Induction for the cardiovascular patient lecture

Question 1

htn patients response to laryngoscopy and induction

Answer 1

More htn when stimulated
More hotn on induction

Question 2

which meds can decrease sympathetic response to laryngoscopy

Answer 2

beta blockers
ntg

Question 3

versed moa, dose, duration, peak, clearance, metabolize

Answer 3

gaba a agonist
2-5mg iv
30-60 min
2-5 min
cleared by kidneys, metbaolized by cyp450

Question 4

versed side effects

Answer 4

greater depression with copd patients
anterograde amnesia
decreased svr, reflex tachy, although no change in CO
decreased cmro2 and cbf

Question 5

why versed over other benzos

Answer 5

works fastest
no pain on injection dt imadizole ring

Question 6

versed reversal

Answer 6

romazicon/ flumanzenil 0.2mg
x5

Question 7

propofol moa

Answer 7

gaba a agonist

Question 8

propofol metabolism/ elimination

Answer 8

rapid liver metabolism
extrahepatic metabolism ie lungs
elimination: central to peripheral redistribution -> hepatic

Question 9

propofol side effects

Answer 9

decrease cbf, cmro2
decrease bp, co, svr

Question 10

propofol hotn risk factors

Answer 10

> 50
ASA 3
baseline MAP <70
co admin with fentanyl

Question 11

prop anti emetic dose

Answer 11

15mg

Question 12

etom moa, dose

Answer 12

gaba agonist
.2-.3mg/kg

Question 13

etom metabolism

Answer 13

ester hydrolysos

Question 14

etom SE

Answer 14

hemodynamic stability, no arryhthmia, no change in hr, scr, cp, bp
CNS- dose dependent decrease in cbf and cmro2
pain, n/v (evomidate)
myoclonia might look like a seziure but doesnt cause seziure
adrenocortical suppresion for 72 hours
can increase mm in steroid pt in a septic state

Question 15

Etomidate cx

Answer 15

known sensitivity
adrenal suppression
acute porphyrias

Question 16

what is porphyrias

Answer 16

rare metabolic disorder caused by enzymes in biosynthetic pathway for heme in HGB

Question 17

ketamine moa, blocks/inhibits

Answer 17

non competitive nmda blocker
inhibits glutamate, depresses thalamic nuclei, blocks afferent pain perception to the thalamus and cortix

Question 18

ketamine metabolism

Answer 18

hepatic c450
active metabolite- 20-30% norketamine

Question 19

ketamine se

Answer 19

increased cbf, cmro2, icp, can be fought by giving gaba agonist with special k
THETA waves
indirect sympathomimetic
increased myocardial contractility, hear o2 consumtpion
increase bp hr co cvp
emergence delirium, nightmare, hallucinations

Question 20

Precedex moa, loading dose, metabolism

Answer 20

A2 agonist- reduces ne release from presynaptic nerve terminal
1mcg/kg over 10 min
extensive hepatic metabolism

Question 21

primary effects of dex

Answer 21

sedation, analgesia, anxiolysis, post op shivering, cv sympatholytic

Question 22

which sedative doesn’t interfere with eeg

Answer 22

dex

Question 23

dex and contractility

Answer 23

no effect

Question 24

fentanyl receptors

Answer 24

mu kappa delta- all
MU most important
mu- respiratory depression, sedation, euphoria
delta- respiratory depression, urinary retentinon, pruritis
kappa- sedation, dysphoria, hallucinations

Question 25

ephederine and tachyphylaxis

Answer 25

yes- decrease of effectiveness over time dt depletion of catecholamine storages

Question 26

complications of vaso

Answer 26

gi ischemia
decreased co
digital necrosis
cardiac arrest at high doses

Question 27

esmolol metabolism

Answer 27

nonspecific plasma esterases

Question 28

esmolol onset and dose

Answer 28

2 min
10-30mg/ time

Question 29

why does ntg effect one vessel over the other

Answer 29

vein>artery bc increased vascular nitric oxide

Question 30

ntg effects cv

Answer 30

decrease myocardial wall tension, cardiac filling pressures, preload, myocardial o2 requirements

Question 31

which pressor when coming off the pump

Answer 31

dobutamine 1-20mcg/kg/min

Question 32

milrinone moa

Answer 32

pde3 inhibitor prevents the breakdown of cAMP
inotropy, vasodilation, no tachycardia
decrease preload and afterload

Question 33

when to caution milrinone

Answer 33

kidney disease bc kidneys eliminate it

Question 34

whats the only sedative to increase iop, icp, cmro2, cpp, cbf

Answer 34

ketamine

Question 35

ketamine dose

Answer 35

2-4mg/kg iv
15-45mcg/kg/min
.5mg/kg iv over 3 minutes for sedation and anlgesia