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.pharmocology > Induction and Maintenance Drugs > Flashcards

Induction and Maintenance Drugs Flashcards

1
Q

Induction

A

Moving from conscious to unconscious state
IV injectable agents (some IM)

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2
Q

Co-induction agents

A

Benzodiazepines (midazolam + ketamine, midaz + propofol, midaz + alfaxalone)
Ketofol (etamine + propofol)
Ketafax (ketamine + alfaxalone)
Lidocaine
Opioids

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3
Q

MOA for induction drugs

A

Enhances GABA (inhibitory NT) at the GABAa receptor

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4
Q

Induction agents

A

Barbituates
Dissociatives
Propofol
Etomidate
Alfaxalone
Opioid induction

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5
Q

Dissociatives

A

Ketamine and Tiletamine

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6
Q

Dissociatives MOA

A

NMDA receptor antagonist → change of awareness, catalepsy, amnesia and analgesia

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7
Q

Effects of Dissociatives

A

↑ CBF, ICP and IOP
Myocardial depression and ↑ HR, BP and CO
Palpebral and corneal reflexes intact
Central eye position

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8
Q

Dissociatives precautions

A

Never use ketamine alone for induction
Apneustic breathing
Hypersalivation (don’t use anticholinergics)
Emergence delirium

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9
Q

What does ketamine alone cause?

A

Muscle and limb rigidity
Induce seizures → CNS stimulation
combine with benzodiazepine

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10
Q

Dissociative contraindications

A

Depleted catecholamines (shock, trauma, stress)
Glaucoma, corneal ulcer with ↑ IOP
CV compromise, etc.

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11
Q

Propofol/ Propofol- 28 effects

A

↓ CBF, ICP and CMRO2 (head trauma, brain lesions)
Extra-hepatic metabolism in dogs (renal and hepatic dz)
Propofol only for boluses or CRI

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12
Q

T/F: Cats have ↓ ability to metabolize propofol

A

TRUE
don’t use for more than 3 consecutive days or use CRI

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13
Q

Precautions for Propofol/ Propofol- 28

A

Respiratory depression → apnea
Myclonus (too slow without premedication)- seizure like
↓ contractility and SVR → hypotension
Prolonged recovery in cats → liver dz

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14
Q

Etomidate effects

A

Good for uncompensated CV dz
↓ CBF, ICP and CMRO2 (neuro brain disorders)
Resp. depression (slight)

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15
Q

Etomidate precautions

A

Expensive
Myoclonus, excitement, retching if used by itself
Suppresses adrenocortical function (3-6 hrs)
Pain and hemolysis if give too fast IV

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16
Q

Alfaxalone

A

Neuro-active steroid anesthetic
Class 4 controlled
Multidose dogs and cats, IDX minor species

17
Q

Effects of Alfaxalone

A

Smooth, rapid induction and m. relaxation
IV induction and maintenance

18
Q

Alfaxalone precautions

A

Emergence delirium on recovery when used alone
No analgesia

19
Q

Opioid induction

A

Benzodiazepine + short acting opioid
Used for Hemodynamically unstable and critically ill patients (ASA 4 or 5)

20
Q

Opioid induction precautions

A

Slower induction
Intubation and O2 support mandatory
Hypersensitive to noise, light and stimulation

21
Q

Maintenance phase

A

Inhalants
Injectable agents IM or IV
Total intravenous anesthesia (TIVA)

22
Q

Inhalans

A

Isoflurane (cheapest)
Sevoflurane
Halothane
Desflurane
all will cause dose dependent CV and resp. depression

23
Q

Inhalant physical properties

A

Vapor pressure
Solubility
Minimum alveolar concentration (MAC)

24
Q

Vapor pressure

A

Ability to evaporate
↑ pressure = easy to evaporate

25
Q

Solubility

A

Inhalant vapor dissolved within a solvent
Sevo by itself = quicker induction and recovery than iso

26
Q

Inhalants move along __________ not concentration gradients

A

Partial pressure gradients

27
Q

Partial pressure gradients

A

Inspired air → alveolar air → blood → brain
Soluble= slow, insoluble= fast

28
Q

Minimum alveolar concentration (MAC)

A

% inhalant that prevents purposeful movement in 50% of patients exposed to a noxious stimulus
lower MAC, more potent the inhalant

29
Q

Sevo is _______ potent than iso, so it requires _______ vaporizer setting to maintain

A

Less
Higher

30
Q

Maintenance with induction agents

A

Ketamine
Tiletamine/zolazapm
Alfaxalone

31
Q

Maintenance with induction agents risk

A

↑ risk to hypoventilation, airwat obstruction and hypoxemia
No assist in ventilation
Depth difficult to control
Resp. arrest

32
Q

TIVA

A

Propofol or alfaxalone CRI + opioid CRI

33
Q

TIVA uses

A

Craniotomies with ↑ ICP
Critically ill patients → hypotension with inhalants
Patients long term ventilation in ICU
Patients with uncoltrolled seizure acitvity
Sx procedures or bronchoscopy of upper airway

34
Q

Precaution with TIVA

A

Intubation and 100% O2 support is mandatory
Hypoventilation → controlled ventilation

.pharmocology (21 decks)

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