Injectable Anesthesia

Question 1

Safe therapeutic indices

Answer 1

Etomidate, Ketamine, Alfaxalone

Question 2

not so safe thereapeutic indices

Answer 2

propofol 3

thiopental 5

Question 3

high therapeutic index means

Answer 3

if you overdose its less likely to be lethal

Question 4

Compartment theory

Answer 4

when give blood iv it moves first to high blood flow areas and then organs with low blood flow

Question 5

Time of awakening for all injectable anesthetics is due to the _______ phase

Answer 5

redistribution

Question 6

continuous infusion can lead to

Answer 6

accumulation and saturate the compartments.

Question 7

Context sensitive half life

Answer 7

time it takes to wake up once CRI is discontinued (for plasma to drop 50%)

Question 8

The lower the protein the

Answer 8

less drug you should give!!

Question 9

drop in serum protein will lead to increase in ______

Answer 9

free portion of anesthetic analgesic drug (non protein bound drug)
also increase in drug effect and side effect

Question 10

Barbiturates

Answer 10

• not used in human med so super expensive for us now.

- includes thiopental(short acting)

Question 11

Mechanism of action for thiopental

Answer 11

• GABA, Allows chloride in when binds to barbituric site

- negative ions make the cell lazy

Question 12

thiopental is one of the best drugs to prevent

Answer 12

oxygen consumption of brain, intracranial pressure

Question 13

thiopental not recommended for

Answer 13

repeated bolus, takes forever to be eliminated (especially bad for liver patients/portosystemic shunts)

Question 14

propofol problems

Answer 14

sleep apnea

respiratory/cardiovascular depression but its ok because short lived

Question 15

propofol benefits

Answer 15

• so easy, people get less vigilant with it (smooth induction and recovery)
• fast in fast out
• recovery due to redistribution
• short context sensitive half life -> great for infusion rate

Question 16

mechanism of action propofol

Answer 16

GABA

Question 17

best for liver patients (PSS)

Answer 17

propofol

because doesn’t rely on liver metabolism

Question 18

prefer not to use propofol with

Answer 18

heart patients

Question 19

high oil/triglycerides/fat in ?

So don’t?

Answer 19

• Propofol vehicle

- Don’t mix with other drugs. May cause fat embolism.

Question 20

Cats produce heinz body and methemoglobinemia when

Answer 20

long term use of propofol

Question 21

Etomidate

Answer 21

GIVE YOUR HEART A BREAK

(Murmur, DCM, ASD) Doesn’t drop BP, CO, not bad for respiratory depression either

Question 22

Etomidate adverse effects?

Answer 22

shuts down adrenal gland, can no longer perform stress functions (bad in trauma cases that you wan’t to use etomidate in)

Question 23

Bleeding, Septic, ICU patients use etomidate?

Answer 23

nah bro

Question 24

Ketamine

Answer 24

“Swimming in a bowl of jello” Dissociative drug. Disconnects cortex from limbic system.
Can’t be used as solo agent, need to add high sedation(Benzdiazepam alpha agonist)

Question 25

Ketamine drawbacks

Answer 25

controlled (date rape, Special K)

Question 26

Ketamagic

Answer 26

can give IM to feral cats

Question 27

only anesthetic drug for analgesia

because?

Answer 27

ketamine

because works nMDA receptor

Question 28

increases sympathetic tone, good for ICU patients

Answer 28

ketamine

Question 29

Alfaxalone

Answer 29

safe for heart, smooth induction, doesnt stop breathing, can give IM, no analgesia

Question 30

alfaxalone drawback

Answer 30

super expensive

Question 31

Alfaxalone is good for patients

Answer 31

with heart issues that we don’t want to mess up the adrenal gland.

Question 32

Heart disease

Answer 32

Etomidate>Alfaxalone

Question 33

kidney disease

Answer 33

Alfaxalone»»> Ketamine

Question 34

Liver disease

Answer 34

Propofol&raquo_space;Alfaxalone

Question 35

Trauma - hypovolemic shock

Answer 35

Ketamine>Alfaxalone

Question 36

Trauma - Head injury

Answer 36

Propofol&raquo_space;> Alfaxalone

Question 37

Trauma - Septic shock

Answer 37

Ketamine» Alfaxalone