Sedative Hypnotic Flashcards

Question

Etomidate Respiratory Effect s

Answer 1

minimal depression on ventilatory response to C02 ^maintains response to C02 increase RR can stimulate ventilation [[useful when maintenance of spont ventilation is desired]] decreases TV [[more shallow breathing]] Hiccups, coughing

Answer 2

give Etomidate

Answer 3

MINIMAL lack of effect of ANS--> SNS, baroreceptors ***HR, ABP, PAP, CO, SVR, PVR unchanged

Answer 4

dose dependent reversible inhibition of 2 enzymes in biosynthesis of cortisol/ aldosterone 11- beta hydroxyls [[major]] 17-alpha hydroxyls [[minor]] prevents the conversion from cholesterol to cortisol **need cortisol to manage stress one shot deal in OR clinical significane is not that big a deal

Answer 5

adrenocortical suppress for 4-8hrs reduces mineralococorticoid and cortisol production dose dependent etomidate can reversible inhibit 2 enzymes in the biosynthesis of cortisol and aldosterone [[prevents conversion of cholesterol to cortisol]]

Answer 6

High incidence give antiemetic [[propofol has anemic properties]]

Answer 7

induction; 0.2 - 0.6 mg/ kg [[typical dose; 0.3 mg/kg]] Maintenance; 10 mcg/ kg/ min ^with N20 and OPIOD [[no analgesia effect]] sedation; 5 - 8 mcg/ kg/ min ^for short procedure Rectal 6.5 mg/kg in Peds

Answer 8

High incidence of NV Higher incidence of myocluns [[dis-inhibition of extrapyrmadial system in CNS Enhances NMDR activity [[mech of action is still GABA]]

Answer 9

Remember to activate need; 2 glutamate 2 glycine allows cations; NA, K, Ca to pass also need AMPA to remove MG pore blocker

Answer 10

liver; ester hydrolysis of N- dealkylation to carboxylic acid biotransformation 5x faster than thiopental [[barb]] 85 % excreted by kidneys 13% biliary excretion 2% excreted unchanged [[safe in renal failure only 2% excreted unchanged]]

Answer 11

phencyclidine derivative lipid soluble prepared in acidic solution racemic mixture of equal parts R and S enantiomers s-enantiomer has been isolated *more potent analgesic [[undergoes faster metabolism and has lower incidence of emergence delirium]]

Answer 12

interacts with many receptors -NMDA receptors;excitatory ligand gated channel [[glutamate and glycine bind to NMDA]] -Opioid Mu, Delta, Kappa, Sigma[[not an opioid receptor]] -Monoaminergic; descending inhibitory pathways for pain [[activates to fight pain]] ``` -inhibits Muscarinic - antagonists antiCHOLINERGIC [[G alpha q or G alpha i]] q --> increased Ca i --> inhibits; decreased cAMP [[constricts]] ^but Ketamine inhibit this ``` -inhibits Calcium Channels

Answer 13

activates NMDA receptors opening of non selective cation channel [[Na, K, Ca]] Ca flux through NMDA receptors is whats thought to play the critical role in synaptic plasticity [[learning and memory]] NMDA is both ligand gated and voltage dependent

Answer 14

Ketamine inhibits the spinal NMDA receptor; glutamate [[primary excitatory NT; play an important role in spinal nociceptive [[pain]] pathways allows for management of post pain

Answer 15

**active metabolite First pass effect metabolized by hepatic microsomal enzymes hydrolysis to form N-demethylation ``` **active metabolite; norketaminie ^minimally active only about 20% then hydroxylated to; hydroxynorketamine ``` conjugated to water soluble Kidneys excrete in urine body clearance is roughly equal to liver blood flow **changes in liver blood flow effect clearance!

Answer 16

KETAMINE and PROPOFOL

Answer 17

2 compartment model [[vessel rich and vessel poor]] High lipid solubility [[potent]] RAPID onset; pKa 7.5 ^peak plasma concentration occurs within 1 min of IV SHORT duration [[protein binding]] Large Vd 3 L/kg E 1/2 t; 2 - 3 hours

Answer 18

protein binding

Answer 19

lipid solubility

Answer 20

Vd propofol 3.5 - 4.5 L/kg etomidate 2.5- 4.5 L/kg ketamine 3 L/kg

Answer 21

E1/2 t propofol E1/2 t; 0.5 - 1.5 hours etomidate E1/2 t; 3 -5 hours Ketamine E1/2 t; 2-3 hours Dex E1/2 t; 2-3 hours

Answer 22

crosses BBB biggest difference ******Depresses neuronel function in; cerebral cortex thalmaus stimulates neuronal function in hippocampus [[dissociative state]] onset 30 seconds max effect within 1 min of IV injection pKa 7.5 [[very close to pH 7.4]] termination of effect is rapid after single bolus [[15 min r/t redistribution]] * amnesia but not as much as benzos and propofol;

Answer 23

Benzos [[versed, atiivan, valium]] propofol >30mcg/kg/min ketamine but not as much

Answer 24

Depress neuronal activity in cerebral cortex thalamus and stimulates the hippocampus [[dissociative state]] ex. hear red but associate it was something else, feel like you aren't you; your body does belong to you sub anesthetic doses need to be careful [[lights down, minimal stim, decrease noise]] *benzos can help with dissociative state [[give versed then induce with ketamine]] ``` also ketamine increases ICP CBF CMR02 IOP ```

Answer 25

nystagmus [[eye movement]] pupil dilation salivation lacrimation myoclonus increased skeletal muscle tone ``` ****ketamine increases CBF ICP CMR02 IOP ^this is why we dont use in neuro patient ``` emergence reaction from dissociative state [[out of body experience, dreaming, excitement, illusion, euphoria, fear

Answer 26

10-30 % of patients who receive Ketamine as part of anesthetic experience emergence delirium *give premed of benzo and it will help with this

Answer 27

patients with increased ICP/ tumor and psych patients bc of emergence delirium

Answer 28

spinal analgesia IV; | 0.2 - 0.5 mg/kg

Answer 29

mu receptor in spinal cord is where activity is coming from | s- enantiomer is better at analgesia

Answer 30

higher affinity as NMDA receptor better at analgesia and less emergence delirium [[R enantiomer better for depression but causes more emergence delirium]]

Answer 31

MINIMAL **really good for asthmatic and COPD patient sympathomimetic [[increases SNS activity activate B2 --> bronchodilator ]] however; increases PVR and salivation **avoid in pulmonary HPTN

Answer 32

its a Sympathomimetic ^Increases SNS activity to bronchioles **Bronchodilation but increases PVR avoid in pulmonary HPTN

Answer 33

Sympathomimetic [[NMDA effect]] **not peripheral effect think activity in nucleus tractus solitairus increases BP, HR and CO [[only if pt has good norepi stores]] inhibits the reuptake of norepi increases myocardial work from the sympathetic nervous system activity ketamine on it own is a CARDIAC DEPRESSANT [[remove your SNS activity]] ketamine will depress CV system elderly, trauma patient with decreased SNS outflow [[critically ill pt will decreased norepi stores --> ketamine is doing to depress CV system]]

Answer 34

elderly pt trauma ot critically ill pt anyone with deceased SNS outflow; ketamine will be a direct myocardial depressant only reason ketamine isn't a myocardial depressant in healthy individuals is bc of indirect SNS activity

Answer 35

sedative/ analgesic 0.2 - 0.5 mg/kg induction ; IV; 1 - 2 mg/kg IM; 4 -8 mg/ kg maintenance; 1 - 2 mg/kg/ hr PO and nasal 6 mg/ kg [[first pass effect]]

Answer 36

Neuro pt with increased ICP, tumor eye surgery; increases IOP Pt with pulmonary HPTN pt with systemic HPTN not intact SNS elderly, trauma pt, critically ill coronary artery disease [[increases work of heart bc of SNS activity increased BP, HR, CO]] vascular aneurysms ^increases BP psych diseases or personality disorder ^emergence delirium

Answer 37

MAO break down epi and norepi now we inhibit MAO and it increases epi and norepi bc not breaking it down [[antidepressant drug]] not we give them ketamine that inhibits the retake of norepi ALOT of norepi alot of CV changes

Answer 38

water soluble selective alpha -2 adrenergic agonist [[G alpha i --> decreased cAMP, increases K conductance ]] Decreases BP and HR produces sedation that most closely mimics sleep does this by impacting; locus ceruleus [[where norepi is produced]] and analgesia comes from dex acting on Mu receptor on spinal cord

Answer 39

vasodilator sedation pain

Answer 40

area in brain that produces norepi dex impacts this area and this is how it it able to closely mimic physiologic sleep

Answer 41

decreased CBF without changing ICP and CMR02 decreases MAC of volatile agents and opioids dex use with anesthetic gasses and opioids allows your to decrease the dose [[inhibits CYP450, how opioids are metabolized, longer duration, decrease dose]] decreases thermoregualtion and inhibits shivering

Answer 42

**bradycardia decreased SVR and BP bolus can increase BP and decrease HR [[decreases CO]] potential for severe bradycardia, heart block and systole attenuate [[reduce]] CV effects with noxious stim [[decreases catecholamine level during GA ^no HR change with intubation

Answer 43

epi norepi dopa

Answer 44

decreased TV no change in RR ^hypoxia from change in TV [[have oxygen]] no change in C02 drive possible upper airway obstruction [[have our airway equipment]]

Answer 45

RAPID conjugation n-methylation hydroxylation metabolites cleared in urine and bile 90% protein bound E1/2 t; 2-3 hours inhibits CYP450 interferes with clearance of other drugs [[opioids duration prolonged; decrease dose]]

Answer 46

ADJUNCT to GA 1 mcg/kg BOLUS over 10-15 min 0.2 - 1 mcg/kg/hr infusion decreases MAC of volatile anesthetics and opioids [[produces some analgesia at spinal cord, mimics physiological sleep bc works on alpha2 and can attenuate HR changes with intubation]]

Answer 47

it most closely mimics physiological sleep produces analgesia decreases MAC for volatile anesthetics and opioids attenuaste HR response to intubation

Answer 48

specific and selective antagonist for dexmetatomidine will rapidly and effectively reverse sedative AND CV effects

Answer 49

Barbiturates --> phenoxybenzamine [[used to reverse effects of accidental arterial injection]] Benzo --> Flumanezol [[noncompetive antagonist]] Dex --> Antipamezole [[reverses sedation and HR]]

Sedative Hypnotic Flashcards

(74 cards)