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Non Barb IV Induction Flashcards

1
Q

Propofol: solubility

A

Not water soluble, lipid soluble

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2
Q

Propofol: prolonged gtt can lead to what. Issues w what allergy

A

Inc plasma TG. Egg yolk allergies.

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3
Q

Two forms of propofol and caution w each

A

Diprivan EDTA (bronchoconstriction in asmthatics). Na metabisulfite- sulfa allergy= bronchospasm

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4
Q

Propofol MOA. No what

A

Gaba A- major. Glycine- minor. Dec dissoc of gaba from receptor. No spinal cord depression

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5
Q

Propofol: VD, what affects it

A

Large, about 4 L/KG. Exceeds hepatic BF. Wt, disease, age, other drugs

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6
Q

Propofol t 1/2

A

0.5-1.5 hrs

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7
Q

Barb cns fx: Dec what

A

CBF, ICP, CMRO2, CPP. Cerebral protection. Dec IOP

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8
Q

Propofol CNS: eeg effects. Onset. Age effects what

A

EEG burst suppression. Onset fast. ED 95- highest in little ones, dec w age

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9
Q

Propofol: other CNS effects

A

Hiccoughs, muscle twitch, hallucinate, opisthotonos. Vit e resemblance= cerebral protection

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10
Q

Propofol resp fx

A

Apnea at induction. Dec TV, RR, resp to co2/02 alt, paco2 inc ph dec. Bronchodilation in COPD. HPV remains

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11
Q

Propofol cv fx

A

25-40% dec BP (more than stp), myoc dep and vasodilation- dec SV/SVR/co. Hr same.

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12
Q

Propofol: doesnt potentiate what. Incidence of what is higher than tpl but less than etomidate and brevital

A

Muscle relaxants. Myoclonus

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13
Q

Propofol: antiemetic and antipruritic when. Amnestic dose. Crosses what

A

Sub-hypnotic doses 10 mg. >30 mcg/kg/min. Placenta (still safe)

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14
Q

Propofol
Induction dose
Toddler induction

A

1-2.5 mg/kg

As high as 3 mg in toddlers

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15
Q

Propofol
Ga maintenance dose
Sedation infusion

A

100-300 mcg/kg/min

25-100 mcg/kg/min

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16
Q

Propofol

Metabolism

A

Conjugated by liver to water soluble. Cp450. Liver func doesnt alter rate.

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17
Q

Propofol metab
Metabolites
Excretion

A

Mostly inactive except for 4 hydroxypropofol, 1/3 as potent. Renal exc, CRF doesnt affect clearance

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18
Q

Etomidate
Derivative of what
Solvent
PH in bottle/body

A

Carboxylated imidazole. Propylene glycol. Bottle- 6.9 (water soluble), lipid soluble at physio pH 8.2

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19
Q

Etomidate

MOA

A

Selective gaba A receptor, increases affinity of gaba

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20
Q

Etomidate

Onset, Vd

A

Rapid. ~3.5 l/Kg. Redistribution terminates effect, 3 compartment model

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21
Q

Etomidate

E 1/2t, binding, what impacts metab

A

4 hrs. Highly protein bound. Hepatic extraction ratio, liver BF changes prolong it.

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22
Q

Etomidate CNS

Direct brain effects

A

Rapid LOC. No analgesia. Decreased CBF, ICP, CMRO2, IOP.

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23
Q

Etomidate CNS

EEG/seizure effects

A

Increases EEG activity if epilepsy, rare grand mal sz. May have myoclonus. Anticonvulsant prop.

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24
Q

Etomidate resp fx

Overall

A

Min dep of co2 response. Dec in TV, inc in RR. Hiccups and coughing.

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25
Etomidate CV | What sets it apart
Minimal change d/t lack of SNS/baroreceptor effect. HR/ABP/PAP/CO/SVR/PVR unchanged.
26
Etomidate endocrine
Dose dep inhib of enzymes in biosynthesis of cortisol/Aldosterone. Major: 11 beta hydroxylase. Suppression for 6 hrs.
27
Etomidate doses | Induction
0.3 mg/kg
28
Etomidate maintenance dose, with what
Gtt 10 mcg/kg/min with n20 and opioid
29
Etomidate sedation dose
5-8 mcg/kg/min for short procedure
30
Etomidate dose | Rectal, in who
6.5 mg/kg in peds
31
Etomidate | 3 misc effects
High NV incidence, myclonus, enhances NMDR activity
32
Etomidate metabolism
Liver ester hydrolysis OR n dealkylation to carboxylic acid. Faster than TPL. Mostly renal, some biliary excretion
33
Ketamine | Derivative, solubility, solution
Phencyclidine. Lipid sol. Acidic solution.
34
Ketamine | Mixture of what, enantiomer difference
Racemic of R and S. S- analgesic, faster metab, less emergence delirium
35
Ketamine MOA | Receptors it interacts with 5 main
NMDA (ion glutamate), opioid (mu/kappa/delta), monoaminergic (pain man), muscarinic antag, ca ch
36
NMDA receptor activation through ketamine
Na and Ca in, k out, action potential. Ca- role in memory inhibition. Ligand and voltage dependent.
37
Ketamine metabolism | How it happens
1st pass, liver enzymes, n demethylation then hydrozylation (norketamine to hydrozynorketamine). Conjugation to water soluble. Urine excretion
38
Ketamine | Metabolism impacted by what
Total clearance equal to liver BF
39
Ketamine | Distribution, onset, duration
2 compartment. Highly lipid soluble, large vd (3l/kg). Rapid onset, short duration.
40
Ketamine | E 1/2t
2-3 hrs
41
Ketamine CNS | Depresses what, stim what
Depresses neuronal function in advanced areas of cortex/thalamus. Stim hippocampus
42
Ketamine CNS What not as prominent as benzos. Onset, peak, termination
Amnesia. 30 sec, 1 min, 15 min.
43
Ketamine CNS | Direct effects
Increased CBF, CMRO2, ICP, and IOP
44
Ketamine CNS | Other effects
Nystagmus, pupil dilation, tears, secretions, myoclonus, inc muscle tone, emergence reactions
45
ketamine- spinal analgesia | Dose. Receptor activity. Antagonism.
0.2-0.5 mg/kg IV. Mu receptor (s enantiomer). NMDA antag (dorsal horn)
46
Ketamine respiratory
Minimal. No alt co2 resp. Bronchial relaxation. Inc PVR and salivation
47
Ketamine CV Direct effects, how Indirect effect
Inc BP, HR, CO. From sympathomimetic (central) effect in nucleus solitarus. Myo depressant, inhib NE reuptake.
48
Ketamine Premedication dose What you use it for
Sedative/analgesic | 0.2-0.5 mg/kg
49
Ketamine induction dose | IV, IM
1-2 mg/kg | 4-8 mg/kg IM
50
Ketamine maintenance dose
1-2 mg/kg/hr
51
Ketamine | PO and nasal dose
6 mg/kg
52
Contraindications for ketamine 6
Inc ICP, open eye injury, CAD (sole anes), vascular aneurysm, systemic/pulm htn, psych diseases
53
Dexmedetomidine | Solubility. Agonist where. Produces what
Water. Selective A2. Mimics sleep, hypnosis @ locus ceruleus, analgesia @ SC
54
Dexmedetomidine | CNS effects
Dec CBF, no sig ICP or CMRO2 change. Dec MAC and dec opioid requirement. Depresses thermoreg
55
Dexmedetomidine CV | Effects
Dec HR, SVR, BP. Bolus can temp inc bp then drop suddenly. Potential for heart block and asystole. Atten CV resp to pain/catecholamine levels
56
Dexmedetomidine Resp | Effects
Minimal RR chance. Small dec TV. No co2 change. Upper a/w obstruc maybe
57
Dexmedetomidine | Metabolism
Rapid. Conjugation, n methylation, hydroxylation. Metabolites cleared in urine and bile.
58
Dexmedetomidine | Binding. E 1/2. How it effects other drugs
Protein. 2-3 hrs. Inhib cyp 450 (esp effects opioid clearance)
59
Dexmedetomidine | How its most commonly used, dose
Adjunct to GA. 1 mcg/kg bolus over 10 min then 0.2-1 mcg/kg/hr gtt
60
Dexmedetomidine antagonist, use
Antipamezole. Mainly used to reverse CV fx.

Anesthesia Pharm (12 decks)

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