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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? (3)

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

How is propofol metabolized?
How is it excreted?
How is it cleared?

A
  • plasma clearance (lungs) > hepatic blood flow
  • Lungs and liver CYP450
  • excreted by kidneys
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9
Q

Hepatic metabolism of propofol produces?

A
  1. Water-soluble sulfate
  2. glucuronic acid
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10
Q

What metabolizes Propofol?

A

CYP450 and UGT1A9

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11
Q

What is the elimination half-time (E ½ time) of Propofol?

A

30 - 90 minutes

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12
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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13
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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14
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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15
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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16
Q

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

A

No

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17
Q

What is the induction drug of choice?

A

Propofol

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18
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.
19
Q

What is the induction dose of Propofol in the elderly?

A

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

20
Q

What plasma Propofol levels correlate with unconsciousness?

A

Unconscious: 2 - 6 μg/mL
Awake: 1 - 1.5 μg/mL

21
Q

What is the conscious sedation dose of Propofol?

A

25 - 100 μg/kg/min

22
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.
23
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 and subcortical pathways
24
Q

What is the sub-hypnotic dosing for Propofol?

A
  • 10 - 15 mg IV
  • followed by 10 mcg/kg/min
25
What is the anti-pruritic dosing of Propofol?
10 mg IV
26
What is the anti-convulsant dosing of Propofol?
1mg/kg IV
27
What are the other benefits of Propofol?
* Bronchodilation * Anti-emetic * Anti-pruritic * Anti-convulsant * Low dose analgesia * Antioxidant * Does not trigger MH
28
What are Propofol’s effects on CMRO₂, CBF, and ICP?
↓ CMRO₂, CBF, and ICP
29
What does large doses of propofol do to cerebral perfusion pressure?
* decrease CPF * support MAP
30
Although it does not produce **seizure**, what can happen during **induction/emergence**?
myoclonus (muscle jerking)
31
Between thiopental, Propofol, and isoflurane, which is the least EEG suppressive?
Propofol
32
Which would decrease blood pressure more, thiopental or Propofol?
Propofol
33
What is the mechanism for propofol-induced hypotension? What conditions will exaggerate this effect?
* SNS inhibition (**smooth muscle relaxation**) * **↓SVR and ↓ ICF Ca⁺⁺** * exaggerated with **hypovolemia, elderly, and LV compromise**
34
How is **Propofol-induced hypotension** from induction modulated?
Intubation (from laryngoscopy stimulation)
35
Why is bradycardia seen with propofol? What would occur with propofol overdose?
* ↓SNS response & baroreceptor reflex depression. * Profound bradycardia & eventual asystole.
36
What are the pulmonary effects of propofol? How does this change with opioids?
* **Dose-dependent depression** of respiratory drive. * **Synergistic** resp depression with opioids
37
How does propofol affect hypoxic pulmonary vasoconstriction?
* Does not affect it * Pulmonary vessels **constrict** to redirect blood flow from poorly ventilated areas of the lung to better-ventilated regions
38
What severe condition(s) can occur with prolonged Propofol infusions?
* **Hepatocellular injury** * **Propofol Infusion Syndrome**
39
What is Propofol Infusion Syndrome?
Metabolic acidosis thought to occur from poisoning of electron transport chain and impaired oxidation of fatty acids.
40
How does propofol affect the **renal** and **heptaic** system?
**No effect** on renal and hepatic function but; * **Green** and **cloudy** urine * Phenols and uric acid crystals
41
What sort of infusion dosing can result in Propofol infusion syndrome?
**> 75 μg/kg/min** for longer than **24 hours**
42
What is the worst side effect in **children** who have Propofol infusion syndrome?
Severe, refractory, **fatal bradycardia**
43
What are the symptoms of Propofol infusion syndrome? How is propofol infusion syndrome diagnosed?
* Urine changes, lactic acidosis, brady-dysrhythmias, and rhabdomyolysis. * ABG & serum lactate concentrations. * **Reversible in early stage**
44
What are the other organ system effects of Propofol?
* Injection pain (lido before) * ↓ IOP * Plt aggregation inhibition * Allergic reactions (lecithin) * Prolonged myoclonus * Abuse/misuse

TxWes Spring '25: Anesthesia Pharm (13 decks)

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