Ketamine

Question 1

Presentation

Answer 1

200mg in 2ml vial

Question 2

Pharmacology

Answer 2

A rapid acting dissociative anaesthetic agent (primarily an NMDA receptor antagonist)
Actions:
Produces a dissociative state characterised by:
A trance-like state with eyes open but not responsive
Nystagmus
Profound analgesia
Normal pharyngeal and laryngeal reflexes
Normal or slightly enchanted skeletal muscle tone
Occasionally a transient and minimal respiratory depression

Question 3

Metabolism

Answer 3

By the liver and excreted by the kidneys

Question 4

Indications

Answer 4

Extreme agitation

Question 5

Contraindications

Answer 5

Known hypersensitivity
Severe hypertension (SBP>180)

Question 6

Precautions

Answer 6

Any condition where significant elevation of both would be hazardous

• hypertension
• CVA
• recent AMI
• CCF

Question 7

Route of admin

Answer 7

IM

Question 8

Side effects

Answer 8

Cardiovascular:
Increase in BP and HR

CNS:
Respiratory depression or apnoea
Emergence reactions (nightmares, restlessness, vivid dreams, confusion, hallucinations, irrational behaviour)
Enchanted skeletal tone
Nausea and vomiting

Ocular:
Diploma and nystagmus with slight increase in intraocular pressure

Other:
Local pain at injection site
Lacrimation
Salivation

Question 9

Special notes

Answer 9

IV
Onset: 30 seconds
Peak: n/a
Duration: 10 minutes

IM
Onset: 3-4 minutes
Peak: n/a
Duration: 12-25 minutes