meds; induction agents

Question 1

Propofol induction dose

Answer 1

1.5-2.5 mg/kg

Question 2

Propofol conscious sedation dose

Answer 2

25-100 mcg/kg/ min

Question 3

Propofol TIVA/ maintainance dose

Answer 3

100-300 mcg/kg/min

Question 4

Propofol onset

Answer 4

30-60 sec

Question 5

Propofol duration

Answer 5

1-8 min

Question 6

Propofol MOA

Answer 6

GABA A -> open Chloride channels -> hyperpolarize

depresses subcortical pathways and has direct effect on vomiting center

Question 7

Propofol Pulmonary effect

Answer 7

bronchodilation

Question 8

Propofol side effets

Answer 8

decrease hr and bp
increased trig
bacteremia
prop infusion syndrome (LA)
Lecithin (egg yolk allergy)
x placenta
decrease ICP/ CPP
decrease Baro R reflex

Question 9

Sedation meds that have anaglesic effect and bronchodilation

Answer 9

ketamine and prop

Question 10

Prop metabolism

Answer 10

Cyp 450

plasma/ tissue uptake and clearance

Question 11

Etomidate induction dose

Answer 11

0.3 mg/kg

Question 12

Etomidate onset

Answer 12

1 min

Question 13

Etomidate side effects

Answer 13

stim CO2 medullary center -> dec VT/inc RR
no change to hr or bp

adrenal cortical suppression
**myoclonus
decreased ICP

Question 14

Etomidate MOA

Answer 14

Gaba A -> open chloride -> hyperpolarize

Question 15

Ketamine induction dose

Answer 15

0.5-1.5 mg/kg

Question 16

Ketamine anaglesia dose

Answer 16

0.2-0.5 mg/kg IV

Question 17

Ketamine IM dose

Answer 17

4-8 mg/kg

catch the kid peds dose

Question 18

Ketamine onset

Answer 18

1 min

Question 19

Ketamine duration

Answer 19

10-20 min

Question 20

Ketamine MOA

Answer 20

NMDA, Opioid,
weak GABA receptors

NMDA antag glutamate; no ca+ open and K+ out = hyperpolarization

Question 21

Ketamine side effects

Answer 21

nystagmus
increase hr, bp and PAP
decreased catecholamine stores
stim noradrenergic neurons
increased salivation (give glyco)
dissociated anesthetic
increase ICP
dec plat aggregation

Question 22

who do we not give ketamine to?

Answer 22

cardiac pts

Question 23

Ketamine metabolism

Answer 23

hepatic -> norketamine (active metabolite) 1/3 as potent

Question 24

midazolam induction dose

Answer 24

0.1-0.2 mg/kg

precede dose w/ fent 50-100 mcg

Question 25

Ketamine gtt dose

Answer 25

1-5 mcg/kg/min

Question 26

midazolam onset for induction

Answer 26

30-60 sec

Question 27

Midazolam duration for induction

Answer 27

5-10 min

Question 28

Midazolam moa

Answer 28

increase gaba binding affinity to gaba a R -> increase cl- opening -> hyperpolarized post synaptic membrane = inhibition of depolarization

Question 29

midazolam side effects

Answer 29

inhibits plat agg dec t cell and Immune resp (gtts mostly) teratogenic

Question 30

midazolam metabolism

Answer 30

CYP3A4 active metabolite thats half as active 1 hydroxymidazolam

Question 31

midazolam in the elderly

Answer 31

half life is double due to decreased hepatic flow

Question 32

pulmonary effects of midazolam

Answer 32

decreased hypoxic drive decrease swallow and cough reflex > depression w/ copd

Question 33

Dexmedetomidine bolus dose and concentration

Answer 33

on hand ; 200mcg/ 2 ml mix with 48 ml of NS new concentration 4mcg/ ml bolus 0.5-1 mcg/kg over 10 min

Question 34

Dexmedetomidine gtt dose

Answer 34

0.1-0.3 mcg/kg/hr

Question 35

Side effects of Dexmedetomidine

Answer 35

decreased Hr and bp sedation vagomimetic actions htn on loading dose Dry mouth

Question 36

Dexmedetomidine MOA

Answer 36

acts at locus coeruleus (in the pons and is part of the RAS) to decrease NE release at the dorsal tegmental bundles and increase inhibitory GABA neurons pain management at the Spinal cord by active on the alpha 2 presynaptic receptors in the sc alpha 2 agonists in the periphery (heart and bv) = decrease NE release -> hypotension/ bradycardia

Question 37

What is propofol infusion syndrome

Answer 37

lactic acidosis, brady - dysrhthmias, rhabdo high doses of > 75mcg/kg/min longer than 24 hr severe refractory and fatal bradycardia in children dx= abg and serum lactate cardiac shock -> ecmo

Question 38

Lidocaine induction dose

Answer 38

1-2 mg/kg (max 100 mg)

Question 39

Lidocaine MOA

Answer 39

sodium channel blocker

Question 40

Lidocaine concentration

Answer 40

20 mg/ml

Question 41

Prop concetration

Answer 41

10mg/ml

Question 42

Best drug to blunt larynx

Answer 42

prop

Question 43

etomidate concetration

Answer 43

0.2% = 2mg/ml

Question 44

induction drug most likely to cause PONV

Answer 44

etomidate

Question 45

ketamine concentration

Answer 45

Comes in 1%, 5%, and 10% solutions – 5% (50 mg/ml) is most common

Question 46

Ketamine contraindications

Answer 46

No MAOI’s – increases epi.

Question 47

Dexmedetomidine concentration

Answer 47

Supplied in 2 ml vials (100mcg/ml); mix with 50 cc NS = 4 mcg/cc

Question 48

Alpha2a effects

Answer 48

Sedation, Hypnosis, Sympatholysis

Question 49

Alpha 2B effects

Answer 49

Vasoconstriction, Anti-shivering, Analgesia, Ca linked– may be excitatory

Question 50

Alpha 2C effects

Answer 50

Learning, Startle response

Question 51

Methohexital trade name

Answer 51

Brevital

Question 52

Methohexital concentration

Answer 52

1% (10 mg/cc) or 2% (20 mg/cc) solution. Usually a 50cc vial of 1% solution

Question 53

Methohexital dose

Answer 53

1.5 mg/kg

Question 54

Methohexital e1/2

Answer 54

4 hours

Question 55

Methohexital side effects

Answer 55

Causes myoclonus and hiccoughs even at low doses cause seizure activity at low doses = epileptogenic. Is used to treat seizures at high doses. Airway irritability

Question 56

Methohexital Uses

Answer 56

rapid, non-painful procedures ECT Cardiversion Mapping sz focus