Benzos Etomidate Ketamine Precedex Propofol pg 5-11.txt

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jaime.davenport
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259499
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Benzos Etomidate Ketamine Precedex Propofol pg 5-11.txt
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2014-02-01 15:19:06
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anesthesia pharm
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anesthesia pharm test 1
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  1. What are 5 common effects of benzos??
    • 1. anxiolysis
    • 2. sedation
    • 3. anticonvulsant actions
    • 4. spinal cord mediated skeletal muscle relaxation (not enough relaxation--still need NMB)
    • 5. anterograde amnesia
  2. What is the MOA of Barbs??
    they do not activate the receptor but they enhance the affinity of the receptor to GABA to resist excitation
  3. What are the side effects of Benzos in general??
    • fatigue
    • drowsiness
    • anterograde amnesia
    • respiratory depression possible so avoid in patients with COPD
  4. What effect lasts longer with benzos? amnestic or sedative??
    amnestic

    ex. you may explain something to a patient post op...they may be awake and respond appropriately but they may not remember what you said...therefore you should wait about 30 mins post op before trying to teach a patient.
  5. How should you treat an overdose of a benzo??
    • assess airway
    • vent support if needed
    • NG with activated charcoal --suction patient
    • Give Flumazenil -- a competitive antagonist (you may have to repeat the dose several times...the benzo given can last longer in the body system than the reversal drug does)


    MOST IMPORTANT THING WITH GIVING BENZOS...MAINTAIN AIRWAY!
  6. What should you be concerned with when using Flumazenil as a reversal??
    giving the drug can cause withdrawal seizures in patients who are dependent on benzos.

    dependent meaning those patients who have taken xanax for the last 30 years.  

    when you give Romazicon....the last 30 years of xanax is reversed.
  7. What is the preop dosing and time frame if you plan to give a patient Diazepam??
    5 to 10 mg po 1 hour before procedure
  8. What is the induction dose for diazepam??
    0.1-0.2mg/kg IV.. this is a last resort..typically use VERSED
  9. what is the dose of diazepam given for seizures??
    5-10mg IV every 5 mins

    for a total of 30mg
  10. What would be the dosing on Diazepam if you want to perform basal sedation??
    give increments of 2.5 mg until patient falls into a light sleep

    may take 5-30 mg for this type of sedation depending on the patient
  11. With Diazepam you want to keep a close eye on your patient after surgery...why is this??
    Diazepam has two active metabolites. one of these metabolites is metabolized slower.  therefore the patient can have episodes of RESLEEPINESS 6-8 hours after the med is given.  therefore you want to keep these patients in the hospital to watch them!
  12. What drug should you avoid giving with Diazepam and why??
    Tagament or Cimetidine

    bc it inhibits P450 enzymes prolonging the effect of diazepam 
  13. What drug do you give postoperatively if you have paradoxical vocal cord motion post extubation???
    VERSED 1mg
  14. What drug is an active metabolite of diazepam that is often used in the treatment of DTs??
    oxazepam
  15. Which benzo is... more potent than valium or versed, has a prolonged onset and longer elimination half-time??
    Lorazepam

    bc of its longer onset and elimination half time is it not used in anesthesia as a preop med
  16. Which benzo is mostly used for anxiety purposes??
    Alprazolam
  17. Which benzo is used to treat seizures??
    clonazepam
  18. Name 3 benzos used for sleep...
    • 1. flurazepam
    • 2. temazepam
    • 3. triazolam
  19. What is Flumazenil and what is it's other name??
    Romazicon

    it is a selective competitive antagonist of benzos
  20. What is the duration of action of Flumazenil??
    1-2 hours
  21. How does Flumazenil work???
    It competitively inhibits the GABA

    reverses benzos
  22. Why do you frequently have to redose Flumazenil???
    it is metabolized faster than benzos so you may need more Flumazenil to block GABA
  23. what is the typical dose for Flumazenil??
    0.1mg IV
  24. Where does Etomidate work??
    causes depression at the Reticular Activating System

    mimics gaba
  25. What is Etomidate dissolved in??
    Propylene Glycol
  26. Why is it that Etomidate causes pain on injection??
    due to the ingredient Propylene Glycol
  27. Name some characteristics of Etomidate.
    Why would you give this drug over the other induction drugs??
    offers cardiac stability bc it has a wider margin of safety than Propofol of STP (can use this if pt has a decreased EF or severe cardiac issues)

    Will decrease ICP will maintain CPP

    good for surgery bc patients wake up quickly
  28. What are some negatives/side effects of Etomidate??
    • pain on injection
    • adrenal suppression
    • myoclonia
    • post op n/v
    • no analgesic properties
    • has been associated with seizures
  29. How long is adrenocortical function decreased after even one dose to etomidate and why is this???
    can be depressed for 5-8 hours

    occurs bc etomidate inhibits enzyme 11-B hydroxylase which is responsible for both mineralcorticoids and cortioosteroids
  30. How does etomidate effects the lungs/ventilation???
    It depresses ventilation less than the other drugs.

    Will decrease TV and increase RR but this only lasts for 3-5 mins.  The body compensates easily.
  31. Which drug would you chose to give if you still want the patient to spontaneous ventilate and if you want to prevent apnea??
    Etomidate
  32. What is Ketamine??
    a phencyclidine derivative
  33. What is the biggest complication for using Ketamine??
    dissociative anesthesia (dissociation between the thalamocoritical systems and the limbic systems)
  34. What are side effects of Ketamine??
    • hallicunations
    • increased HR,BP,CO due to SNS effects
    • increased secretions
    • emergence phenomenon
    • nystagmus
  35. What is Ketamine's MOA?
    binds noncompetively to NMDA receptor, inhibits the action of NMDA receptor by glutamate and increases the effect of GABA
  36. Which drug is good of PO or IV drug abusers??
    Ketamine

    bc it works on different receptors so patients will not build up a tolerance to this drug
  37. What are diagnoses that make Ketamine an idea induction drug??
    • shock
    • cardiac tamponade
    • significant hypovolemia 


    this drug will increase CO!!

    • also good for burns/painful dressing changes
    • bronchospasm
    • hot spots in C sections
    • good for inadequate regional techniques 
  38. How does Ketamine effect the Respiratory System???
    • bronchodilation *so good for asthma patients 
    • mantains laryngeal reflexes and skeletal muscles tone
    • maintains respiratory drive
  39. Droperidol is typically used to treat... 
    N/V

    however..try zofran and phenergan first

    blocks dopamine in the medualla 

    it is also used to treat pruritis associated with opioid administration
  40. What is the main concern with Droperidol administration???
    • prolonged QT interval with excessive doses
    • risk for Torsades

    must be on a 12 lead for 2-3 post dose no matter what the size of the dose is
  41. What class of drugs is precedex??
    nonselective alpha 2 agonist

    same class as clonidine 
  42. Precedex infusion can not exceed ....??
    24 hours
  43. what is the DOC in awake fiberoptic intubations??  why??
    Precedex

    • bc it does not depress the ventilatory drive 
    • so patients can spontaneously breath but remain calm
  44. how do low and high doses of precedex affect the BP??
    • low does will decrease the BP
    • but high doses will increase the BP
  45. What is precedex??
    an isopropylphenol that is given IV as a 1% solution in an aqueous solution of 10% soybean oil
  46. What is different about the AstraZeneca brand of propofol??
    contains EDTA to retard bacterial growth 
  47. What are contraindications to propofol?
    • soy or egg allergy
    • pregnancy
    • dx of cardiomyopathy or hypovolemia
    • dx of lipid metabolism such as diabetic, hyperlipidemia, pancreatitis, hyperlipoproteinemia
  48. For TIVA what is the dose range for Propofol??
    100-300mcg/kg/min
  49. What are some benefits of propofol??
    • antiemetic effects
    • antipuritic effects
    • anticonvulsant activity
    • attenuation of bronchooconstriction
  50. How does propofol effect the respiratory system??
    • depression of ventilation
    • bronchodilation
    • decrease wheezing
  51. How does propofol effect the heart???
    • depresses
    • inhibits SNS
  52. How does propofol effect the CNS?
    • decreases ICP
    • decreases CBF
    • autoregulation is not effected by med
  53. propofol infusion syndrome
    • occurs with high doses of propofol
    • -infusions > 4 mg/kg/hr
    • 1 in every 270 patients
  54. what are the manifestations of propofol infusion syndrome
    • cardiac failure
    • rhabdomyosis
    • severe metabolic acidosis
    • death
  55. bradycardia related death and propofol
    • profound bradycardia and asytole after administration of propofol
    • -reported in both adults and children
    • -propofol weakens response to atropine.
  56. difference between diprivan and propofol is mainly
    • pH biggest difference
    • diprivan pH=7-8.5
    • propofol pH 4.5-6.4
  57. MOA of propofol
    • asserts its sedative hypnotic effects on GABA
    • -increases trans-membrane Cl which hyperpolarizes the post synaptic cell membrane and functional inhibiting of the post synaptic neuron
  58. propofol clearance and pharmokinectics
    • extra hepatic clearance (pulmonary uptake, first pass elimination, renal excretion)
    • clearance exceeds haptic blood flow which emphasizes tissue uptake especially into the lungs
    • -considered to be hepatic and extra hepatic with no evidence of impaired clearance with cirrhosis

    *****extra hepatic elimination of propofol occurs during anhepatic phase of liver transplantation

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