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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
Q

Etomidate

CV Effects

A

-Minimal to no change HR, CO, SVR, MAP
-May result in sudden ↓ BP if hypovolemic

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25
Q

Etomidate

Pulm effects

A

↓ Vt, ↑ RR,↓ MV

26
Q

Etomidate

CNS effects

Hint-5

A

-↓ CBF, CMRO2
-↓ ICP
-↑/↔ CPP
-Burst suppression possible
-Proconvulsant, lowers seizure threshold

27
Q

Etomidate

GI effects

A

PONV

28
Q

can Etomidate cause myclonus and/or hiccups

A

yes

29
Q
A
30
Q

Do Etominate and propofol cause pain with injection

A

yes

31
Q

Etomidate cautions

A

-Contraindication: Adrenal suppression
-Avoid if porphyria
-Caution with seizure history, associated with epileptogenic activity

32
Q

A single dose of Etomidate can cause? what does it inhibit and for up to how long?

A

Single dose may cause adrenocortical suppression – Inhibits cortisol synthesis (11β-hydroxylase) for up to 72 hrs

33
Q

Does etomidate release histamine?

A

Nope

34
Q

T/F Etomidate has analgesic properties

A

False, Lacks analgesic properties

35
Q

What is Ketalar?

A

Ketamine

36
Q

Ketamine

class/ category and use

A

-Class/Category: NMDA antagonist; IV anesthetic; Dissociative anesthetic

-Uses: Pre-medication; Induction, maintenance, analgesia; Sedation

37
Q

Ketamine

MOA

A

Non-competitive NMDA antagonist

38
Q

Ketamine induction dose

A

Induction Dose: 1-2 mg/kg

39
Q

Ketamine sedation dose

A

Sedation dose: 0.2-0.8 mg/kg

40
Q

Ketamine analgesia dose

A

Analgesia dose: 0.2-0.5 mg/kg IV

41
Q

Ketamine

Onest, peak, duration

A

Onset: 30-60 sec
Peak: 1 min
Duration: 10-20 min

42
Q

Ketamine

Metabolism

A

Hepatic

43
Q

Active metabolite of ketamine

A

Norketamine (20-33% potency)

44
Q

Ketamine excretion

A

Renal (Norketamine), Hepatic (Ketamine)

45
Q

Ketamine

CV effects

A

-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
Q

Ketamine

Pulm effects

A

-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
Q

Ketamine

CNS effects

6

A

-↑ 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
Q

Ketamine

GI effects

A

-N/V

49
Q

Ketamine causes what to eyes

A

nystagmus and pupil dilation

50
Q

How does ketamine effect secretions and what could it cause

A

↑ secretions: Salivation,may promote laryngospasm

51
Q

Ketamine emergence reactions

8

A
  • Vivid dreams
  • out-of-body experiences
  • fear
  • hallucinations
  • alterations in mood and affect
  • delirium
  • restlessness
  • combativeness
52
Q

Ketamine Contraindications

5

A
  • Poorly controlled CV disease
  • pregnancy
  • active psychosis
  • severe liver disease
  • open globe injury
53
Q

Ketamine Relative Contraindications

A

Increased ICP when spontaneously ventilating, increased IOP

54
Q

Use ketamine causiously with which patient populations

A
  • HTN
  • pulm HTN
  • increased ICP
  • CAD
  • severe right heart dysfunction
55
Q

T/F Avoid ketamine if porphyria

A

True

56
Q

Ketamine is MH safe (T/F)

A

True

57
Q

Ketamine provides what two pillars of anesthesia

A

analgesia and amnesia

58
Q

Ketamine produces what type of state in patients

A

Dissociative effect produces trance-like cataleptic state

59
Q

Does ketamine cause histamine release

A

NO

60
Q

which drug has highest incidence of PONV for all IV anesthetics ?

A

Etomidate

61
Q

Which drug has lowest protein binding, and what is the %

A

Ketamine, 12%

62
Q

which drug has the highest volume of distrubution of any induction agent

A

propofol

63
Q

what are hypotension predictors in propofol

4

A
  • 50 or older
  • baseline DPB<70 mmhg
  • ASA III/ IV
  • high dose fentanyl co-administration

Anesthesia Pharmacology (6 decks)

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