IV anesthetics Flashcards by Adrie McFarland

What is the PKa of Propofol?

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What is the preservative for Diprivan? Vs Generic?

Diprivan: Disodium
Generic: Sodium

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MOA of propofol

Direct GABA agonist

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Onset of Propofol

30-60 sec

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Duration of Propofol

5-10 min

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Where does clearance of Propofol occur?

Liver
Lungs

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Propofol and seizure need to know?

Propofol has anticonvulsant effects but in few reported cases it has caused seizures

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Phenol excretion due to propofol will turn your urine which color?

Green

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Where is egg lecithin? Yolk or egg white

Yolk

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What kind of allergies have been thought to cause cross reactivity with Propofol?

egg
soy
peanut

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Is Propofol safe to give with peanut, soy, or egg allergy?

Yes

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Dose to give for antiemetic effect?

10 mg

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Dose of Propofol to give itching?

10 mg

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Benzyl alcohol is a preservative in Propofol we should avoid in _

Infants

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Metabisulfite is a preservative in Propofol that can cause _ in patients with _

bronchospasm
asthma

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How long until you need to toss your propofol stick?

6 hours

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How long until you need to toss your Propofol infusion

12 hours

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What causes propofol infusion syndrome?

triglycerides which starve the cells of oxygen

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Propofol infusion syndrome risk factors?

> 67 mcg/kg/hr
Infusion > 48 hours
Sepsis
Continuous catecholamine infusions
High dose steriod
Steroid

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Which population is propofol infusion syndrome most common in?

Kids

Should not be used in ICU setting as gtt

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Cardiac presentation in propofol infusion

Bradycardia
Asystole

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Is Fospropofol an aqueous or lipid solution?

Aqueous

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Does Fospropofol also burn like Propofol?

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Does Fospropofol support microbial growth?

No!

Not a lipid emulsion

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Initial bolus dose of Fospropofol

6.5 mg/kg

Repeat bolus of Fospropofol

1.6 mg/kg

Onset of Fospropofol

5-10 min

Duration of Fospropofol

15-45 min

Which is a prodrug and which is an active drug b/w Fospropofol and Propofol?

Prodrug: Fosprop Active: Prop

Side effect that Decadron and Fosprop share?

Genital and anal burning

Which 2 systems does Ketamine dissociate?

sensory (thalamus) and limbic (awareness)

IV induction dose of Ketamine

1-2 mg/kg

Maintenance infusion dose of Ketamine

1-3 mg/min

Low dose infusion of Ketamine (opioid sparing effect)

1-3 mcg/kg/min

Analgesic dose of Ketamine

0.1-0.5 mg/kg

IM dose of Ketamine

4-8 mg/kg

PO dose of Ketamine

10 mg/kg

IV onset of Ketamine

30-60 sec

Onset of IM Ketamine

2-4 min

Duration of Ketamine

(10-20 min) May require 60-90 min to return to full orientation)

What does chronic Ketamine use do to its clearance?

Chronic Ketamine use leads to induction of the enzymes that metabolize it... leading to more rapid metabolization

How is the active metabolite of Ketamine excreted and what is it called? What is its potency

Norketamine Renal Up to 1/3 as potent

Is Ketamine a direct myocardial stimulant or depressant? What must be in tact to negate the effect?

Depressant SNS tone! If they are catecholamine depleted they may not get the increased HR BP and SVR --> BAD

What are the 2 respiratory considerations you must keep in mind when it comes to Ketamine?

It increases secretions It is a BRONCHODILATOR

Why should you use caution with Ketamine and a pt with seizure hx?

Ketamine increases EEG activity

What is the MOST effective way to prevent emergence delirium when using Ketamine?

Benzo! Versed > Valium

Risk factors for emergence delirium using Ketamine

> 15 years Female gender Ketamine dose > 2mg/kg Hx of personality disorder

Which drug has an Imidazole ring?

Etomidate

Imidazole ring opens or closes in acidic environment?

Opens! *Think of it as burning it open

Imidazole ring opens or closes in a physiologic pH environment?

Closes

Is water solubility increased or decreased with an open imidazole ring?

Increased

MOA of Etomidate

GABA A agonist

Dose of Etomidate

0.2-0.4 mg/kg IV

Onset of Etomidate

30-60 sec

Duration of Etomidate

5-15 min

How is Etomidate metabolized?

Liver + nonspecific esterases

If you use Etomidate for induction will it blunt the SNS response?

No Need Opioid or Esmolol

Can Etomidate cause respiratory depression?

Very mild

Who should you avoid Etomidate in?

Patients with seizure activity! It will not cause sz in patients that do not have a hx of it

Cortisol production is dependent on which 2 enzymes that etomidate inhibits?

17 and 11 Beta hydroxylase

Adrenocortical function after a dose of Etomidate can be supressed for how long?

up to 24 hr

What disease process seen often in the ICU should Etomidate be avoided in and why?

Sepsis They need to be able to mount a stress response!

Does Etomidate cause PONV?

Yes! it is more common than with any other induction agent

Is Etomidate good or bad in patients with acute intermittent porphyria?

BAD!

MOA of Thiopental?

GABA A agonist

Dose of Thiopental?

2-5 mg/kg in adults 5-6 mg/kg in kids

Active metabolite of thiopental

None if low dose After hight dose: Phenobarbital

Thiopental leads to histamine release T/F?

Intra arterial injection of thiopental can lead to

tissue necrosis

What kind of ring does Precedex have?

Imidazole

Loading dose of Ketamine?

1 mcg/kg over 10 min

Maintenance infusion dose for Precedex?

0.4-0.7 mcg/kg/hr

Onset with loading dose

10-20 min

Does Precedex uncouple CBF and CMRO2?

YES! CBF decreases CMRO2 does not change ICP does not change

Precedex provides an anti_

shivering effect

What kind of ring does Midazolam have in its structure?

Imidazole *Like Etomidate and Precedex

MOA of Midazolam

GABA A

IV sedation dose of Versed

0.01-0.1 mg/kg

IV induction dose of Versed

0.1-0.4 mg/kg

PO sedation Versed dose in kids

.5-1.0 mg/kg

Onset of Versed

30-60 sec

DOA of Versed

20-60 min

Active metabolite of Versed? What is its potency?

1-hydroxymidazolam 0.5

Which benzo undergoes enterohepatic recirculation?

Valium Which is why it lasts so long!

How is remimazolam metabolized? How does it differ from other benzos?

By tissue esterases Ultra short acting

DOA of Romazicon

30-60 min

Initial dose of Romazicon? Subsequent dose?

0.2 0.1 Q 1 min

Triggering agents for acute intermittent porphyria

Barbs Etomidate Ketamine Ketorolac Amiodarone CCB Birth control pills

About what % is Ketamine protein bound