Med Review Induction Agents

Question 1

Propofol is typically supplied as __% solution, equating to what concentration?

Answer 1

Propofol 1% = 10 mg/mL

Question 2

____ is typically given as pretreatment for propofol administration, why?

Answer 2

1-2% Lidocaine to avoid pain with propofol injection

Question 3

Propofol

• E1/2:
• protein binding:

Answer 3

• E1/2: 0.5 - 1.5 hours
• protein binding: 98%

Question 4

Which induction agent causes bronchodilation and suppresses SNS response to laryngoscopy?

Answer 4

Propofol

Question 5

What are some complications that can occur with propofol administration?

Answer 5

• Lipidemia
• Englarged liver
• Metabolic acidosis
• Rhabdo
• Myoglobinuria
• Propofol Infusion Syndrome

Question 6

Propofol Infusion Syndrome is characterized by what symptoms?

Answer 6

Sudden onset of bradycardia that leads to asystole and is resistant to treatment

Question 7

What is the MOA of Etomidate?

Answer 7

GABA modulator (does not mimic)

Question 8

Which induction agent is generally considered cardiovascularly stable

Answer 8

Etomidate

Question 9

Which induction agent is beneficial in unstable patients, trauma, elderly, and cardiovascular instable patients?

Answer 9

Etomidate

Question 10

Which drug can cause adrenocortical suppression? How long does this effect typically last?

Answer 10

Etomidate
- can last about 4 - 8 hours

Question 11

Which induction agent can cause PONV in 30% of patients?

Answer 11

Etomidate

Question 12

Ketamine causes what kind of anesthesia?

Answer 12

Dissociative anesthesia, not a hypnotic. Also provides intense analgesic and profound amnestic effects

Question 13

What is the IM dose for ketamine? What patient population is this good for?

Answer 13

4 - 8 mg/kg
for pediatrics

Question 14

What is ketamine metabolized into?

Answer 14

metabolizes 20-30% into nor-ketamine (active metabolite)

Question 15

What is the E1/2 of ketamine

Answer 15

E1/2 : 2 hours

Question 16

What are contraindications for ketamine?

Answer 16

No MAOIs (increases epinephrine)

Question 17

How does ketamine administration affect epinephrine and norepinephrine? What effect does this have?

Answer 17

increases Epi and inhibits reuptake of NorEpi
Causes:

• ↑SVR/PVR
• ↑ HR
• ↑ CO
• ↑ SNS

Question 18

What positive airway effects does ketamine have?

Answer 18

• Intense Bronchodilation
• Reflexes remain intact but not protected

Question 19

What negative airway effect does ketamine produce? What should be done because of this?

Answer 19

• increased salivary secretion (sialagogue)
• should administer Glycopyrrolate (robinul)

Question 20

What psychedelic effects can ketamine cause? What does should be done because of this?

Answer 20

Delirium and hallucinations

• should administer with benzodiazepine, barbiturate, or propofol

Question 21

What is the adult dose for methohexital (brevital)?

Answer 21

1.5 mg/kg

Question 22

What are the main negative effects of methohexital administration?

Answer 22

• cause myoclonus even at low dose
• causes seizure activity even at low dose
• airway irritability

Question 23

What are the main uses for methohexital?

Answer 23

• suppress seizures at high doses
• ECT (doesnt suppress seizures): can map seizure foci
• cardioversion