine

31
Q

What receptor does barbiturates, benzos, and propofol target?

A

GABA-A receptors

32
Q

How do you approach patients who are allergic to egg and need propofol?

A

Most patients are allergic to egg albumin (egg whites) and not egg lecithin (yolk - what propofol is used in)

33
Q

What does it mean to be a more potent drug? A more efficacious drug?

A

More potent: same effect achieved by a lower dose

More efficacious: same dose gives a lesser effect

34
Q

Blood is sampled from the hepatic vein. Which would have the lowest concentration compared to central blood: propofol, fentanyl, midazolam, etomidate, esmolol

A

Propofol: completely metabolized by the liver on a single pass

Midazolam, fentanyl and etomidate are only partially metabolized on a single pass

Esmolol is metabolized by RBC esterases

35
Q

A drug is highly protein bound but the patient has low levels of protein. Compared to normal protein levels, the drug would be: less efficacious, more potent, higher ED50, cleared slowly

A

More potent (more in the free/active form)

ED50: dose at which 50% of patients respond - this would decrease in this case (lower dose for the same response)

36
Q

Which of the following does not work through a G-protein coupled receptor: Fentanyl, midazolam, epinephrine, serotonin, histamine

A

Midazolam (GABA-A which is a ligand-gated ion channel); the rest work through GPCR (through cAMP or IP3)

37
Q

What is the largest extrahepatic site of metabolism for propofol?

A

The lungs

38
Q

How is fospropofol different from propofol?

A

Prodrug of propofol that needs to get metabolized in the liver to become propofol and formaldehyde; thus it has a slower onset of action

39
Q

Which of the following does not have an active metabolite: midazolam, propofol, meperidine, ketamine, morphine

A

Propofol

Midazolam -> alpha-1-hydroxymidazolam

Meperidine -> normeperidine (CNS excitation in renal failure)

Ketamine -> norketamine

Morphine -> M6G

Anesthesiology (21 decks)

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