Unf Top Shelf Drugs - Sedatives

Front 1

What is the brand name for Etomidate?

Back 1

Amidate

Front 2

How is Etomidate supplied?

Back 2

2 mg/ml

Front 3

What is the induction dose for Etomidate?

Back 3

0.1-0.4 mg/kg
(70 kg patient = 7 - 28 mg)
(100 kg patient = 10 - 40 mg) Typical dose 20-40 mg

Front 4

What is the Onset of Etomidate?

Back 4

30 to 60 seconds

Front 5

What is the Duration of Etomidate?

Back 5

3 to 10 minutes

Front 6

How is Etomidate metabolized?

Back 6

Primary through ester hydrolysis secondary through hepatic

Front 7

Is Etomidate highly protein bond?

Back 7

Yes 77% bond to albumin

Front 8

What receptor does Etomidate effect?

Back 8

Potentiation of GABA (A) -mediated chloride channels

Front 9

What effects does Etomidate have on the CNS?

Back 9

Potent cerebral vasoconstrictor
Decreases CBF & ICP Myoclonus

Front 10

What effects does Etomidate have on CV?

Back 10

Minimal changes in BP & HR
(Drop in BP maybe exaggerated by hypovolemia)

Front 11

What effect does Etomidate have on respiratory?

Back 11

Minimal depression, but if given rapidly IV may cause apnea.
Exaggerated depression with inhaled anesthetics or opioid

Front 12

What effect does Etomidate have on endocrine?

Back 12

Adrenal suppression

Front 13

Who (patient population) would you choose Etomidate over propofol or barbiturates?

Back 13

In patients with compromised myocardial contractility

Front 14

Does infusion of Etomidate hurt?

Back 14

Yes

Front 15

Is recovery from Etomidate fast?

Back 15

Yes 3 - 10 minutes

Front 16

Does Etomidate produce analgesia?

Back 16

No, it produces hypnotic effects

Front 17

What is the half life of Etomidate?

Back 17

75 minutes

Front 18

What is the pregnancy category of Etomidate?

Back 18

Category C

Front 19

What is the brand name for Ketamine?

Back 19

Ketalar

Front 20

How is Ketamine supplied?

Back 20

10 mg/ml

Front 21

What is the Induction dose for Ketamine?

Back 21

0.5 - 2 mg/kg
(70 kg patient 35 -140 mg)
(100 kg patient 50 -200 mg)
Typical dose ????

Front 22

What is the Onset of Ketamine?

Back 22

30 seconds

Front 23

What is the Duration of Ketamine?

Back 23

5 to 15 minutes

Front 24

Does Ketamine produce analgesia?

Back 24

Yes significant analgesia

Front 25

The cataleptic state aka "dissociative anesthesia" is associated with which IN anesthetic?

Back 25

Ketamine

Front 26

What is the cataleptic state aka "dissociative anesthesia"?

Back 26

After the admin of Ketamine the patient's eyes remain open with a slow nystagmic gaze.

Front 27

What is the major psychological issue with Ketamine?

Back 27

Unpleasant hallucinations

Front 28

How is Ketamine metabolized?

Back 28

Hepatic CYP450 system

Front 29

Is Ketamine bond to protein?

Back 29

It has a low protein binding (12%)

Front 30

What receptor does Ketamine work on?

Back 30

Inhibition of the N-methyl-D-aspartate receptor complex

Front 31

Is amnesia complete with solo admin of Ketamine?

Back 31

Amnesia is not complete, however when benzos are coadmin then amnesia is complete

Front 32

What effects does Ketamine have on CNS?

Back 32

Cerebral vasodilator, increases CBF & CMRO2 (metabolic rate)

Front 33

What effects does Ketamine have on CV?

Back 33

Significant, but transient increase in BP, HR, & CO

Front 34

What effects does Ketamine have on respiratory?

Back 34

Minor depression Hypercapnia response preserved
After rapid IV may cause apnea
Increase salivation which is a risk for laryngospasm (especially in peds)
Relaxes bronchial smooth muscles

Front 35

What is the pregnancy category for Ketamine?

Back 35

Ketamine is contraindicated in pregnancy, there is no FDA assignment however the manufacture has assigned Category B

Front 36

What is the Brand name for Methohexital?

Back 36

Brevital

Front 37

How is Methohexital supplied?

Back 37

10 mg/ml

Front 38

What is the Induction dose for Methohexital?

Back 38

1 - 1.5 mg/kg
(70kg patient 70 - 105 mg)
(100kg patient 100 - 150 mg)
Typical dose 70 mg

Front 39

What is the Onset of Methohexital?

Back 39

45 seconds - 1 minute

Front 40

What is the Duration of Methohexital?

Back 40

4 to 7 minutes

Front 41

How is Methohexital metabolized?

Back 41

Hepatic metabolism by oxidation

Front 42

Chronic use of barbiturates does what to liver enzymes?

Back 42

Induces oxidative mircosomal enzymes

Front 43

What receptors does Methohexital work on?

Back 43

GABA (A) and unknown inhibition of excitatory receptors

Front 44

What effect does Methohexital have on CNS?

Back 44

Potent cerebral vasoconstrictor
Decreases CBF, ICP, & cerebral blood volume
Decreases CMRO2 Neuroprotection from focal cerebral ishemia

Front 45

Does Methohexital have analgesic effects?

Back 45

No, in fact evidence suggest that it lowers the pain threshold and increases pain

Front 46

Does Methohexital decrease activity on EEG?

Back 46

No it is an exception among barbiturates.

Front 47

Which barbiturate activates epileptic foci?

Back 47

Methohexital

Front 48

What effects does Methohexital have on CV?

Back 48

Decrease in BP 2/2 vasodilation
Increase HR

Front 49

What effects does Methohexital have on respiratory?

Back 49

Marked depression with decreased TV and RR, apnea
Decreased hypercapnia and hypoxia response
Requires neuromuscular blocking drugs for instrumentation of airway

Front 50

What Pregnancy category is Methohexital?

Back 50

Category B

Front 51

What is the brand name for Propofol?

Back 51

Diprvan

Front 52

How is Propofol supplied?

Back 52

10 mg/ml

Front 53

What is the induction dose of Propofol?

Back 53

1.5 - 2.5 mg/kg
(70 kg patient 105 - 175 mg)
(100 kg patient 150 - 250 mg)
Typical dose around 175 - 200 mg

Front 54

What is the Onset of Propofol?

Back 54

45 seconds to a minute

Front 55

What is the Duration of Propofol?

Back 55

5 to 10 minutes

Front 56

How is Propofol stored?

Back 56

In a lipid emulsion.

Front 57

Can you give Propofol to a patient with an egg allergy?

Back 57

Yes, Maybe, No, depends because the major component of the lipid emulsion is egg yolk lecithin... clear as mud?

Front 58

How long should a Propofol bottle be used for after it has been opened and why?

Back 58

6 hours because of the lipid emulsion can support bacterial growth

Front 59

How is Propofol metabolized?

Back 59

Hepatic metabolism, however their maybe up to 30% metabolism in the lungs

Front 60

Is Propofol highly protein bond?

Back 60

Yes 97% bond

Front 61

Describe the context-sensitive half-time of Propofol.

Back 61

The context-sensitive half-time of Propofol is brief, even after prolonged infusion allowing for rapid recovery

Front 62

What receptors does Propofol work on?

Back 62

Potentiation of chloride current mediated channels at the GABA (A) receptor complex

Front 63

What are the effects of Propofol on CNS?

Back 63

Hypnotic effect without analgesic effects
Decreased CBF, CMRO2, ICP
Has neuroprotective properties
Anticonvulsant effects

Front 64

What are the effects of Propofol on CV?

Back 64

Most pronounced decrease in BP
Vasodilates Arterial and Venous - reduced preload and afterload Inhibits baroreflex (very small increase in HR)

Front 65

What are the effects of Propofol on Respiratory?

Back 65

Potent respiratory depressant
Apnea after induction dose
Response to hypoxia and hypercapnia is reduced
Relaxes reflexes for instrumentation of the airway
Decrease wheezing

Front 66

Would you use Propofol in a patient you are concerned about post-op N/V?

Back 66

Yes Propofol has antiemetic activity

Front 67

Does Propofol potentiate neuromuscular blockage drugs?

Back 67

NO

Front 68

What should you do if you unexpectedly get tachycardia during Propofol induction?

Back 68

Evaluate for metabolic acidosis (ABG)
Known as propofol infusion syndrome

Front 69

Does Propofol hurt on injection?

Back 69

Yes

Front 70

Do children require more or less Propofol for induction?

Back 70

More 2.5 - 3.5 mg/kg