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DH: Clinical Pharmacology > Induction Drugs > Flashcards

Induction Drugs Flashcards

1
Q

What is the MOA for Propofol?

A

GABA-A agonist & transmembrane chloride conductance

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2
Q

Propofol Dose:
Induction, Sedation, TIVA

A

Induction: 2mg/kg IV
Sedation: 25-100mCg/kg/min
TIVA: 100-300mcg/kg/min

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3
Q

What is the Onset and Elimination half-life of Propofol?

A

Onset: 30 sec.
Elim HL: 0.5-1.5hrs

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4
Q

How is Propofol Metabolized?

A

Plasma (Lungs) > Hepatic

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5
Q

What are 6 benefits of Propofol?

A
  1. Bronchodilator
  2. Suppresses SNS response to laryngoscopy
  3. Anti-nausea
  4. Anti-pruritic
  5. Anticonvulsant & amnestic
  6. Prompt recovery w/o residual sedation
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6
Q

What are 4 concerns with Propofol admin?

A
  1. Pain on injection; Tx Lido.
  2. Propofol infusion Syndrom
  3. Crosses placenta
  4. Black box warning for pediatric bradycardia
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7
Q

What patient population might we use choose to use Etomidate? (2)

A
  1. Cardiac Instability: Low EF%
  2. Induces seizure
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8
Q

What is the MOA of Etomidate?

A

GABA-A modulator

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9
Q

What must be present in order for Etomidate to work?

A

GABA

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10
Q

4 Advantages of Etomidate?

A
  1. CV stability
  2. Minimal MAP reduction
  3. No histamine release
  4. Reduces ICP
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11
Q

5 Disadvantages of Etomidate

A
  1. Pain on injection
  2. Adrenocortical suppression
  3. High myoclonus incidence
  4. No analgesia
  5. PONV in 30% of patients
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12
Q

Which induction drug has the worst PONV rates?

A

Etomidate (30% of patients)

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13
Q

What is another name for Ketamine?

A

PCP or Angel Dust

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14
Q

What is Ketamine’s MOA?

A

Dissociative amnesia: Depresses neuronal function of the cortex & thalamus but stimulates the limbic system.

Activates opioid receptors and subcortical neurons in the spinal tract.

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15
Q

What is ketamine dosing?
Adult, Pedi, Analgesia?

A

Adult: 1.5mg/kg IV
Pedi: 4-8mg/kg IM
Analgesia: 02 -0.5mg/kg IV

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16
Q

What is the onset, duration, and Elim halflife of Ketamine?

A

Onset: 1min
Duration: 10-20min
Elim: 2hours

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17
Q

What are some benefits of Ketamine?

A
  1. Analgesia
  2. Maintains airway
  3. Bronchodilator
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18
Q

True or False: Ketamine can be used for conscious sedation?

A

False. It can be used, but do to it’s dissociative amnestic properties, it cannot be used without proper airway protection.

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19
Q

What are 3 concerns with Ketamine use during induction?

A
  1. Emergence Delirium
  2. Increased SNS response
  3. Increased secretions
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20
Q

What drugs might be co-admin with ketamine during induction?

A
  1. Versed
  2. Glycopyrrolate
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21
Q

Which induction drug is a racemic mixture?

A

Ketamine (R + S)

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22
Q

What does ketamine metabolize into?

A

20-30% Nor-ketamine (1/3 active metabolite)

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23
Q

What is the MOA of Dexmedetomidine?

A

A2 Receptor stimulation

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24
Q

What are 3 primary uses of Dexmedetomidine?

A

ICU sedation, CV Surgery, TIVA

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25
4 Benefits of Precedex?
1. Minimal respiratory depression 2. Anti-shivering properties 3. Useful in drug addiction and ETOH 4. Enhances chronic pain management in patients with tolerance issues.
26
What is the dosing for Precedex?
Loading: 1mcg/kg/min Infusion: 0.2-07mcg/kg/hr.
27
Which version of Ketamine is better? R or S?
S-Ketamine: More potent, less side effects.
28
What Class of drug is Methohexital?
Barbiturate
29
What is another name for Methohexital?
Brevital
30
Which induction agent do we need to be most concerned about accidental intra-arterial injection?
Methohexital - immedaite intense vasoconstriction causing extreme pain, cyanosis, gangrene, and permanent nerve damage.
31
What do we give for unintentional intra-arterial injection of Methohexital?
Papaverine or lidocaine
32
What is the dose of Methohexital?
1.5mg/kg
33
What is the elimination half-life of Methohexital?
4 hours.
34
What do we primarily use Methohexital for?
Rapid, non-painful procedures: ECT and Seizure mapping.
35
What is a side effect of Methohexital?
Myoclonus and hiccoughs
36
What is a serious complication associated with long-term, high-dose Propofol infusion?
Propofol-infusion syndrome
37
What is the standard concentration of Propofol?
10mg/ml
38
What type of anesthesia is associated with Ketamine?
Dissociative
39
What is the induction drug has only 1 dose? Non-titratable
Etomidate (0.3mg/kg)
40
What receptor dose Dexmedetomidine primarily act on?
Alpha- 2
41
What common side effect of Ketamine is pre-treated with a benzodiazepine?
hallucinations
42
What is the context-sensitive half-time of Propofol?
Less than 40 minutes.
43
What induction drug is specifically contraindicated with MAOIs?
Ketamine
44
What is side effect is most commonly associated with Etomidate?
Adrenal cortical suppression
45
What induction drug covered in Dr. C's PPT is not really an induction drug?
Dexmedetomidine
46
What allergy might be a concern for the admin of Propofol?
Egg Allergy: 1% Lipid solution
47
What percent reduction in Propofol do we use for elderly?
25-50% No change for liver and renal disease.
48
What dose of Propofol can be used for anti-emetic?
10-15mg IV followed by 10mcg/kg/min.
49
Antipruritic dose for Propfol?
10mg IV
50
Propofol Infusion syndrome occurs after what length of propofol adminstration?
> 58 hours with high doses (5mg/kg/hr).
51
What is Propofol Infusion syndrome?
sudden onset bradycardia that progresses to asystole and resistant to treatment.
52
True or False: children require lower doses of Propofol due to size and clearance.
False. Children require increased doses of Propofol due to large central distribution, higher metabolism, and clearance.
53
What induction drug has a blackbox warning and what for?
Propofol: Profound bradycardia to Asystole in Pediatric patients. Treat with Atropine and/or Glycopyrrolate.
54
Which induction drug has a decrease in Systemic BP and HR?
Propofol
55
Which induction drug has increased BP and HR?
Ketamine
56
Which induction drug typically has no change on BP or HR?
Etomidate
57
What induction drug has the highest incidence of myoclonus?
Etomidate
58
What is a rare negative outcome associated with Etomidate?
Adrenocortical Suppression: dose-dependent inhibition of 11-B-Hydroxylase.
59
What is it and When does Adrenocortical Suppression typically occur?
Decreased conversion of cholesterol to cortisol reducing the stress response and causing potential immunocompromise in patients. Time: 4-8hours post-op
60
What patient population might we worry about adrenocortical Suppression?
Septic, Hypotension, and Hemorrhage.
61
True or False: Ketamine is amnestic, intense analgesic, and hypnotic agent.
False. Not a Hypnotic.
62
What is a ketamine dart?
Ketamine + Versed + Robinol
63
Which true induction agent does not cause burning on injection?
Ketamine
64
What induction agent is at risk for developing Tachyphylaxis?
Ketamine, especially in burns
65
Which induction agent maintains airway tone?
Ketamine: Pharyngeal and laryngeal reflexes are intact, but this is not a protected airway - dissociations.
66
What 3 medications can treat Ketamine hallucinations?
Benzos, Barbs, and Propofol.
67
How many classes of alpha-2 receptors are there?
a2-A: sedation, hypnosis, sympatholytic. a2-B: vasoconstriction, anti-shivering, analgesia, Ca++ linked. a2-C: Learning, Startle Response.
68
What induction agent is administered slowly?
Dexmedetomidine 1mcg/kg per 10 minutes to avoid transient HTN.
69
Which induction agent is an anti-salivation drug on its own?
Dexmedetomidine.
70
Which induction agent can be used to decrease muscle rigidity seen with high opioid admin?
Dexmedetomidine.
71
Which induction agent is used to offset drug addicts and ETOH withdrawal?
Dexmedetomidine.
72
Why might an anesthesia provider use Dexmedetomidine for chronic pain?
Increases drug effects without side effects in patients with high tolerance.
73
Why might Methohexital be used in ECT?
Low doses: Epileptogenic (lowers seizure threshold) = Seizure activity. High doses: treats seizures.
74
Which induction agent is the fastest?
Propofol 30-60sec. With rapid injection, onset can be <15 sec.
75
Which is the only induction agent given in mcg/kg?
Dexmedetomidine: 05-1mcg/kg over 10 minutes

DH: Clinical Pharmacology (4 decks)

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