Pharm: Induction Drugs Flashcards
Propofol IV Induction dose
Adult 1-2.5mg/kg (adult)
ASA I-II 2.25mg/kg
Elderly 0.1-1.5 mg/kg (ASA II-IV, elderly)
Peds 2.5-3.5 mg/kg
Propofol concentration
1%
10mg/mL
Propofol TIVA dose
TIVA 100-200
mcg/kg/min
Propofol antiemetic dose
Antiemetic 10-20 mg IV or
10-20 mcg/kg/min
Brand name for propofol
Diprivan
Propofol drug class and action site
Class: alkylphenol
Direct GABAa agonist
Active at glycine receptors
Propofol onset, redistribution, and half life
Onset: 30secs
R: 5-15 min
HL: 1-2hrs
98% protein bound
Etomidate concentration
2mg/mL
Etomidate class and receptor
direct GABAa agonist
class: imidazole
Etomidate induction dose
0.2-0.3mg/kg
Etomidate half life and awakening time
awaken: 5-15min
HL: 2-5hrs
Etomidate contraindication
Porphyria
Midazolam action
Benzo receptor on GABA complex.
Modulates GABA
Midazolam induction dose
0.1-0.2mg/kg
Midazolam preop doses
adults: 0.5-2mg IV
peds: 0.05-0.1mg/kg
peds oral: 0.5mg/kg
Midazolam on set and lipid solubility
onset-rapid
high lipid solubility - 95% protein bound
Ketamine drug class and receptor action
class: phencyclidine derivative
receptors: binds to NMDA and inhibits glutamate as a NC antagonists
Ketamine concentraions
10mg/mL IV
50mg/mL IM
Ketamine induction dose
2-4mg/kg IV
4-6mg/kg IM
Ketamine sedation/analgesia dose and infusion
0.2-0.8mg/kg IV bolus
5-20mcg/kg/min
Ketamine preop/analgesia
10-20mg
Active metabolite of ketamine
norketamine
Ketamine half life, loss of consciousness and onset
HL: 2.5 hrs
LOC 30-60 sec
Onset 2-5 min
Dexmedetomidine (Precedex) action
Selective alpha 2 adrenergic agonist
Dexmedetomidine (Precedex) procedural sedation dose
1mg/kg over 10 mins
Dexmedetomidine (Precedex) maintenance dose
0.2-0.5mcg/kg/min
Dexmedetomidine (Precedex) emergence delirium dose
adult: 10-20mg IV
Dexmedetomidine (Precedex) site of action and effects
Anxiolysis & hypnotic
effects from action in
pontine locus
Cerulues nucleus mediates
SNS, memory, analgesia,
arousal, and vigilance
Dexmedetomidine (Precedex) important fact about amnesia
amnesia is not guaranteed
Methohexital (Brevital) drug class and action
class: N-methylated oxybarbiturate
action: potentiates GABAa, depress RAS, suppress transmission of ACh
Methohexital (Brevital) concentration
1% solution
10mg/mL
Methohexital (Brevital) induction dose
1-2mg/kg IV
Methohexital (Brevital) length of action
ultra short acting (4-7mins)
Methohexital (Brevital) important detail regarding seizures
known for myoclonic activity
Thiopental (pentothal) drug class and receptor action
class: barbiturate
action: potentiates GABAa, dress RAS, suppress transmission of ACh.
Thiopental (pentothal) concentration
2.5% solution
25mg/mL
Thiopental (pentothal) induction dose
3-4mg/kg IV
Thiopental (pentothal) time to LOC, peak and duration
LOC: 10-30 sec
peak: 1 min
duration: 5-8min
sedative
drug that induces states of calm or slep
hypnotic
drug that induces hypnosis or sleep
anxiolytic
drug that reduces anxiety
sedative-hypnotic
drug that reversibly depresses the CNS system activity
Types of induction: Standard
“Basic principles of all”
Attempt to mas ventilage prior to NMBD
Admin NMB, mask ventilate while it takes affect
DL/VL with ETT
Confirm ETT and mechanically ventilate
Types of induction: RSI
“Basic principles of all”
Assist cricoid pressure as pt loses consciousness
Hold pressure until confirmed ETT
Rapid succinylcholine after propofol
DL/VL with ETT
Mechanical ventilation with inhaled anesthetic
NO MASK VENTILATION!!
Types of induction: standard LMA
“Basic principles of all
Optional – attempt to mask ventilate
Insert LMA and manually ventilate to assess air leak
Select spontaneous ventilation, manual ventilation, or PSV Pro mode with inhaled anesthetic
Types of induction: TIVA
“Basic principles of all”
NMBD for ETT (not LMA insertion)
Intubation/ LMA insertion
Immediately start continuous infusion of propofol after induction bolus
Start appropriate ventilation for airway device
