Pain & Sedation

Question 1

What receptor does propofol work on?

Answer 1

GABAa subunit (ethanol works on same receptor - acute alcohol intoxication will have synergistic effect)

Question 2

What is the chemical name for propofol?

Answer 2

2,6-diisopropylphenol

Question 3

What is cytochrome P450?

Answer 3

Set of enzymes responsible for phase I of metabolism (converting lipid soluble to water soluble)

Question 4

What does it mean when cytochrome P450 is induced?

Answer 4

Medications are metabolized faster (increases tolerance to med)

Example: chronic alcoholism, smoker

Question 5

What does it mean when cytochrome P450 is inhibited?

Answer 5

Medications are metabolized at a slower rate

Question 6

What receptors do benzodiazepines work on?

Answer 6

GABAy

Question 7

What receptors do neurosteroids & barbituates work on?

Answer 7

GABAB

Question 8

What receptor does etomidate work on?

Answer 8

GABAa

Question 9

What is the benefit of using etomidate vs propofol for induction?

Answer 9

etomidate is cardiac stable and has little to no cardio-respiratory effects (propofol decreases SVR, causes venodilation, and decreased contractility causing hypotension)

Question 10

What class of medication is etomidate?

Answer 10

non-barbituate hypnotic (does not provide analgesia)

high lipid solubility = rapid onset

Question 11

Normal dose of etomidate?

Answer 11

0.2 - 0.3 mg/kg

Question 12

What are four potential problems during recovery from etomidate?

Answer 12

1. Suppression of adrenocortical response to stress
2. nausea and vomiting
3. low plasma cortisol concentration
4. depressed immune response.