Exam 2: 10 Feb Ketamine And Etomidate

Question 1

What are the properties of ketamine?

Answer 1

Rapid onset, minimal cardiovascular effects, profound analgesia

Ketamine is a dissociative anesthetic that binds to NMDA receptors, inhibiting glutamate activation.

Question 2

What is etomidate primarily known for?

Answer 2

Adrenal cortical suppression and minimal cardiovascular impact

Etomidate is a hypnotic agent used in anesthesia.

Question 3

What is the mechanism of action of ketamine?

Answer 3

Binding to NMDA receptors

This action leads to dissociative amnesia and analgesia.

Question 4

List some side effects of etomidate.

Answer 4

• Myoclonic movements
• Adrenal cortical suppression

Monitoring for adrenal suppression is crucial.

Question 5

What is the significance of lipid solubility in anesthetic drugs?

Answer 5

Influences drug onset and action

More lipid-soluble drugs have faster onset due to better ability to cross cellular membranes.

Question 6

What is the primary site of action for anesthetic drugs?

Answer 6

The brain

Drugs need to reach the brain to produce anesthesia.

Question 7

How does albumin binding affect drug availability?

Answer 7

Reduces drug availability for action

Drugs bound to albumin cannot exert their effects until they are released.

Question 8

True or False: Ketamine has a high potential for abuse.

Answer 8

True

Monitoring for emergence delirium is important.

Question 9

What technique can reduce venous irritation when administering propofol?

Answer 9

Flushing the line after administration

Using lidocaine prior to propofol can also help.

Question 10

What is the elimination route for etomidate?

Answer 10

Urine and bile

Elimination involves both renal and biliary pathways.

Question 11

Fill in the blank: Ketamine produces _______ due to its pharmacological properties.

Answer 11

dissociative amnesia

Question 12

What are the cardiovascular effects of ketamine?

Answer 12

• Sympathetic stimulation
• Impact on blood pressure and heart rate

Ketamine can stimulate the sympathetic nervous system.

Question 13

What is the importance of understanding drug pharmacokinetics?

Answer 13

Avoid complications like emergence delirium and myoclonic movements

Proper dosing and administration techniques are critical.

Question 14

What is the role of plasma esterases in drug metabolism?

Answer 14

Metabolizes drugs like etomidate

Plasma esterases help in the hydrolysis of certain anesthetic agents.

Question 15

What are the clinical uses of ketamine?

Answer 15

• Pediatric patients
• Burn patients

Ketamine is favored for its analgesic properties and minimal pain at injection.

Question 16

What is the half-life of etomidate?

Answer 16

2 to 5 hours

The half-life can vary based on individual pharmacokinetics.

Question 17

What is the impact of etomidate on cerebral blood flow?

Answer 17

Minimal changes

Etomidate maintains hemodynamic stability.

Question 18

What should be monitored in patients receiving etomidate?

Answer 18

Adrenal cortical suppression

Cortisol support may be necessary during prolonged use.

Question 19

What is the primary advantage of using propofol?

Answer 19

Versatility in various procedures

Propofol is commonly used in endoscopy and dental outpatient procedures.

Question 20

Fill in the blank: The mechanism of action of most induction agents involves the opening of _______ channels.

Answer 20

chloride

Question 21

What are the risks of mixing propofol with other drugs?

Answer 21

Potential for lipid embolism

Following facility protocols is crucial to ensure safety.

Question 22

What is the significance of the pharmacologic care plan?

Answer 22

Guides medication administration and patient monitoring

It includes options like Plan A and Plan B for various scenarios.

Question 23

What percentage of drug elimination occurs through the urinary system?

Answer 23

Approximately 85%

This percentage is contrasted with 10-13% elimination through the GI system.

Question 24

What is the elimination half-life range of the discussed drugs?

Answer 24

Two to five hours.

Question 25

What effect does high albumin binding have on a drug's duration of action?

Answer 25

Longer duration of action.

Question 26

What is the typical dose of the drug discussed for induction?

Answer 26

0.3 mg/kg.

Question 27

What are the alternatives to propofol for IV induction of anesthesia?

Answer 27

Barbiturates.

Question 28

What kind of effects does etomidate have on the adrenal cortex?

Answer 28

Adrenal cortical suppression.

Question 29

True or False: Etomidate has analgesic effects.

Answer 29

False.

Question 30

What can be administered prior to etomidate to reduce myoclonic movements?

Answer 30

Opioids or benzodiazepines.

Question 31

What is the relationship between etomidate and cerebral blood flow?

Answer 31

It decreases cerebral blood flow.

Question 32

Fill in the blank: The peak effect of etomidate occurs within _______.

Answer 32

One minute.

Question 33

What is the significance of the peak effect timing in relation to surgical interventions?

Answer 33

It informs when to manipulate the airway.

Question 34

What side effect is associated with the use of etomidate?

Answer 34

Myoclonic movements.

Question 35

What is the consequence of adrenal cortical suppression during anesthesia?

Answer 35

Hypotension and reduced stress response.

Question 36

What is the typical dose range for etomidate during induction?

Answer 36

0.2 to 0.4 mg/kg.

Question 37

How does etomidate affect the amplitude of somatosensory evoked potentials?

Answer 37

It may increase the amplitude, leading to false positives.

Question 38

What is the effect of etomidate on mean arterial pressure?

Answer 38

Mild decrease.

Question 39

True or False: Etomidate can cause intra-arterial damage.

Answer 39

False.

Question 40

What is the primary concern with myoclonic movements in patients under etomidate?

Answer 40

Patient safety and risk of injury.

Question 41

What impact does etomidate have on the respiratory system?

Answer 41

It depresses ventilation but to a lesser extent.

Question 42

What should be monitored in patients receiving opioids to prevent CO2 narcosis?

Answer 42

End-tidal CO2 levels.

Question 43

What is a common dose of fentanyl for a patient weighing 75 kg?

Answer 43

75 mcg.

Question 44

What is the potential effect of prolonged CO2 elevation in patients?

Answer 44

Longer recovery time and narcosis.

Question 45

What is the main advantage of etomidate in unstable cardiovascular patients?

Answer 45

It is the most stable drug.

Question 46

Fill in the blank: The duration of action for highly protein-bound drugs is typically _______.

Answer 46

Longer.

Question 47

What is the effect of etomidate on the cerebral metabolic rate of oxygen?

Answer 47

Decreases it.

Question 48

What is the typical range for minute ventilation or respiratory rate when managing opioid-induced respiratory depression?

Answer 48

35 to 45 ## Footnote Breathing may start to improve around 50.

Question 49

What should be done if opioids are administered and the patient is still not breathing?

Answer 49

Bring them back down by altering minute ventilation or respiratory rate.

Question 50

What is the main component that helps with pain management in ketamine?

Answer 50

N-methyl-D-aspartate (NMDA) receptor blocking ## Footnote This is crucial for its analgesic properties.

Question 51

What type of drug is lidocaine categorized as?

Answer 51

Weak base ## Footnote It is highly albumin-bound.

Question 52

What is the relationship between ketamine and PCP?

Answer 52

Ketamine is related to PCP, also known as phencyclidine or Angel Dust.

Question 53

What is a notable side effect of ketamine, particularly during emergence?

Answer 53

Emergence delirium.

Question 54

What is the duration of action for ketamine?

Answer 54

10 to 20 minutes for short duration, 60 to 90 minutes to return to full consciousness.

Question 55

What are the three types of ketamine available?

Answer 55

* S(+)-ketamine * R(-)-ketamine * Racemic ketamine

Question 56

What is the main difference between S(+)-ketamine and racemic ketamine?

Answer 56

S(+)-ketamine has more intense analgesia, being two times greater than racemic.

Question 57

What is the mechanism of action for ketamine?

Answer 57

It binds competitively to NMDA receptors and inhibits activation by glutamate.

Question 58

What is the onset time for IV administration of ketamine?

Answer 58

Rapid onset within 30 seconds to 1 minute.

Question 59

What can be used to counteract the muscarinic effects of ketamine?

Answer 59

Antimuscarinic agents such as glycopyrrolate.

Question 60

True or False: Ketamine is not plasma bound and can traverse directly into the brain.

Answer 60

True.

Question 61

Fill in the blank: Ketamine is extensively cleared through the _______.

Answer 61

kidneys.

Question 62

What is the active metabolite of ketamine responsible for prolonged analgesia?

Answer 62

An active metabolite produced during hepatic metabolism.

Question 63

What is the effect of ketamine on catecholamines?

Answer 63

Inhibits uptake of catecholamines back into post ganglionic sympathetic nerve endings.

Question 64

What is the half-life of ketamine?

Answer 64

Up to 2 to 3 hours.

Question 65

What is the clearance rate of ketamine from the brain?

Answer 65

High hepatic clearance of one liter per minute.

Question 66

What is the recommended induction dose for IV ketamine?

Answer 66

Varies based on clinical application.

Question 67

What can cause increased toxicity risk in renal and hepatic impaired patients when using certain drugs?

Answer 67

Prolonged clearance time.

Question 68

What is the commonality in weak bases and weak acids concerning drug nomenclature?

Answer 68

Weak bases usually have a name that precedes the chemical formula.

Question 69

What can occur if a patient experiences hypertonic reactions during ketamine administration?

Answer 69

It can lead to complications such as rhabdomyolysis.

Question 70

What is a common side effect of ketamine that requires monitoring?

Answer 70

Intense salivation.

Question 71

What is the typical duration for amnesia effects post-ketamine administration?

Answer 71

Amnesia persists for 60 to 90 minutes.

Question 72

What is the concentration of ketamine available?

Answer 72

25 milligrams per ml

Question 73

To achieve a concentration of five NAICS per ml, how much volume should be used?

Answer 73

Four or five ml

Question 74

What are the clinical uses of ketamine?

Answer 74

* Acutely hypovolemic patients * Bronchodilator * Burn dressing changes * Debridement and skin grafting * Reversal of opioid tolerance * Treatment of psychiatric disorders

Question 75

What is the typical dosage range for continuous ketamine infusion?

Answer 75

15 to 30 mcg per kg per minute IV

Question 76

What routes can ketamine be administered in pediatric induction?

Answer 76

* IV * IM * Intranasal

Question 77

What are the effects of ketamine on cerebral blood flow and intracranial pressure?

Answer 77

* Increases cerebral blood flow by 60% * Can increase intracranial pressure

Question 78

What is the recommended dose range for ketamine to avoid increasing intracranial pressure?

Answer 78

0.5 to 2 mg per kg IV

Question 79

True or False: Ketamine significantly depresses ventilation.

Answer 79

False

Question 80

What side effects can occur due to ketamine use?

Answer 80

* Emergence delirium * Hallucinations * Vivid dreams * Proprioceptive disturbances

Question 81

What can be used to prevent emergence delirium associated with ketamine?

Answer 81

* Dexamethasone * Alpha-2 agonists

Question 82

What are the cardiovascular effects of ketamine?

Answer 82

* Increases blood pressure * Increases heart rate * Increases cardiac output

Question 83

What is the mechanism of action for ketamine's effects on the nervous system?

Answer 83

Depresses the inferior colliculus and medial geniculate nucleus

Question 84

Fill in the blank: Ketamine can inhibit ______ aggregation.

Answer 84

platelet

Question 85

What are the risks associated with using ketamine in patients with pulmonary hypertension?

Answer 85

It can cause pulmonary hypertension up to 44%

Question 86

What is the concern regarding mixing propofol with other drugs?

Answer 86

Can form lipid bubbles that may lead to pulmonary embolism

Question 87

What is the recommended practice regarding mixing ketamine with propofol?

Answer 87

Not recommended due to stability issues

Question 88

What should be done before drawing up drugs for administration?

Answer 88

Alcoholize the rubber stopper

Question 89

True or False: Ketamine has a significant histamine release.

Answer 89

False

Question 90

What is a common clinical setting for the use of ketamine in treating mental health issues?

Answer 90

Wellness clinics for depression and PTSD

Question 91

What is the impact of ketamine on upper airway reflexes?

Answer 91

Preserves upper airway reflexes

Question 92

What is the effect of ketamine on seizure threshold?

Answer 92

Does not alter the seizure threshold

Question 93

What is the significance of the black box warning associated with propofol?

Answer 93

Indicates risks such as bradycardia leading to asystole

Question 94

Fill in the blank: Ketamine is effective for patients with ______ sleep apnea.

Answer 94

obstructive

Question 95

What personal protective equipment is needed for drug preparation?

Answer 95

Hats, mask, and gloves

Question 96

What is the purpose of alcoholizing the rubber stopper?

Answer 96

To ensure sterility before injection

Question 97

How long should the alcohol stay on the rubber stopper?

Answer 97

15 seconds

Question 98

True or False: Sterility practices in pharmacology change when entering CRNA school.

Answer 98

False

Question 99

What serious consequence occurred due to improper sterilization practices by some practitioners?

Answer 99

Indictments for murder due to infections

Question 100

What outbreak occurred in Nevada related to syringe sharing?

Answer 100

Hep C outbreak

Question 101

Fill in the blank: ONE syringe, ______ person, ______ time.

Answer 101

one

Question 102

What should students refer to for drug information?

Answer 102

Drug index of the stocking book

Question 103

Which reading material is preferred by the speaker for pharmacology?

Answer 103

Stalking

Question 104

What is a noted difficulty with the reading material 'Bearish'?

Answer 104

It is difficult to read

Question 105

What should be avoided when injecting into a port?

Answer 105

Injecting without sterilizing the port

Question 106

What is the recommended practice when preparing medications?

Answer 106

Alcoholize the rubber stopper

Question 107

What does CRNA stand for?

Answer 107

Certified Registered Nurse Anesthetist

Question 108

What did the speaker emphasize about nursing practices?

Answer 108

They should not change in CRNA school

Question 109

What does the speaker suggest for finding specific drugs?

Answer 109

Look them up in the drug index

Question 110

What type of table is compared to the setup for drug preparation?

Answer 110

Buffet table