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Anesthesia Drug Test Quick Facts > INDUCTION AGENTS > Flashcards

INDUCTION AGENTS Flashcards

1
Q

brand name of etomidate

A

amidate

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2
Q

how is etomidate supplied

A

2 mg/mL

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3
Q

what is the MOA of etomidate

A

benzylimidazole producing agonism of GABAa by binding directly to a specific site on the protein and enhancing the affinity for GABA

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4
Q

which receptor subunit does etomidate primarily bind to?

A

Beta-subunits on the GABAa receptor

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5
Q

induction dose for etomidate

A

0.2-0.6mg/kg

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6
Q

maintenance dose for etomidate

A

5-20 mcg/kg/min

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7
Q

MAC dose for etomidate

A

MAC 0.1-0.2 mg/kg

→ followed by 0.05 mg/kg every 3-5 minutes as needed

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8
Q

onset of etomidate

A

30-60 seconds

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9
Q

peak of etomidate

A

1 minute

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10
Q

duration of etomidate

A

3-5 minutes

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11
Q

half-life of etomidate

A

2.6 hours

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12
Q

metabolism of etomidate

A

hepatic and plasma esterases

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13
Q

best quality of etomidate i.e. s/e it has the least of

A

CV

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14
Q

endocrine se of etomidate

A

adrenal suppression (suppresses cortisol biosynthesis)

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15
Q

GI se of etomidate

A

N/V on emergence

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16
Q

derm se of etomidate

A

Local: pain at site 30-80%

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17
Q

NMS se of etomidate

A

NMS: Myoclonus (33%) transient skeletal movements, uncontrolled eye movements 1-10% hiccups

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18
Q

how does etomidate effect IOP, ICP, CMRO2 & perfusion pressure

A

Decreases IOP, ICP, CMRO2 BUT maintains perfusion pressure

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19
Q

what enzyme does etomidate inhibit

A

CYP 450

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20
Q

what conditions do you avoid etomidate with

A

Trauma, critical illness, sepsis (adrenal insufficiency)

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21
Q

why do you avoid etomidate during stress

A

Decreases cortisol levels

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22
Q

brand name of propofol

A

Diprivan

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23
Q

how is propofol supplied

A

10mg/mL

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24
Q

uses of proposal

A

Induction of anesthesia in patients > 3 years old
Maintenance of anesthesia > 2 month,
in adults, for monitored anesthesia care
sedation during procedures
sedation in intubated pt

25
Q

onset of propofol

A

9-51 seconds

26
Q

what effect does the dose or rate have on onset of propofol

A

higher dose faster onset

higher rate faster onset

27
Q

duration of action of propofol

A

3-10 minutes

28
Q

peak of propofol

A

9-51 s

29
Q

half life of propofol

A

Biphasic

initial 40 minutes, terminal 4-7 hours after 10 day infusion may be unto 1-3 das

30
Q

elimination of propofol

A

urine 88%

metabolites 40% as glucouronide metabolite

feces 2%

31
Q

metabolism of propofol

A

hepatic to water soluble sulfate and flucuronicide conjugates 50%

32
Q

adverse effects of propofol

A

HYPOTENSION: children 17%; adults 3% to 26%),

Movement (children 17%; adults 3% to 10%),

Injection site burning, stinging, or pain (children 10%; adults 18%),

Apnea lasting 30-60 seconds (children 10%; adults 24%), apnea lasting >60 seconds (children 5%; adults 12%),

Hypertension (children 8%), arrhythmia (1% to 3%),

bradycardia (1% to 3%),

cardiac output decreased (1% to 3%; concurrent opioid use increases incidence), tachycardia (1% to 3%),

Pruritus (1% to 3%),

rash (children 5%; adults 1% to 3%),

Hypertriglyceridemia (3% to 10%),

Respiratory acidosis during weaning (3% to 10%)

33
Q

contraindications with propofol

A

Hypersensitivity to propofol or any component of the formulation; hypersensitivity to eggs, egg products, soybeans, or soy products; when general anesthesia or sedation is contraindicated

34
Q

brand name of ketamine

A

katalar

35
Q

how is ketamine supplied?

A

50mg/mL

36
Q

what is the mechanism of action of ketamine?

A

Ketamine is a noncompetitive NMDA receptor antagonist that blocks glutamate.

Produces a cataleptic-like state in which the patient is dissociated from the surrounding environment by direct action on the cortex and limbic system.

37
Q

uses of ketamine

A

Low (sub anesthetic) doses produce analgesia
modulate central sensitization,
hyperalgesia
opioid tolerance.

Reduces polysynaptic spinal reflexes.

Analgesia and Sedation

38
Q

dose of ketamine IM for induction

A

I.M.: 6.5 to 13 mg/kg

39
Q

dose of ketamine IV for induction

A

I.V.: 1 to 4.5 mg/kg

40
Q

IV dose of ketamine for induction if versed if also given

A

(0.5-2mg/kg if versed has been given)

41
Q

rapid sequence IV dose for intubation

A

Rapid sequence intubation: 2mg/kg IV

1-2mg/kg is most common induction dose

42
Q

onset of IV ketamine

A

I.V.: Anesthetic effect: 30 seconds;

43
Q

onset of IM ketamine

A

I.M.: Anesthetic effect: 3-4 minutes

44
Q

DOA ketamine IV

A

Anesthetic effect: I.V.: 5-10 minutes;

45
Q

DOA ketamine IM

A

I.M.: 12-25 minutes

46
Q

half life of ketamine alpha and beta phase

A

Alpha: 10-15 minutes; Beta: 2.5 hours

47
Q

excretion of ketamine

A

Primarily urine

48
Q

metabolism of ketamine

A

Hepatic via hydroxylation and N-demethylation; the metabolite norketamine is 33% as potent as parent compound;

greater conversion to norketamine occurs after oral administration as compared to parenteral administration

49
Q

AE ketamine CV

A

Cardiovascular: Arrhythmia, bradycardia/tachycardia, hyper-/hypotension,

50
Q

ae ketamine GI

A

Anorexia,
nausea,
salivation !!!!!
increased vomiting

51
Q

ae ketamine derm

A

Erythema (transient),
morbilliform rash (transient),
Pain at the injection site,
exanthema at the injection site,

52
Q

ae ketamine MSK

A

Skeletal muscle tone enhanced (tonic-clonic movements

53
Q

ae ketamine resp

A 
Airway obstruction,
 apnea, 
bronchial secretions increased, 
respiratory depression, 
laryngospasm,
54
Q

ae ketamine eye

A

Diplopia,
intraocular pressure increased,
nystagmus,

55
Q

ae ketamine misc

A

Anaphylaxis,

56
Q

ae ketamine neuro

A 
Intracranial pressure increased
dependence with prolonged use, 
emergence reactions (~12%; includes confusion, delirium, dreamlike state, excitement, hallucinations, irrational behavior, vivid imagery)
57
Q

clinical pearls with ketamine

A

Increases HR, BP, CO secondary to catecholamine release.

Causes bronchodilation.

Lowers seizure threshold.

May cause emergence psychosis.

58
Q

name the induction agents

A 
etomidate
ketamine
propofol
Methohexital
Thiopental

Anesthesia Drug Test Quick Facts (19 decks)

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