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Nurs 575 Anesthesia Pharmacology > Week 4 Induction agents and benzos > Flashcards

Week 4 Induction agents and benzos Flashcards

1
Q

Predictors for hypotension during Propofol induction?

A
  • Age 50 or older
  • ASA III/IV
  • MAP less than 70mmHg
  • Co-administration of Fentanyl

Nagelhout 7th edition, Ch. 9, pg. 104

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2
Q

Which induction agents are preferred in patients with asthma?

A
  • Propofol
  • Ketamine

Nagelhout 7th edition, Ch. 9, pg. 104

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3
Q

What respiratory effects does Propofol present with?

A
  • Apnea w/ induction doses
  • Decreases in Tidal volume > Decreases in RR
  • Bronchodilatory effects (minimal)
  • Decreases respiratory center sensitivity to CO2

Nagelhout 7th edition, Ch. 9, pg. 104

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4
Q

What miscellaneous effects does Propofol have

A
  • Mild antiemetic
  • Anti-pruritic effects to opioid induced pruritis
  • Pain on injection

Nagelhout 7th edition, Ch. 9, pg. 104-105

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5
Q

What can you do to reduce pain on administration of propofol?

A
  • 20-40mg Lidocaine prior
  • Use larger vein (AC)

Nagelhout 7th edition, Ch. 9, pg. 104-105

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6
Q

Induction dose of Propofol?

A

1-2mg/kg

Nagelhout 7th edition, Ch. 9, pg. 107, Table 9.8

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7
Q

Induction dose of Etomidate

A

0.2-0.3 mg/kg

Nagelhout 7th edition, Ch. 9, pg. 107, Table 9.8

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8
Q

Induction dose of Midazolam?

A

0.1-0.2 mg/kg

Nagelhout 7th edition, Ch. 9, pg. 107, Table 9.8

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9
Q

Induction dose of Dexmedetomidine?

A

1 mcg/kg over 10 min
0.2-0.7 mcg/kg/hr infusion

Nagelhout 7th edition, Ch. 9, pg. 107, Table 9.8

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10
Q

Induction dose of Ketamine?

A

2-4mg/kg IV
4-6mg/kg IM

Nagelhout 7th edition, Ch. 9, pg. 110, Box 9.3

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11
Q

Etomidate’s niche as an induction agent?

A
  • Alternative to propofol
  • Little to no cardiorespiratory effects

Nagelhout 7th edition, Ch. 9, pg. 106

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12
Q

What limits Etomidates use as an induction agent?

A

Adrenocortical suppression of cortisol, aldosterone, corticosterone

  • Occurs due to inhibition of enzymes involved in adrenal steroidogenesis

Nagelhout 7th edition, Ch. 9, pg. 108

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13
Q

What occurs in 10-60% of patients receiving etomidate?

A
  • Myoclonia

Nagelhout 7th edition, Ch. 9, pg. 107

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14
Q

What drugs can we give to minimize myoclonia after etomidate administration?

A
  • Dexmedetomidine
  • Midazolam
  • Lidocaine
  • Rocuronium

Nagelhout 7th edition, Ch. 9, pg. 107

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15
Q

What patients do you see hemodynamic changes with Etomidate?

A
  • Aortic/Mitral valvular disorders

Nagelhout 7th edition, Ch. 9, pg. 108

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16
Q

How does Etomidate inhibit Cortisol and Aldosterone production?

A

It inhibits 11-Beta-hydroxylase from converting

  • 11-deoxycortisol to cortisol
  • 11-deoxycorticosterone to corticosterone -> aldosterone

Nagelhout 7th edition, Ch. 9, pg. 109 - Fig. 9.5

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17
Q

Why has Ketamine historically been avoided in patients with Head injury/increased ICP?

A

Increased:

  • CBF
  • CMRO2
  • ICP
  • CPP
  • IOP

Nagelhout 7th edition, Ch. 9, pg. 104, Table 9.4 & pg. 111

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18
Q

What can be given with Ketamine to offset risks in neurologically impared patients?

A
  • Controlled Ventilation
  • GABA-A receptor agonist (Midazolam)
  • Propofol

avoid N2O too

Nagelhout 7th edition, Ch. 9, pg. 111

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19
Q

Ketamine’s effects on CV measures?

A

Ketamine is a circulatory stimulant

  • Inc. SBP
  • Inc. HR
  • Inc. contractility/CO
  • CVP

SVR seems to be spared/pt dependent

Nagelhout 7th edition, Ch. 9, pg. 111

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20
Q

How does ketamine produce a positive inotropic effect?

A
  • Inhibits neuronal/extraneuronal reuptake of norepinephrine

Nagelhout 7th edition, Ch. 9, pg. 111

21
Q

When would you be concerned Ketamine won’t provide a positive inotropy?

A

In critically ill patients with depleted catecholemine stores, you’ll see a negative inotropic effect.

Nagelhout 7th edition, Ch. 9, pg. 111

22
Q

Respiratory effects of Ketamine?

A

Minor & short duration

  • Maintained ventilation
  • Normal ABGs & CO2 response
  • Inc. pulmonary compliance
  • Decreased pulm. resistance (NE reuptake inhibition)
  • Does increase tracheal, bronchial, & salivary secretions

Why drug of choice in asthmatic patients

Nagelhout 7th edition, Ch. 9, pg. 111

23
Q

Benzodiazepines MoA?

A

Binds to GABA-A receptors to increase affinity for endogenous GABA, which (opens ligand gated Cl- channels) hyperpolarizes the post-synaptic membrane.

Nagelhout 7th edition, Ch. 9, pg. 113

24
Q

Flumazenil MoA

A
  • High affinity competitive GABA-A antagonist
  • Binds to GABA-A receptor without producing increased GABA affinity

Nagelhout 7th edition, Ch. 9, pg. 114

25
CNS effects of Benzos? | 7
* Anxiolysis * Sedation * Sleep * Anesthesia * Anticonvulsant * Anterograde Amnesia * Muscle Relaxing ## Footnote Nagelhout 7th edition, Ch. 9, pg. 114
26
CV effects of Benzos?
* Minimal * May see decrease in BP when Versed coadministered with Fentanyl ## Footnote Nagelhout 7th edition, Ch. 9, pg. 114
27
Respiratory effects of Benzos?
* Dose-dependent respiratory depression * Decreased minute volume * Decreased slope of CO2 response curve Worsened when given with opioids ## Footnote Nagelhout 7th edition, Ch. 9, pg. 114
28
Dose for Flumazenil as reversal?
* 0.2 mg slow titration up to 1mg (3 mg for OD) ## Footnote Nagelhout 7th edition, Ch. 9, pg. 115
29
Onset/DoA Flumazenil
* Onset: 1-2 min * Duration: 45-90 min ## Footnote Nagelhout 7th edition, Ch. 9, pg. 115
30
What patient populations should the use of Flumazenil be avoided?
* Benzo dependent * TCA OD * Antidepressant OD * Known hx of seizures * **Risk of Seizures** ## Footnote Nagelhout 7th edition, Ch. 9, pg. 115
31
Dexmedetomidine's end MoA
α2-andrenergic agonist - results in decreased catecholamine release ## Footnote Nagelhout 7th edition, Ch. 9, pg. 115
32
Precedex's main site of action
* Noradrenergic nucleus in the Locus Coeruleus ## Footnote Nagelhout 7th edition, Ch. 9, pg. 115
33
CNS effects of Precedex? | 6
* Decreased CBF d/t cerebral vasoconstriction * Decreased emergence delirium * Anti-shivering * Decreased neuroendocrine response to surgical stimulation * Decreased withdrawl effects from opioids, sedative, & ETOH * Enhances analgesia ## Footnote Nagelhout 7th edition, Ch. 9, pg. 116
34
CV effects of Precedex?
* Bradycardia * Hypotension * Decreased myocardial oxygen demand (antianginal) ## Footnote Nagelhout 7th edition, Ch. 9, pg. 116
35
Other effects of Precedex?
* Mild diuretic via α2 stimulation * Antiinflammatory * Gastro/renal protective * Decreased incidence of emergence delirium in pediatrics ## Footnote Nagelhout 7th edition, Ch. 9, pg. 116
36
What two drug pathways have exhibited neurotoxic effects in animal studies?
* Increase inhibitory GABA pathways (Propofol, Des, Iso, Sev, & Etomidate) * Block excitatory glutamate pathways (Ketamine) ## Footnote Nagelhout 7th edition, Ch. 9, pg. 116
37
Diprivan contains which perservative?
Disodium edetate (EDTA) ## Footnote Nagelhout 7th edition, Ch. 9, pg. 102, Table. 9.1
38
Generic Propofol could contain which perservatives?
* Sodium Metabisulfite * Benzyl Alcohol ## Footnote Nagelhout 7th edition, Ch. 9, pg. 102, Table 9.1
39
Which sedative(s) **decrease** CBF, CPP, ICP, CMRO2 & IOP upon administration?
* Etomidate * Propofol ## Footnote Nagelhout 7th edition, Ch. 9, pg. 104, table 9.4
40
Which sedative(s) **increase** CBF, CPP, ICP, CMRO2 & IOP upon administration?
* Ketamine ## Footnote Nagelhout 7th edition, Ch. 9, pg. 104, table 9.4
41
Midazolam's effect of CBF, CPP, CMRO2, ICP & IOP?
* CBF - Up or down * CPP decrease * CMRO2 decrease * ICP/IOP Decrease ## Footnote Nagelhout 7th edition, Ch. 9, pg. 104, table 9.4
42
Dexmedetomidine's effect of CBF, CPP, CMRO2, ICP & IOP?
* CBF decrease * CPP up or down * CMRO2 - no change * ICP/IOP decrease ## Footnote Nagelhout 7th edition, Ch. 9, pg. 104, table 9.4
43
When should syringes/vials with Propofol be discarded if they were used/accessed?
6 hours ## Footnote Nagelhout 7th edition, Ch. 9, pg. 101
44
By what mechanism do the effects of Propofol primarily dissipate?
* Rapid redistribution from central to peripheral compartments ## Footnote Nagelhout 7th edition, Ch. 9, pg. 101
45
Which induction agent enhances the analgesia from opioids and prevents hyperalgesia?
Ketamine ## Footnote Nagelhout 7th edition, Ch. 9, pg. 110
46
Which Benzodiazepene(s) were formulated for anesthesia?
* Midazolam * technically Remimazolam ## Footnote Nagelhout 7th edition, Ch. 9, pg. 113
47
Procedural sedation dose for Remimazolam?
5mg IV & 2.5-5mg q 2min PRN ## Footnote Dr. C's PPT, slide 45
48
Which sedative's ability to lower seizure threshold is the gold standard in ECT?
* Methohexital ## Footnote Dr. C's PPT, Slide 54

Nurs 575 Anesthesia Pharmacology (18 decks)

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