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Anesth Pharm 1 - rudy > Other nonvolatile anesthetic agents > Flashcards

Other nonvolatile anesthetic agents Flashcards

1
Q

Which induction agents reduce ICP?

A

propofol, thiopental, and etomidate

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2
Q

Which induction agent raises ICP?

A

ketamine

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3
Q

Which induction agent has no effect on ICP?

A

precedex

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4
Q

Two common side effects seen during emergence from ketamine.

A

combativeness and delirium

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5
Q

Ketamine produces this type of anesthesia.

A

dissociative (the thalamus is dissociated from the limbic cortex. sound and vision are mixed up)

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6
Q

Ketamine dose - induction

A

1 - 2 mg/kg IV

3 - 5 mg/kg IM

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7
Q

Ketamine is an antagonist of what receptor?

A

N-methyl-D-aspartate (NMDA)

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8
Q

Does ketamine increase or decrease arterial blood pressure, heart rate, and cardiac output?

A

increase

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9
Q

Due to ketamine’s effects on the cardiovascular system, its use should be avoided in patients with these diagnoses.

A

coronary artery disease, uncontrolled hypertension, congestive heart failure, and arterial aneurysms

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10
Q

Large doses of this medication cause direct myocardial depression.

A

ketamine

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11
Q

Ketamine has _______ stimulatory effects on the sympathetic nervous system.

A

indirect

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12
Q

Is ketamine a bronchoconstrictor?

A

no, it is a potent bronchodilator. it is a good induction agent for asthmatic patients.

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13
Q

T or F, ketamine causes increased salivation?

A

true

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14
Q

This medication is the closest thing to being a “complete” anesthetic, as it induces analgesia, amnesia, and unconsciousness.

A

ketamine

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15
Q

This medication attenuates ketamine’s cardio-stimulatory effects and prolongs its elimination half-life.

A

diazepam

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16
Q

Etomidate dose - induction

A

0.2 - 0.5 mg/kg IV

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17
Q

Propofol dose - induction

A

1 - 2.5 mg/kg IV

18
Q

Propofol dose - maintenance infusion

A

50 - 200 mcg/kg/min IV

19
Q

Propofol dose - sedation infusion

A

25 - 100 mcg/kg/min IV

20
Q

Etomidate’s mechanism of action

A

depresses the reticular activating system and mimics the inhibitory effects of GABA (specifically it appears to bind to a subunit of the GABA type A receptor, increasing its affinity for GABA)

21
Q

What is the name of the active metabolite of ketamine?

A

norketamine (it is an active metabolite, but is less potent than ketamine)

22
Q

Long-term infusions of etomidate can lead to this?

A

adrenocortical suppression (induction doses of etomidate transiently inhibit enzymes involved in cortisol and aldosterone synthesis)

23
Q

How is etomidate metabolized?

A

by hepatic enzymes and plasma esterases

24
Q

Etomidate can cause sudden, generalized, asynchronous muscle contractions known as what?

A

myoclonia

25
Q

Propofol mechanism of action

A

GABA interaction (hyperpolarization of chloride ion channels)

26
Q

Is the pH of propofol hypertonic, isotonic, or hypotonic?

A

isotonic (7.0 - 8.5)

27
Q

Is propofol contraindicated in patients with an egg allergy?

A

no

28
Q

What percentage of propofol is protein bound?

A

98%

29
Q

Potentiation of effects will be seen when propofol is given with these types of medications.

A

sedatives and narcotics

30
Q

T or F, propofol has antipruritic and antiemetic effects?

A

true

31
Q

How is propofol metabolized?

A

CYP450 (then the metabolites are excreted by the kidneys)

32
Q

The major cardiovascular effect of propofol is a decrease in what? (and this is due to what three things?)

A

arterial blood pressure (due to a drop in systemic vascular resistance [inhibition of sympathetic vasoconstricor activity], cardiac contractility, and preload)

33
Q

Propofol depresses the body’s normal response to? (pulmonary in nature)

A

hypercarbia

34
Q

Propofol should be used cautiously in these patient populations

A

sulfite allergy (new formulation has sulfite ingredient), hypovolemic, cardiac issues (fixed CO - aortic stenosis), or elderly

35
Q

How does etomidate’s short duration of action differ from propofol’s short duration of action?

A

etomidate is metabolized by esterases. propofol is rapidly redistributed.

36
Q

Is ketamine a weak acid or base?

A

weak base

37
Q

Is propofol a weak acid or base?

A

weak acid

38
Q

What is the onset of propofol?

A

30 seconds

39
Q

What is the duration of propofol?

A

2 - 8 minutes

40
Q

What is the onset of ketamine?

A

30 - 60 seconds

41
Q

What is the duration of ketamine?

A

10 - 20 minutes

42
Q

Ketamine is a structural analogue of…

A

phencyclidine

Anesth Pharm 1 - rudy (3 decks)

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