ICU Agents

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Author:
rclee06
ID:
150931
Filename:
ICU Agents
Updated:
2012-04-29 16:14:20
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wusop
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PK
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  1. What is the brand name of propofol?
    Diprivan
  2. What are indications for the use of propofol?
    • General anesthesia
    • ICU sedation in intubated mechanically ventilated patients
  3. What is the MOA of propofol?
    • Agonist at GABA receptors
    • Blocks NMDA receptors
  4. What is the LD of propofol?
    5 mcg/kg/minute CI (0.3 mg/kg/hr)
  5. Do elderly patients have a higher or lower LD?
    Lower--give 80% of adult dose
  6. What weight should be used when calculating a propofol dose in obese patients?
    IBW
  7. What are the cardiovascular AE of propofol?
    • Hypotension
    • Bradycardia
  8. Are injection site reactions more common in peripheral or central lines?
    Peripheral
  9. What are AE of propofol?
    • CV
    • Injection site rxn
    • Hypertriglyceridemia
    • Propofol-related infusion syndrome
    • Infections
  10. At what doses it is more common to see propofol-related infusion syndrome?
    > 83 mcg/kg/min for > 48 hours
  11. What are some signs and symptoms of propofol-related infusion syndrome?
    • Metabolic acidosis
    • Rhabdomyolysis
    • Hyperkalemia
    • Heart failure
  12. If propofol is given with these types of drugs it will have increased sedative effects?
    Narcotics
  13. In propofol distriubtion, which step is slow? Why?
    • Slow return from poorly perfused tissue into blood
    • Due to saturated clearance
  14. Does propofol cross the BBB?
    yes
  15. What is the onset of action of propofol?
    30-40 seconds
  16. What is the duration of propofol?
    • 3-10 minutes
    • dose and rate dependent (if they have been on it longer it might take longer for the affects to wear off)
  17. What is the Vd for propofol?
    2-10 L/kg
  18. After a ___ day infusion, the Vd of propofol increases to ___ L/kg.
    • 10
    • 60
  19. Is the Vd of propofol increased or decreased in elderly patients? Obese patients?
    • Decreased: due to decreased CO
    • Increased: distributes more into tissues
  20. What is the main type of metabolism of propofol?
    Hepatic (2C9)
  21. Are propofol metabolites active or inactive?
    Inactive
  22. What type of excretion does propofol undergo?
    Renal
  23. What type of half life does propofol have? How long is the 1/2 life?
    • biphasic
    • 40 minutes initially and 4-7 hours terminal
  24. What are indications for neuromuscular blocking agents?
    • Facilitated mechanical ventilation
    • Manage increased intercranial pressure
    • immobilization during procedures
    • Treat muscle spasms (burn victims)
    • Decrease oxygen consumption
  25. Do depolarizing agents or non-depolarizing agents activate the Ach receptors?
    Depolarizing
  26. What is the MOA of non-depolarizing agents?
    Bind to nicotinic Ach receptors and act as competitive antagonists
  27. What is the onset of action of succinylcholine?
    • 30-60 seconds (IV)
    • 2-3 minutes (IM)
  28. What is the onset of action of Pancuronium?
    2-3 minutes
  29. What is the onset of action of Vecuronium?
    3-4 minutes
  30. What is the onset of action of rocuronium?
    1-2 minutes
  31. What is the onset of action of atracurium?
    3-5 minutes
  32. What is the onset of action of cisatracurium?
    2-3 minutes
  33. Which neuromuscular blocking agent has a duration of 90-100 minutes?
    Pancuronium
  34. What class of nondepolarizing agents do atracurium and cisatracurium fall uncer?
    Benzylisoquinolinium
  35. The distriubtion of neuromuscular blockage agents is highly ________ and ________ soluble.
    • Ionized
    • Water
  36. Which drug has the smallest Vd?
    Atracurium
  37. Which drug has the largest Vd?
    Pancuronium
  38. How are the aminosteroidal agents metabolized?
    Deacetylated in the liver
  39. Do the aminosteroidal agents have active or inactive metabolites?
    Active--hhalf as potent as the parent compound
  40. How are the benzylisoquinolinium agents metabolized?
    Hydrolysis--degraded spontaneously in plasma at body temp (Hoffman)
  41. Do the benzylisoquinolinium agents have active or inactive metabolites?
    inactive
  42. What is the metabolite of benzylisoquinolinium agents?
    Laudanosine
  43. Which drug is eliminated 100% renally?
    Succinylcholine
  44. Which drugs should not be given in patients with renal or liver failure?
    Aminosteroidal agents
  45. What should you monitor when giving neuromuscular blockade agents?
    • Vital signs
    • Train-of- four
  46. What drugs should be given to patients who have HTN?
    • Atracurium
    • Vecuronium
  47. What are CV effects of neuromuscular agents?
    Hypertension and tachycardia
  48. Why do patients experience hypotension with these drugs?
    Histamine release
  49. What drugs should be avoided in patients with hypotensioN?
    • Atracurium
    • Succinylcholine
  50. What type of drugs most often causes myopathy?
    Aminosteroidal
  51. What are the SE of neuromuscular blocking agents?
    • CV: hypertension, tachycardia, hypotension
    • Myopathy
    • Tachyphylaxis
  52. What drugs will interact with NBA and enhance blockade?
    • CCBs
    • BBs
    • Furosemide
    • Antibiotics (aminoglycosides)
    • Immunosuppressive agents
    • Lithium
    • Inhaled anesthetics
  53. What drugs will interact with NBA and decrease blockade?
    • Carbamazepine
    • Phenytoin
    • Ranitidine
    • Theophylline

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