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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
Q

Does prop mess with your kidneys or liver fx

A

No

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25
Q

Prolonged prop infusions cause green urine due to excreted __ and cloudy urine from __ acid excretion

A

Green urine - excreted phenols

Cloudy urine - uric acid excretion

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26
Q

Effects of propofol on ventilation

A

Vent depression - even worse w opioids

Dec TV and rr

Dec co2/hypoxia response

Bronchodilator

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27
Q

Prop __ IOP from induction to intubation

A

Lowers

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28
Q

Talk to me about prop allergy

A

Patients with prior exposure to di-isopropyl (perfumes/detergents/fabric softener/ skin preps)
Multiple other allergies
NMB allergies

Soy
Egg whites

29
Q

The most common adverse effect of prop

How can we help that?

A

Pain on injection

Lidocaine & opioids

Larger bore IV

30
Q

Etomidate chemical structure

A

Carboxylated imidazole ring

31
Q

Imidazole ring is __ soluble at acid pH and __ soluble at physiologic pH

A

Water

Lipid

32
Q

Etom mech of action

A

Enhances effects of GABA

Just like prop

33
Q

Etom Vd is __ due to large tissue uptake

A

Large

34
Q

Etom pKa

A

4.2

35
Q

Etom peak brain levels _ minute after admin

A

1 min

36
Q

Etomidate and protein binding

A

Etom is 76% protein bound, thus decrease in hypo blood protein leads to increase circulating etomidate

37
Q

Prompt awakening for etom due to __

A

Redistribution

38
Q

Etom half time __

A

2-5 hours

39
Q

Induction dose of etom

A

0.2-0.4 mg/kg

40
Q

How to prevent shake and bake with etom

Effects of etom on epilepsy

A

Give opioids and benzodiazepines

Etomidate can cause excitatory spikes and myoclonus/tremors, but can also break status epilepticus
Use w caution in epileptics

41
Q

Etom has __ analgesic properties

A

No

42
Q

Etom and ECTs?

A

Preferable to thiopental and propofol

43
Q

Etom __ PONV

A

Increases incidence

44
Q

Etom and icp…

A

Decreases cerebral metabolic o2 (35-45%) requirements and ICPs

Increase cerebral vasoconstriction

45
Q

Etom and epileptic patients?

A

Cautiously

Dose dependent

Double edged, can also terminate status epilepticus

46
Q

Etom __ IOP

A

Lowers

47
Q

Accidental intra-arterial etom injection

A

“OK”

48
Q

Etom can make your patient breathe like a _ on a hot rock

A

Lizard

Dec TV in rr

Go for spon breathing pt

Can cause apnea

49
Q

Etom causes adrenocortical suppression

Inhibition of what enzyme? It’s job?

Time frame of inhibition?

Special consideration populations–

A

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
Q

Ketamine drug class

A

Phencyclidine derivative

PCP structurally similar James Brown, hog tranquilizer

51
Q

Ketamine acts on a lot of receptors EXCEPT __

A

GABA

52
Q

Ketamine peaks in 1 minute and is __ significantly bound to plasma proteins

A

NOT

53
Q

__ is the active metabolite of ketamine

A

Norketamine

54
Q

Ketamine in the neuro room?

A

No

55
Q

Which antisialagogue for ketamine and why?

A

Glyco because atropine and scop cross BBB and increase delirium

56
Q

Ketamine induction dose

A

1-2 mg/kg IV

4-8 mg/kg IM

57
Q

Ketamine retains laryngeal and pharyngeal reflexes

A

True

58
Q

Ketamine- consciousness returns in __ minutes and baseline in __

A

10-20 mins

60-90 mins

59
Q

Ketamine and CAD?

A

No, increases myocardial O2 needs

60
Q

Ketamine and catecholamine depleted patients?

A

No

61
Q

Ketamine and asthma and MH?

A

Yes

62
Q

Ketamine and systemic HTN, pulm HTN, inc ICP, eye cases?

A

No

63
Q

Ketamine inc cerebral blood flow so __ must be employed

A

Hyperventilation

64
Q

Mechanism of CV effects with ketamine?

A

Inc SNS outflow = inc plasma catecholamine levels

65
Q

Ketamine relaxes airways and has no __ release or __ reactions

A

Histamine

Allergic

66
Q

Ketamine _ mac

A

Reduces

67
Q

Ketamine __ NMBs

A

enhances

68
Q

Ketamine and cortical blindness

A

Depression of inferior colliculus and medial geniculate nucleus

69
Q

Ketamine and emergence delirium

A

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
Q

Is etomidate painful on injection like propofol?

A

Yes

71
Q

Why is etomidate drug of choice for CV pts?

A

Minimal neg inotrope effects

Cardiovascular stability .3mg/kg or more dosing

ANPH 500 - Pharmacology - McCarver (11 decks)

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