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TxWes Spring '25: Anesthesia Pharm > Induction Drugs - Propofol Exam 2 > Flashcards

Induction Drugs - Propofol Exam 2 Flashcards

1
Q

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

A

Induction = 1.5 - 2.5 mg/kg IV
Maintenance = 100 - 300 μg/kg/min
Conscious sedation = 25 - 100 μg/kg/min1.5 - 2.5 mg/kg IV

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2
Q

What is the most common concentration of a 1% solution?

A

10mg/mL

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3
Q

What are the inactive ingredients in Propofol?

A
  • 1.2% Lecithin (from egg yolks) Lecithin can cause anaphylaxis in individuals 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, burns on injection more often.
  • Aquavan - prodrug with less injection pain, 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 receptor modulator that increases Cl⁻ conductance.

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7
Q

Does Propofol cause immobility through spinal cord-depression?

A

No, 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

Primarily through hepatic metabolism, with minor contributions from renal clearance and pulmonary elimination.

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9
Q

What metabolizes Propofol?

A

CYP450 and UGT1A9

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10
Q

What is the elimination half-time (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 considered a low context-sensitive half-time?

A
  • 40 minutes (for an 8 hours infusion)
  • Low CS half-time
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12
Q

What are the characteristics of Propofol regarding
1. elimination half-time
2. volume of distribution
3. clearance

A
  • E ½ time = 30 - 90 minutes
  • Vd = 3.5 - 4.5
  • 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

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16
Q

What 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

1 mg/kg IV (25 - 50% lower than regular adult)

19
Q

What plasma Propofol levels correlate with unconsciousness?

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 characteristics of Propofol in conscious sedation?

A
  • Minimal analgesia
  • Anti-convulsive and amnestic properties
  • Prompt recovery with 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 the other 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

What does large doses of propofol do to cerebral perfusion pressure?

A

decrease

29
Q

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

A

myoclonus

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 ↓ ICF 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 respiratory drive.
  • 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 benign condition(s) can occur from prolonged Propofol infusions?

A
  • Green and cloudy urine
  • 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?

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

TxWes Spring '25: Anesthesia Pharm (8 decks)

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