Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
122 Cards in this Set
- Front
- Back
|
how does propofol come
|
1% solution, 10mg/ml
|
|
|
is propofol acid or base
|
weak acid
|
|
|
does propofol have enantiomers
|
no
|
|
|
is propofol water or lipid soluble
|
lipid
|
|
|
what is the induction dose of propofol
|
2mg/kg iv
|
|
|
Sedation dose of propofol
|
25-100mcg/kg/min
|
|
|
TIVA dose for propofol
|
100-300mcg/kg/min
|
|
|
onset of propofol
|
30-60 sec
|
|
|
Elimination 1/2 life of propofol
|
.5-1.5 hrs
|
|
|
Protein binding of propofol
|
98%
|
|
|
Context sens 1/2 time of propofol
|
<40 min (for up to 8 hr infusion)
|
|
|
is propofol an amnestic
|
not reliable
|
|
|
how does propofol work
|
GABA facilitator - decreases rate of dissociation from the receptor, increases duration of action by holding the Cl channels open and hyperpolarizing the membrane
|
|
|
what does propofol do to Ca conductance
|
decreases intracellular Ca conductance (can be used for neuroprotection)
|
|
|
Uses of propofol
|
IV sedation
IV induction TIVA( street ready sooner) |
|
|
How is propofol with PONV
|
has less PONV and can actually be used to treat severe PONV
|
|
|
What does propofol do to CMRO2, CBF, ICP, CO2 response and auto regulation
|
CMRO2 - decreases
CBF - decreases ICP- decreases CO2 response- leaves intact |
|
|
can you have burst suppressio with propofol
|
yes
|
|
|
is propofol an analgesic
|
no
|
|
|
Can propofol provide neuro protection
|
yes but watch for hypotension
|
|
|
What is opisthotonos
|
seen only with propofol
seen in peds head and lower limb bent backwards while trunk is arched forward not assoc. with seizures |
|
|
When is hypotension more pronounced with propofol
|
when hypovolemic- pretreat with fluids
|
|
|
difference between baro receptors in barbs and propofol
|
barbs- they are reset
propofol- they are blunted - dont see reflex tachycardia which can worsen hypotension |
|
|
Propofol does what to HR
|
Vagotonic (no action on SA/AV node)- causes bradycardia, can prevet with anticholinergic
|
|
|
what kind of ionotrope is propofol
|
negative ionotrope- interferes with trans-sacrcolemma Ca conductance
|
|
|
What does propofol do to smooth muscles and arteries
|
relaxes smooth muscle and dilates arteries
|
|
|
What does propofol do to IOP
|
decreases it 30-40%
|
|
|
What does propofol do to laryngeal reflexes, RR, TV
|
Blunts reflexes
decreases TV and RR with induction doses |
|
|
does induction dose of propofol produce apnea
|
yes- is dose dependent
|
|
|
What does sedation doses of propofol do to RR and TV
|
increases rr and shallow breathing
|
|
|
What does propofol do to HPV
|
attenuates it- ok for induction but not for maintenance during thoracotomy case
|
|
|
What is the induction DOC for asthmatics
|
propofol- bronchodilation
|
|
|
What does propofol do the CO2 responsivness
|
blunts respiratory centers- bad for conscious sedation, expect higher EtCO2 levels
|
|
|
What drug is good to use in high-end hepatic phase of liver transplant
|
propofol
|
|
|
What phase of metabolism for propofol
|
mostly phase 2 conjugation
|
|
|
what are some rare problems seen with prolonged propofol infusions
|
lipidemia
fatty infiltrates enlarged liver metabolic acidosis rhabdomyalysis myoglobinuria |
|
|
What is propofol infusion syndrome
|
sudden onset bradycardia resistant to treatment (esp atropine, can use isuprel)
seen with prolonged infusion at doses >4mg/kg/hr) |
|
|
Can we use propofol for children under 17
|
yes for induction and TIVA just not ICU sedation
|
|
|
What type of preservative is seen in propofol
|
sulfate- can trigger asthma in sulfate sensitive pts
|
|
|
can we give propofol to pts with egg allergies
|
yes
|
|
|
how do we avoid contamination of propofol
|
use single dose vials
no mixing 6hr limit once open 2 hr limit once drawn up |
|
|
Do we use propofol in OB
|
Only when mom's asthmatic- must pump and dump
can lower apgars |
|
|
anti-emetic dose of propofol
|
10-15 mg
|
|
|
antipruritic dose of propofol
|
10-15 mg
|
|
|
does propofol cause malignant hyperthermia
|
no
|
|
|
how do we blunt the pain of propofol injection and what else does this help
|
lidocaine pretreatment
blunts tracheal stimulus to intubation and good pretreatment defasciculation dose for rocuronium |
|
|
What is the only active isomer in etomidate- is it a racemic mixture
|
d-isomer
no |
|
|
what two drugs have a caboxylated imidazole ring
|
midazolam
etomidate |
|
|
is etomidate an acid or base
|
base
|
|
|
Dose of etomidate
Elderly? |
0.3 mg/kg
dont adjust for elderly |
|
|
preparation of etomidate
|
0.2% solution
2 mg/ml |
|
|
onset of etomidate
|
30-60 sec
|
|
|
protein binding of etomidate
|
75%
|
|
|
elimination of etomidate
|
very rapid
extremely high extraction ratio |
|
|
Metabolism of etomidate
|
Ester hydrolysis through carboxylic acid
|
|
|
MOA of etomidate
|
GABA potentiation- cant directly activate GABA receptors- must have GABA present
|
|
|
Uses of etomidate
|
cardiovascular unstable pts with minimal reserve
|
|
|
can etomidate be used with seizure mapping
|
yes, will show increased activity in elctrogenic foci, but stop seizures at high doses
|
|
|
What does etomidate do to CMRO2, CBF, ICP
|
decreases all
poetent cerebral vasoconstrictor uncouples because continues to decrease below the 60% |
|
|
What does etomidate do to the motor centers in the brain- how can we treat this
|
disinhibits them- will see myoclonic activity without EEG activity
give pretreatment 2mg dose of etomidate, opiates, or BZ |
|
|
what cv effects does etomidate have
|
minimal changes in HR, SV, CO,
may decrease MAP(15%) because of decrease in SVR |
|
|
Resp effects of etomidate
|
little resp depression- wont see full apnea with induction dose
|
|
|
is etomidate a TIVA drug
|
no
|
|
|
What does etomidate do to IOP
|
decreases
|
|
|
does etomidate burn on injection
|
yes- not a problem with intra-arterial but may cause thrombophlebitis
|
|
|
what induction agent causes the most NV
|
etomidate
|
|
|
What is a rare problem with etomidate
|
adrenocortical suppression- inhibits the enzyme that converts cholesterol to catecholamines- will see decrease in circulating cate. in 2 min
|
|
|
solution for ketamine
|
1-5-10%
most common 5% 10-50-100mg/ml |
|
|
is ketamine a hypnotic
|
no
|
|
|
is ketamine a racemic mixture
|
yes with S more potent
|
|
|
Protein Binding of Ketamine
|
12%- almost none
|
|
|
Adult dose of ketamine
|
1.5 mg/kg IV
|
|
|
IM dart dose of ketamine
|
4-8 mg/kg
onsets- 5-6 min peaks 20 min |
|
|
Intense analgesic dose of ketamine
|
0.2-0.5 mg/kg
|
|
|
What does Ketamine do to the pt
|
causes a dissociative anesthesia- puts pt in a catatoic state
|
|
|
How does ketamine work
|
suppresses thalamic pathways and stimulation of the Limbic System (reward system in the brain)
functional interruption of connection between sensory and perception |
|
|
is ketamine amnestic
|
yes- profoudly
|
|
|
is ketamine an analgesic
|
yes-opiod agonist at Mu, kappa and delta opiod receptors. potentiates all other analgesics
|
|
|
What does ketamine do to epi and nor epi
|
inhibits reuptake
|
|
|
what all types of receptors does ketamine act on
|
stimulates norepi and serotonin receptors in the spinal cord that modulate pain perception
stimulates muscarinic receptors and can have some muscle relaxant issues Inhibits NMDA recptors and blocks normal action of glutamate |
|
|
What does ketamine do to CMRO2, CBF, ICP, IOP
|
increases all - brain is stimulated just not communicating
coupled |
|
|
can you use ketamine for pt with intracranial pathology
|
no
|
|
|
What does ketamine do to SNS, SVR, PVR, HR, CO, Myocardial oxygen demand
|
increases
|
|
|
you would not give ketamine to a pt on what concurrent drug
|
MAOI
cocaine |
|
|
What if pts catecholamines are depleted if giving ketamine
|
will be a myocardial depressant, must have catecholamines
|
|
|
What does ketamine do to resp system
|
little depression, airway intact, bronchodilator, salagog
|
|
|
what can you give for salivation seen with ketamine
|
robinol
|
|
|
how is ketamine metabolized
|
30% to an active metabolite that is rapidly cleared
autoinducer-pts do develop tolerance |
|
|
does ketamine release histamine
|
no
|
|
|
what is the least allergic induction agent
|
etomidate
|
|
|
how common are allergic reactions with ketamine
|
rare
|
|
|
does ketamine burn on injection
|
no
|
|
|
what two drugs did we learn that do not induce malignant hyperthermia
|
ketamine
propofol |
|
|
uses for ketamine
|
temper tantrum
analgesia for spinal OB for epidurals that arent working right outpt. GYN procedures |
|
|
how can we decrease critters seen with ketamine
|
give with propofol, BZ
|
|
|
is dexmed a hypnotic
|
no
|
|
|
what is the use of dexmed
|
augment agent for anesthetics
analgesic properties decrease MAC and opiod requirements cardiac surgery |
|
|
Dexmed is more selective for what
|
alpha 2 agonist
|
|
|
protein binding of dexmed
|
94%
|
|
|
what will you see when you first start dexmed
|
flash of hypertension
|
|
|
3 divisions of alpha 2 and their properties
|
alpha 2a- sedation, hypnosis, analgesia, sympatholysis
alpha 2b- vasoconstriction, anti-shivering, analgesia, Ca-linked alpha 2c- learning and startle response |
|
|
Where does dexmed work
|
locus ceruleus at the alpha 2 receptors- activates K leaving and inhibits Ca VGC to hyperpolarize the cell. Decreases norepi release from the cortex and norepi inhibition on the VLPO which releases GABA and turns down the rest of the brain
|
|
|
which induction agent produces a much more natural and restorative sedative state than any other
|
precedex
|
|
|
what does dexmed do to alpha 2 recptors at the cord level
|
stimulates SC neurons through dorsal gray and stimulates release of ACh and enkephalins that inhibit post synaptic neurons- descending pathways that modulate pain sensation of the cords
|
|
|
is dexmed coupled or uncoupled
|
uncoupled
causes cerebral vasoconstriction without altering the CMRO2 |
|
|
What does dexmed do to CO2 reactivity in the brain
|
leaves it intact
|
|
|
does dexmed have any neuroprotection
|
does decrease release of some excitatory toxins that lead to ischemia
|
|
|
can dexmed be used for intracranial pathology
|
no
|
|
|
how do we avoid the flash HTN seen initially with dexmed
|
slow loading infusion
|
|
|
What does Dexmed do to BP,HR, CO, SVR, PVR
|
decreases
|
|
|
does dexmed cause cardiovascular vasoconstriction or dilation
|
vasoconstriction- so get decreased filling, decreased HR, myocardial O2 demand goes down
|
|
|
Alpha 2 agonist promotes release of what with dexmed
|
Nitrous Oxide
|
|
|
do you see rebound HTN with discontinuation of this drug
|
No - can actually attenuate some fo the rebound seen when withdrawling anesthesia or sedation
|
|
|
What is the least resp depressent agent we discussed
|
dexmed- careful with pts with obstructive sleep apnea
|
|
|
dose of dexmed
|
1mcg/kg loading over 10 min
infuse 0.2-0.7 mcg/kg/HR ' |
|
|
Onset of dexmed
|
5 min
peak 15 min D 1/2 t- 6 min |
|
|
how is dexmed supplied
|
2 ml vial of 100mcg/ml dilute in 50 ml of NS
|
|
|
what is elimination 1/2 t of dexmed
|
1.5 hrs
|
|
|
what is the reversal for dexmed
|
Atipamezole- alpha 2 antagonist
50 mcg/kg |
|
|
which drug did we discuss that is also an anti-salagogue
|
dexmed
|
|
|
What does dexmed do to shivering
|
anti-shivering- widens thermoregulation
pt will get cold |
|
|
what all does atipamezole reverse
|
dry mouth, bradycardia, sedation, without rebound HTN
good for s/s of substance withdrawl |
