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Anesthesia Pharm > Non Barb IV Induction > Flashcards

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
Q

Etomidate CV

What sets it apart

A

Minimal change d/t lack of SNS/baroreceptor effect. HR/ABP/PAP/CO/SVR/PVR unchanged.

26
Q

Etomidate endocrine

A

Dose dep inhib of enzymes in biosynthesis of cortisol/Aldosterone. Major: 11 beta hydroxylase. Suppression for 6 hrs.

27
Q

Etomidate doses

Induction

28
Q

Etomidate maintenance dose, with what

A

Gtt 10 mcg/kg/min with n20 and opioid

29
Q

Etomidate sedation dose

A

5-8 mcg/kg/min for short procedure

30
Q

Etomidate dose

Rectal, in who

A

6.5 mg/kg in peds

31
Q

Etomidate

3 misc effects

A

High NV incidence, myclonus, enhances NMDR activity

32
Q

Etomidate metabolism

A

Liver ester hydrolysis OR n dealkylation to carboxylic acid. Faster than TPL. Mostly renal, some biliary excretion

33
Q

Ketamine

Derivative, solubility, solution

A

Phencyclidine. Lipid sol. Acidic solution.

34
Q

Ketamine

Mixture of what, enantiomer difference

A

Racemic of R and S. S- analgesic, faster metab, less emergence delirium

35
Q

Ketamine MOA

Receptors it interacts with 5 main

A

NMDA (ion glutamate), opioid (mu/kappa/delta), monoaminergic (pain man), muscarinic antag, ca ch

36
Q

NMDA receptor activation through ketamine

A

Na and Ca in, k out, action potential. Ca- role in memory inhibition. Ligand and voltage dependent.

37
Q

Ketamine metabolism

How it happens

A

1st pass, liver enzymes, n demethylation then hydrozylation (norketamine to hydrozynorketamine). Conjugation to water soluble. Urine excretion

38
Q

Ketamine

Metabolism impacted by what

A

Total clearance equal to liver BF

39
Q

Ketamine

Distribution, onset, duration

A

2 compartment. Highly lipid soluble, large vd (3l/kg). Rapid onset, short duration.

40
Q

Ketamine

E 1/2t

41
Q

Ketamine CNS

Depresses what, stim what

A

Depresses neuronal function in advanced areas of cortex/thalamus. Stim hippocampus

42
Q

Ketamine CNS
What not as prominent as benzos.
Onset, peak, termination

A

Amnesia. 30 sec, 1 min, 15 min.

43
Q

Ketamine CNS

Direct effects

A

Increased CBF, CMRO2, ICP, and IOP

44
Q

Ketamine CNS

Other effects

A

Nystagmus, pupil dilation, tears, secretions, myoclonus, inc muscle tone, emergence reactions

45
Q

ketamine- spinal analgesia

Dose. Receptor activity. Antagonism.

A

0.2-0.5 mg/kg IV. Mu receptor (s enantiomer). NMDA antag (dorsal horn)

46
Q

Ketamine respiratory

A

Minimal. No alt co2 resp. Bronchial relaxation. Inc PVR and salivation

47
Q

Ketamine CV
Direct effects, how
Indirect effect

A

Inc BP, HR, CO. From sympathomimetic (central) effect in nucleus solitarus. Myo depressant, inhib NE reuptake.

48
Q

Ketamine
Premedication dose
What you use it for

A

Sedative/analgesic

0.2-0.5 mg/kg

49
Q

Ketamine induction dose

IV, IM

A

1-2 mg/kg

4-8 mg/kg IM

50
Q

Ketamine maintenance dose

A

1-2 mg/kg/hr

51
Q

Ketamine

PO and nasal dose

52
Q

Contraindications for ketamine 6

A

Inc ICP, open eye injury, CAD (sole anes), vascular aneurysm, systemic/pulm htn, psych diseases

53
Q

Dexmedetomidine

Solubility. Agonist where. Produces what

A

Water. Selective A2. Mimics sleep, hypnosis @ locus ceruleus, analgesia @ SC

54
Q

Dexmedetomidine

CNS effects

A

Dec CBF, no sig ICP or CMRO2 change. Dec MAC and dec opioid requirement. Depresses thermoreg

55
Q

Dexmedetomidine CV

Effects

A

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
Q

Dexmedetomidine Resp

Effects

A

Minimal RR chance. Small dec TV. No co2 change. Upper a/w obstruc maybe

57
Q

Dexmedetomidine

Metabolism

A

Rapid. Conjugation, n methylation, hydroxylation. Metabolites cleared in urine and bile.

58
Q

Dexmedetomidine

Binding. E 1/2. How it effects other drugs

A

Protein. 2-3 hrs. Inhib cyp 450 (esp effects opioid clearance)

59
Q

Dexmedetomidine

How its most commonly used, dose

A

Adjunct to GA. 1 mcg/kg bolus over 10 min then 0.2-1 mcg/kg/hr gtt

60
Q

Dexmedetomidine antagonist, use

A

Antipamezole. Mainly used to reverse CV fx.

Anesthesia Pharm (12 decks)

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