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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
Q

4 Benefits of Precedex?

A
  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.
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26
Q

What is the dosing for Precedex?

A

Loading: 1mcg/kg/min
Infusion: 0.2-07mcg/kg/hr.

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27
Q

Which version of Ketamine is better? R or S?

A

S-Ketamine: More potent, less side effects.

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28
Q

What Class of drug is Methohexital?

A

Barbiturate

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29
Q

What is another name for Methohexital?

A

Brevital

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30
Q

Which induction agent do we need to be most concerned about accidental intra-arterial injection?

A

Methohexital - immedaite intense vasoconstriction causing extreme pain, cyanosis, gangrene, and permanent nerve damage.

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31
Q

What do we give for unintentional intra-arterial injection of Methohexital?

A

Papaverine or lidocaine

32
Q

What is the dose of Methohexital?

A

1.5mg/kg

33
Q

What is the elimination half-life of Methohexital?

A

4 hours.

34
Q

What do we primarily use Methohexital for?

A

Rapid, non-painful procedures: ECT and Seizure mapping.

35
Q

What is a side effect of Methohexital?

A

Myoclonus and hiccoughs

36
Q

What is a serious complication associated with long-term, high-dose Propofol infusion?

A

Propofol-infusion syndrome

37
Q

What is the standard concentration of Propofol?

A

10mg/ml

38
Q

What type of anesthesia is associated with Ketamine?

A

Dissociative

39
Q

What is the induction drug has only 1 dose? Non-titratable

A

Etomidate (0.3mg/kg)

40
Q

What receptor dose Dexmedetomidine primarily act on?

A

Alpha- 2

41
Q

What common side effect of Ketamine is pre-treated with a benzodiazepine?

A

hallucinations

42
Q

What is the context-sensitive half-time of Propofol?

A

Less than 40 minutes.

43
Q

What induction drug is specifically contraindicated with MAOIs?

A

Ketamine

44
Q

What is side effect is most commonly associated with Etomidate?

A

Adrenal cortical suppression

45
Q

What induction drug covered in Dr. C’s PPT is not really an induction drug?

A

Dexmedetomidine

46
Q

What allergy might be a concern for the admin of Propofol?

A

Egg Allergy: 1% Lipid solution

47
Q

What percent reduction in Propofol do we use for elderly?

A

25-50%
No change for liver and renal disease.

48
Q

What dose of Propofol can be used for anti-emetic?

A

10-15mg IV followed by 10mcg/kg/min.

49
Q

Antipruritic dose for Propfol?

A

10mg IV

50
Q

Propofol Infusion syndrome occurs after what length of propofol adminstration?

A

> 58 hours with high doses (5mg/kg/hr).

51
Q

What is Propofol Infusion syndrome?

A

sudden onset bradycardia that progresses to asystole and resistant to treatment.

52
Q

True or False: children require lower doses of Propofol due to size and clearance.

A

False. Children require increased doses of Propofol due to large central distribution, higher metabolism, and clearance.

53
Q

What induction drug has a blackbox warning and what for?

A

Propofol: Profound bradycardia to Asystole in Pediatric patients. Treat with Atropine and/or Glycopyrrolate.

54
Q

Which induction drug has a decrease in Systemic BP and HR?

A

Propofol

55
Q

Which induction drug has increased BP and HR?

A

Ketamine

56
Q

Which induction drug typically has no change on BP or HR?

A

Etomidate

57
Q

What induction drug has the highest incidence of myoclonus?

A

Etomidate

58
Q

What is a rare negative outcome associated with Etomidate?

A

Adrenocortical Suppression: dose-dependent inhibition of 11-B-Hydroxylase.

59
Q

What is it and When does Adrenocortical Suppression typically occur?

A

Decreased conversion of cholesterol to cortisol reducing the stress response and causing potential immunocompromise in patients.
Time: 4-8hours post-op

60
Q

What patient population might we worry about adrenocortical Suppression?

A

Septic, Hypotension, and Hemorrhage.

61
Q

True or False: Ketamine is amnestic, intense analgesic, and hypnotic agent.

A

False. Not a Hypnotic.

62
Q

What is a ketamine dart?

A

Ketamine + Versed + Robinol

63
Q

Which true induction agent does not cause burning on injection?

A

Ketamine

64
Q

What induction agent is at risk for developing Tachyphylaxis?

A

Ketamine, especially in burns

65
Q

Which induction agent maintains airway tone?

A

Ketamine: Pharyngeal and laryngeal reflexes are intact, but this is not a protected airway - dissociations.

66
Q

What 3 medications can treat Ketamine hallucinations?

A

Benzos, Barbs, and Propofol.

67
Q

How many classes of alpha-2 receptors are there?

A

a2-A: sedation, hypnosis, sympatholytic.
a2-B: vasoconstriction, anti-shivering, analgesia, Ca++ linked.
a2-C: Learning, Startle Response.

68
Q

What induction agent is administered slowly?

A

Dexmedetomidine
1mcg/kg per 10 minutes to avoid transient HTN.

69
Q

Which induction agent is an anti-salivation drug on its own?

A

Dexmedetomidine.

70
Q

Which induction agent can be used to decrease muscle rigidity seen with high opioid admin?

A

Dexmedetomidine.

71
Q

Which induction agent is used to offset drug addicts and ETOH withdrawal?

A

Dexmedetomidine.

72
Q

Why might an anesthesia provider use Dexmedetomidine for chronic pain?

A

Increases drug effects without side effects in patients with high tolerance.

73
Q

Why might Methohexital be used in ECT?

A

Low doses: Epileptogenic (lowers seizure threshold) = Seizure activity.
High doses: treats seizures.

74
Q

Which induction agent is the fastest?

A

Propofol 30-60sec.
With rapid injection, onset can be <15 sec.

75
Q

Which is the only induction agent given in mcg/kg?

A

Dexmedetomidine: 05-1mcg/kg over 10 minutes

DH: Clinical Pharmacology (3 decks)

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