Pharm propofol Flashcards
What is the most frequently administered drug for induction of anesthesia
propofol
possible toxicity when used with_____ due to _______
benzos, propylene glycol
Propofol is ______ and requires a _______ vehicle for _________
insoluble, lipid, emulsification
molecular structure of propofol
substituted isopropylphenol
potential allergens
egg and soy bean
Preservative of diprivan made by AstraZeneca
disodiumedenate (EDTA)
Preservatives inhibit bacterial growth up to hours?
12 hours
Preservative of generic propofol made by Baxter, Pfizer
Sodium metabisulfite
What causes allergy with sodium metabisulfite preservative?
sulfites
Generic propofol can cause negative effects such as
sulfite allergy,
anaphylaxis,
asthmatic episodes in pts with known hx of asthma
How does Aquavan(not approved), water-soluble propofol work?
propofol is liberated after hydrolysis of the parent compound by endothelial cell surface alkaline phosphatases. The prodrug has a larger volume of distribution and a higher potency than propofol. (Takes longer and last longer)
What propofol brand was cancelled and associated with more pain on injection?
Ampofol, low lipid emulsion, does not require preservative
GABA has ____ subunits made up of what three?
5, alpha, beta, gamma
Induction drugs work on different receptors of GABA?
True, receptor sites for specific drugs
Propofol is a CYP _____ and _____
substrate and inhibitor, 3A4
Will a one time dose of propofol or other induction agents inhibit enzymes?
No, not likely
Rapid clearance of propofol from the plasma exceeds hepatic blood flow and is responsible for less
“hangover effect”
CNS effects of propofol
Decrease CBF, CMRO2, ICP, IOP,
neuroprotective during focal inflammation(similar structure to vit e which is neuroprotect),
anti-epileptic properties (decrease seizure activity 35-35%)
may observe myoclonic movement on induction
Respiratory effects of propofol
Respiratory depressant,
apnea after induction,
maintenance decrease mv by decrease tv and RR,
decrease response to hypercapnia and hypoxia,
significant reduction in upper airway reflexes,
Propofol is good for intubating and LMAs because
less laryngospasm, bronchospasm, and wheezing than barbs and benzos
CV effects of propofol
profound decrease in systemic blood pressure,
BP exaggerated in elderly, hypovolemia, rapid injection,
Dramatic inhibition of baroreceptors,
Bradycardia and hypotension
Propofol potentiate muscle relaxants?
No
Anti-emetic dose of propofol
10-20mg IV intermittent or 10mcg/kg/min
Propofol has _____ activity and ______ properties.
antipyretic and antioxidant
dose of propofol and time for risk of PIS
> 24-48hrs and >67(70)mcg/kg/min
If unexpected tachycardia occurs while on propofol check
for metabolic/lactic acidosis,
serum lactate,
ABG
Treatment of PIS
Discontinue,
treat lactic acidosis,
support multi-system failure
Presentation of PIS in children
Anion gap metabolic acidosis,
bradyarrhythmia, (do not get tachy like adults)
liver dysfunction,
rhabdomyolysis of cardiac and skeletal muscle leading to organ failure,
hyperkalemia,
acute kidney injury,
cardiac dysfunction,
PIS more profound in kids due to
enters mitochondria easily because of high lipophilicity. Disrupts electron transport chain leading to failure of ATP production which inhibits fatty acid metabolism. Fatty acid buildup occurs.
Patients with _______ deficiency and ______ disorders are at higher risk of PRIS
carbohydrate deficiency (energy supply relies on lipolysis, children are more prone due to lower glycogen stores and greater dep. on fat metabolism)
clinical and subclinical mitochondrial disorders frequently in pediatrics (disorders related to fatty acid metabolism, lack ability to metabolize fatty acids and combined with long-chain fatty acids in propofol can accumulate )
Fospropofol different from propofol
slower onset time with stronger and longer duration of sedation,
No lipids,
Attached molecule of propofol released when metabolism breaks
