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Clinical prep > meds; induction agents > Flashcards

meds; induction agents Flashcards

1
Q

Propofol induction dose

A

1.5-2.5 mg/kg

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2
Q

Propofol conscious sedation dose

A

25-100 mcg/kg/ min

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3
Q

Propofol TIVA/ maintainance dose

A

100-300 mcg/kg/min

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4
Q

Propofol onset

A

30-60 sec

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5
Q

Propofol duration

A

1-8 min

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6
Q

Propofol MOA

A

GABA A -> open Chloride channels -> hyperpolarize

depresses subcortical pathways and has direct effect on vomiting center

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7
Q

Propofol Pulmonary effect

A

bronchodilation

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8
Q

Propofol side effets

A

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

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9
Q

Sedation meds that have anaglesic effect and bronchodilation

A

ketamine and prop

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10
Q

Prop metabolism

A

Cyp 450

plasma/ tissue uptake and clearance

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11
Q

Etomidate induction dose

A

0.3 mg/kg

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12
Q

Etomidate onset

A

1 min

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13
Q

Etomidate side effects

A

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

adrenal cortical suppression
**myoclonus
decreased ICP

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14
Q

Etomidate MOA

A

Gaba A -> open chloride -> hyperpolarize

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15
Q

Ketamine induction dose

A

0.5-1.5 mg/kg

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16
Q

Ketamine anaglesia dose

A

0.2-0.5 mg/kg IV

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17
Q

Ketamine IM dose

A

4-8 mg/kg

catch the kid peds dose

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18
Q

Ketamine onset

A

1 min

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19
Q

Ketamine duration

A

10-20 min

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20
Q

Ketamine MOA

A

NMDA, Opioid,
weak GABA receptors

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

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21
Q

Ketamine side effects

A

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

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22
Q

who do we not give ketamine to?

A

cardiac pts

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23
Q

Ketamine metabolism

A

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

24
Q

midazolam induction dose

A

0.1-0.2 mg/kg

precede dose w/ fent 50-100 mcg

25
Q

Ketamine gtt dose

A

1-5 mcg/kg/min

26
Q

midazolam onset for induction

A

30-60 sec

27
Q

Midazolam duration for induction

A

5-10 min

28
Q

Midazolam moa

A

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

29
Q

midazolam side effects

A

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

30
Q

midazolam metabolism

A

CYP3A4 active metabolite thats half as active 1 hydroxymidazolam

31
Q

midazolam in the elderly

A

half life is double due to decreased hepatic flow

32
Q

pulmonary effects of midazolam

A

decreased hypoxic drive
decrease swallow and cough reflex

> depression w/ copd

33
Q

Dexmedetomidine bolus dose and concentration

A

on hand ; 200mcg/ 2 ml
mix with 48 ml of NS

new concentration 4mcg/ ml

bolus 0.5-1 mcg/kg over 10 min

34
Q

Dexmedetomidine gtt dose

A

0.1-0.3 mcg/kg/hr

35
Q

Side effects of Dexmedetomidine

A

decreased Hr and bp

sedation
vagomimetic actions
htn on loading dose
Dry mouth

36
Q

Dexmedetomidine MOA

A

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

37
Q

What is propofol infusion syndrome

A

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

38
Q

Lidocaine induction dose

A

1-2 mg/kg (max 100 mg)

39
Q

Lidocaine MOA

A

sodium channel blocker

40
Q

Lidocaine concentration

A

20 mg/ml

41
Q

Prop concetration

A

10mg/ml

42
Q

Best drug to blunt larynx

A

prop

43
Q

etomidate concetration

A

0.2% = 2mg/ml

44
Q

induction drug most likely to cause PONV

A

etomidate

45
Q

ketamine concentration

A

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

46
Q

Ketamine contraindications

A

No MAOI’s – increases epi.

47
Q

Dexmedetomidine concentration

A

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

48
Q

Alpha2a effects

A

Sedation, Hypnosis, Sympatholysis

49
Q

Alpha 2B effects

A

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

50
Q

Alpha 2C effects

A

Learning, Startle response

51
Q

Methohexital trade name

A

Brevital

52
Q

Methohexital concentration

A

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

53
Q

Methohexital dose

A

1.5 mg/kg

54
Q

Methohexital e1/2

A

4 hours

55
Q

Methohexital side effects

A

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

56
Q

Methohexital Uses

A

rapid, non-painful procedures

ECT
Cardiversion
Mapping sz focus

Clinical prep (21 decks)

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