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  1. What is propofol used for?
    • general anesthesia
    • ICU sedation in intubated, mechanically-ventilated patients
  2. What is the MOA of propofol?
    • Agonist at GABA receptors
    • Blocks NMDA receptors
  3. What is the dosing for propofol?
    • 5 mcg/kg/minute continuous infusion (0.3 mg/kg/hour)
    • lower dose in elderly (80% of adult dose)
    • obse patients use IBW

    Increase by 5-10 mcg/kg/minute every 5-10 mins

    MD: 5-80 mcg/kg/min
  4. What are the AE of propofol?
    • CV effects: hypotension, bradycardia
    • Injection site reaction
    • Hypertriglyceridemia
    • Propofol-related infusion syndrom
    • Infections
  5. What interactions does propofol have?
    • Increased sedative effects when given with narcotics
    • Few drug interactions
    • No drug-disease state interactions
  6. Describe the 3 compartement model of propofol.
    • 1. Distribution from blood to tissues (rapid)
    • 2. Redistribution and metabolic clearance (rapid)
    • 3. Slow return from poorly perfused tissue into blood
  7. Discuss propofol's lipophilicity and protein-binding.
    • Highly lipophilic (crosses BBB)
    • Highly protein bound 98-99%
  8. Discuss the onset, duration, distribution, metabolism and excretion of propofol.
    • Onset: 30-40 seconds
    • Duration: 3-10 minutes (dose and rate dependent)
    • Distribution: 2-10 L/kg (dec in elderly, inc in obese)
    • Metabolism: hepatic (2C9; to inactive metabolites)
    • Excretion: renal (half-life is biphasic; 40 min initial & 4-7 hrs terminal)
  9. What are neuromuscular blocking agents indicated for?
    • Facilitated mechanical ventilation
    • Manage increased ICP
    • Immobilization during procedures
    • Treat muscle spasms
    • Decrease oxygen consumption
  10. What is the MOA of Neuromuscular blocking agents?
    • Depolarizing agents = activate the receptors (succinylcholine)
    • Non-depolarizing agents = do NOT activate the receptors
  11. Whar are the 2 types of neuromuscular blocking agents?
    • 1. Depolarizing agents: resemble Ach --> bind to & activate Ach receptors
    • 2. Nondepolarizing agents: bind to nicotonic Ach receptors and act as competitive antagonists
  12. What are the classes of non-depolarizing agents of nueromusclar blocking drugs?
    • aminosteroidal
    • benzylisoquinolinium
  13. What is the distribution of neuromuscular blocking agents?
    • highly ionized
    • water soluble
    • Vd similar to extracellular fluid volume
    • ~200 ml/kg
    • Atra << cis< roc,vec << pan
    • atra = lowest at 87
    • pan = highest at 241
  14. How are neuromusclar blocking agents metabolized?
    aminosteroidal agents: dacetylated in the liver; production of active metabolites

    benzylisoquinolinium agents: hydrolysis; metabolite (laudanosine)
  15. Which neuromuscular blocking agents can be given to renally impaired patients?
    benzylisoquinolinium agents (atracurium, cisatracurium)

    These are Hofmann eliminated = spontaneously eliminated (not done renally)
  16. How are neuromuscular blocking agents dosed and monitored?
    Weight based dosing: bolus or continuous infusion

    • Monitoring:
    • Vital signs
    • Train-of-four (TOF)
    • response to twitch stimuli
  17. Which neuromuscular blocking agents enhance blockade (increase pt time on ventilator)?
    • CCB
    • beta-blocker
    • furosemide
    • antibiotics
    • immunosuppresive agents
    • lithium
    • inhaled anesthetics
  18. Which neuromuscular blocking agents decrease blockade (decrease pt time on ventilator)?
    • carbamazepine
    • phenytoin
    • ranitidine
    • theophylline
  19. Which neuromuscular blocking agents are ok to use if a patient has hypertension or tachycardia?
    • atracurium
    • vecuronium
  20. Which neuromuscular blocking agents should be avoided if a patient has hypotension and why?
    atracurium and succinlycholine

    they are vasodilators and if a patient already has hypotension it will cause further lowering of their BP
  21. Which neuromuscular blocking agents cause myopathy?
    most common with aminosteroid compounds
  22. What are the 3 main side effects of neuromuscular blocking agents?
    • CV effects (hypertension & tachycardia, hypotension)
    • Myopathy
    • Tachyphylaxis
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