Induction agents & Properties Flashcards by Linsay AugustinCRNA

Propofol class

Sedative Hypnotic medication

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Is propofol water or lipid soluble

Lipid Soluble

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Propofol contains

Soybean, glycerol, Egg

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Does propofol emulsion cause histamine release

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Propofol should not be administered to

Patient who has had an anaphylactic reaction to eggs

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What is the most commonly used IV administered anesthetic induction agents?

PROPOFOL

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Good properties of propofol

Rapid onset and offset
Rapid redistribution
Low N/V

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Does propofol has any antiemetic effects

Yes

So good that they administered in PACU at times 10-20mg for post op N/V

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Induction agents that causes the most hypotension

PROPOFOL

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Propofol : Pain on injection attenuated with

Lidocaine.

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CNS effects of Propofol

Stimulation of GABA-A receptors is likely responsible for anesthetic properties of drugs.

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Induction dose of propofol produces anesthesia lasting

5-10 minutes

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CV effects of Propofol

Dose related Decrease BP, SVR

Decrease myocardial contractility at HIGHER DOSES

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RESP effects of propofol

Dose dependent decrease or respiratory drive

Ventilatory response to CO2 is decreased

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Prolonged infusion can produced Green urine for this drug? Why?

Propofol; Because of the presence of Phenolic or quinol metabolite

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Propofol excretion is

urine

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Propofol effect on renal, liver, and coagulation

None

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Propofol and NMB

Increases the depth of blockade NOT THE DURATION

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Propofol induction dose
Alternate
Loss of consciousness within

1.5 - 2.5mg/kg
20 to 40 mg until onset of unconsciousness
60 sec or less

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Propofol dose should be reduced in those patients

Older, hypovolemic and poor cardiac reserve

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Propofol infusion/maintenance dose is

20 to 200 mcg/kg/ min

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Propofol METABOLISM

Hepatic to water-soluble sulfate and glucuronide conjugates

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ETOMIDATE best benefits

Rapid onset and offset
MINIMAL CV effecs
CEREBRAL PROTECTION

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ETOMIDATE is a weak acid or base

Weak base

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ETOMIDATE MOA

Causes neuronal hyperpolarization and subsequent depression of the reticular activating system through the inhibition of neural signals. Increase affinity of GABA receptor for GABA molecule

For Etomidate what is responsible for the rapid offset due to an initial decrease in plasma concentration

REDISTRIBUTION

What kind of diseases can DOUBLE the half time of ETOMIDATE?

Renal or hepatic disease (LOW PLASMA PROTEIN)

For ETOMIDATE: Following an intravenous administration of a bolus, _________exists in the nonionized form in plasma, ______ of which is protein bound, primarily to

99% of etomidate ; 75% ; albumin.

METABOLISM OF ETOMIDATE

Etomidate is metabolized via ester hydrolysis (both plasma and hepatic)

Does ETOMIDATE have active metabolite?

What is the induction dose of ETOMIDATE? loss of consciousness within

0.3mg/kg ; 2 minutes

Maintenance of anesthesia with Etomidate can be achieved via initial infusion rates of______. Goal of therapy is _________ (concentration)

100 mcg/kg/min | 300-500 ng/dL

Etomidate provides cerebral protection by

decreasing cerebral metabolic rate, with a proportional decrease in CBF, thus maintaining an appropriate O2 supply/demand ratio.

ETOMIDATE and MAP

Unaffected

Best induction agent for patients with hemodynamic instability, decreased ejection fraction, coronary artery disease, or valvular heart disease who require a stable CO and MAP

ETOMIDATE

ETOMIDATE and BP

minimally affected

Coronary blood flow will be decreased, as will the myocardial O2 requirement, preserving the O2 supply/demand ratio with this Induction agents

ETOMIDATE

ETOMIDATE and respiratory depression

Minimal depression in TV

ETOMIDATE decreases ICP

Yes

Induction agent Associated with MYOCLONUS

ETOMIDATE

INDUCTION agent associated with PORPHYRIA

ETOMIDATE

How do you reduce the risk of MYOCLONUS in patients receiving ETOMIDATE

The risk of myoclonus can be decreased with concomitant opioid or midazolam use.

Etomidate should not be used in patients with a history of

porphyria

Thrombophlebitis, which can occur

24 to 48 h after the use of etomidate, appears in up to 25% of patients.

What is KETAMINE structurally related to ?

PCP (phencyclidine)

The anesthesia produced by ketamine is termed ______Why?

dissociative | because patients appear to be dissociated from their environment rather than simply nonreactive.

Ketamine is also a recreational drug of abuse (best known under the names

vitamin K and special K).

MOA of KETAMINE: The properties of ketamine are primarily mediated by

Noncompetitive antagonism at N-methyl-d-aspartate (NMDA) receptors, but the drug also has local anesthetic properties.

The most prominent excitatory amino acid in the body?

Glutamate

Ketamine has even been reported to interact

with mu, dela, and kappa opioid receptors

Ketamine inhibits reuptake of the monoamines

epinephrine, dopamine, and serotonin

Ketamine anesthesia is reversed by_______

anticholinesterases, which will elevate aCh

Local anesthetic effect of ketamine has been explained by its interaction with

Na+ channels.

Ketamine CV effects

mimics sympathetic nervous system stimulation, causing increased blood pressure, cardiac output, and myocardial O2 consumption. H

Ketamine and HR and BP

Increase

Ketamine and CO

Increase

This initial action of ketamine on the cardiovascular system is due to

amine reuptake inhibition.

Ketamine alone does not induce respiratory depression, so airway patency is

well maintained during ketamine anesthesia

KETAMINE and airway and Asthma patients

produces bronchodilation so GOOD agent for asthma

KeTAMINE and ICP and CBF

a cerebral vasodilator-->causes an increase in cerebral blood flow and intracranial pressure in patients with space-occupying intracranial lesions

EMERGENCE DELIRIUM associated with this agent

KETAMINE (5-30 % of patients)

KETAMINE administered

IV, IM, SC, SL, PO

Combining ketamine with ________improves postoperative analgesia and reduces side effects.

opioids

remains useful as an agent well suited for short and very painful procedures performed outside the operating room _______

KETAMINE

GABA- A receptors have 5 subunits which are

``` Alpha Beta 1 Beta 2 Beta 2 Gamma 2 ```

This medication acts on all GABA-A receptors

Propofol

Etomidate works on Those GABA-A subunits

B2 and B3

Induction agent associated with Adreno-corticosuppression

ETOMIDATE

Only induction agent with ANALGESIA

Ketamine

ETOMIDATE and N/V

Associated with increased rates of postoperative nausea and vomiting;

Propofol MOA

GABA agonist, increase Cl- ion conductance, Hyperpolarization of cell.

Nitrous on skeletal muscle tone

Increases skeletal muscle tone