IV

Question 1

Propofol:
Onset

Duration

Dose

Answer 1

30-60 Seconds

5-10 minutes

2mg/kg - Induction

Question 2

Propofol:
Pka and preservative

Answer 2

11

Diprivan - disodium edetate
Generic - sodium metabisulfite(causes bronchospasm)

Question 3

What is unique to propofol?

Answer 3

Antioxidant through free radical scavenging

-green urine due to phenol

-Cloudy due to increased uric acid

-no analgesia

Question 4

Can you give a patient with an egg allergy propofol?

Answer 4

Probably, they are allergic to the albumin in egg whites.
The product used (lecithin) in prop is derived from the yolk

Question 5

What is propofol infusion syndrome?

Answer 5

Related to long chain fatty acids that impairs oxidative phosphorylation and fatty acid metabolism. This starves the cell of O2

Question 6

Risk factors for prop infusion syndrome?

Answer 6

dose > 4mg/kg/hour

infusion > 48 hours

Sepsis, steroids, catecholamines

cerebral injury

children

Question 7

How does prop infusion syndrome presented?

Answer 7

Acute refractory bradycardia that leads to asystole PLUS

metabolic acidosis
Rhabdo
Fatty liver
Renal failure
HLD
Lipemia

Question 8

Treatment for prop infusion syndrome?

Answer 8

Pacing
ECMO
PDE inhibitors
CRRT

Question 9

Prop dose to achieve antipruritic and antiemetic effects?

Answer 9

10mg

Question 10

Difference with fospropofol and propofol?

Answer 10

• genital burning
  -no burning on injection
  -doesn’t support bacterial growth

Question 11

Fospropofol:
Onset
Duration
Dose

Answer 11

-5-13 minutes
-15-45 minutes
-6.5 mg/kg

Question 12

Ketamine receptors?

Answer 12

NMDA

Secondary:
Opioid, MAO, serotonin, muscarnic, NE

Dissociates the thalamus from the limbic system

Question 13

Ketamine:

Dose
Duration
Onset

Answer 13

Dose:
IV- Induction 1-2mg kg
IM - 5mg/kg
PO-10mg/kg

Duration - 10-20 minutes
Onset - 45 seconds

Question 14

Ketamine cardio effects?

Answer 14

Increased SNS tone unless <0.5mg/kg

Myocardial depressant if SNS is not intact

Question 15

Ketamine respiratory effects?

Answer 15

-Bronchodilation and increased secretions

-MAINTAINS muscle tone and respiratory drive

Question 16

Ketamine CNS effects?

Answer 16

-Increases everything and causes analgesia

-Blocks wind up

Question 17

Protein binding of IV anesthetics?

Answer 17

All very high except ketamine - 12%

Question 18

Etomidate:
Dose
Onset
Duration

Answer 18

.2-.4 mg/kg

30-60 seconds

5-15 minutes

Question 19

Etomidate key notes:

Answer 19

-Maintains hemodynamic stability (small SVR drop)

-Does not block SNS response to DL

-Mild resp depression

-Decreases all CNS effects

-NO analgesia

-HIGH PONV

-Suppresses adrenal gland through (11-b Hydroxylase)

-Myoclonus (can lead to seizure)

Question 20

What is porphyria?

Answer 20

Defect in heme synthesis which is a key component of Hgb, myoglobin, and P450

Acute is worse

Question 21

Signs and symptoms of porphyria

Answer 21

• first sign is severe abdominal pain

-anxiety, confusion

-weakness

AVOID STRESS AND NPO STATUS

Question 22

Drugs to avoid in porphyria

Answer 22

-Barbiturates
-Ketamine
-Etomidate

-Toradol
-CCB’s
-Birth control
-Amio

Question 23

How is porphyria treated?

Answer 23

-liberal hydration
-Glucose (reduces ALA synthase)
-Heme arginate
-Prevent hypothermia

Question 24

Potency of Benzo’s greatest to least

Answer 24

ativan, versed, valium

Question 25

What type of amnesia do benzo's provide?

Answer 25

ANTEGRADE, do not impair memories from before (retrograde)

Question 26

Effects of benzo's?

Answer 26

Minimal change with sedation dose Everything decreases with induction dose

Question 27

Which induction agents undergo biotransformation in the plasma?

Answer 27

-Fospropofol (prodrug) -Etomidate (esterases)

Question 28

Which drugs cause pain on injection?

Answer 28

1. Valium 2. Etomidate 3. Propofol

Question 29

What enzymes does etomidate suppress?

Answer 29

11 beta hydroxylase 17 alpha hydroxylase

Question 30

What two organs metabolize propofol?

Answer 30

Liver and Lungs

Question 31

IV, PO, and IM dose of Ketamine?

Answer 31

Induciton 1-2mg/kg PO 10mg/kg IM 4-8mg/kg

Question 32

Dose of etomidate ?

Answer 32

.2-.4mg/kg

Question 33

When can thiopental be used for neural protection?

Answer 33

focal ischemia(temp stroke, carotid) NOT global (MI)

Question 34

Process for heme

Answer 34

Succinyl-CoA +glycine ALA synthase Precursors Heme

Question 35

What to avoid with porphyria

Answer 35

Barbiturates Etomidate Ketamine Ketorolac Amio CCB Birth control Emotional stress Prolonged NPO

Question 36

What happens if thiopental is injected into the bloodstream? How is it treated?

Answer 36

Extreme vasoconstriction and crystal formation Alpha blocker or Sympathectomy - stellate ganglion or brachial plexus block

Question 37

What is the dose for methohexitol?

Answer 37

1-1.5mg/kg

Question 38

Dose, Duration, Onset and Clearance of Precedex?

Answer 38

Dose-1mcg/kg Onset- 10-20 minutes Duration - 10-30 min Clearance - Liver

Question 39

Other routes Precedex can be given?

Answer 39

Buccal and Nasal 3-4mcg/kg - 1 hour before surgery

Question 40

How do benzo's and Gaba agonists affect the Gaba channel?

Answer 40

Block Benzo's cause frequent opening Others keep channel open

Question 41

What is the PO dose versed? Bioavailability?

Answer 41

0.5-1mgkg 50% due to first past

Question 42

What drugs can produce isoelectic on EEG?

Answer 42

Propofol and Barbiturates NOT Benzos

Question 43

Unique features to remimidaz

Answer 43

Ultra short - plasma esterase Must protect from light and discard after 8 hours Contradicted with hypersensitivity to Dextran 40

Question 44

Unique features of Flumazenil

Answer 44

Very high affinity but short duration Initial dose is .2mg followed by .1mg Q1 min Competitive Antagonist

Question 45

How does adding fluoride Ions affect the drug?

Answer 45

Decreased potency Increased Vapor pressure Increased resistance to biotransformation