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AS - N928 Basic Principles of Anesthesia > Induction Drugs > Flashcards

Induction Drugs Flashcards

1
Q

Midazolam

A

Available 1-5mg/mL
Use 3mL syringe
Dose 0.02-0.04mg/kg IV

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2
Q

Fentanyl

A

Available 50mcg/mL
Use 5mL syringe
Dose 1-3mcg/kg
High-dose as sole anesthetic 50-150mcg/kg (cardiac surgery induction)

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3
Q

Lidocaine 2%

A

Available 20mg/mL
Use 5mL syringe
Dose 1-1.5mg/kg IBW

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4
Q

Propofol

A

Available 10mg/mL
Use 20mL syringe
Dose 1.5-2.5mg/kg

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5
Q

Etomidate

A

Available 2mg/mL

Dose 0.2-0.4mg/kg

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6
Q

Ketamine

A

Available 5-100mg/mL
Dilute to 10mg/mL
Dose 1-2.5mg/kg

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7
Q

Succinylcholine

A

Available 20mg/mL
Use 10mL syringe
Dose 0.5-1.5mg/kg
RSI 1.5mg/kg

*Based on ACTUAL body weight

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8
Q

Rocuronium

A

Available 10mg/mL
Use 3mL syringe
Dose 0.6 OR 1.2mg/kg (RSI)

*Based on IBW

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9
Q

Vecuronium

A

Available 1-2mg/mL
Use 5-10mL syringe
Dose 0.08-0.1mg/kg

*Based on IBW

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10
Q

Cisatracurium

A

Available 2mg/mL
Dose 0.15-0.2mg/kg

*Based on IBW

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11
Q

Midazolam PK/PD

A 
GABA allosteric 
Phase 1 oxidation via CYP450
Active metabolites x2
Elimination not altered by renal failure
Exaggerated effects in liver dysfunction
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12
Q

Midazolam Onset

A

2min

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13
Q

Midazolam Duration

A

1-6hr

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14
Q

Midazolam SE

A 
↓CBF & CMRO2
Not neuroprotective
Antegrade amnesia
Dose dependent respiratory depression
Minimal cardiac effects
Fetal depression
Contraindicated in pregnancy
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15
Q

Fentanyl PK/PD

A

Phenylpiperidine
Opioid agonist
Pulmonary 1st pass effect → 2° peaks
Phase 1 oxidation

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16
Q

Fentanyl Onset

A

2-5min

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17
Q

Fentanyl Duration

A

0.5-1hr

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18
Q

Fentanyl SE

A 
Allergy extremely rare
Ø cross-reactivity 
Elderly exaggerated response d/t ↓clearance
Similar side effects to Morphine
NO histamine release
Bradycardia 
Minimal ↑ICP
Seizure activity & myoclonus
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19
Q

Lidocaine PK/PD

A

Local anesthetic
Weak base amide
Preferentially binds to open & inactive VGNa+ channels
Blocks K+ channels, Ca2+ channels, & GPCRs to lesser extent
Pulmonary 1st pass effect
Hepatic metabolism via CYP450

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20
Q

Lidocaine Onset

A

45-90sec

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21
Q

Lidocaine Duration

A

10-20min

22
Q

Lidocaine SE

A

Blunts SNS response to intubation
Improves bowel function return in laparoscopic cases
Accumulation & toxicity concern (infusion)
ERAS protocol

23
Q

Propofol PK/PD

A 
Sedative hypnotic
GABA allosteric
Hyperpolarizes cell via Cl¯ channels
Weak acid
Oxidation via CYP450
Active metabolite (insignificant)
Pulmonary 1st pass effect
24
Q

Propofol Onset

A

<40sec

25
Q

Propofol Duration

A

5-10min

26
Q

Propofol SE

A 
Neuro protectant
↓CBF, ICP, CPP, CMRO2
Myoclonus
Bronchodilation
Respiratory depression
Hypotension
PRIS
No analgesic properties
Caution in cardiac compromised patients
Lecithin or sulfate allergy (asthmatics)
Decrease dose in elderly
27
Q

Etomidate PK/PD

A 
Sedative hypnotic
GABA allosteric
α2B adrenergic receptors 
Imidazole ring
Single isomer R 5x more potent
75% albumin bound
Rapid distribution
Metabolism plasma esterases via hydrolysis & hepatic CYP enzymes
28
Q

Etomidate Onset

A

30-60sec

29
Q

Etomidate Duration

A

3-10min

30
Q

Etomidate SE

A

↓CBF & CMRO2
↓ICP maintain CPP
Myoclonus
↓TV ↑RR
Ideal induction agent w/ unstable cardiac patient
Maintain BP
No analgesic properties
↑PONV incidence
Adrenocortical suppression (inhibits 11β-hydroxylase)
Contraindicated in porphyrias & critically ill septic shock

31
Q

Ketamine PK/PD

A 
Sedative hypnotic
N-methyl-D-aspartate antagonist
Disassociation between thalamocortical & limbic systems
Weak GABAa action
Racemic mixture
Oxidation via CYP450
Dependent on hepatic blood flow
Norketamine active metabolite
32
Q

Ketamine Onset

A

30sec

33
Q

Ketamine Duration

A

5-15min
Return to consciousness 10-20min
Full orientation 60-90min

34
Q

Ketamine SE

A 
Dissociative anesthesia
Airway reflexes intact
↑secretions
Potent amnestic/analgesic
↑ CBF, ICP, CMRO2
Nystagmus ↑IOP
Maintain spontaneous respirations
Bronchodilation
SNS activation ↑HR ↑SVR
Contraindicated in ophthalmic procedures
35
Q

Succinylcholine PK/PD

A

Depolarizing NMB (agonist-antagonist)
Binds to nAChR & prevents ACh binding
ACh molecules linked via acetate methyl groups
Rapid hydrolysis via butyrylcholinesterase PChE

NO fade
Only Phase I
Dibucaine # >70 Heterogenous atypical 40-60
Homogenous <30
Elderly slower onset d/t ↓circulation & ↓PChE levels

36
Q

Succinylcholine Contraindications

A
  • Burn patients
  • Abdominal infection
  • Metabolic acidosis
  • Closed head injury
  • nAChR upregulation
  • Myoglobinuria
  • Pediatric patients <5yo
37
Q

Succinylcholine Onset

A

30-60sec

38
Q

Succinylcholine Duration

A

5-15min

39
Q

Succinylcholine SE

A 
Bradycardia or tachycardia
Hyperkalemia 0.5mEq/dL
Ventricular dysrhythmias
↑ICP & IOP
↑abdominal pressure
Myalgias
*Malignant hyperthermia
40
Q

Rocuronium PK/PD

A 
Steroidal
Non-depolarizing neuromuscular blocker
nAChR antagonist
Competitively antagonizes ACh to block depolarization
Hepatic & renal excretion
Most commonly used & inconsistent
41
Q

Rocuronium Onset

A

2-3min

RSI 1min

42
Q

Rocuronium Duration

A

30-60min

Intermediate

43
Q

Rocuronium SE

A

Allergic reactions

Histamine release

44
Q

Vecuronium PK/PD

A 
Steroidal
Non-depolarizing neuromuscular blocker
nAChR antagonist
Pancuronium w/o quaternized methyl group
↓potency
1° hepatic metabolism
Renal unchanged
Elim 50-60% hepatic & 40-50% renal
3-OH metabolite
45
Q

Vecuronium Onset

A

2-3min

Peak 5-7min

46
Q

Vecuronium Duration

A

30-60min

Intermediate

47
Q

Vecuronium SE

A

AVOID in renal impaired patients

48
Q

Cisatracurium PK/PD

A

Benzylisoquinolinium
Non-depolarizing neuromuscular blocker
nAChR antagonist
Hoffman elimination - spontaneous degradation

49
Q

Cisatracurium Onset

A

2-4min

50
Q

Cisatracurium Duration

A

30-60min

Intermediate

51
Q

Cisatracurium SE

A

NO histamine release
Atracurium cis-isomer
DOC hepatic & renal failure

AS - N928 Basic Principles of Anesthesia (18 decks)

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