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Anesthesiology > Injectables > Flashcards

Injectables Flashcards

1
Q

Which injectable anesthetics may be given IM?

A
  • Ketamine
  • Telazol
  • Alfaxalone
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2
Q

General qualities shared by injectable anesthetic drugs (6)

A 
• Very liposoluble
• Highly protein bound
• Reach the Brain rapidly
• Redistributed to other tissue
• Accumulation in fat
• Decrease in drug
plasmatic 
concentration
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3
Q

Opiods review (6)

A
  • Fentanyl or hydromorphone bolus
  • ↓ HR and ventilation
  • No myocardial depression
  • Reversible
  • Analgesic
  • Short acting (fentanyl)
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4
Q

2 injectable opiods

A
  • Fentanyl

- Hydromorphone

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5
Q

5 CV effects of Ketamine

A 
• Sympathetic Stimulation
• ↑ HR and BP
• Careful in HCM
• Direct myocardial
depressant
• May ↑ IOP
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6
Q

Injectable anesthetic drugs (6)

A
  • Propofol
  • Ketamine
  • Telazol
  • Etomidate
  • Alfaxalone
  • Opioids (Fentanyl and Hydromorphone)
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7
Q

Etomidate acts on _________ receptors and is _________ based. It is a ________ derivative and may cause _________.

A
  • GABA A receptors
  • propylene glycol
  • Imidazole
  • hemolysis
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8
Q

Ketamine undergoes Hepatic metabolism in ____ and _____ and is eliminated unchanged by ____

A
  • dogs and horses

- cats

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9
Q

Propofol acts on the _________ to cause _________ resulting in _________

A
  • GABA receptors
  • ↑ influx of Cl
  • hyperpolarization
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10
Q

2 shelf lives of Propofol formulations once opened

A
  • 6 hours

- 28 days (2% Benzyl-alcohol)

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11
Q

Alfaxalone acts on _____

A

GABA

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12
Q

5 Neurologic effects of Propofol

A
  • Decrease CMR02
  • Decrease ICP
  • Protective for brain ischemia
  • Treatment for seizures
  • Decrease EEG activity
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13
Q

Alfaxalone Review (6)

A
  • Fast acting
  • No problem if given perivascular
  • Short cardiovascular depression
  • Apnea, respiratory depression
  • CNS friendly
  • Can be given intramuscularly
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14
Q

What is the main drawback to Etomidate use?

A

adrenal suppression (Addisonian crisis)

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15
Q

Telazol Review (4)

A
  • Similar effects of Ket/val
  • Smaller volume
  • Associated with rough recoveries w/o premeds
  • Can be reconstituted with Ketamine and alpha2
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16
Q

3 Respiratory effects of Ketamine

A

• Apneustic breathing
• Apnea
• Maintained laryngeal
reflexes and PaO2

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17
Q

Neurologic effects of opiods

A 
• Increase in intracranial pressure (if hypoventilation
occurs)
• May affect heart
automaticity and
conduction
18
Q

The formulation of Propofol with the long opened shelf life is FDA approved only in _____

A

dogs

19
Q

Characteristics of Propofol induction (6)

A
  • Induction in 30 sec
  • Excitation (bolus)
  • Apnea
  • Duration 10-15 min
  • Cumulative
  • Splenic engorgement
20
Q

Neurologic effects of Etomidate

A
  • CNS friendly
  • Myoclonus
  • Poor muscle relaxation
  • Usually combined w/ benzo or opiods
21
Q

Etomidate Review (6)

A
  • Minimal cardiovascular changes
  • Adrenal supression
  • Poor muscle relaxant
  • Combined with opioid or benzo for induction
  • Expensive
  • Good for cardiac patients
22
Q

Neurologic effects of Alfaxalone

A

• CNS friendly
• Potential protective effect in premature fetus when labor is induced by glucocorticoids
(Betamethasone)
• Excitation in cats during recovery (IM route)

23
Q

Propofol anesthesia lasts for ____-___ minutes after induction dose

A

10-15

24
Q

Neurologic effects of Telazol

A

• Maintained reflexes
– Coughing
– Swallowing
– corneal reflexes

25
Q

3 Neurologic effects of Ketamine

A 
• ↑ ICP and CBF
• Somatic analgesia
• Excitement at emergence
– Motor activity
– Sensitivity to touch
– Violent recovery
26
Q

Ketamine is a _________ compound

A

cyclohexamine

27
Q

Ketamine causes dissociation between the __________ and __________

A
  • thalamus

- limbic system

28
Q

What is the benefit of adding 2% Benzyl-alcohol to the Propofol formulation?

A

Extends opened shelf life from 6 hours to 28 days

29
Q

CV effects of Etomidate

A

Cardiovascular and respiratory stability

30
Q

CV and respiratory effects of Telazol

A

• Similar to ketamine
• ↑ HR, BP and SVR
due to sympathetic
stimulation

31
Q

Telazol comes as a ____ which is reconstituted with ________

A
  • lyophilized powder

- sterile water

32
Q

Once saturation occurs, plasma concentration
only decreases with
_______

A

drug elimination

33
Q

Propofol review (6)

A 
• Fast acting
• No problem if given perivascular
• Short cardiovascular depression
• Apnea, respiratory depression
• CNS friendly
• Contamination after 6 hours opened
– Benzyl alcohol prolongs shelf-life and decrease
contamination
34
Q

4 Clinical effects of Ketamine

A
  • ↑ Salivation and mucus
  • Poor muscle relaxation
  • Reflexes are maintained
  • Rough recoveries
35
Q

3 most important distribution tissues of the body

A
  • Splanchnic viscera
  • Muscles
  • Fat
36
Q

Cardiorespiratory effects of Alfaxalone

A 
• Minimal
cardiovascular effects
– ↑HR and C.O.
– ↓ BP (vasodilation)
• Dose dependent
respiratory depression
– Apnea after bolus
37
Q

Propofol is an __________ compound

A

alkylphenol

38
Q

Ketamine Review (8)

A
  • Increase sympathetic tone
  • Poor muscle relaxant
  • Combine with Benzodiazepines for induction
  • Increase myocardium work load
  • Increase ICP, CBF, IOP, â seizures threshold
  • Rough recoveries
  • Apneustic breathing, apnea
  • Maintained reflexes
39
Q

4 CV effects of Propofol

A
  • Myocardial depression
  • Decrease in CO
  • Decrease in BP
  • Increase HR
40
Q

3 Respiratory effects of Propofol

A
  • Decrease in Vt
  • Hypoventilation
  • Apnea
41
Q

Cardiorespiratory effects of Opioids

A 
• Cardiovascular friendly
• ↓ HR
• Dose dependent
respiratory depression
• Analgesia

Anesthesiology (13 decks)

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