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Top Shelf Drugs > Induction agents (non-barb and non-benzo) > Flashcards

Induction agents (non-barb and non-benzo) Flashcards

1
Q

Which induction agents reduce ICP?

A

propofol, thiopental, and etomidate

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2
Q

Which induction agent raises ICP?

A

ketamine

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3
Q

Which induction agent has no effect on ICP?

A

precedex

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4
Q

Two common side effects seen during emergence from ketamine.

A

combativeness and delirium

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5
Q

Ketamine (Kerolar) produces this type of anesthesia.

A

dissociative (the thalamus is dissociated from the limbic cortex. sound and vision are mixed up)

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6
Q

Ketamine (Kerolar) induction dose, onset, peak, duration?

A

dose: 1 - 2 mg/kg IV; 3 - 5 mg/kg IM
onset: 30 seconds
peak: does not peak
duration: 5 - 15 minutes

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7
Q

Ketamine’s mechanism of action?

A
  • N-methyl-D-aspartate (NMDA) antagonist - blocks ion (calcium/sodium/potassium) channel of the receptor inhibiting depolarization
  • muscarinic agonist
  • D-opioid agonist (weak)
  • sodium and calcium channel blocker
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8
Q

Does ketamine (Kerolar) increase or decrease arterial blood pressure, heart rate, and cardiac output?

A

increase

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9
Q

Due to ketamine’s effects on the cardiovascular system, its use should be avoided in patients with these diagnoses.

A

coronary artery disease, uncontrolled hypertension, congestive heart failure, and arterial aneurysms

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10
Q

Large doses of this medication cause direct myocardial depression.

A

ketamine

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11
Q

Ketamine (Kerolar) has _______ stimulatory effects on the sympathetic nervous system.

A

indirect

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12
Q

Is ketamine (Kerolar) a bronchoconstrictor?

A

no, it is a potent bronchodilator. it is a good induction agent for asthmatic patients.

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13
Q

T or F, ketamine (Kerolar) causes increased salivation?

A

true

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14
Q

This medication is the closest thing to being a “complete” anesthetic, as it induces analgesia, amnesia, and unconsciousness.

A

ketamine

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15
Q

This medication attenuates ketamine’s cardio-stimulatory effects and prolongs its elimination half-life.

A

diazepam

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16
Q

Etomidate (Amidate) induction dose, onset, peak, duration?

A

dose: 0.2 - 0.5 mg/kg IV
onset: 30 seconds
peak: 1 minute
duration: 3 - 10 minutes

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17
Q

Propofol (Diprivan) induction dose, onset, peak, duration?

A

dose: 1.5 - 2.5 mg/kg IV
onset: 30 seconds
peak: 1 minute
duration: 5 - 10 minutes

18
Q

Propofol (Diprivan) initial and maintenance dose using either the infusion or bolus method?

A
  • infusion method
    initiation dose: 100 - 150 mcg/kg/min over 3 - 5 min
    maintenance dose: 25 - 75 mcg/kg/min
  • bolus method -
    initiation dose: slow injection 0.5 mg/kg over 3 - 5 min
    maintenance dose: incremental doses of 10 or 20 mg

per the drug card

19
Q

Etomidate’s mechanism of action

A
  • GABA receptor agonist (binds to beta-subunit of GABA receptor, increasing its affinity for GABA)
  • GABA causes an influx of chloride in the post-synaptic neurons, hyperpolarizing the cell, and making it less responsive to neurotransmitters
20
Q

What is the name of the active metabolite of ketamine?

A

norketamine (it is an active metabolite, but is less potent than ketamine)

21
Q

Long-term infusions of etomidate (Amidate) can lead to this?

A

adrenocortical suppression (induction doses of etomidate transiently inhibit enzymes involved in cortisol and aldosterone synthesis)

22
Q

How is etomidate (Amidate) metabolized?

A

by hepatic enzymes and plasma esterases

23
Q

Etomidate (Amidate) can cause sudden, generalized, asynchronous muscle contractions known as what?

A

myoclonia

24
Q

Propofol’s (Diprivan) mechanism of action?

A
  • GABA receptor agonist (binds to beta-subunit of GABA receptor, increasing its affinity for GABA)
  • GABA causes an influx of chloride in the post-synaptic neurons, hyperpolarizing the cell, and making it less responsive to neurotransmitters
25
Q

Is the pH of propofol hypertonic, isotonic, or hypotonic?

A

isotonic (7.0 - 8.5)

26
Q

Is propofol contraindicated in patients with an egg allergy?

A

no

27
Q

What percentage of propofol is protein bound?

A

98%

28
Q

Potentiation of effects will be seen when propofol is given with these two types of medications…

A

sedatives and narcotics

29
Q

T or F, propofol has antipruritic and antiemetic effects?

A

true

30
Q

How is propofol metabolized?

A

mostly hepatic, some pulmonary

excreted by kidneys

31
Q

The major cardiovascular effect of propofol is a decrease in what? (and this is due to what three things?)

A

arterial blood pressure (due to a drop in systemic vascular resistance [inhibition of sympathetic vasoconstricor activity], cardiac contractility, and preload)

32
Q

Propofol depresses the body’s normal response to? (pulmonary in nature)

A

hypercarbia

33
Q

Propofol should be used cautiously in these patient populations…

A

sulfite allergy (new formulation has sulfite ingredient), hypovolemic (d/t decreased SVR + inotropy), cardiac issues (fixed CO - aortic stenosis), or elderly

34
Q

How does etomidate’s short duration of action differ from propofol’s short duration of action?

A

etomidate is metabolized by esterases. propofol is rapidly redistributed.

35
Q

Is ketamine a weak acid or base?

A

weak base

36
Q

Is propofol a weak acid or base?

A

weak acid

37
Q

Ketamine is a structural analogue of…

A

phencyclidine

38
Q

How is ketamine (Kerolar) metabolized?

A

hepatic

39
Q

Ketamine (Kerolar) is useful in these situations…

A
  • in c-section for abruption, placenta previa, and as supplement to bad blocks
  • in burn patients for dressing changes
40
Q

Etomidate (Amidate) cardiac effects.

A

none, it is cardiac stable

it’s good for hypovolemia, trauma, stenosis, and heart failure

41
Q

Does etomidate (Amidate) release histamine?

A

no

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