PM Lecture 10 Feb 25 Ketamine And Etomidate Flashcards
What are the properties of ketamine?
Rapid onset, minimal cardiovascular effects, profound analgesia
Ketamine is a dissociative anesthetic that binds to NMDA receptors, inhibiting glutamate activation.
What is etomidate primarily known for?
Adrenal cortical suppression and minimal cardiovascular impact
Etomidate is a hypnotic agent used in anesthesia.
What is the mechanism of action of ketamine?
Binding to NMDA receptors
This action leads to dissociative amnesia and analgesia.
List some side effects of etomidate.
- Myoclonic movements
- Adrenal cortical suppression
Monitoring for adrenal suppression is crucial.
What is the significance of lipid solubility in anesthetic drugs?
Influences drug onset and action
More lipid-soluble drugs have faster onset due to better ability to cross cellular membranes.
What is the primary site of action for anesthetic drugs?
The brain
Drugs need to reach the brain to produce anesthesia.
How does albumin binding affect drug availability?
Reduces drug availability for action
Drugs bound to albumin cannot exert their effects until they are released.
True or False: Ketamine has a high potential for abuse.
True
Monitoring for emergence delirium is important.
What technique can reduce venous irritation when administering propofol?
Flushing the line after administration
Using lidocaine prior to propofol can also help.
What is the elimination route for etomidate?
Urine and bile
Elimination involves both renal and biliary pathways.
Fill in the blank: Ketamine produces _______ due to its pharmacological properties.
dissociative amnesia
What are the cardiovascular effects of ketamine?
- Sympathetic stimulation
- Impact on blood pressure and heart rate
Ketamine can stimulate the sympathetic nervous system.
What is the importance of understanding drug pharmacokinetics?
Avoid complications like emergence delirium and myoclonic movements
Proper dosing and administration techniques are critical.
What is the role of plasma esterases in drug metabolism?
Metabolizes drugs like etomidate
Plasma esterases help in the hydrolysis of certain anesthetic agents.
What are the clinical uses of ketamine?
- Pediatric patients
- Burn patients
Ketamine is favored for its analgesic properties and minimal pain at injection.
What is the half-life of etomidate?
2 to 5 hours
The half-life can vary based on individual pharmacokinetics.
What is the impact of etomidate on cerebral blood flow?
Minimal changes
Etomidate maintains hemodynamic stability.
What should be monitored in patients receiving etomidate?
Adrenal cortical suppression
Cortisol support may be necessary during prolonged use.
What is the primary advantage of using propofol?
Versatility in various procedures
Propofol is commonly used in endoscopy and dental outpatient procedures.
Fill in the blank: The mechanism of action of most induction agents involves the opening of _______ channels.
chloride
What are the risks of mixing propofol with other drugs?
Potential for lipid embolism
Following facility protocols is crucial to ensure safety.
What is the significance of the pharmacologic care plan?
Guides medication administration and patient monitoring
It includes options like Plan A and Plan B for various scenarios.
What percentage of drug elimination occurs through the urinary system?
Approximately 85%
This percentage is contrasted with 10-13% elimination through the GI system.
What is the elimination half-life range of the discussed drugs?
Two to five hours.
What effect does high albumin binding have on a drug’s duration of action?
Longer duration of action.
What is the typical dose of the drug discussed for induction?
0.3 mg/kg.
What are the alternatives to propofol for IV induction of anesthesia?
Barbiturates.
What kind of effects does etomidate have on the adrenal cortex?
Adrenal cortical suppression.
True or False: Etomidate has analgesic effects.
False.
What can be administered prior to etomidate to reduce myoclonic movements?
Opioids or benzodiazepines.
What is the relationship between etomidate and cerebral blood flow?
It decreases cerebral blood flow.
Fill in the blank: The peak effect of etomidate occurs within _______.
One minute.
What is the significance of the peak effect timing in relation to surgical interventions?
It informs when to manipulate the airway.
What side effect is associated with the use of etomidate?
Myoclonic movements.
What is the consequence of adrenal cortical suppression during anesthesia?
Hypotension and reduced stress response.
What is the typical dose range for etomidate during induction?
0.2 to 0.4 mg/kg.
How does etomidate affect the amplitude of somatosensory evoked potentials?
It may increase the amplitude, leading to false positives.
What is the effect of etomidate on mean arterial pressure?
Mild decrease.
True or False: Etomidate can cause intra-arterial damage.
False.
What is the primary concern with myoclonic movements in patients under etomidate?
Patient safety and risk of injury.
What impact does etomidate have on the respiratory system?
It depresses ventilation but to a lesser extent.
What should be monitored in patients receiving opioids to prevent CO2 narcosis?
End-tidal CO2 levels.
What is a common dose of fentanyl for a patient weighing 75 kg?
75 mcg.
What is the potential effect of prolonged CO2 elevation in patients?
Longer recovery time and narcosis.
What is the main advantage of etomidate in unstable cardiovascular patients?
It is the most stable drug.
Fill in the blank: The duration of action for highly protein-bound drugs is typically _______.
Longer.
What is the effect of etomidate on the cerebral metabolic rate of oxygen?
Decreases it.
What is the typical range for minute ventilation or respiratory rate when managing opioid-induced respiratory depression?
35 to 45
Breathing may start to improve around 50.
What should be done if opioids are administered and the patient is still not breathing?
Bring them back down by altering minute ventilation or respiratory rate.
What is the main component that helps with pain management in ketamine?
N-methyl-D-aspartate (NMDA) receptor blocking
This is crucial for its analgesic properties.
What type of drug is lidocaine categorized as?
Weak base
It is highly albumin-bound.
What is the relationship between ketamine and PCP?
Ketamine is related to PCP, also known as phencyclidine or Angel Dust.
What is a notable side effect of ketamine, particularly during emergence?
Emergence delirium.
What is the duration of action for ketamine?
10 to 20 minutes for short duration, 60 to 90 minutes to return to full consciousness.
What are the three types of ketamine available?
- S(+)-ketamine
- R(-)-ketamine
- Racemic ketamine
What is the main difference between S(+)-ketamine and racemic ketamine?
S(+)-ketamine has more intense analgesia, being two times greater than racemic.
What is the mechanism of action for ketamine?
It binds competitively to NMDA receptors and inhibits activation by glutamate.
What is the onset time for IV administration of ketamine?
Rapid onset within 30 seconds to 1 minute.
What can be used to counteract the muscarinic effects of ketamine?
Antimuscarinic agents such as glycopyrrolate.
True or False: Ketamine is not plasma bound and can traverse directly into the brain.
True.
Fill in the blank: Ketamine is extensively cleared through the _______.
kidneys.
What is the active metabolite of ketamine responsible for prolonged analgesia?
An active metabolite produced during hepatic metabolism.
What is the effect of ketamine on catecholamines?
Inhibits uptake of catecholamines back into post ganglionic sympathetic nerve endings.
What is the half-life of ketamine?
Up to 2 to 3 hours.
What is the clearance rate of ketamine from the brain?
High hepatic clearance of one liter per minute.
What is the recommended induction dose for IV ketamine?
Varies based on clinical application.
What can cause increased toxicity risk in renal and hepatic impaired patients when using certain drugs?
Prolonged clearance time.
What is the commonality in weak bases and weak acids concerning drug nomenclature?
Weak bases usually have a name that precedes the chemical formula.
What can occur if a patient experiences hypertonic reactions during ketamine administration?
It can lead to complications such as rhabdomyolysis.
What is a common side effect of ketamine that requires monitoring?
Intense salivation.
What is the typical duration for amnesia effects post-ketamine administration?
Amnesia persists for 60 to 90 minutes.
What is the concentration of ketamine available?
25 milligrams per ml
To achieve a concentration of five NAICS per ml, how much volume should be used?
Four or five ml
What are the clinical uses of ketamine?
- Acutely hypovolemic patients
- Bronchodilator
- Burn dressing changes
- Debridement and skin grafting
- Reversal of opioid tolerance
- Treatment of psychiatric disorders
What is the typical dosage range for continuous ketamine infusion?
15 to 30 mcg per kg per minute IV
What routes can ketamine be administered in pediatric induction?
- IV
- IM
- Intranasal
What are the effects of ketamine on cerebral blood flow and intracranial pressure?
- Increases cerebral blood flow by 60%
- Can increase intracranial pressure
What is the recommended dose range for ketamine to avoid increasing intracranial pressure?
0.5 to 2 mg per kg IV
True or False: Ketamine significantly depresses ventilation.
False
What side effects can occur due to ketamine use?
- Emergence delirium
- Hallucinations
- Vivid dreams
- Proprioceptive disturbances
What can be used to prevent emergence delirium associated with ketamine?
- Dexamethasone
- Alpha-2 agonists
What are the cardiovascular effects of ketamine?
- Increases blood pressure
- Increases heart rate
- Increases cardiac output
What is the mechanism of action for ketamine’s effects on the nervous system?
Depresses the inferior colliculus and medial geniculate nucleus
Fill in the blank: Ketamine can inhibit ______ aggregation.
platelet
What are the risks associated with using ketamine in patients with pulmonary hypertension?
It can cause pulmonary hypertension up to 44%
What is the concern regarding mixing propofol with other drugs?
Can form lipid bubbles that may lead to pulmonary embolism
What is the recommended practice regarding mixing ketamine with propofol?
Not recommended due to stability issues
What should be done before drawing up drugs for administration?
Alcoholize the rubber stopper
True or False: Ketamine has a significant histamine release.
False
What is a common clinical setting for the use of ketamine in treating mental health issues?
Wellness clinics for depression and PTSD
What is the impact of ketamine on upper airway reflexes?
Preserves upper airway reflexes
What is the effect of ketamine on seizure threshold?
Does not alter the seizure threshold
What is the significance of the black box warning associated with propofol?
Indicates risks such as bradycardia leading to asystole
Fill in the blank: Ketamine is effective for patients with ______ sleep apnea.
obstructive
What personal protective equipment is needed for drug preparation?
Hats, mask, and gloves
What is the purpose of alcoholizing the rubber stopper?
To ensure sterility before injection
How long should the alcohol stay on the rubber stopper?
15 seconds
True or False: Sterility practices in pharmacology change when entering CRNA school.
False
What serious consequence occurred due to improper sterilization practices by some practitioners?
Indictments for murder due to infections
What outbreak occurred in Nevada related to syringe sharing?
Hep C outbreak
Fill in the blank: ONE syringe, ______ person, ______ time.
one
What should students refer to for drug information?
Drug index of the stocking book
Which reading material is preferred by the speaker for pharmacology?
Stalking
What is a noted difficulty with the reading material ‘Bearish’?
It is difficult to read
What should be avoided when injecting into a port?
Injecting without sterilizing the port
What is the recommended practice when preparing medications?
Alcoholize the rubber stopper
What does CRNA stand for?
Certified Registered Nurse Anesthetist
What did the speaker emphasize about nursing practices?
They should not change in CRNA school
What does the speaker suggest for finding specific drugs?
Look them up in the drug index
What type of table is compared to the setup for drug preparation?
Buffet table
