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Prodigy Quick Review > Other Sedative/Hypnotics > Flashcards

Other Sedative/Hypnotics Flashcards

1
Q

What is the standard induction dose of propofol in a

healthy adult?

A

1.5 to 2.5 mg/kg
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 486.

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2
Q

Does propofol trigger malignant hyperthermia?

A

No. Propofol is safe to use on patients susceptible to MH
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 487.

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3
Q

What is the chemical composition of propofol?

A

Propofol is a 2,6-diisopropyl phenol prepared in an emulsion of
10% soybean oil, 2.25% glycerol, and 1.2% purified egg lecithin.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 104.

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4
Q

Describe the cardiovascular effects of propofol.

A

Direct myocardial depression occurs, hypotension, decreased
CO and SVR, and peripheral vasodilation. Peripheral
vasodilation and direct myocardial depression are concentration
and dose-dependent. There is arterial vasodilation and
venodilation caused by reduction in sympathetic activiity and by
a direct effect on vascular smooth muscle.
Nagelhout JJ, Zaglaniczny KL. Nurse Anesthesia. 4th ed.
Philadelphia, PA: WB Saunders Company; 2010: 135.

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5
Q

What is the maintenance infusion dose for propofol?

A

100-200 mcg/kg/min
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 110.

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6
Q

What is the antiemetic dose of propofol?

A

10-20 mg
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 487

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7
Q

Describe how propofol affects CMRO2, ICP, cerebral

blood flow, and CPP.

A

CMRO2, ICP, cerebral blood flow, and CPP are all decreased
following adminstration of propofol. This is a result of a
decrease in MAP and cerebral vasoconstriction.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 107.

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8
Q

What accounts for the rapid reawakening of patients

following sedative and anesthetic doses of propofol?

A

Rapid redistribution from the central compartment to the
peripheral compartment
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 104.

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9
Q

Does age affect propofol’s kinetics?

A

Yes. Elderly patients require less of the drug, while chidren
require higher doses due to their increased volume of
distribution.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 105.

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10
Q

How does total body clearance of propofol exceed

hepatic blood flow?

A

Extrahepatic mechanisms exist in addition to metabolism by the
liver.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 105.

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11
Q

When should an open vial or prepared syringe of

propofol be discarded? Why?

A

Opened vials and syringes should be thrown away if they are
not used within 12 hours or within 6 hours if the drug was
transferred from the original vial. The chemical compositon of
propofol makes it favorable to bacterial contamination.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 104.

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12
Q

On what receptors does propofol exert its effects?

A

GABA and the GABA(A) glycoprotein receptor complex
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 106-107.

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13
Q

How does propofol affect respiratory function?

A

Dose-dependent respiratory depression occurs, with decreases
in tidal volume more prominent than decreases in the
respiratory rate. Apnea often occurs following initial induction
doses.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 108.

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14
Q

Describe how the pain on injection of propofol can

be attenuated.

A

Concominant mixture or pretreatment with lidocaine or
pretreatment with an opioid is useful in minimizing the pain on
injection seen with propofol.
Katzung BG, Masters, SB, & Trevor AJ. Basic and Clinical
Pharmacology. 12th ed. New York: McGraw-Hill; 2012: 441.

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15
Q

In what patients would there be an exaggerated

cardiac depressive response to propofol?

A

Standard induction doses of propofol are associated with
significant cardiac depression, however patients greater than
50, ASA 3-4, MAP <70, and concomitant administration of large
doses of fentanyl will see an increased myocardial depression
greater than normal.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 107.

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16
Q

On what receptor does ketamine exert its effects?

A

The NMDA receptor.
Nagelhout JJ, Zaglaniczny KL. Nurse Anesthesia. 4th ed.
Philadelphia, PA: WB Saunders Company; 2010: 129.

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17
Q

Following a single induction dose of ketamine, what

is the duration of anesthesia?

A

Ketamine-induced anesthesia lasts from 10-20 mintues
following an induction dose. 60-90 minutes may be required to
recover fully, however.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 692.

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18
Q

What is the recommended dose of ketamine used for

preemptive analgesia?

A

10-20 mg IV
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 115.

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19
Q

What is the IM induction dose for ketamine

A

4 to 8 mg/kg
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 490.

20
Q

What is the induction dose of ketamine?

A

2-4 mg/kg
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 115.

21
Q

Ketamine causes what type of state upon its

administration? What are its effects?

A

A dissociative state. Patient’s feel separated from the
environment, catatonic, have amnesia, analgesia, with or
without a loss of consciousness.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 113.

22
Q

Pretreatment with what drug is reccomended in use

with ketamine to reduce adverse effects?

A

Benzodiazepines such as midazolam (0.025-0.05mg) and
diazepam (0.2-0.3mg). These drugs reduce the incidence of
sensory and perceptual illusions, nightmares, and postoperative
disorientation associated with the use of ketamine.
Katzung BG, Masters, SB, & Trevor AJ. Basic and Clinical
Pharmacology. 11th ed. New York: McGraw-Hill; 2009: 437.

23
Q

Ketamine is chemically related to what drug?

A

Phencyclidine (PCP)
Katzung BG, Masters, SB, & Trevor AJ. Basic and Clinical
Pharmacology. 11th ed. New York: McGraw-Hill; 2009: 437.

24
Q

Does ketamine cause respiratory depression?

A

Yes. This respiratory depression is minimal, however in
clinically relevant doses. The decrease in tidal volume is more
significant over the decrease in the respiratory rate.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 116.

25
Q

What is the primary route of metabolism for

ketamine?

A

Ketamine is metabolized by microsomal cytochrome P450
enzmes
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 490.

26
Q

Describe the ocular effects of ketamine.

A

Ketamine causes increased muscle tone, nystagmus, muscle
spasms, and increased IOP.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 116.

27
Q

Are airway reflexes intact following ketamine

administration?

A

Yes. Protective airway reflexes are preserved. Muscle tone of
the jaw and tongue are maintained as well. Swallowing,
gagging, and coughing occur in response to stimulation of the
airway.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 116.

28
Q

How does ketamine affect salivary gland, bronchial,

and tracheal secretions?

A

They are all increased. Treatment with an antisialagogue is
used to attenuate these effects.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 116.

29
Q

Why would ketamine be the IV induction agent of

choice in the patient with active bronchospasm?

A

Ketamine decreases pulmonary resistance and increases
pulmonary compliance.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 116.

30
Q

How does ketamine affect myocardial oxygen

consumption and cardiac work?

A

They are both increased. Since there is an increase in cardiac
work and myocardial oxygen consumption, there is a negative
balance between myocardial oxygen supply and demand. Due
to this, ketamine should be avoided in patients with severe
coronary artery disease
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 490-491.

31
Q

How does ketamine affect BP, CO, HR, and CVP?

A

They are all increased. Ketamine is the only IV induction agent
that is a circulatory stimulant. This is caused by stimulation to
the central sympathetic nervous system, and by the inhibition of
the reuptake of norepinephrine at sympathetic nerve terminals.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 115.

32
Q

How does ketamine affect CBF, CMRO2, and ICP.

A

They are all increased.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 115.

33
Q

Describe the CNS effects of ketamine.

A

The patient is in a dissociated state, is cataleptic, often with the
eyes being open. Horizontal nystagmus is present. The pupils
are reactive to light. There is an increase in salivary gland
secretions, lacrimation and eye blinking remain, there is an
increase in skeletal muscle tone, and airway reflexes are intact.
This cataleptic state is the result of electrophysiologic inhibition
of thalamocortical pathways and by the stimulation of the limbic
system.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 114-115.

34
Q

Does ketamine cross the placental border?

A

Yes. Ketamine is very lipid soluble and quickly crosses from the
placenta to the fetus. Induction doses of 0.5-1 mg/kg, however,
does not compromise neonatal status at delivery. Uterine blood
flow is maintained as well as uterine tone. Induction doses of 2-
2.5 mg/kg result in a depressed neonate upon delivery.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 116.

35
Q

Should ketamine be used in adult patients with poor

right ventricular reserve?

A

No. Ketamine is contraindicated in patients with poor right
ventricular reserve due to the increase in pulmonary artery
pressure. This increase is not as prominent in the pediatric
patient.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 491.

36
Q

Ketamine administration should be used cautiously

in what patients?

A

Ketamine should be used cautiously in patients with increased
ICP, angina, CHF, high blood pressure, increased IOP, and
pyschiatric disease.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 116.

37
Q

In what patient populations would induction with

etomidate be advantageous?

A

Etomidate causes minimal cardiovascular depression,
therefore, making it useful in patients with limited cardiovascular
reserve.
Katzung BG, Masters, SB, & Trevor AJ. Basic and Clinical
Pharmacology. 12th ed. New York: McGraw-Hill; 2012: 443-444.

38
Q

Describe how etomidate causes adrenal suppression.

A

Adrenal suppression results from a dose-dependent inhibition of
adrenocortical enzymes. The enzyme 11 Beta-hydroxylase is
inhibited, which is essential in the production of both
mineralocorticoids and corticosteroids. Adrenal suppression for
5 to 8 hours can be seen after a single induction dose of
etomidate.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 489.

39
Q

How does etomidate affect cerebral blood flow,

CMRO2, and ICP?

A

They are all decreased. Adequate CPP is maintained due to
etomidate’s hemodynamic stability.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 111.

40
Q

Describe the cardiovascular effects of etomidate.

A

Etomidate administration causes minimal changes in
hemodynamic status. It is considered the induction drug of
choice in patients with cardiovascular disease, as well as any
other patients in whom maintenance of a normal BP is
imperative. Slight decreases in BP following administration of
etomidate are due to a minor decrease in SVR.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 111.

41
Q

How is etomidate metabolized?

A

Etomidate is metabolized in the liver via hepatic microsomal
enzymes and plasma esterases. The primary mode of
metabolism in the plasma and liver is ester hydrolysis.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 110.

42
Q

What accounts for the myoclonic movements often

seen with induction doses of etomidate?

A

Subcortical disinhibition that is unrelated to cortical seizure
activity. Single muscles or many muscle groups can be
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 111.

43
Q

What is the standard induction dose for etomidate?

A

0.2-0.3 mg/kg
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 489.

44
Q

What are the side effects of etomidate?

A

Adrenocortical suppression, myoclonia, pain on injection,
thrombophlebitis, and postoperative nausea and vomiting,
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 112.

45
Q

What are the respiratory effects of etomidate?

A

Respiratory rate increases but minute volume decreases in a
dose-dependent fashion. Brief periods of apnea may be seen
followed by hyperventilation, and the ventilatory response to
CO2 is decreased.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 111.

46
Q

Does etomidate possess any analgesic properties?

A

No. Etomidate does not have any intrinsic analgesic properties.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 110.

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