Ketamine

Question 1

What is the Pharmacology of Ketamine

Answer 1

Anesthetic agent with analgesic effects at lower doses.

Actions
- Primarily acts on NMDA receptors (antagonist to Glutamate). It may also interact with opioid and musurninic receptors. Produces a trans-like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes.

Question 2

What is the Presentation of Ketamine and how is it Metabolized

Answer 2

Presentation
- 200mg 2ml

Metabolized
- Liver and excreted by the kidneys

Question 3

What are the Indications and Contraindications of Ketamine

Answer 3

Indications

• Intubation
• Analgesia
• Sedation
  
  • Agitation
  • Pt movement during CPR.

Contraindications
- Suspected non traumatic brain injury with severe hypertension (systolic BP > 180)

Question 4

What are the Side Effects and Precautions

Answer 4

Side Effects 
CV
- Hypertension
- Tachycardia 
CNS
- Emergent reactions ( Restlessness, Vivid dreams, confusion, hallucinations, irrational behavior). 
- Increased muscle tone (may resemble seizure) 
Resp
- Transit Resp depression and Aponea. 
GI 
- Nausea and Vomiting 
Other
- Injection site pain, Lacrimation, hypersalvavation, nystagmus and double vision.  

Precaution
- May exacerbate Cardiovascular conditions ( Uncontrolled Hypertension, Stroke, recent MI and cardiac failure) due to effects on BP and HR.

Question 5

Route of Administration and Special Notes.

Answer 5

Route of Administration

• IV
• IM
• IN

Special notes 
IV
Onset: 30 Secs
Peak: 20 Minutes
Duration: 5 - 10 Minutes

IM
Onset: 3 - 4 Minutes
Peak: 20 Minutes
Duration: 12 - 25 Minutes

IN
Onset: 5 Minutes
Peak: 20 Minutes
Duration: 45 Minutes