Induction Meds

Question 1

Etomidate (amidate)

class

Answer 1

• induction agent
• GABA mimetic, imidazole derivative
• not preferred over propofol, but better for pt who cannot tolerate hypotension

Question 2

Etomidate (amidate)

MOA

Answer 2

• binds to GABA receptors

- enhances affinity for GABA neurotransmitters

Question 3

Etomidate (amidate)

induction dose

Answer 3

induction: 0.3 - 0.6 mg/kg

Question 4

Etomidate (amidate)

onset/peak/duration

Answer 4

onset: 30-40 sec
peak: 1 min
duration: 3-10 min

Question 5

Etomidate (amidate)

effects

Answer 5

potent, direct cerebral vasoconstrictor (decrease ICP)
decrease TV, increase RR
myoclonus dystonia (premed with fentanyl or versed

Question 6

Etomidate (amidate)

cautions/general

Answer 6

• focal epilepsy
• **least myocardial effects of all induction drugs
• PAINFUL injection (pH acidic)
• adrenal suppression- cholesterol cannot convert to cortisol

Question 7

Propofol (diprivan)

class

Answer 7

1st choice induction agent, anticonvulsant

antiemetic

Question 8

Propofol (diprivan)

dose

Answer 8

> 65 y = 1.0 - 1.5 mg/kg
<65 y = 1.5 - 2.5 mg/kg
peds = 2.5 - 3.5 mg/kg

drip: GA : 100-300 mcg/kg/min
conscious sedation: 25-200 mcg/kg

Question 9

Propofol (diprivan)

onset/peak/duration

Answer 9

onset: 30-40 sec
peak: 1 min
duration: 3-10 mins

Question 10

Propofol (diprivan)

MOA

Answer 10

GABA receptors

increases duration of channel opening

Question 11

Propofol (diprivan)

effects

Answer 11

-inhibits vasoconstriction –> hypotension
-decreases respiratory drive –> apnea
bronchodilation (mild)
-bradycardia
-relaxes smooth vascular muscles
-inhibits sympathetic vasoconstrict
-decreases ICP & IOP

Question 12

Propofol (diprivan)

excretion

Answer 12

kidneys

Question 13

Propofol (diprivan)

caution

Answer 13

• NOT for pts allergic to soy or eggs
• elderly need less, slower clearance
• BURNS on injection, mix with lido (20-40 mg)
• peds have increased distribution
• PROPOFOL INFUSION SYDROME

Question 14

Thiopental (sodium pentothol)

class

Answer 14

induction agent, barbituate

Question 15

Thiopental (sodium pentothol)

dose

Answer 15

induction: 3-5 mg/kg

* decrease dose by 50-70% for elderly

Question 16

Thiopental (sodium pentothol)

MOA

Answer 16

GABA - directly activates receptors

Question 17

Thiopental (sodium pentothol)

effects

Answer 17

• myocardial depression, decreased SVR
• histamine release
• precipitates porphyria
• mild hypotension

Question 18

Thiopental (sodium pentothol)

caution/other

Answer 18

-rapid redistribution, brain gets ~10% initial dose
-highly lipid soluble, albumin binding
-hangs out in fat = not fast wake up
acidosis will increase intensity
alkalosis will decrease intensity

Question 19

Ketamine (ketalar)

class

Answer 19

induction agent
phencyclidine derivative
amnesic, analgesic

Question 20

Ketamine (ketalar)

dose

Answer 20

induction = IV 1-2 mg/kg
IM 6-13 mg/kg
trauma TIVA = 200 mg + 10 mg versed
drip = 1-2 mg/kg/hr

Question 21

Ketamine (ketalar)

onset/peak/duration

Answer 21

onset = 30 sec
peak = 3-5 min
duration = 8-15 min

Question 22

Ketamine (ketalar)

MOA

Answer 22

bind non-competitively to NMDA

• inhibits activation of NMDA
• decreases presynaptic release of glutamate
• potentiates release of GABA

Question 23

Ketamine (ketalar)

effect

Answer 23

-“dissociative anesthesia” - limbic not connected to
thalamocortical
-copious secretions - give robinul
-emergence delirium - give with versed
-increased HR, increased CO & bronchodilation
**stimulates SNS

Question 24

Ketamine (ketalar)

caution & extra

Answer 24

• atropine & scopolamine also cross BBB- increase risk of
  emergence
• does not cause apnea or hypotension