ketAMINE - *ALS only*

Question 1

Classification

ketAMINE

Answer 1

• sedative
• analgesic
• general anaesthetic

Question 2

INDICATIONs

ketAMINE

Answer 2

PCP
- moderate to severe pain assoc.** w/ trauma**

☎️ cliniCALL REQUIRED for
- peds 5-12y/o - due to trauma
- palliative pt
- mod-severe pain 2nd non-traumatic back pain
- mod-severe pain assoc. abdo pain//renal colic
- for induction and maintenance of general anesthesia

ACP
- analgesia
- induction of sedation prior to intubation
- procedural sedation
- severe agitation/excited delirium syndrome (ExDS)

Question 3

CONTRAINDICATIONs

ketAMINE

Answer 3

• hypersensitivity
• UNABLE to MANAGE ADVERSE EFFECTs
• conditions where elevated BP may be harmful

PCP - not for sedation & < 5 y/o
ACP - < 6 months

Question 4

Pharmacodynamics

ketAMINE

Answer 4

• noncompetitive NMDA receptor antagonist that blocks glutamate
• LOW (subanesthetic) doses = analgesia // modulates central sensitization // hyperalgesia // opioid tolerance // reduces polysynaptic spinal reflexes

Question 5

Pharmacokinetics

ketAMINE

Answer 5

IV
onset - 30s
duration - 5-10mins; recovery 1-2hrs
IM
onset - 3-4mins
duration - 12-25mins; recovery 1-2hrs
IN
onset - 5-10mins
peak - 20mins
duration - 45mins (analgesia)

Question 6

ADVERSE EFFECTs

ketAMINE

Answer 6

• Emergence phenomenon (confusion, delirium, excitement, hallucinations)
• Laryngospasm (<1%)
• Tachycardia, hypertension (>10%)
• Bradycardia and hypotension (1-10%)
• Anaphylaxis (<1%)
• Hypersalivation (<1%)
  Extreme muscle rigidity/tone (<1%)
• Nystagmus, increased intraocular pressure
• Apnea, respiratory depression ( rare, transient reaction w/ rapid IV bolus dose
• Erythema, morilliform rash, rash at injection site

*treat emergence reactions w/ midazolam as required

Question 7

Warnings // Precautions

ketAMINE

Answer 7

• severe hypertension (SBP >180)
• SAH // epidural hematoma with severe HTN
• myocardial ischemia, cardiac arrhythmias

SAH - subarachnoid hemorrhage