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Anesthesia Pharmacology > Induction Drugs > Flashcards

Induction Drugs Flashcards

1
Q

Propofol (Diprivan)

Drug Class
&
MOA

A

GABAA Agonist

Gamma AminoButyric Acid (GABA) agonist; selectively modulates GABAA receptors

↑ Cl- conductance

Hyperpolarization of the postsynaptic cell membrane & functional inhibition of the postsynaptic neuron

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2
Q

Propofol (Diprivan)

Induction Dose

A

IV: 1.5-2.5 mg/kg

Induction DOC - GI cases & TIVA

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3
Q

Propofol (Diprivan)

Conscious Sedation Dose
Maintenance Dose

A

Conscious Sedation
IV: 25-100 mcg/kg/min

Maintenance
IV: 100-300 mcg/kg/min

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4
Q

Propofol (Diprivan)

Anti-emetic Dose
Anti-pruritic Dose

A

Anti-emetic
IV: 10-15 mg

Anti-pruritic
IV: 10 mg

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5
Q

Propofol (Diprivan)

Anti-convulsant Dose

A

IV: 1 mg/kg

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6
Q

Propofol (Diprivan)

Onset
Peak
Duration
Half-life

A

Onset
30 sec

Peak
2.2 min

Duration
1-8 min

Half-life
30-90 min

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7
Q

Propofol (Diprivan)

Metabolism & Elimination

A

Metabolism
Liver: CYP450
Lungs: 1st pass clearance

Elimination
Kidneys

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8
Q

Propofol (Diprivan)

Side Effects

A

CNS
↓ CMRO2, CBF, ICP
Autoregulation r/t CBF & PaCO2 are maintained
Can produce myoclonus

Respiratory
Dose-dependent depression of MV
INTACT hypoxic pulmonary vasoconstriction response
Can have bronchodilator activity

Cardiovascular
Inhibition of SNS: ↓ SBP/HR
Profound ↓ HR & asystole d/t baroreceptor reflex depression is possible

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9
Q

Propofol (Diprivan)

Considerations

A

Propofol Infusion Syndrome - Lactic Acidosis
Infusions of >75 µg/kg/ min for > 24 hrs

Allergy concern: Lecithin is found in egg yolk

Crosses the placenta but is rapidly cleared in neonatal circulation

Cloudy urine d/t uric acid crystallization;
Green urine d/t phenols

Inhibits PLT aggregation that is induced by TXA2 & platelet-activating factor

More effectice than ondansetron as anti-emetic

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10
Q

Etomidate (Amidate)

Drug Class
&
MOA

A

GABAA Agonist

Gamma AminoButyric Acid (GABA) agonist; selectively modulates GABAA receptors

↑ Cl- conductance

Hyperpolarization of the postsynaptic cell membrane & functional inhibition of the postsynaptic neuron

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11
Q

Etomidate (Amidate)

Induction Dose

A

IV: 0.2-0.4 mg/kg

DOC for unstable CV pts

No analgesic effects

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12
Q

Etomidate (Amidate)

Onset
Peak
Duration
Half-life

A

Onset
30-60 sec

Peak
1 min

Duration
3-5 min

Half-life
2-5 hrs

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13
Q

Etomidate (Amidate)

Metabolism & Elimination

A

Metabolism
Hepatic: Hydolysis by hepatic & plasma esterases

Elimination
Kidneys: 85% active metabolite in urine

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14
Q

Etomidate (Amidate)

Side Effects

A

CNS
Potent, direct cerebral vasoconstrictor
↓ CMRO2 & CBF by 35-45% & ↓ ICP

Respiratory
NO Δ in MV
↓Vt is offset by compensatory ↑ in RR

Cardiovascular
CV stable - None to little ↓MAP; Can worsen w/ hypovolemia; No Δ in HR

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15
Q

Etomidate (Amidate)

Considerations

A

High incidence of myoclonus (occurs in 50-80% of pts); Can be prevented by giving opioids/BZDs

Adrenocortical Suppression
Dose-dependent inhibition of the conversion of cholesterol to cortisol; stress response ↓ & ↓BP; longer mechanical ventilation; Occurs 4-8 hrs after initial dose
Caution: sepsis & hemorrhage

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16
Q

Ketamine (Ketalar)

Drug Class
&
MOA

A

Non-competitive inhibition of
N-Methyl-D-Aspartate (NMDA) receptors by glutamate & ↓ presynaptic release of glutamate postsynaptic neuron

Other receptor sites:
Opioid µ, K, δ, & weak σ
Weak GABAA

17
Q

Ketamine (Ketalar)

Induction Dose

A

IV: 0.5-1.5 mg/kg
IM: 4-8 mg/kg

18
Q

Ketamine (Ketalar)

Maintenance Dosing

A

IV: 0.2-0.5 mg/kg
IM: 4-8 mg/kg

19
Q

Ketamine (Ketalar)

Analgesic Dosing

A

IV: 0.2-0.5 mg/kg

20
Q

Ketamine (Ketalar)
Onset
Peak
Duration
Half-life

A

Onset
IV: 30-60 sec - IM: 2-5 min
Peak
IV: 1 min - IM: 5 min
Duration
10-20 min
Half-life
2-3 hrs

21
Q

Ketamine (Ketalar)

Metabolism
&
Elimination

A

Metabolism
Liver: CYP450 & plasmaesterases

Metabolite
norketamine (1/3 potency)

Elimination
Kidneys

22
Q

Ketamine (Ketalar)

Side Effects

A

CNS
Potent cerebral vasodilator
↑ CBF by 60%

Respiratory
No significant depression of ventilation
Ventilatory response to CO2 is maintained
↑ salivary secretions
↑↑ Bronchodilator activity; no histamine release

Cardiovascular
Mimics SNS stimulation:
↑BP, PAP, HR, CO, CMRO2, plasma Epi & NE levels
Blunted by pre-med w/ BZDs or inhaled anesthetics & N20

23
Q

Ketamine (Ketalar)

Considerations

A

Emergence Delirium

Avoid in pulmonary HTN & ↑ICP

Inhibits plasma cholinesterases:
Prolongs apnea from succinylcholine

Give glycopyrrolate IV 0.2 mg to counter m-Ach effects of
↑oral secretions (Sialagogue)

Anesthesia Pharmacology (16 decks)

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