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Anaesthesiology > Intravenous drugs > Flashcards

Intravenous drugs Flashcards

1
Q

Define onset of action

A

How long it takes from the moment of induction to the patient sleeping

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2
Q

Is GABA A inhibitory or stimulatory?

A

They are the main inhibitory receptors of the CNS

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3
Q

What are NMDA receptors?

A

The main stimulatory receptors of the CNS

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4
Q

How do the intravenous drugs affect GABA A?

A

They stimulate it

  • Thiopentone
  • etomidate
  • propofol
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5
Q

How do the intravenous drugs affect NMDA?

A

They inhibit it

-ketamine

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6
Q

Which drug is in powder form?

A

Thiopentone and you mix it with 20ml of water

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7
Q
  1. Which drug is a barbitone?

2. Which drugs are non-barbitones?

A
  1. Thiopentone

2. Propofol,ketamine, etomidate

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8
Q

What is the dose of thiopentone?

What is the maximum concentration we can give?

A
  1. 3-5 mg/kg

2. The maximum concentration is 2,5%(25mg/ml)

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9
Q

What is the taste of thiopentone?

A

Garlic

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10
Q

What is the ph of thiopentone?

Why can’t we inject it intramuscularly?

A
  1. 10-11

2. It is painful and it can cause gangrene and spasm and arterial anderitis if injected in the wrong place

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11
Q

What drug helps as an excellent anti-convulsant?

A

Thiopentone

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12
Q

What is the effect of thiopentone on the respiratory system?

A

It can cause laryngospasm in someone with asthma already and has a high risk of apnoea

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13
Q

What is the effect of thiopentone on the CVS?

A

Decreased CO about 10-20% caused by vasodilators , SVR and it increases the HR to compensate(baroreceptors)

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14
Q

What is the absolute contra-indication for thiopentone?

A

Porphyria

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15
Q

What drug is referred to as the milk of amnesia?

A

Propofol

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16
Q

What can we give to lessen the effects of burning on injection of propofol?

A

lignocaine

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17
Q

What is the dose of propofol?

A

2-2,5 mg/kg

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18
Q

What is the benefit of propofol on the respiration?

A

Allows for the use of an LMA

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19
Q

What is the effect of propofol on the CVS?

A
  • causes hypotension because of decreased Cardiac output and SVR
  • The HR does not compensate and it can lead to bradycardia
  • make sure not to use in patients with sepsis or septic shock
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20
Q

Why is propofol too good to be true?

A
  1. anti-emetic
  2. anti-pruritic
  3. anxiolytic
  4. amnesia
  5. no hangover/ accummulation
  6. it is good with porphyria
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21
Q

Why must we use propofol within 6 hours of opening a vial?

A

To prevent bacterial cultures

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22
Q

If we mix the propofol with lignocaine or saline how fast do we need to use it by?

A

30 minutes because it can cause an emulsion deterioration and can cause thrombosis

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23
Q

What is the drug dose for Etomidate?

A

0,3 mg/kg

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24
Q

What is the function of etomidate on GABA?

A

Etomidate stimulates the GABA-A receptor

25
Q

What is the function of etomidate on the CVS?

A

It is very stable and only has a risk of bradycardia when mixed with a high dose of opioids and suxamethonium

26
Q

What is the function of etomidate in the Resp system?

A

It has decreased chance of allergic reaction, respiratory depression, coughing and hiccups and so suitable for asthmatics

27
Q

What are the 5 B’s of Etomidate?

A
  1. Braak- PONV
  2. Beweeg- myoclonic movements especially when sleeping due to the increased hyperactivity of the brainstem
  3. Brand-It burns
  4. Bynier- it causes adrenal insufficiency
  5. baie duur- used to be very expensive
28
Q

Why can we not use Etomidate in TIVA? (total intravenous anaesthetic)

A

It causes adrenal insufficiency which leads to Addison’s disease

29
Q

What does an intravenous induction agent do?

A

-It will induce unconsciousness when it is being injected at the start of general anaesthetic. You can give it to maintain maintenance

30
Q

What is TIVA?

A
  • Stands for total intravenous anaesthesia
  • This means that the patient will not be receiving any other inhalational anaesthesia
  • The patient still receives oxygen or N20 or oxygen
  • Propofol is usually used and sometimes ketamine
31
Q

What is the 10-8-6 rule?

A

It is the rule that is applied for propofol infusion
-we give the patient 1mg.kg as an initial dose and then 10mg.kg for 10 minutes and then 8mg.kg after the next 10 minutes then 6mg.kg thereafter

32
Q

What are the concentrations of propofol for induction in elderly people and young children/infants?

A

Infants- 2,5-3mg.kg

Elderly-1-1,5mg.kg

33
Q

What is the effects of propofol on CNS?

A
  • can be used for epilepsy
  • has rapid loss of unconsciousness
  • causes sedation and drowsiness at low doses
34
Q

What are the effects of propofol on respiratory system?

A
  • it has a high risk for apnea
  • reduces alveolar minute ventilation
  • decreased functional residual capacity
35
Q

What is the effects of propofol on GIT?

A

-good anti-emetic properties

36
Q

What is propofol infusion syndrome and what is the danger?

A
  • Long term infusion for more than 48 hours particularly of 5mg.kg in children
  • it causes lipaemia, metabolic acidosis, cardiomyopathy
37
Q

In which patients should we not use propofol in?

A

-patients with hypovolaemia, heart failure and fixed cardiac output

38
Q

What is the effect of thiopentone on CNS?

A

-it decreases CRM02(cerebral metabolic rate of oxygen consumption), intracranial pressure

39
Q

What is dangerous about injecting thiopentone in the tissue?

A

-sloughing and necrosis

40
Q

What is dangerous about injecting thiopentone into an artery?

A

Intense arterial spasm and pain down the arm

-white arm with cyanosis fingers and skin discoloration

41
Q

What are the absolute and relative contra-indications for thiopentone?

A

Absolute: porphyria, known allergy
Relative: heart conditions, asthma

42
Q

What is the effect of etomidate on the CNS?

A

-It causes epilogenic(myoclonus and involuntary movements) in patients that are known with epilepsy

43
Q

Why is etomidate called vomidate in the anaesthetic community?

A

-because it leads to post-operative nausea and vomiting

44
Q

How do we treat the hallucinations caused by ketamine?

A

Benzodiazepines or opioids

45
Q

What is the effect of ketamine on the CNS?

A
  • It causes myoclonus, nystagmus vocalisation especially in uncontrolled epilepsy
  • increases intra-cranial and intra-ocular pressure
  • Very effective analgesia that can work alone particularly in general anaesthesia
46
Q

What is the effect of ketamine on the CVS?

A
  • Causes sympathetic nervous system stimulation which causes increase in heart rate, cardiac output, increase blood pressure, peripheral resistance
  • the possible myocardial depression is overridden by the sympathetic nervous system
47
Q

What is the effect of ketamine on the resp system?

A
  • causes increased secretions(saliva, bronchial secretions) which will need to be treated pre-operatively by anticholinergics eg. atropine
  • maintains good functional residual capacity
48
Q

What are the indications for using ketamine?

A

-bronchodilatory reasons
-paediatric patients
-analgesia
-

49
Q

What are some of the contra-indications for ketamine?

A
  • epileptic pts
  • psychiatric patients
  • not suitable for eye surgeries, cerebral surgeries
  • CVS disorder- hypertension, ischaemia Herat disease
50
Q

What is the induction dose for ketamine?

A

IV: 1-2 mg.kg
IM: 5-10 mg.kg
Maintenance: 0,5 mg.kg incremental boluses

51
Q

What is the analgesic dose for ketamine?

A

IV: 0,2-0,4 mg.kg
IM: 2-4mg.kg

52
Q

Give two examples of benzodiazepines?

A
  1. Midazolam

2. Diazepam

53
Q

Which benzodiazepines are soluble and insoluble in water?

A

Soluble-midazolam

Insoluble- diazepam

54
Q

What is the dosage for IV in midazolam?

A

0,1-0,3 mg.kg

55
Q

What is most likely cause for post induction hypotension?

A

-propofol and thiopentone

56
Q

Which IV induction agent works on the same receptor as nitrous oxide?

A

Ketamine which works on the NMDA receptor

57
Q

Which induction agent causes an increase in cardiac output

A

Ketamine

58
Q

Which agent is they least metabolized by the liver?

A

Sevoflurane

Anaesthesiology (25 decks)

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