Pharamcology

Question 1

Dexmedetomidine (Precedex)

Answer 1

Analgesic with anxiolytic properties
Premedication for induction or 14:28
Sedation for mechanically ventilated pt
Peek effect time 1-4 minutes
0.5- 1.0 mcg/kg/hr titrate slowly
0.2-0.7 mcg/kg/hr
Max dose 5 mcg/kg/hr

Question 2

Ketaphol

Answer 2

Mixing ketamine with propofol- to manage that hypotensive response with the propofol
2:1, 3:1, 4:1
Procedural sedation and continued sedation
Less hypotension with stimulus
Same incidents of emergence
Still a need to augment with versed
Seems to be a bandaid on the diprovan issue
Demonstrate benefits of airway preservation, hemodynamic stability, maintancene of spont resp, lots of appropriate effect of analgesic receptors and rapid recovery
Procedures done and have seen as sedatio nin hospital and then transporterd to other hosp
Dont necessarily wake up from stimulus and can titrate up and it effect there bp less, can still augment with versed

Question 3

Propodol (diprovan): “milk of amnesia”

Answer 3

Easy to wake pt and when turn it off pt wake up relatively quickly
Short surgical procedure or inhospital
sedative/ hypnotic
Good for induction and continued sedation
Anesthetic and amnesic
Bad transport drug
Instead of increasing the propofol best to augment with a different drug to keep pt sedated like versed/ versed and fentanyl
Bad for hemodynamics
Hypotension- propofol related infusion syndrome
Pt wakes up and titrates up and then bp drop
Peek effect in 1-2 minutes
1-2.5 mg/kg for induction
1-50mcg/kg/min maintenance

Question 4

Ketamine

Answer 4

Great for induction and continued sedation in the hemodynamically unstable pt
Ideal for a resp (asthma) induction- brochodialatror side effect
Possibly a septic pt
Rapid onset and duration 10-15 minutes
Need to add versed to avoid anesthesia rage
Populous that have this ages 18-26 typically specific to men
Potential for pt to have emergence rage
So when medication wearing off get into a rage state
Put brain into a nightmare state
Keeps bp up and small adrenal response where increased hr a bronchodilation response

1-4mg/kg
Peak effect <1 minute

Question 5

Etomidate

Answer 5

This is a common go to for sedation prior to paralysis and intubation and alot of short term surgical procedures- skin being removes or melanoma
Effective actions
Few sid effects
Decreased oxygen consumption and increases cerebral blood flow
0.3mg/kg
Peek effect 3-5 minutes
Basically tells the brain everything is fine and slow and relax
Some will say this cause adrenal insufficiency
Kidney or adrenal disease- Careful or avoid use all together
Loss favor to ketamine

Question 6

RSI medications use

Answer 6

Paralytics
Induction agents
Analgesics
Sedatives
Reversal agents

Question 7

Considerations-base factors

Answer 7

weight, sex, environment, time, pt condition, pregnancy, physciological factors, latrinsic response

Question 8

considerations for medication-weight

Answer 8

IBW vs actual body weight
Titratet to effect

Question 9

considerations for medication-sex

Answer 9

Females are more responsive to hormone-base meds
More responsive to beta blockers

Question 10

considerations for medication- environment

Answer 10

Temperature of the pt
Allergens in the air
How long med been exposed to temp ranges
Near expirations
Some meds break down to direct sunlight and high/low temps

Question 11

considerations for medication- time

Answer 11

after a meal or stomach empty

Question 12

considerations for medication-pt condition

Answer 12

Overall health (shock)
Kidney function
Liver function
Advanced age
All can interfere with meds that you may give

Question 13

considerations for medication-pregnancy

Answer 13

Fetal risk
A- no risk
X- very high risk
Risk to benefit ratio the risk of side effects may outweight the benefits of meds

Question 14

considerations for medication-Physiological factors

Answer 14

Analgesia and sedation
How fast burn off based on metabolic rate
Abuser of drug smay have a higher tolerance

Question 15

latrinsic response

Answer 15

Latrinsic response or adverse condition inadvertently induce in a pt as a result of treatment idosyunchrasies in meds unique respoonde to med that is out of the norm
Tolerance
Cross tolerance
Or tolerance to diff med from a current clas of meds typically from a opioid med
Cumulative effect
Therapeutic or not
Reglan give them analgesia which will have accumulative effect more tired and more effect because of the reglan
Drug induced interaction when the effects of one drug alters the other and can cause interferance of the efficacy drug trying to give
Understand whe ndrugs work against each other and not effective