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KM (Spring 2024) Anesthesia Pharm ** > Induction Meds: Propofol > Flashcards

Induction Meds: Propofol Flashcards

(45 cards)

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1
Q

What is the most common concentration of a 1% solution?

A
  • 10mg/mL

S39

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2
Q

What are the inactive ingredients in propofol? Why is one particularly important?

A
  • 1.2% Lecithin (from egg yolks) can cause anaphylaxis with egg allergies.
  • 2.25% glycerol
  • 10% soybean oil

S39

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2
Q

What are the disadvantages of propofol’s inactive ingredient composition?

A
  • ↑ bacterial growth
  • ↑ plasma triglycerides with prolonged infusions
  • Pain on injection

S39

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3
Q

Differentiate Ampofol and Aquavan.

A

Ampofol:
- low-lipid
- no preservative that burns on injection more often.

Aquavan:
- prodrug with less injection pain but causes dysesthesias. –
- Slower onset
- larger Vd
- high potency.

S40

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4
Q

What is the mechanism of action of propofol?

A

GABA-A receptor modulator that increases Cl⁻ conductance.

S41

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5
Q

How does propofol cause immobility through spinal cord-depression?

A
  • Trick question. Immobility from propofol is not from drug-induced spinal cord depression.
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6
Q

What are the clearance characteristics of propofol?

A

The clearance of propofol is primarily through hepatic metabolism
with minor contributions from renal clearance and pulmonary elimination.

S 42

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7
Q

What metabolizes propofol?

A

CYP450 and UGT1A9

S42

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8
Q

What is the E ½ time of propofol?

A
  • 30 - 90 minutes

S 42

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9
Q

What is the context-sensitive half-time of propofol?
Is this low or high?

A
  • 40 minutes (for an 8 hours infusion)
  • Low CS ½ time.

S42

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10
Q

Differentiate blood pressure and heart rate changes that occur with propofol vs thiopental.

A
  • Propofol: ↓BP & ↓HR
  • Thiopental: ↓BP & ↑HR
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11
Q

Does propofol cross the placenta?
What are the consequences of this?

A
  • Yes but is rapidly cleared from neonatal circulation.

S45

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12
Q

Do cirrhosis and renal dysfunction have significant effects on propofol metabolism?

A

No

S45

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13
Q

What drug is the induction drug of choice?

A

Propofol

S46

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14
Q

What is theinduction dose of propofol in adults and children?

A
  • Adults: 1.5-2.5 mg/kg IV
  • Pediatrics:** higher doses** due to larger central volume and clearance rate.
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15
Q

What is the induction dose of propofol in the elderly?

A

1 mg/kg IV (25 - 50% lower than regular adult)

S47

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16
Q

What plasma Propofol levels would correlate with unconsciousness?
What about awakening?

A
  • Unconscious: 2 - 6 μg/mL
  • Awake: 1 - 1.5 μg/mL

S47

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17
Q

What is the conscious sedation dose of Propofol?

A

25 - 100 μg/kg/min

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18
Q

What are the characteristics of Propofol in the context of conscious sedation?

Study These Flashcards
A
  • Minimal analgesia but has anti-convulsive and amnestic properties.
  • Prompt recovery w/ low residual sedation
  • ↓ risk of PONV
  • Midazolam or opioids as adjuncts.

S47

19
Q

What are the anti-emetic properties of Propofol?
Why is this thought to occur?

Study These Flashcards
A
  • Very anti-emetic (more effective than Ondansetron)
  • Direct depressant of vomiting center

S49

20
Q

What is the sub-hypnotic dosing for propofol?

Study These Flashcards
A

10 - 15 mg IV, followed by 10 mcg/kg/min

S49

21
Q

What is the anti-pruritic dosing of propofol?

Study These Flashcards
A

10 mg IV

from Neuraxial opioids or cholestasis

S50

22
Q

What is the anti-convulsant dosing of Propofol?

Study These Flashcards
A

1 mg/kg IV

S50

23
Q

What are “other” category benefits of propofol?

Study These Flashcards
A
  • Bronchodilation
  • Anti-emetic
  • Anti-pruritic
  • Anti-convulsant
  • Low dose analgesia
  • Antioxidant
  • Does not trigger MH

S50

24
What are Propofol's effects on CMRO₂, CBF, and ICP?
- ↓ CMRO₂, CBF, and ICP ## Footnote S51
25
Large doses of Propofol may ___________ cerebral perfusion pressure.
decrease ## Footnote S51
26
Though Propofol will not produce seizures, it will produce __________.
myoclonus (involuntary twitching or jerking) ## Footnote S51
27
Between thiopental, propofol, and isoflurane, which is the least EEG suppressive?
Propofol ## Footnote S52
28
Which would decrease blood pressure more: thiopental or propofol?
Propofol ## Footnote S53
29
What is the mechanism for propofol-induced hypotension? What conditions will exaggerate this effect?
- SNS inhibition causing ↓SVR and ↓ ICF Ca⁺⁺ - exaggerated in Hypovolemia, elderly, and LV compromise ## Footnote S53
30
How is propofol-induced hypotension from induction usually counteracted?
- Intubation (from laryngeal stimulation).
31
Why is bradycardia seen with propofol? What would occur with propofol overdose?
- ↓SNS response & baroreceptor reflex depression. - Profound bradycardia & eventual asystole with overdose ## Footnote S54
32
What are the pulmonary effects of propofol? How does this change with opioids?
- Dose-dependent depression of respiratory drive. - **Synergistic** resp depression with opioids - Intact hypoxic pulmonary vasoconstriction response - Painful surgical stimulation counteracts the ventilatory depressant effects ## Footnote S55
33
What severe condition(s) can occur with prolonged Propofol infusions?
Hepatocellular injury or Propofol Infusion Syndrome. ## Footnote S56
34
What is Metabolic acidosis thought to occur from poisoning of electron transport chain and impaired oxidation of fatty acids?
Propofol Infusion Syndrome ## Footnote S57
35
What relatively benign condition(s) can occur from prolonged propofol infusions? Why does this happen?
**Green and cloudy urine** from phenols and uric acid crystals. *Neither alters renal function.* ## Footnote S56
36
What infusion dosing can result in Propofol Infusion Syndrome?
>75 μg/kg/min for longer than 24 hours ## Footnote S57
37
What is the worst side effect in children who have Propofol Infusion Syndrome?
- Severe, refractory, **fatal bradycardia** ## Footnote S57
38
What are the symptoms of Propofol Infusion Syndrome? How is Propofol Infusion Syndrome diagnosed?
- Urine changes, lactic acidosis, brady-dysrhythmias, and rhabdomyolysis. - ABG & serum lactate concentrations *Reversible in the early stage ## Footnote S57
39
What are the "other" organ system effects of propofol?
- Injection pain (give lido before) - ↓ IOP - Plt aggregation inhibition - Allergic reactions (lecithin) - Prolonged myoclonus - Abuse/misuse ## Footnote S58
40
What is the *Induction dose* of Propofol
1.5 - 2.5 mg/kg IV ## Footnote S37
41
What is the *conscious sedation dose* of Propofol?
25 - 100 µg/kg/min ## Footnote S37
42
What is the maintenance dose of Propofol?
100 to 300 µg/kg/min ## Footnote S37
43
What does rapid injection (<15 seconds) of Propofol produce?
unconsciousness within 30 seconds ## Footnote S37
44
What is the clearance of Propofol?
30 - 60 mL/kg/min ## Footnote S42 and S44

KM (Spring 2024) Anesthesia Pharm ** (101 decks)

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