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Apex Review > Intravenous anesthetics > Flashcards

Intravenous anesthetics Flashcards

1
Q

What is the mechanism of action of propofol?

A

GABA-A agonist

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2
Q

What is the onset of action of propofol?

A

30-60 seconds

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3
Q

What is the duration of action of propofol?

A

5-10 minutes

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4
Q

What is the clearance of propofol?

A

liver+ extra hepatic metabolism

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5
Q

What is the active metabolite of propofol?

A

None

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6
Q

What is the induction dose of propofol?

A

1.5-2.5 mg/kg IV

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7
Q

What is the maintenance dose of propofol?

A

25-200 mcg/kg/min

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8
Q

What are the respiratory effects of propofol?

A

decreased respiratory drive

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9
Q

What are the CV effects of propofol?

A

decreased BP, SVR, preload, and contractility

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10
Q

What are the CNS effects of propofol?

A

decreased ICP & IOP, no analgesia, +/- seizure activity
decreased CBF, decreased CMRO2

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11
Q

What is the pKa of propofol?

A

11

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12
Q

GABA-A receptor stimulation leads to

A

hyperpolarization of the neurons by increasing Cl- conductance; more Cl- inside the cell makes the cell more negative; this reduces resting membrane potential leading to prevention of action potential

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13
Q

With propofol, there is a rapid redistribution

A

from the blood to the vessel rich group
redistribution from the VRG to the muscle and fat follows

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14
Q

The brain concentration of propofol peaks at

A

~1 minute

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15
Q

How does propofol affect the CO2 response curve?

A

shifts CO2 response curve down and to the right (less sensitive to CO2)–> respiratory depression and/or apnea

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16
Q

Can myoclonus occur with propofol?

A

yes

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17
Q

Does propofol provide analgesia?

A

no

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18
Q

How can propofol infusions change the color of urine?

A

green urine= phenol excretion
cloudy urine= increased uric acid excretion

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19
Q

Propofol has _______ properties.

A

antioxidant properties- free radical scavenging properties

20
Q

What organs are primarily responsible for propofol metabolism?

A

liver (CYP 450)
lungs

21
Q

Name 2 preservatives that may be added to the propofol vial.

A

disodium edetate (diprivan)
sodium metabisulfate (generic formula)

22
Q

Propofol infusion syndrome is categorized by the presence of:
a. hypokalemia
b. bradycardia
c. respiratory failure
d. metabolic acidosis

A

b. bradycardia
d. metabolic acidosis

23
Q

Propofol infusion syndrome presents with

A

acute refractory bradycardia–> asystole + at least one of the following:
metabolic acidosis (base deficit > 10 mmol/L)
rhabdomyolysis
enlarged or fatty liver
renal failure
hyperlipidemia
lipemia (cloudy plasma or blood)

24
Q

Propofol may be safely administered to patients allergic to

A

soy, peanuts, and probably egg

25
Q

Most people with egg allergies are allergic to the__________. Egg lecithin found in propofol is derived from

A

albumin in egg whites; derived from the yolk

26
Q

Risk factors for propofol infusion syndrome include

A

children receiving high doses (4 mg/kg/hr) over long periods of time (>48 hours)
sepsis (inadequate oxygen delivery)
continuous catecholamine infusions
high-dose steroids
significant cerebral injury

27
Q

Treatments for propofol infusion syndrome include

A

discontinuing propofol and initiating cardiac pacing, PDE inhibitors, and ECMO
maximize gas exchange
glucagon
renal replacement therapy

28
Q

Propofol increases the risk of ______ contamination.

A

bacterial and fungal

29
Q

What measures should be taken to reduce the risk of bacterial contamination with propofol?

A

propofol syringes must be discarded within 6 hours
infusions (and the tubing) must be discarded within 12 hours

30
Q

_______ to generic propofol preparations can cause complications.

A

Additives

31
Q

Describe two additives to generic propofol that can lead to complications.

A

metabisulfite–> bronchospasm in asthmatics
benzyl alcohol–> should be avoided in infants

32
Q

Propofol also has the following properties:

A

antipruritic and antiemetic

33
Q

Pain on injection with propofol is reduced by

A

lidocaine, opioids and administration through larger and more proximal veins

34
Q

How does propofol cause propofol infusion syndrome?

A

propofol contains long-chain triglycerides (LCT) and an increased LCT load impairs oxidative phosphorylation and fatty acid metabolism. this starves cells of oxygen particularly in cardiac and skeletal muscle

35
Q

Fospropofol is:
a. prepared as a lipid emulsion
b. metabolized by alkaline phosphatase
c. a prodrug
d. associated with pain at the injection site

A

b. metabolized by alkaline phosphatase
c. a prodrug

36
Q

What is the mechanism of action of fospropofol?

A

GABA-A agonist

37
Q

What is the onset of action of fospropofol?

A

5-13 minutes (much longer than propofol)

38
Q

What is the duration of action of fospropofol?

A

15-45 minutes

39
Q

What is the clearance of fospropofol?

A

liver+ extrahepatic metabolism

40
Q

What is the active metabolite of fospropofol?

A

propofol (fospropofol is a prodrug)

41
Q

What is the induction of fospropofol?

A

6.5 mg/kg IV

42
Q

What is the repeat dose of fospropofol?

A

max 1.6 mg/kg every 4 minutes

43
Q

What are the respiratory effects of fospropofol?

A

similar to propofol

44
Q

What are the CV effects of fospropofol?

A

similar to propofol

45
Q

What are the CNS effects of fospropofol?

A

similar to propofol

46
Q

What are other side effects of fospropofol?

A

genital and anal burning

47
Q

Advantages of fospropofol over propofol include

A

prevents burning
doesn’t support microbial growth in the same way as lipid emulsion (no preservative)

Apex Review (224 decks)

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