IV Agents Flashcards

Question

Physical properties of Sodium Thiopentone?

Answer 1

Barbiturate (anti-convulsant)] Yellow, amorphous powder that can be dissolved in H20/saline Alkaline solution (pH 10,5) Must not be mixed with low pH solutions (i.e. glucose, muscle relaxants) as barbiturates will precipitate Stinky Mix 500 mg ampoule with 20 ml saline = 25 mg/ml (2,5%) Solution stable for 24-48 hours

Answer 2

Adults: 3-5 mg/kg Children: 5-6 mg/kg

Answer 3

``` Smooth LOC (within 30s) Recovery 5-10min Small doses may cause antanalgesia Good anti-convulsant Used in treatment of status epilepticus (brain protection: decreased cerebral metabolic rate of O2 consumption and decreased ICP) ```

Answer 4

↓ CO 10-20% (peripheral vaso-dilatation, negative inotropic effect, ↓ central catecholamine release) Exaggerated in CF, hypovolaemia, fixed CO etc.

Answer 5

POTENT depression of respiratory centre Laryngeal reflexes NOT depressed until deep (early instrumentation may result in laryngospasm) Histamine release (not suited for asthmatics)

Answer 6

Extreme irritant to local tissues (beware extra-vascular and intra-arterial injections)

Answer 7

Prevent: Avoid veins next to known arteries 2,5% (NOT 5%) and test dose ``` Treat spasm: Leave cannula in artery and inject Papaverine 40-80mg in 10-20ml saline Sympathetic block (vasodilates) Anti-coagulation (thrombus) Analgesia ```

Answer 8

Absolute: Porphyria Known allergy to Thiopentone ``` Relative: CF Hypovolaemia Fixed CO Asthma ```

Answer 9

Imidazole derivative pH 8,1 (alkaline) 1 ml ampoules with 2 mg/ml of drug dissolved in water with 35% propylene glycol May be mixed with saline or water to make 1 mg/ml solution Also available in fat emulsion (not to be confused with propofol) Burns on insertion

Answer 10

0,2-0,3 mg/kg

Answer 11

Rapid onset Rapid recovery (6-8min) High incidence of involuntary movement and myoclonus

Answer 12

Very stable | May cause marked bradycardia with synthetic opioids and suxamethonium

Answer 13

Little respiratory depression | No histamine release

Answer 14

High incidence of PONV (“vomidate”) | Anti-emetic recommended

Answer 15

Inhibits cortisol and aldosterone synthesis in the adrenal cortex (one dose suppresses adrenal function 5-8h)

Answer 16

``` Acidic solution Suitable for IV, IM or oral 1% and 10% solutions available Stable in solution Long shelf life ```

Answer 17

When surgical anaesthesia terminated, 50-60% drug still remains in body in active form Main metabolite has weak hypnotic properties (Causes complete analgesia with superficial sleep)

Answer 18

Induction: IV: 1-2mg/kg (onset 30-60s, lasts 5-15min) IM: 5-10mg/kg (onset 3-8min, lasts 10-30min) Maintenance: 0,5mg/kg IV (incremental boluses) OR 1-4mg/kg/hr (infusion) Analgesia: 0,2-0,4mg/kg IV/2-4mg/kg IM, followed by infusion of 0,2-0,2mg/kg/hr

Answer 19

``` IV induction 90s Complete analgesia and amnesia Involuntary movements not uncommon Increases ICP and intra-ocular pressure Psychic reactions during recovery (can be reduced by concurrent administration of benzodiazepines or opioids) ```

Answer 20

Sympathomimetic effect ↑HR ↑BP ↑CO Direct stimulation of central catecholamine release A direct myocardial depressant that may be unmasked if catecholamine stores are depleted

Answer 21

Minimal respiratory depression Pharyngeal reflexes preserved and good airway control (do not need to instrument) Bronchodilation No histamine release Increased bronchial and salivary secretions (administration of a drying agent recommended)

Answer 22

PONV relatively common

Answer 23

May cause uterine contractions in first trimester

Answer 24

``` Poor risk surgical patients Paediatric surgery Burns patients Short procedures Analgesia Anaesthesia in sub-optimal conditions (“field work”) Treatment of status asthmaticus ```

Answer 25

``` CVS disorders Raised ICP Cerebral aneurysms Open eye injuries Increased intraocular pressure Psyche patients Epileptics Thyrotoxicosis Full stomach Early pregnancy Tricylclic antidepressants ```

Answer 26

Rapidly absorbed after oral or IM administration Metabolites have little clinical significance High clearance Short elimination half-life Accumulation less likely to occur than Diazepam, and may be administered as a continuous infusion

Answer 27

Premed (30-60 min pre-op): 7,5-15,0 mg orally | Induction: 0,1-0,3 mg/kg IV

Answer 28

``` Slower induction Good anterograde amnesia Low incidence of excitatory phenomena Anticonvulsant Disorientation after a prolonged period in the elderly ```

Answer 29

Stable Slight fall in BP Small transient increased HR

Answer 30

Benzodiazepine antagonist

Answer 31

Termination of GA induced/maintained with benzo's Reversal of benzo sedation Reversal of benzo OD Diagnostic measure in unconsciousness of unknown origin

Answer 32

0,2 mg IV | A second dose of 0,1 mg may be injected after 60s and repeated every 60s up to a total dosage of 1 mg

IV Agents Flashcards

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