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Anesthesia Drug Test Quick Facts > INDUCTION AGENTS > Flashcards

INDUCTION AGENTS Flashcards

1
Q

brand name of etomidate

A

amidate

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2
Q

how is etomidate supplied

A

2 mg/mL

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3
Q

what is the MOA of etomidate

A

benzylimidazole producing agonism of GABAa by binding directly to a specific site on the protein and enhancing the affinity for GABA

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4
Q

which receptor subunit does etomidate primarily bind to?

A

Beta-subunits on the GABAa receptor

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5
Q

induction dose for etomidate

A

0.2-0.6mg/kg

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6
Q

maintenance dose for etomidate

A

5-20 mcg/kg/min

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7
Q

MAC dose for etomidate

A

MAC 0.1-0.2 mg/kg

→ followed by 0.05 mg/kg every 3-5 minutes as needed

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8
Q

onset of etomidate

A

30-60 seconds

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9
Q

peak of etomidate

A

1 minute

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10
Q

duration of etomidate

A

3-5 minutes

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11
Q

half-life of etomidate

A

2.6 hours

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12
Q

metabolism of etomidate

A

hepatic and plasma esterases

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13
Q

best quality of etomidate i.e. s/e it has the least of

A

CV

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14
Q

endocrine se of etomidate

A

adrenal suppression (suppresses cortisol biosynthesis)

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15
Q

GI se of etomidate

A

N/V on emergence

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16
Q

derm se of etomidate

A

Local: pain at site 30-80%

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17
Q

NMS se of etomidate

A

NMS: Myoclonus (33%) transient skeletal movements, uncontrolled eye movements 1-10% hiccups

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18
Q

how does etomidate effect IOP, ICP, CMRO2 & perfusion pressure

A

Decreases IOP, ICP, CMRO2 BUT maintains perfusion pressure

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19
Q

what enzyme does etomidate inhibit

A

CYP 450

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20
Q

what conditions do you avoid etomidate with

A

Trauma, critical illness, sepsis (adrenal insufficiency)

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21
Q

why do you avoid etomidate during stress

A

Decreases cortisol levels

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22
Q

brand name of propofol

A

Diprivan

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23
Q

how is propofol supplied

A

10mg/mL

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24
Q

uses of proposal

A

Induction of anesthesia in patients > 3 years old
Maintenance of anesthesia > 2 month,
in adults, for monitored anesthesia care
sedation during procedures
sedation in intubated pt

25
onset of propofol
9-51 seconds
26
what effect does the dose or rate have on onset of propofol
higher dose faster onset | higher rate faster onset
27
duration of action of propofol
3-10 minutes
28
peak of propofol
9-51 s
29
half life of propofol
Biphasic | initial 40 minutes, terminal 4-7 hours after 10 day infusion may be unto 1-3 das
30
elimination of propofol
urine 88% metabolites 40% as glucouronide metabolite feces 2%
31
metabolism of propofol
hepatic to water soluble sulfate and flucuronicide conjugates 50%
32
adverse effects of propofol
HYPOTENSION: children 17%; adults 3% to 26%), Movement (children 17%; adults 3% to 10%), Injection site burning, stinging, or pain (children 10%; adults 18%), Apnea lasting 30-60 seconds (children 10%; adults 24%), apnea lasting >60 seconds (children 5%; adults 12%), Hypertension (children 8%), arrhythmia (1% to 3%), bradycardia (1% to 3%), cardiac output decreased (1% to 3%; concurrent opioid use increases incidence), tachycardia (1% to 3%), Pruritus (1% to 3%), rash (children 5%; adults 1% to 3%), Hypertriglyceridemia (3% to 10%), Respiratory acidosis during weaning (3% to 10%)
33
contraindications with propofol
Hypersensitivity to propofol or any component of the formulation; hypersensitivity to eggs, egg products, soybeans, or soy products; when general anesthesia or sedation is contraindicated
34
brand name of ketamine
katalar
35
how is ketamine supplied?
50mg/mL
36
what is the mechanism of action of ketamine?
Ketamine is a noncompetitive NMDA receptor antagonist that blocks glutamate. Produces a cataleptic-like state in which the patient is dissociated from the surrounding environment by direct action on the cortex and limbic system.
37
uses of ketamine
Low (sub anesthetic) doses produce analgesia modulate central sensitization, hyperalgesia opioid tolerance. Reduces polysynaptic spinal reflexes. Analgesia and Sedation
38
dose of ketamine IM for induction
I.M.: 6.5 to 13 mg/kg
39
dose of ketamine IV for induction
I.V.: 1 to 4.5 mg/kg
40
IV dose of ketamine for induction if versed if also given
(0.5-2mg/kg if versed has been given)
41
rapid sequence IV dose for intubation
Rapid sequence intubation: 2mg/kg IV | 1-2mg/kg is most common induction dose
42
onset of IV ketamine
I.V.: Anesthetic effect: 30 seconds;
43
onset of IM ketamine
I.M.: Anesthetic effect: 3-4 minutes
44
DOA ketamine IV
Anesthetic effect: I.V.: 5-10 minutes;
45
DOA ketamine IM
I.M.: 12-25 minutes
46
half life of ketamine alpha and beta phase
Alpha: 10-15 minutes; Beta: 2.5 hours
47
excretion of ketamine
Primarily urine
48
metabolism of ketamine
Hepatic via hydroxylation and N-demethylation; the metabolite norketamine is 33% as potent as parent compound; greater conversion to norketamine occurs after oral administration as compared to parenteral administration
49
AE ketamine CV
Cardiovascular: Arrhythmia, bradycardia/tachycardia, hyper-/hypotension,
50
ae ketamine GI
Anorexia, nausea, salivation !!!!! increased vomiting
51
ae ketamine derm
Erythema (transient), morbilliform rash (transient), Pain at the injection site, exanthema at the injection site,
52
ae ketamine MSK
Skeletal muscle tone enhanced (tonic-clonic movements
53
ae ketamine resp
``` Airway obstruction, apnea, bronchial secretions increased, respiratory depression, laryngospasm, ```
54
ae ketamine eye
Diplopia, intraocular pressure increased, nystagmus,
55
ae ketamine misc
Anaphylaxis,
56
ae ketamine neuro
``` Intracranial pressure increased dependence with prolonged use, emergence reactions (~12%; includes confusion, delirium, dreamlike state, excitement, hallucinations, irrational behavior, vivid imagery) ```
57
clinical pearls with ketamine
Increases HR, BP, CO secondary to catecholamine release. Causes bronchodilation. Lowers seizure threshold. May cause emergence psychosis.
58
name the induction agents
``` etomidate ketamine propofol Methohexital Thiopental ```

Anesthesia Drug Test Quick Facts (19 decks)

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