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95 Cards in this Set
- Front
- Back
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Does protein bound mean that a drug does not have a fast onset?
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No, high protein binding keeps the drug in the blood and in near contact with the vessel rich group (e.g. brain)
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What determines the speed of onset of a drug?
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Lipid solubility, ionization, Vd, CO, speed of injection (bolus v. drip)
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What most determines the duration of action of a drug?
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Protein binding
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What is the induction speed of barbiturates?
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30 seconds
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What is the duration of action of barbiturates?
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8-12 minutes (d/t redistribution)
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What are the CV effects of barbiturates?
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Minimal SBP drop d/t peripheral vasodilation, decreased venous return and thus decreased CO. Increase in HR d/t baroreceptor response to vasodilation. Negative ionotropy.
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What are the respiratory effects of barbiturates?
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Transiet apnea from medullary depression, decreased VT and RR upon emergence (may require assisted ventilation)
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Do barbiturates depress airway and laryngeal reflexes?
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No
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What is the dose for sodium thiopental?
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3-5 mg/kg IV
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What is the distribution t1/2 of thiopental?
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2-5 minutes
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What is the elimination t1/2 of thiopental?
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8-11 hrs
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What is the IV dose of methohexital?
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1-1.5 mg/kg IV
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What is the PR dose of methohexital?
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20-30 mg/kg PR
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What is the elimination t1/2 of methohexital?
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Ultra-short acting, elimination t1/2 = 4hours
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What are unusual side effects of methohexital?
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Greater incidence of excitatory phase on induction, increased incidence of cough/hiccups, decreased sz threshold, activation of seizure foci
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What is the duration of action of methohexital?
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5-7 min
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What are sxs of porphyria?
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Abd pain, N/V, and most importantly, autonomic instability. In anesthesia -> seizures, coughing, laryngospasm, CV collapse
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What is the onset of etomidate and why?
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Rapid onset due to high lipid solubility
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Does etomidate have analgesic properties?
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No
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What is a common visible side effect of etomidate?
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moyclonus d/t disinhibition of CNS pathways controlling extrapyramidal pathways (#1 drug for myoclonus)
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What are the CV effects of etomidate?
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Minimal, no histamine release, but hypovolemia -> decreased SBP
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What are the respiratory effects of etomidate?
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Minimal effects on ventilation, does not induce apnea unless narcotic is also administered
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What are the muscular effects of etomidate? What helps with these?
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Myoclonus, decreased w/ narcotic administration
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What is the dose for etomidate (adults, elderly)?
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Adults: 0.15-3 mg/kg; Elderly: 0.1-0.2 mg/kg
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What are relative contraindications to etomidate?
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Hx of seizures, hx of PONV
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Does ketamine produce analgesia?
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Yes
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What is the MOA of ketamine?
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Produces dissociative amnesia by functionally seperating the thalamus from the limbic cortex (cuts off communication b/t the cortex and RAS)
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What receptors does ketamine interact with?
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NMDA, opioids, muscarinic
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Is ketamine lipid soluble?
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Highly
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Describe redistribution of ketamine
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Rapid
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Describe metabolism of ketamine
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Metabolized to active metabolite w/ 1/3 activity of ketamine, which can lead to cumulative effect, esp. w/ infusions
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What is the elimination t1/2 of ketamine?
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2.5-3 hours
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What are the CV effects of ketamine?
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Increased HR, BP, PAP and CO d/t stimulation of CNS
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When is ketamine inappropriate?
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Pts w/ CAD, HTN, CHF, aneurisms, d/t sympathetic stimulation; Psych patients d/t delerium;
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What are the respiratory effects of ketamine?
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Minimal impact on ventilation, but w/ opioids -> apnea; Potent bronchodilator; Increased salivation, requiring antimuscarinic (but this may increase tachycardia)
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What are the CNS effects of ketamine?
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Increased ICP, CBP, CMRO2, cerebral vasodilation
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What are the ocular effects of ketamine?
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Nystagmus, increased IOP
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What are the muscular effects of ketamine?
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Muscle rididity and athenoid (worm-like) movements of the mouth + tounge. Myoclonus (less than etomidate)
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Describe the psych effects of ketamine
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unpleasant dreams/illusions in up to 30% of cases
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Who are more likely to have dellerium w/ ketamine?
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Older people, women, personality disorder, high doses
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What is the induction dose of ketamine?
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1-2 mg/kg IV
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What is the sedation dose of ketamine?
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5-10 mg q 2 min
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What is the IM dose of ketamine?
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4-6 mg/kg
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What are the absolute contraindications to ketamine?
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Uncontrolled HTN, Hx CVA, vavular heart ds, open eye injury
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What are the relative contraindications to ketamine?
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Increased ICP/IOP, Ischemic heart ds, psych disease, epilepsy
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What are advantages of ketamine?
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potent analgesia, CV support, bronchodilator, respirations maintained, IM administration
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What are disadvantages of ketamine?
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Catecholamine surge, hypersalivation, delirium, increased muscle tone
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What agent has the most rapid and complete awakening among IV agents?
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Propofol
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Describe asptic handling of propofol
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Date/label/time syringe, use w/in 6 hours
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What substances may propofol contain?
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Soybean oil, glycerol, egg lechitin
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Describe the onset of propofol
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Rapid d/t high lipid solubility
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What is the elimination t1/2 of propofol?
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55 min -> rapid awakening
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How is propofol metabolized/excreted?
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In the liver to water soluble substances, excreted by kidney
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What useful post-op properties does propofol have?
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Antiemetic, but ends when propofol ends.
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What are the CV effects of propofol?
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Decreased SVR, preload, myocardial contractility -> SBP decrease 20-30%, minimal change in HR.
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What are the respiratory effects of propofol?
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Dose-dependent respiratory depression, bronchodilation (but less than ketamine)
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What are the CNS effects of propofol?
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Decreased CBF, ICP, CMRO2. CPP can be dangerously reduced.
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What are the occular effects of propofol?
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Decreased IOP
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What is the induction dose of propofol?
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2-3 mg/kg IV
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What is the maintenence dose of propofol for GA?
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100-200 mcg/kg/min
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What is the sedation dose for propofol?
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25-75 mcg/kg/min IV
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What are the indications for propofol?
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Induction of GA, sedation in ambulatory procedures, releives pruritis in pts w/ neuraxial opiates
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What are the absolute contraindications to propofol?
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Allergy (incl peanut allergy, egg, soy); Impaired cerebral circulation
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What are the relative contraindications to propofol?
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Hypovolemia, decompensated heart disease
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What does dexmetedomidine provide?
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analgesia, sedation, anxiolysis, antisialogogue
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What is the t1/2 of dexmedetomidine?
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1.5 hours
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What is the peak of dexmedetomidine?
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15 minutes
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What are the CV effects of dexmedetomidine?
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Decreased BP, HR, catecholamines, possible paradoxical HTN and increased HR at begining d/t peripheral a2-stimulation->vasodilation->barroreceptor response
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What are the respiratory effects of dexmedetomidine?
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Minimal
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What are the CNS effects of dexmedetomidine?
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Anxiolysis, sedation, decreased MAC 35-50%, can promote hypothermia but effective against shivering
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What is the dose for dexmedetomidine?
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Load 1 mcg/kg x 10 mins, then infuse at 0.2-0.7 mg/kg/hr
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What are the effects of benzos?
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Sedation, hypnosis, anxiolysis, anticonvulsant, amnesia, muscle relaxant, induction
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Where is the action of benzos?
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Exclusively in the postsynaptic CNS
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What is the onset of benzos and duration? Why?
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Rapid, d/t high lipid solubility
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Are benzos protein bound?
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Highly
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When are benzos redistributed after an induction dose?
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Within 15-17 minutes after induction dose
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Do benzos cause pain on injection? why?
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Yes, d/t propylene glycol
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Where are benzos metabolized and eliminated?
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Metabolized by liver, eliminated by kidneys
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Describe versed
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Short acting, Elim t1/2 = 2-2.5 hrs, t1/2 increased in RF, P450 metabolism
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Describe ativan
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Intermediate acting, elim t1/2=10-15 hrs
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Describe vallium
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Long-acting, elim t1/2=20-50 hrs, active metabolite prolongs effect
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What is the induction dose of versed?
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0.1-0.2 mg/kg
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What is the sedation dose of versed?
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1-2.5 mg IV
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What is the sedation dose of ativan?
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1-2 mg IV
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What is the induction dose of vallium?
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0.2-0.3 mg/kg IV
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What is the sedation dose of vallium?
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5-10 mg IV
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What are the indications for benzos?
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Preop sedation, Induction for GA, Monitored anesthesia care, decrease delerium w/ ketamine, Seizure suppression, anxiolysis
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What reduced the indicence of delerium w/ ketamine?
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Benzos
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What are absolute contraindications to benzos?
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Pregnancy (1st trimester), Allergy/sensitivity
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What are relative contraindications to benzos?
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Critically ill, hemodynamically unstable
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What are the advantages of benzos?
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CV stablity in moderate doses, Increased seizure threshold, antagonist available
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What are the disadvantages of benzos?
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No analgesic properties, pain on injection, Respiratory depression in high doses, Hypotension w/ narcotics, Prolonged effect in patients with kidney/liver disease
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What is the t1/2 of flumazenil?
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Shorter than benzos - duration of action = 20 minutes
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When does flumazenil peak?
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1-3 minutes
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What is the dose of flumazenil?
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0.1-0.2 mg Q 1 min to a total of 1 mg
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