IV Induction Agents Flashcards
Sympathetic Nervous System evokes the
fight or flight response SEAN: Sympathetic Epi/Norepi Adrenergic Nicotinic
Parasympathetic Nervous System evokes the
Rest and DIgest Parasympathetic Acetycholine Cholinergic Muscarinic
Most induction agents work at
the GABA receptor
Advantages of IV anesthesia/induction agents:
-Provide rapid onset of general anesthesia.
Disadvantages of IV induction/anesthesia agents
Lack of true “Ideal” IV anesthetic.
Balanced Anesthesia is the
Use multiple drugs to achieve goal: Inhalation agents IV induction agents Sedative/hypnotic agents Opioids Neuromuscular blocking drugs
All IV induction agents are
lipophilic, cross BBB
Recovery from a single dose of drug is caused by
redistribution of the drug to less perfused tissues.
T/F Single dose termination is determined by extent or speed of metabolism.
FALSE
Single dose termination IS NOT determined by extent or speed of metabolism.
Two of the most common barbiturates in Anesthesia:
Thiopental (no longer used, death penalty)
In Alpha 2 receptors, the medication binds to _______ and slows the release of _______, which slows fight or flight (sympathetic)
An agonist that slows down the body
norepinephrine, norepinephrine
Precedex
Mechanism of action for Barbiturates:
Post synaptic enhancement of GABA mediated neurotransmitters
Barbiturates are reversibly bound to
protein (plasma albumin)
an increased free level if albumin levels are low
Barbiturates have a prompt and predictable __________, but does not have any _________
loss of consciousness
NO analgesic properties
Barbiturates can abruptly stop
seizures
Barbiturates blunt the baroceptor relfex, which may cause a compensatory
increase in HR
Barbiturates cause a
histamine release
Barbiturate contraindications:
Porphyria
Allergy
Benzodiazepines scope of properties include
Anxiolytic Sedation Anticonvulsant Muscle Relaxation Amnesia
Midazolam has a _______ and work on _______
imidazole ring, GABA
Midazolam is highly
lipid soluble and protein bound
Midazolam (is/ is not) neuroprotective
IS NOT
Withdrawal of barbs/ benzos may last
weeks to months
must be tapered off
cause opposite symptoms, HTN, tachy
Flumazenil reverses
benzos (benzo agonist) competitive
may precipitate withdrawal
Propofol requires a
lipid vehicle, which makes it prone to bacterial growth
some formulations of propofol have a
sulfite, which may cause allergic reactions
Mechanism of action for propofol
GABA
Propofol has/ does not have neuroprotective effects
HAS
Side effects of propofol include
rare but potential for PE
Propofol Infusion Syndrome is a
lactic acidosis seen generally at higher doses for >24 hours, causes Kidney Fx, Rhabdo, Cardiac Arrest
tx: stop propofol, tx acidosis, support organ fx
Ketamine works on
NMDA receptors
Ketamine requires a ______ with administration for amnesia
benzo
Use of ketamine may cause _______ if not additionally given a benzo
emergence delirium
The active metabolite of Ketamine is
norketamine
Do not use ketamine in patients with
intracranial pathology
Ketamine may be used for ______, when other drugs fail
status epilepticus
Etomidate causes a depression of
adrenocortical function for 4-8 hours after a dose. Patients with sepsis/hemorrhage may be at a disadvantage receiving Etomidate if the cortisol response is compromised.
Etomidate works on
the GABA receptor
Etomidate is the drug of choice for
unstable cardiac patients. (provides cardiovascular stability)
The use of etomidate increases incidence of _______ and dose not effect duration of induced seizure activity, good for _______, low incidence of ________
PONV
ECT
allergic reaction
Dexmedetomidate is a
highly selective alpha-2 adrenergic agnonist
With dexmedetomidate use, all other concentrations of anesthetic agents must be __________
decreased (synergistic effects with other anesthetics)
With use of dexmedetomidate, there is a risk of ___________.
Tolerance
