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Nurs 575 Anesthesia Pharmacology > Week 4 Induction agents and benzos > Flashcards

Week 4 Induction agents and benzos Flashcards

1
Q

Predictors for hypotension during Propofol induction?

A
  • Age 50 or older
  • ASA III/IV
  • MAP less than 70mmHg
  • Co-administration of Fentanyl

Nagelhout 7th edition, Ch. 9, pg. 104

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2
Q

Which induction agents are preferred in patients with asthma?

A
  • Propofol
  • Ketamine

Nagelhout 7th edition, Ch. 9, pg. 104

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3
Q

What respiratory effects does Propofol present with?

A
  • Apnea w/ induction doses
  • Decreases in Tidal volume > Decreases in RR
  • Bronchodilatory effects (minimal)
  • Decreases respiratory center sensitivity to CO2

Nagelhout 7th edition, Ch. 9, pg. 104

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4
Q

What miscellaneous effects does Propofol have

A
  • Mild antiemetic
  • Anti-pruritic effects to opioid induced pruritis
  • Pain on injection

Nagelhout 7th edition, Ch. 9, pg. 104-105

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5
Q

What can you do to reduce pain on administration of propofol?

A
  • 20-40mg Lidocaine prior
  • Use larger vein (AC)

Nagelhout 7th edition, Ch. 9, pg. 104-105

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6
Q

Induction dose of Propofol?

A

1-2mg/kg

Nagelhout 7th edition, Ch. 9, pg. 107, Table 9.8

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7
Q

Induction dose of Etomidate

A

0.2-0.3 mg/kg

Nagelhout 7th edition, Ch. 9, pg. 107, Table 9.8

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8
Q

Induction dose of Midazolam?

A

0.1-0.2 mg/kg

Nagelhout 7th edition, Ch. 9, pg. 107, Table 9.8

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9
Q

Induction dose of Dexmedetomidine?

A

1 mcg/kg over 10 min
0.2-0.7 mcg/kg/hr infusion

Nagelhout 7th edition, Ch. 9, pg. 107, Table 9.8

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10
Q

Induction dose of Ketamine?

A

2-4mg/kg IV
4-6mg/kg IM

Nagelhout 7th edition, Ch. 9, pg. 110, Box 9.3

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11
Q

Etomidate’s niche as an induction agent?

A
  • Alternative to propofol
  • Little to no cardiorespiratory effects

Nagelhout 7th edition, Ch. 9, pg. 106

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12
Q

What limits Etomidates use as an induction agent?

A

Adrenocortical suppression of cortisol, aldosterone, corticosterone

  • Occurs due to inhibition of enzymes involved in adrenal steroidogenesis

Nagelhout 7th edition, Ch. 9, pg. 108

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13
Q

What occurs in 10-60% of patients receiving etomidate?

A
  • Myoclonia

Nagelhout 7th edition, Ch. 9, pg. 107

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14
Q

What drugs can we give to minimize myoclonia after etomidate administration?

A
  • Dexmedetomidine
  • Midazolam
  • Lidocaine
  • Rocuronium

Nagelhout 7th edition, Ch. 9, pg. 107

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15
Q

What patients do you see hemodynamic changes with Etomidate?

A
  • Aortic/Mitral valvular disorders

Nagelhout 7th edition, Ch. 9, pg. 108

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16
Q

How does Etomidate inhibit Cortisol and Aldosterone production?

A

It inhibits 11-Beta-hydroxylase from converting

  • 11-deoxycortisol to cortisol
  • 11-deoxycorticosterone to corticosterone -> aldosterone

Nagelhout 7th edition, Ch. 9, pg. 109 - Fig. 9.5

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17
Q

Why has Ketamine historically been avoided in patients with Head injury/increased ICP?

A

Increased:

  • CBF
  • CMRO2
  • ICP
  • CPP
  • IOP

Nagelhout 7th edition, Ch. 9, pg. 104, Table 9.4 & pg. 111

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18
Q

What can be given with Ketamine to offset risks in neurologically impared patients?

A
  • Controlled Ventilation
  • GABA-A receptor agonist (Midazolam)
  • Propofol

avoid N2O too

Nagelhout 7th edition, Ch. 9, pg. 111

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19
Q

Ketamine’s effects on CV measures?

A

Ketamine is a circulatory stimulant

  • Inc. SBP
  • Inc. HR
  • Inc. contractility/CO
  • CVP

SVR seems to be spared/pt dependent

Nagelhout 7th edition, Ch. 9, pg. 111

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20
Q

How does ketamine produce a positive inotropic effect?

A
  • Inhibits neuronal/extraneuronal reuptake of norepinephrine

Nagelhout 7th edition, Ch. 9, pg. 111

21
Q

When would you be concerned Ketamine won’t provide a positive inotropy?

A

In critically ill patients with depleted catecholemine stores, you’ll see a negative inotropic effect.

Nagelhout 7th edition, Ch. 9, pg. 111

22
Q

Respiratory effects of Ketamine?

A

Minor & short duration

  • Maintained ventilation
  • Normal ABGs & CO2 response
  • Inc. pulmonary compliance
  • Decreased pulm. resistance (NE reuptake inhibition)
  • Does increase tracheal, bronchial, & salivary secretions

Why drug of choice in asthmatic patients

Nagelhout 7th edition, Ch. 9, pg. 111

23
Q

Benzodiazepines MoA?

A

Binds to GABA-A receptors to increase affinity for endogenous GABA, which (opens ligand gated Cl- channels) hyperpolarizes the post-synaptic membrane.

Nagelhout 7th edition, Ch. 9, pg. 113

24
Q

Flumazenil MoA

A
  • High affinity competitive GABA-A antagonist
  • Binds to GABA-A receptor without producing increased GABA affinity

Nagelhout 7th edition, Ch. 9, pg. 114

25
Q

CNS effects of Benzos?

7

A
  • Anxiolysis
  • Sedation
  • Sleep
  • Anesthesia
  • Anticonvulsant
  • Anterograde Amnesia
  • Muscle Relaxing

Nagelhout 7th edition, Ch. 9, pg. 114

26
Q

CV effects of Benzos?

A
  • Minimal
  • May see decrease in BP when Versed coadministered with Fentanyl

Nagelhout 7th edition, Ch. 9, pg. 114

27
Q

Respiratory effects of Benzos?

A
  • Dose-dependent respiratory depression
  • Decreased minute volume
  • Decreased slope of CO2 response curve

Worsened when given with opioids

Nagelhout 7th edition, Ch. 9, pg. 114

28
Q

Dose for Flumazenil as reversal?

A
  • 0.2 mg slow titration up to 1mg
    (3 mg for OD)

Nagelhout 7th edition, Ch. 9, pg. 115

29
Q

Onset/DoA Flumazenil

A
  • Onset: 1-2 min
  • Duration: 45-90 min

Nagelhout 7th edition, Ch. 9, pg. 115

30
Q

What patient populations should the use of Flumazenil be avoided?

A
  • Benzo dependent
  • TCA OD
  • Antidepressant OD
  • Known hx of seizures
  • Risk of Seizures

Nagelhout 7th edition, Ch. 9, pg. 115

31
Q

Dexmedetomidine’s end MoA

A

α2-andrenergic agonist - results in decreased catecholamine release

Nagelhout 7th edition, Ch. 9, pg. 115

32
Q

Precedex’s main site of action

A
  • Noradrenergic nucleus in the Locus Coeruleus

Nagelhout 7th edition, Ch. 9, pg. 115

33
Q

CNS effects of Precedex?

6

A
  • Decreased CBF d/t cerebral vasoconstriction
  • Decreased emergence delirium
  • Anti-shivering
  • Decreased neuroendocrine response to surgical stimulation
  • Decreased withdrawl effects from opioids, sedative, & ETOH
  • Enhances analgesia

Nagelhout 7th edition, Ch. 9, pg. 116

34
Q

CV effects of Precedex?

A
  • Bradycardia
  • Hypotension
  • Decreased myocardial oxygen demand (antianginal)

Nagelhout 7th edition, Ch. 9, pg. 116

35
Q

Other effects of Precedex?

A
  • Mild diuretic via α2 stimulation
  • Antiinflammatory
  • Gastro/renal protective
  • Decreased incidence of emergence delirium in pediatrics

Nagelhout 7th edition, Ch. 9, pg. 116

36
Q

What two drug pathways have exhibited neurotoxic effects in animal studies?

A
  • Increase inhibitory GABA pathways (Propofol, Des, Iso, Sev, & Etomidate)
  • Block excitatory glutamate pathways (Ketamine)

Nagelhout 7th edition, Ch. 9, pg. 116

37
Q

Diprivan contains which perservative?

A

Disodium edetate (EDTA)

Nagelhout 7th edition, Ch. 9, pg. 102, Table. 9.1

38
Q

Bargain bin Propofol could contain which perservatives?

A
  • Sodium Metabisulfite
  • Benzyl Alcohol

Nagelhout 7th edition, Ch. 9, pg. 102, Table 9.1

39
Q

Which sedative(s) decrease CBF, CPP, ICP, CMRO2 & IOP upon administration?

A
  • Etomidate
  • Propofol

Nagelhout 7th edition, Ch. 9, pg. 104, table 9.4

40
Q

Which sedative(s) increase CBF, CPP, ICP, CMRO2 & IOP upon administration?

A
  • Ketamine

Nagelhout 7th edition, Ch. 9, pg. 104, table 9.4

41
Q

Midazolam’s effect of CBF, CPP, CMRO2, ICP & IOP?

A
  • CBF - Up or down
  • CPP decrease
  • CMRO2 decrease
  • ICP/IOP Decrease

Nagelhout 7th edition, Ch. 9, pg. 104, table 9.4

42
Q

Dexmedetomidine’s effect of CBF, CPP, CMRO2, ICP & IOP?

A
  • CBF decrease
  • CPP up or down
  • CMRO2 - no change
  • ICP/IOP decrease

Nagelhout 7th edition, Ch. 9, pg. 104, table 9.4

43
Q

When should syringes/vials with Propofol be discarded if they were used/accessed?

A

6 hours

Nagelhout 7th edition, Ch. 9, pg. 101

44
Q

By what mechanism do the effects of Propofol primarily dissipate?

A
  • Rapid redistribution from central to peripheral compartments

Nagelhout 7th edition, Ch. 9, pg. 101

45
Q

Which induction agent enhances the analgesia from opioids and prevents hyperalgesia?

A

Ketamine

Nagelhout 7th edition, Ch. 9, pg. 110

46
Q

Which Benzodiazepene(s) were formulated for anesthesia?

A
  • Midazolam
  • technically Remimazolam

Nagelhout 7th edition, Ch. 9, pg. 113

47
Q

Procedural sedation dose for Remimazolam?

A

5mg IV

&

2.5-5mg q 2min PRN

Dr. C’s PPT, slide 45

48
Q

Which sedative’s ability to lower seizure threshold is the gold standard in ECT?

A
  • Methohexital

Dr. C’s PPT, Slide 54

Nurs 575 Anesthesia Pharmacology (9 decks)

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