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Anesthesia Pharmacology > IV Anesthetics- Hypnotics > Flashcards

IV Anesthetics- Hypnotics Flashcards

1
Q

Propofol

Class/ category and uses

A

Class/ Category:GABA agnoist, IV anesthetic, sedative-hypnotic

Uses: Induction, maintenance, sedation, anti-emetic

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2
Q

MOA Propofol

A

GABA (A) agonist

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3
Q

Propofol

Bolus dose

A

1.5-2.5 mg/kg, IBW

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4
Q

Propofol

Maintenance infusion

A

100-200 mcg/kg/min, TBW

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5
Q

Propofol

Sedation Infusion

A

25-75 mcg/kg/min

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6
Q

Propofol

Onset and Peak

A

-Onset: 30-60 sec
-Peak: 1.5-2 min

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7
Q

Propofol

Duration and elimination

A

-Duration: 5-10 min
- Hepatic/ Pulmonary

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8
Q

Propofol

CV effects

A

-↓ BP(exaggerated in hypovolemia, elderly, and LV dysfunction)
-↓ SVR
-↔/↓ HR

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9
Q

Propofol

Pulm Effects

A

-↓ RR, ↓ TV
-↓ hypoxia response
-Attenuates bronchoconstriction

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10
Q

Propofol

CNS effects

A

-↓ CBF, ↓ CMRO2
-↓ ICP
-↓ CPP (cerebral perfusion pressure)
-May produce EEG burst suppression or isoelectric EEG

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11
Q

Can propofol cause myoclonus

A

YES

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12
Q

T/F propfol caues disinhibition (paradoxical exictation)/ unpredicatble movement

A

true

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12
Q

Which medication infustion requires tubing changes, how often, use within once primed, and why

A

Lipid formulation supports bacterial growth – Use within 6 hrs, change tubing every 12 hrs

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13
Q

Two cautions with propofol

A

-Caution with mitochondrial disease
-Causally associated with soy & egg allergy (specifically yolks)

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14
Q

Does propfol have analgesic effect

A

minimal to none

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15
Q

T/F propofol triggers MH

A

False

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16
Q

what is Diprivan

A

propofol

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17
Q

T/F propfol causes histamine release

A

False, no histamine release

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18
Q

what is Amidate

A

Etomidate

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19
Q

Etomidate

Class/ Category and use

A

-Class/ category: GABA agonist, IV anesthetic
- Use: induction

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20
Q

Mechanism of action of Etomidate

A

GABA (A) agonist

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21
Q

Etomidate dose and what is it

A

Bolus: 0.2-0.3 mg/kg

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22
Q

Etomidate

Onset, Peak, Duration

A

-Onset: 30-60 sec
-Peak: 1-2 mins
-Duration: 5-15 min

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23
Q

Etomidate

Elimination

2!

A

Hepatic/ plasma cholinesterase

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24
Etomidate | CV Effects
-Minimal to no change HR, CO, SVR, MAP -May result in sudden ↓ BP if hypovolemic
25
Etomidate | Pulm effects
↓ Vt, ↑ RR,↓ MV
26
Etomidate | CNS effects ## Footnote Hint-5
-↓ CBF, CMRO2 -↓ ICP -↑/↔ CPP -Burst suppression possible -**Proconvulsant**, lowers seizure threshold
27
Etomidate | GI effects
PONV
28
can Etomidate cause myclonus and/or hiccups
yes
29
30
Do Etominate and propofol cause pain with injection
yes
31
Etomidate cautions
-Contraindication: Adrenal suppression -Avoid if porphyria -Caution with seizure history, associated with epileptogenic activity
32
A single dose of Etomidate can cause? what does it inhibit and for up to how long?
Single dose may cause adrenocortical suppression – Inhibits cortisol synthesis (11β-hydroxylase) for up to 72 hrs
33
Does etomidate release histamine?
Nope
34
T/F Etomidate has analgesic properties
False, Lacks analgesic properties
35
What is Ketalar?
Ketamine
36
Ketamine | class/ category and use
-Class/Category: NMDA antagonist; IV anesthetic; Dissociative anesthetic -Uses: Pre-medication; Induction, maintenance, **analgesia**; Sedation
37
Ketamine | MOA
Non-competitive NMDA antagonist
38
Ketamine induction dose
Induction Dose: 1-2 mg/kg
39
Ketamine sedation dose
Sedation dose: 0.2-0.8 mg/kg
40
Ketamine analgesia dose
Analgesia dose: 0.2-0.5 mg/kg IV
41
Ketamine | Onest, peak, duration
Onset: 30-60 sec Peak: 1 min Duration: 10-20 min
42
Ketamine | Metabolism
Hepatic
43
Active metabolite of ketamine
Norketamine (20-33% potency)
44
Ketamine excretion
Renal (Norketamine), Hepatic (Ketamine)
45
Ketamine | CV effects
-Typically ↑ HR, BP, CO, SVR -If **endogenous catecholamine deplete or repeat doses**, may have a direct myocardial depressant effect (↓ BP & HR), possible CV collapse -↑ MVO2
46
Ketamine | Pulm effects
-**Bronchodilator** -Airway reflexes slightly depressed or remain intact when used alone; when used at high doses or with other agents, resp depression/apnea possible -↑ PAP, PVR
47
Ketamine | CNS effects ## Footnote 6
-↑ CBF, CMRO2 (CBF>CMRO2) -↑ ICP if not mechanically ventilated -↑ CPP -**May produce** burst suppression at **high doses** -Anticonvulsant, unlikely to promote seizure -Little effect on cerebrovascular autoregulation or PaCO2 responsiveness
48
Ketamine | GI effects
-N/V
49
Ketamine causes what to eyes
nystagmus and pupil dilation
50
How does ketamine effect secretions and what could it cause
↑ secretions: Salivation,may promote laryngospasm
51
Ketamine emergence reactions ## Footnote 8
* Vivid dreams * out-of-body experiences * fear * hallucinations * alterations in mood and affect * delirium * restlessness * combativeness
52
Ketamine Contraindications ## Footnote 5
* Poorly controlled CV disease * pregnancy * active psychosis * severe liver disease * open globe injury
53
Ketamine Relative Contraindications
Increased ICP when spontaneously ventilating, increased IOP
54
Use ketamine causiously with which patient populations
* HTN * pulm HTN * increased ICP * CAD * severe **right** heart dysfunction
55
T/F Avoid ketamine if porphyria
True
56
Ketamine is MH safe (T/F)
True
57
Ketamine provides what two pillars of anesthesia
analgesia and amnesia
58
Ketamine produces what type of state in patients
Dissociative effect produces trance-like cataleptic state
59
Does ketamine cause histamine release
NO
60
which drug has highest incidence of PONV for all IV anesthetics ?
Etomidate
61
Which drug has lowest protein binding, and what is the %
Ketamine, 12%
62
which drug has the highest volume of distrubution of any induction agent
propofol
63
what are hypotension predictors in propofol ## Footnote 4
* 50 or older * baseline DPB<70 mmhg * ASA III/ IV * high dose fentanyl co-administration

Anesthesia Pharmacology (7 decks)

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