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ANPH 500 - Pharmacology - McCarver > Prop, Etom, Keta > Flashcards

Prop, Etom, Keta Flashcards

0
Q

Dose for induction using propofol

A

1-2.5 mg/kg

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1
Q

2,6 - di-isopropylphenol can also be found in __

A

Perfumes and laundry detergents

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2
Q

Propofol chemical class

A

Alkyl phenol

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3
Q

What induction drug has the most rapid and complete awakening?

A

Propofol

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4
Q

Propofol half time

A

0.5 - 1.5 hours

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5
Q

Does cirrhosis or end stage renal or old age affect the elimination of prop?

A

No

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6
Q

Prop __ cross placenta

A

Can

But is rapidly cleared from fetal circulation

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7
Q

Does propofol support growth of bacteria?

A

Yes - E. coli and pseudomonas

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8
Q

Peds dose for prop induction

A

2.5-3.5 mg/kg

Due to larger central distribution and greater clearance

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9
Q

How does propofol work?

A

GABA receptors –> influx chlorine –> hyper polarization

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10
Q

Why not due inhalation induction on everyone?

A

Skip stage two with IV induction

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11
Q

Elderly need 25-50% smaller prop dose due to

A

Smaller central distribution volumes and decreased clearance

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12
Q

Prop conscious sedation dose in Mcg/kg/min

A

25-300 mcg/kg/min

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13
Q

Dose for PONV using prop

A

10-15 mg, followed by a 10 mcg/kg/min infusion

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14
Q

Prop dose for pruritus of neuroaxial opioids

A

10mg

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15
Q

Prop has anti-convulsant properties due to __

A

GABA mediated pre and post synaptic inhibition

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16
Q

4 things propofol does to brain

A

Decreases cerebral metabolic o2 requirements, cerebral blood flow, and ICP

Anticonvulsant - anti seizure
Can have uncommon induction convulsion but not seizures rt spontaneous excitatory movt of sub cortical origin

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17
Q

Prop __ change evoked potentials

A

Does NOT

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18
Q

Prop inhibits sympathetic vasoconstrictor nerve activity causing __

A

Decreased BP

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19
Q

Increase worsening of bp drop with using propofol with what factors?

A

Hypovolemia (dehydration)
Elderly
Dec LV fx
Aortic stenosis

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20
Q

Prop may have negative inotropic effects due to __

A

Decreased intracellular Ca++

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21
Q

Can you rapidly change your des while on prop and not have a CV response?

A

Unfortunately not

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22
Q

Should you give prop to a child with “googlie eyes” undergoing strabismus surg?

A

Be careful, can increase oculocardiac reflex causing bradycardia or arrest

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23
Q

Props effects on lungs of asthmatics

A

Bronchodilation

Reduces wheezes

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24
Does prop mess with your kidneys or liver fx
No
25
Prolonged prop infusions cause green urine due to excreted __ and cloudy urine from __ acid excretion
Green urine - excreted phenols Cloudy urine - uric acid excretion
26
Effects of propofol on ventilation
Vent depression - even worse w opioids Dec TV and rr Dec co2/hypoxia response Bronchodilator
27
Prop __ IOP from induction to intubation
Lowers
28
Talk to me about prop allergy
Patients with prior exposure to di-isopropyl (perfumes/detergents/fabric softener/ skin preps) Multiple other allergies NMB allergies Soy Egg whites
29
The most common adverse effect of prop How can we help that?
Pain on injection Lidocaine & opioids Larger bore IV
30
Etomidate chemical structure
Carboxylated imidazole ring
31
Imidazole ring is __ soluble at acid pH and __ soluble at physiologic pH
Water Lipid
32
Etom mech of action
Enhances effects of GABA | Just like prop
33
Etom Vd is __ due to large tissue uptake
Large
34
Etom pKa
4.2
35
Etom peak brain levels _ minute after admin
1 min
36
Etomidate and protein binding
Etom is 76% protein bound, thus decrease in hypo blood protein leads to increase circulating etomidate
37
Prompt awakening for etom due to __
Redistribution
38
Etom half time __
2-5 hours
39
Induction dose of etom
0.2-0.4 mg/kg
40
How to prevent shake and bake with etom Effects of etom on epilepsy
Give opioids and benzodiazepines Etomidate can cause excitatory spikes and myoclonus/tremors, but can also break status epilepticus Use w caution in epileptics
41
Etom has __ analgesic properties
No
42
Etom and ECTs?
Preferable to thiopental and propofol
43
Etom __ PONV
Increases incidence
44
Etom and icp...
Decreases cerebral metabolic o2 (35-45%) requirements and ICPs Increase cerebral vasoconstriction
45
Etom and epileptic patients?
Cautiously Dose dependent Double edged, can also terminate status epilepticus
46
Etom __ IOP
Lowers
47
Accidental intra-arterial etom injection
"OK"
48
Etom can make your patient breathe like a _ on a hot rock
Lizard Dec TV in rr Go for spon breathing pt Can cause apnea
49
Etom causes adrenocortical suppression Inhibition of what enzyme? It's job? Time frame of inhibition? Special consideration populations--
via inhibition of conversion of cholesterol to cortisol via enzyme 11-beta-hydroxylase Enzyme inhibitions lasts 4-8 hrs so use cautiously with septic and bleeders
50
Ketamine drug class
Phencyclidine derivative PCP structurally similar James Brown, hog tranquilizer
51
Ketamine acts on a lot of receptors EXCEPT __
GABA
52
Ketamine peaks in 1 minute and is __ significantly bound to plasma proteins
NOT
53
__ is the active metabolite of ketamine
Norketamine
54
Ketamine in the neuro room?
No
55
Which antisialagogue for ketamine and why?
Glyco because atropine and scop cross BBB and increase delirium
56
Ketamine induction dose
1-2 mg/kg IV 4-8 mg/kg IM
57
Ketamine retains laryngeal and pharyngeal reflexes
True
58
Ketamine- consciousness returns in __ minutes and baseline in __
10-20 mins 60-90 mins
59
Ketamine and CAD?
No, increases myocardial O2 needs
60
Ketamine and catecholamine depleted patients?
No
61
Ketamine and asthma and MH?
Yes
62
Ketamine and systemic HTN, pulm HTN, inc ICP, eye cases?
No
63
Ketamine inc cerebral blood flow so __ must be employed
Hyperventilation
64
Mechanism of CV effects with ketamine?
Inc SNS outflow = inc plasma catecholamine levels
65
Ketamine relaxes airways and has no __ release or __ reactions
Histamine Allergic
66
Ketamine _ mac
Reduces
67
Ketamine __ NMBs
enhances
68
Ketamine and cortical blindness
Depression of inferior colliculus and medial geniculate nucleus
69
Ketamine and emergence delirium
Increased with female patients older than 15 with a hx of psych illness and doses greater than 2mg/kg Give versed 5 mins before
70
Is etomidate painful on injection like propofol?
Yes
71
Why is etomidate drug of choice for CV pts?
Minimal neg inotrope effects Cardiovascular stability .3mg/kg or more dosing

ANPH 500 - Pharmacology - McCarver (11 decks)

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