Just Special Considerations Flashcards
Propofol
- pain on injection
- “egg/soy/ peanut allergies”
- few contraindications
- Awakening 5-15 minutes (nagelhout), but 4 minutes (during class?)
CNS: decreases everything “neuro-protective”, controversy in epileptic pts, myoclonia 2/2 disinhibition of subcortical ctrs
CV: mild-mod decrease in BP, CO
Resp: transient respiratory depression, decrease Vt, apnea common in intubation doses, min. bronchodilating effect, propofol or ketamine preferred induction agents in pts with asthma.
GI: antiemetic
PRIS
Etomidate
IV induction agent, similar to propofol but with less CV instability
Awakening: 5-15 min after administration
Adrenal cortical suppression - affects CYP450 dependent enzymes, and 11B-hydroxylase
Metab: ester hydrolysis
CNS: decreases everything, maybe not CPP bc maintain MAP, myoclonia - pretreat with precedex, midaz, rocuronium, and lidocaine. Decreases amplitude and increases latency of auditory evokes potentials.
Resp: dose-dependent VE (minute volume) decrease, resp depression < propofol. Ventilatory response to CO2 decreases. Little effect on bronchial tone.
metocloperamide
SLOW IV PUSH - think about it. It’s a cholinomimetic, so if you push it fast, you can have abdominal cramping, anxiety, restlessness.
Avoid all dopamine antagonists in Parkinson’s dz.
Avoid in pheochromocytoma - causes release of catecholamines from tumor
metocloperamide
SLOW IV PUSH - think about it. It’s a cholinomimetic, so if you push it fast, you can have abdominal cramping, anxiety, restlessness.
Avoid all dopamine antagonists in Parkinson’s dz.
Avoid in pheochromocytoma - causes release of catecholamines from tumor
ondansetron
no renal dosage adjustments, but decreased clearance if hepatic impairment.
QTc prolongation
most effective if given at the end of surgical procedure
palonosetron
newest, most selective agent
more than 80% excreted in urine in 6 days
no dosage adjustments for elderly, renal, or hepatic pts
NO SAFETY data on peds <18 yrs old - don’t give to peds!
