Pharmacology

Question 1

Sodium thiopental
Pros (3)
Cautions

Answer 1

Rapid onset and clearance
Reduction of cerebral oxygenation consumption
Anticonvulsant effects
Inhibition of sympathetic response of CNS, therefore reduced myocardial contractility and systemic vascular resistance, potential hypotension

Question 2

Sodium thiopental
Presentation
Preparation
Final conc
Dose

Answer 2

Presentation: 500mg powder
Preparation: Draw up 20ml NaCl
Final conc: 25mg/ml
Dose: 3mg/kg rapid IV push.
Shocked trauma patients 1-2mg/kg
80kg=210mg=8.4ml

Question 3

Ketamine
Benefits
Concern?

Answer 3

Significant analgesia - opioid receptor
Anaesthesia
Amnesia - NMDA receptor neuroinhibition
Cardiovascularly stable - catecholamine releasing effect
Raise in ICP

Question 4

Ketamine
Presentation
Preparation
Final conc
Dose

Answer 4

Presentation: 200mg in 2ml
Prep: Draw up in 20ml NaCl
Final conc: 10mg/ml
Dose: 1.0-2.0mg/kg IV

Question 5

Propofol (class)
Pros
Cons

Answer 5

Non-barbituate hypnotic agent
Rapid deep sedation
Significant relaxation of laryngeal musculature
Excellent induction agent for stable non emergent patients (elective theatre)
Potential for hypotension
Myocardial depression
Reduction in cerebral perfusion

Question 6

Propofol
Presentation:
Preparation:
Final conc:
Dose:

Answer 6

Presentation: 200mg in 20ml
Preparation: draw up undiluted
Final conc: 10mg/ml
Dose: titeare to effect ~1.0-1.5mg/kg
Trial 4ml bolis
Dose reduced in shocked patients

Question 7

Suxamethonium
MOI

Answer 7

Depolarising muscle relaxant
Non-competitive agonist at the ACh receptor
Fasciculations then paralysis

Question 8

Suxamethonium
Presentation:
Preparation:
Final conc:
Dose:
Onset:
Duration:

Answer 8

Presentation: 100mg/2ml
Preparation: draw up undiluted
Final conc: 50mg/ml
Dose: 1.5mg/kg
Onset: 30-60 seconds
Duration: 6-12 mins

Question 9

Suxamethonium contraindications (7)

Answer 9

Hyperkalaemia
Burns patients more than 24hrs post injury (can be used acutely)
Spinal cord trauma (from day 10-100)
Crush injury / rhabdo with HyperKalaemia
Congenital or acquired myopathy
Subacute and chronic upper and motor neuron denervation
Hx of malignant hyperthermia

Question 10

Rocuronium
MOI

Answer 10

Non-depolarising
Competive agonist of ACh motor end plate
No Fascilulations

Question 11

Rocuronium traditionally taught benefits

Answer 11

Sux is contraindicated or ongoing paralysis required
Some currently advocate use as primary agent

Question 12

Rocuronium
Presentation:
Preparation:
Final concentration:
Storage:
Dose:
Onset:
Duration:

Answer 12

Presentation: 50mg in 5ml
Preparation: Draw up undiluted
Final concentration: 10mg/ml
Storage: Store refrigerated (2-8 deg C) use w/in 60 days
Dose: 1.2-1.6mg/kg IV push (80kg=96-128mg~120mg/12ml)
Onset: 45-90 seconds
Duration: 15-40 minutes

Rptd dose not recommended assoc myopathy

Question 13

Post induction sedation agents

Answer 13

Propofol, Morphine, midazolam

Question 14

Propofol post induction (maintenance)
Preparation:
Starting dose:

Answer 14

Preparation: Undiluted in syringe driver (usually 50ml)
Starting dose: 30-50mg/hr = 3-5ml/hr, titrated to effect
Increasing dose may result in hypo

Question 15

Morphine and midazolam post induction
Preparation:
Starting dose:

Answer 15

Preparation: 1mg/ml of morphine, 1mg/ml midazolam (often combined)
Starting dose: 3-5mg/hr (3-5ml/hr) titrated to effect.
Trauma patient may require higher doses up to 20mg/hr

Question 16

Post intubation Hypotension
Pneumonic (7)

Answer 16

AH-SHITE

Anaphylaxis, Acidosis
Heart - tamponade, pulm hypertension
Stacked breaths
Hypovolaemia
Induction agents (sedation)
Tension Pneumothorax
Electrolytes