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AS - N928 Basic Principles of Anesthesia > Induction Drugs > Flashcards

Induction Drugs Flashcards

(51 cards)

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1
Q

Midazolam

A

Available 1-5mg/mL
Use 3mL syringe
Dose 0.02-0.04mg/kg IV

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2
Q

Fentanyl

A

Available 50mcg/mL
Use 5mL syringe
Dose 1-3mcg/kg
High-dose as sole anesthetic 50-150mcg/kg (cardiac surgery induction)

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3
Q

Lidocaine 2%

A

Available 20mg/mL
Use 5mL syringe
Dose 1-1.5mg/kg IBW

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4
Q

Propofol

A

Available 10mg/mL
Use 20mL syringe
Dose 1.5-2.5mg/kg

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5
Q

Etomidate

A

Available 2mg/mL

Dose 0.2-0.4mg/kg

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6
Q

Ketamine

A

Available 5-100mg/mL
Dilute to 10mg/mL
Dose 1-2.5mg/kg

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7
Q

Succinylcholine

A

Available 20mg/mL
Use 10mL syringe
Dose 0.5-1.5mg/kg
RSI 1.5mg/kg

*Based on ACTUAL body weight

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8
Q

Rocuronium

A

Available 10mg/mL
Use 3mL syringe
Dose 0.6 OR 1.2mg/kg (RSI)

*Based on IBW

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9
Q

Vecuronium

A

Available 1-2mg/mL
Use 5-10mL syringe
Dose 0.08-0.1mg/kg

*Based on IBW

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10
Q

Cisatracurium

A

Available 2mg/mL
Dose 0.15-0.2mg/kg

*Based on IBW

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11
Q

Midazolam PK/PD

A 
GABA allosteric 
Phase 1 oxidation via CYP450
Active metabolites x2
Elimination not altered by renal failure
Exaggerated effects in liver dysfunction
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12
Q

Midazolam Onset

A

2min

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13
Q

Midazolam Duration

A

1-6hr

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14
Q

Midazolam SE

A 
↓CBF & CMRO2
Not neuroprotective
Antegrade amnesia
Dose dependent respiratory depression
Minimal cardiac effects
Fetal depression
Contraindicated in pregnancy
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15
Q

Fentanyl PK/PD

A

Phenylpiperidine
Opioid agonist
Pulmonary 1st pass effect → 2° peaks
Phase 1 oxidation

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16
Q

Fentanyl Onset

A

2-5min

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17
Q

Fentanyl Duration

A

0.5-1hr

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18
Q

Fentanyl SE

A 
Allergy extremely rare
Ø cross-reactivity 
Elderly exaggerated response d/t ↓clearance
Similar side effects to Morphine
NO histamine release
Bradycardia 
Minimal ↑ICP
Seizure activity & myoclonus
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19
Q

Lidocaine PK/PD

A

Local anesthetic
Weak base amide
Preferentially binds to open & inactive VGNa+ channels
Blocks K+ channels, Ca2+ channels, & GPCRs to lesser extent
Pulmonary 1st pass effect
Hepatic metabolism via CYP450

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20
Q

Lidocaine Onset

A

45-90sec

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21
Q

Lidocaine Duration

22
Q

Lidocaine SE

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A

Blunts SNS response to intubation
Improves bowel function return in laparoscopic cases
Accumulation & toxicity concern (infusion)
ERAS protocol

23
Q

Propofol PK/PD

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A 
Sedative hypnotic
GABA allosteric
Hyperpolarizes cell via Cl¯ channels
Weak acid
Oxidation via CYP450
Active metabolite (insignificant)
Pulmonary 1st pass effect
24
Q

Propofol Onset

25
Propofol Duration
5-10min
26
Propofol SE
``` Neuro protectant ↓CBF, ICP, CPP, CMRO2 Myoclonus Bronchodilation Respiratory depression Hypotension PRIS No analgesic properties Caution in cardiac compromised patients Lecithin or sulfate allergy (asthmatics) Decrease dose in elderly ```
27
Etomidate PK/PD
``` Sedative hypnotic GABA allosteric α2B adrenergic receptors Imidazole ring Single isomer R 5x more potent 75% albumin bound Rapid distribution Metabolism plasma esterases via hydrolysis & hepatic CYP enzymes ```
28
Etomidate Onset
30-60sec
29
Etomidate Duration
3-10min
30
Etomidate SE
↓CBF & CMRO2 ↓ICP maintain CPP Myoclonus ↓TV ↑RR Ideal induction agent w/ unstable cardiac patient Maintain BP No analgesic properties ↑PONV incidence Adrenocortical suppression (inhibits 11β-hydroxylase) Contraindicated in porphyrias & critically ill septic shock
31
Ketamine PK/PD
``` Sedative hypnotic N-methyl-D-aspartate antagonist Disassociation between thalamocortical & limbic systems Weak GABAa action Racemic mixture Oxidation via CYP450 Dependent on hepatic blood flow Norketamine active metabolite ```
32
Ketamine Onset
30sec
33
Ketamine Duration
5-15min Return to consciousness 10-20min Full orientation 60-90min
34
Ketamine SE
``` Dissociative anesthesia Airway reflexes intact ↑secretions Potent amnestic/analgesic ↑ CBF, ICP, CMRO2 Nystagmus ↑IOP Maintain spontaneous respirations Bronchodilation SNS activation ↑HR ↑SVR Contraindicated in ophthalmic procedures ```
35
Succinylcholine PK/PD
Depolarizing NMB (agonist-antagonist) Binds to nAChR & prevents ACh binding ACh molecules linked via acetate methyl groups Rapid hydrolysis via butyrylcholinesterase PChE NO fade Only Phase I Dibucaine # >70 Heterogenous atypical 40-60 Homogenous <30 Elderly slower onset d/t ↓circulation & ↓PChE levels
36
Succinylcholine Contraindications
- Burn patients - Abdominal infection - Metabolic acidosis - Closed head injury - nAChR upregulation - Myoglobinuria - Pediatric patients <5yo
37
Succinylcholine Onset
30-60sec
38
Succinylcholine Duration
5-15min
39
Succinylcholine SE
``` Bradycardia or tachycardia Hyperkalemia 0.5mEq/dL Ventricular dysrhythmias ↑ICP & IOP ↑abdominal pressure Myalgias *Malignant hyperthermia ```
40
Rocuronium PK/PD
``` Steroidal Non-depolarizing neuromuscular blocker nAChR antagonist Competitively antagonizes ACh to block depolarization Hepatic & renal excretion Most commonly used & inconsistent ```
41
Rocuronium Onset
2-3min | RSI 1min
42
Rocuronium Duration
30-60min | Intermediate
43
Rocuronium SE
Allergic reactions | Histamine release
44
Vecuronium PK/PD
``` Steroidal Non-depolarizing neuromuscular blocker nAChR antagonist Pancuronium w/o quaternized methyl group ↓potency 1° hepatic metabolism Renal unchanged Elim 50-60% hepatic & 40-50% renal 3-OH metabolite ```
45
Vecuronium Onset
2-3min | Peak 5-7min
46
Vecuronium Duration
30-60min | Intermediate
47
Vecuronium SE
AVOID in renal impaired patients
48
Cisatracurium PK/PD
Benzylisoquinolinium Non-depolarizing neuromuscular blocker nAChR antagonist Hoffman elimination - spontaneous degradation
49
Cisatracurium Onset
2-4min
50
Cisatracurium Duration
30-60min | Intermediate
51
Cisatracurium SE
NO histamine release Atracurium cis-isomer DOC hepatic & renal failure

AS - N928 Basic Principles of Anesthesia (18 decks)

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