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Spr24 Pharm II > Induction Drugs-(Propofol) (Ex 2) > Flashcards

Induction Drugs-(Propofol) (Ex 2) Flashcards

1
Q

For Propofol, what are the doses for:
1. Induction
2. Maintenance
3. Conscious sedation

A
  1. Induction = 1.5 - 2.5 mg/kg IV
  2. Maintenance = 100 - 300 μg/kg/min
  3. Conscious sedation = 25 - 100 μg/kg/min
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2
Q

What is the concentration of a 1% solution?

A
  • 10mg/mL
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3
Q

What are the inactive ingredients in propofol? Why is one particularly important?

A
  • 1.2% Lecithin (from egg yolks) can cause anaphylaxis with egg allergies.
  • 2.25% glycerol
  • 10% soybean oil
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4
Q

What are the disadvantages of propofol’s inactive ingredient composition?

A
  • ↑ bacterial growth
  • ↑ plasma triglycerides with prolonged infusions
  • Pain on injection
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5
Q

Differentiate Ampofol and Aquavan.

A
  • Ampofol - low-lipid, no preservative that burns on injection more often.
  • Aquavan - prodrug with less injection pain but causes dysesthesias. Slower onset, larger Vd, and high potency.
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6
Q

What is the mechanism of action of propofol?

A
  • GABA-A receptor modulator that increases Cl⁻ conductance.
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7
Q

How does propofol cause immobility through spinal cord-depression?

A
  • Trick question. Immobility from propofol is not from drug-induced spinal cord depression.
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8
Q

What are the clearance characteristics of propofol?

A

The clearance of propofol from plasma exceeds hepatic blood flow.

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9
Q

What metabolizes propofol?

A
  • Hepatic CYP450 enzymes and excreted by kidneys.
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10
Q

What is the E ½ time of propofol?

A
  • 30 - 90 minutes
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11
Q

What is the context-sensitive half-time of propofol? Is this a relatively low or high context half-time?

A
  • 40 minutes (for an 8 hour infusion)
  • Low CS ½ time.
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12
Q

What are the following characteristics of propofol:
1. Elimination ½ time.
2. Volume of distribution
3. Clearance (mL/kg/min)

A
  1. E ½ time = 30 - 90 minutes
  2. Vd = 3.5 - 4.5
  3. Clearance = 30 - 60 mL/kg/min
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13
Q

Differentiate blood pressure and heart rate changes that occur with propofol vs thiopental.

A
  • Propofol: ↓BP & ↓HR
  • Thiopental: ↓BP & ↑HR
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14
Q

Does propofol cross the placenta? What are the consequences of this?

A
  • Yes but is rapidly cleared from neonatal circulation.
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15
Q

Do cirrhosis and renal dysfunction have significant effects on propofol metabolism?

A

No significant impact

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16
Q

What drug is the induction drug of choice?

A

Propofol

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17
Q

What is the induction dose of propofol in adults? Children?

A
  • Adults: 1.5-2.5 mg/kg IV
  • Pediatrics: higher doses due to larger central volume and clearance rate.
18
Q

What is the induction dose of propofol in the elderly?

A

25 - 50% lower than regular adult

19
Q

What plasma propofol levels would correlate with unconsciousness?
What about awakening?

A
  • Unconscious: 2 - 6 μg/mL
  • Awake: 1 - 1.5 μg/mL
20
Q

What is the conscious sedation dose of propofol?

A
  • 25 - 100 μg/kg/min
21
Q

What are the anesthetic characteristics of propofol in the context of conscious sedation?

A
  • Minimal analgesia but has anti-convulsive and amnestic properties.
  • Prompt recovery w/ low residual sedation
  • ↓ risk of PONV
  • Midazolam or opioids as adjuncts.
22
Q

What are the anti-emetic properties of propofol?
Why is this thought to occur?

A
  • Very anti-emetic (more effective than ondansetron)
  • Direct depressant of vomiting center
23
Q

What is the sub-hypnotic dosing for propofol?

A
  • 10 - 15 mg IV, followed by 10 mcg/kg/min
24
Q

What is the anti-pruritic dosing of propofol?

A
  • 10 mg IV
25
Q

What is the anti-convulsant dosing of propofol?

A

1mg/kg IV

26
Q

What are “other” category benefits of propofol?

A
  • Bronchodilation
  • Anti-emetic
  • Anti-pruritic
  • Anti-convulsant
  • Low dose analgesia
  • Antioxidant
  • Does not trigger MH
27
Q

What are propofol’s effects on CMRO₂, CBF, and ICP?

A
  • ↓ CMRO₂, CBF, and ICP
28
Q

Large doses of propofol may ______ cerebral perfusion pressure.

A

decrease

29
Q

Though propofol will not produce seizures, it will produce _______.

A

myoclonus (originates from the muscle)

30
Q

Between thiopental, propofol, and isoflurane, which is the least EEG suppressive?

A
  • Propofol
31
Q

Which would decrease blood pressure more, thiopental or propofol?

A

Propofol

32
Q

What is the mechanism for propofol-induced hypotension?
What conditions will exaggerate this effect?

A
  • SNS inhibition causing ↓SVR and ↓ intracellular Ca⁺⁺.
  • Hypovolemia, elderly, and LV compromise
33
Q

How is propofol-induced hypotension from induction usually counteracted?

A
  • Intubation (from laryngeal stimulation).
34
Q

Why is bradycardia seen with propofol?
What would occur with propofol overdose?

A
  • ↓SNS response & baroreceptor reflex
    depression.
  • Profound bradycardia & eventual asystole.
35
Q

What are the pulmonary effects of propofol?
How does this change with opioids?

A
  • Dose-dependent depression of ventilation.
  • Synergistic resp depression with opioids
36
Q

What severe condition(s) can occur with prolonged propofol infusions?

A
  • Hepatocellular injury or Propofol Infusion Syndrome.
37
Q

What is Propofol Infusion Syndrome?

A
  • Metabolic acidosis thought to occur from poisoning of electron transport chain and impaired oxidation of fatty acids.
38
Q

What relatively benign condition(s) can occur from prolonged propofol infusions?
Why does this happen?

A

Green and cloudy urine from phenols and uric acid crystals.

Neither alters renal function.

39
Q

What sort of infusion dosing can result in propofol infusion syndrome?

A
  • > 75 μg/kg/min for longer than 24 hours
40
Q

What is the worst side effect in children who have propofol infusion syndrome?

A
  • Severe, refractory, fatal bradycardia
41
Q

What are the symptoms of propofol infusion syndrome?
How is propofol infusion syndrome diagnosed?

A
  • Urine changes, lactic acidosis, brady-dysrhythmias, and rhabdomyolysis.
  • ABG & serum lactate concentrations.
42
Q

What are the “other” organ system effects of propofol?(5)

A
  • Injection pain (lido before)
  • ↓ IOP
  • Plt aggregation inhibition
  • Allergic reactions (lecithin)
  • Prolonged myoclonus

Spr24 Pharm II (32 decks)

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