Card Set Information
Select ICU agents 15
Select ICU Agents
What is propofol used for?
ICU sedation in intubated, mechanically-ventilated patients
What is the MOA of propofol?
Agonist at GABA receptors
Blocks NMDA receptors
What is the dosing for propofol?
5 mcg/kg/minute continuous infusion
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
What are the AE of propofol?
: hypotension, bradycardia
Injection site reaction
Propofol-related infusion syndrom
What interactions does propofol have?
Increased sedative effects when given with narcotics
Few drug interactions
No drug-disease state interactions
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
Discuss propofol's lipophilicity and protein-binding.
Highly lipophilic (crosses BBB)
Highly protein bound 98-99%
Discuss the onset, duration, distribution, metabolism and excretion of propofol.
: 30-40 seconds
: 3-10 minutes (dose and rate dependent)
: 2-10 L/kg (dec in elderly, inc in obese)
: hepatic (2C9; to inactive metabolites)
: renal (half-life is biphasic; 40 min initial & 4-7 hrs terminal)
What are neuromuscular blocking agents indicated for?
Facilitated mechanical ventilation
Manage increased ICP
Immobilization during procedures
Treat muscle spasms
Decrease oxygen consumption
What is the MOA of Neuromuscular blocking agents?
Depolarizing agents = activate the receptors (succinylcholine)
Non-depolarizing agents = do NOT activate the receptors
Whar are the 2 types of neuromuscular blocking agents?
: resemble Ach --> bind to & activate Ach receptors
: bind to nicotonic Ach receptors and act as competitive antagonists
What are the classes of non-depolarizing agents of nueromusclar blocking drugs?
What is the distribution of neuromuscular blocking agents?
Vd similar to extracellular fluid volume
Atra << cis< roc,vec << pan
atra = lowest at 87
pan = highest at 241
How are neuromusclar blocking agents metabolized?
aminosteroidal agents: dacetylated in the liver; production of active metabolites
benzylisoquinolinium agents: hydrolysis; metabolite (laudanosine)
Which neuromuscular blocking agents can be given to renally impaired patients?
benzylisoquinolinium agents (atracurium, cisatracurium)
These are Hofmann eliminated = spontaneously eliminated (not done renally)
How are neuromuscular blocking agents dosed and monitored?
Weight based dosing:
bolus or continuous infusion
response to twitch stimuli
Which neuromuscular blocking agents enhance blockade (increase pt time on ventilator)?
Which neuromuscular blocking agents decrease blockade (decrease pt time on ventilator)?
Which neuromuscular blocking agents are ok to use if a patient has hypertension or tachycardia?
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
Which neuromuscular blocking agents cause myopathy?
most common with aminosteroid compounds
What are the 3 main side effects of neuromuscular blocking agents?
CV effects (hypertension & tachycardia, hypotension)