Pharm III, Inj. Anesthetics

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HLW
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74653
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Pharm III, Inj. Anesthetics
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2011-03-23 21:40:32
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Pharm III, Inj. Anesthetics
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  1. Advantages of Propofol (4):
    • Rapid Induction
    • Rapid Metab
    • Non-cumulative (CRI)
    • Smooth Recovery, w/o hangover
  2. Disadvantages of Propofol(6):
    • Cardiovascular Depressant
    • Respiratory Depressant
    • Supports Bacterial Growth
    • Pain on Inj (occasional)
    • Twitching/jerking (esp w/o premed)
    • Shakes
  3. Alfaxalone is categorized as a....
    Pregnanedione steroidal anesthetic agent
  4. Alfaxaan...
    Onset:
    Duration:
    Protein Binding:
    Recovery:
    • Onset: Slower than porpfol
    • Duration: Short
    • Protein Binding: Moderate 50%
    • Recovery: Rapid
  5. Which drugs don't cause irritation if inj para-vascularly?
    • Propofol
    • Alfaxaan
  6. Alfaxaan CNS Fx:
    Binds to central GABAa receptors
  7. Alfaxaan Repiratory Fx:
    • Mild
    • Decreased Tidal volume and RR
    • Apnea (if inj too rapidly)
  8. Alfaxaan Cardio Fx:
    Similiar to Propofol, Dose dep
  9. Advantages of Alfaxaan over Saffan (older prep)(4):
    • No histamine Release
    • Dogs and Cats
    • Rapid Recovery
    • IV (also IM in cats)
  10. Advantages of Alfaxalone (5):
    • Rapid Induction/Recovery
    • Rapid Metab
    • Non-cumulative
    • Admin IV or IM
    • Less Respiratory Depression than propofol or thiopental
  11. Disadvantages of Alfaxalone (3):
    • Anaphylaxis in cats
    • Poor recovery w/ hypersensitivity/paddling/muscle tremors
    • IM requires large volume
  12. Dissociative Agents (2):
    • Ketamine
    • Tilemine
  13. What Fx does Ketamine produce(3)?
    • Amnesia
    • Analgesia
    • Unconsciousness
  14. Ketamine is often used with:
    • Benzodiazapines
    • ACP
    • Alpha 2 Agonists
  15. ___% Ketamine has a pH of ___, so it stings IV and IM
    • 10%
    • 3.5
  16. What do the new formulations of Ketamine consist of?
    • S Ketamine
    • (Racemic used in Vet Med)
  17. What properties allow Ketamine to rapidly cross the BBB (3)?
    • Low MW
    • High Lipid Solubility
    • pKa ~physiological pH
  18. Ketamine: Plasma Protein Binding?
    Less Protein Binding -> OD in hypoproteinemic P's
  19. Ketamine: Induction speed?
    Slow (30 sec)
  20. Active Metabolites of Ketamine:
    Nor-ketamine
  21. Excretion of Ketamine:
    • Ketamine- Unchanged in urine
    • Nor-Ketamine- Kidneys
  22. What is Ketamine's primary site for anesthetic action? What Fx does this produce?
    • Thalamoneocortical Projection System=
    • DEPRESSES Cortex & Thalamus and STIMULATES the Limbic Sys (hippocampus)
    • Functional Disorganization of the thalamus and limbic cortex
  23. CNS side fx of Ketamine (3):
    • Thalamoneocortical Projection
    • Emergence Phenomena (hallucination, out of body, dreams, etc)
    • Increased salivation (espc in cats and pigs- Tx with anticholinergic)
    • Blocks polysynaptic Reflexes in spinal cord
    • Blocks medial Reticular Formation (nociception to brain)
  24. Ketamine Neurotransmitters in CNS (6):
    • NMDA Antag
    • Excitatory glutamate
    • Cholinergic receptor inhibition
    • Opioid Receptor agonism
    • Blocks Norepi
    • Interacts w/ GABAa
  25. Ketamine is a bad choice for...(4)
    • Head Trauma P
    • Neurosurgery P
    • Ocular Sx P
    • Cardiovascular Dz P
  26. Why is Ketamine a bad choice for Head Trauma & Neurosurgery P's (7)?
    • Increases CMRO2
    • Increases CBF
    • Increases ICP
    • Myoclonic Activity
    • Seizures
    • Congestive Heart Failure
    • Severe Hypoertension
  27. Ketmamine is never given alone d/t...
    • Myoclonus
    • Poor Muscle Relaxant
    • Unpleasant Dreams
    • Emergence Reactions
  28. What drugs are often given w/ Ketamine(6)?
    • Bezodiazopines
    • Opioid
    • Guaiphenesin
    • Ace
    • Alpha 2 Agonist
    • +/- Anticholinergic for salivation
  29. D/T Ketamine's Myoclonic Activities, is should always be given with....
    A drug w/ muscle relaxant activities
  30. Why is Ketamine a bad choice for ocular Sx P's?
    • Increases Intra-ocular P
    • Dilated, centrally fixed pupils
    • Nystagmus (esp horses)
    • Corneal Reflexes present
    • Eyelids remain open
  31. What drug requires the use of eye lube?
    Ketamine
  32. Ketamine CVS Fx:
    • Increased BP
    • Increased HR
    • Increased CO
  33. How does Ketamine cause stimulation of the CVS?
    • Stimulation of Sympathetic NS
    • Inhibition of Norepinephrine uptake
  34. Specifically, how does Ketamine induce stress on the CVS (3)?
    • Increases Pulmonary Arterial P
    • Increases Myocardial work
    • Also had myocardial depressant effect
  35. Price doesn't use Ketamine in dogs, unless...
    they can be heavily sedated during recovery
  36. Price doesn't use Ketamine in dogs, unless...
    prolonged inhalational anesthesia
  37. Ketamine is often used for...
    • Horses
    • Darting wild animals
  38. While monitering a P under ketamine anesthesia, it is important to consider
    Cranial nerver and other relflexes will be different than other anesthetic techniques
  39. Contraindications to Ketamine (9):
    • Head Trauma/Neuro Sx
    • Sole Anesthetic for visceral surgery
    • Glaucoma
    • CVS Dz (HCM, Valvular Stenosis, CHF)
    • Hyperthyroid cats
    • Hepatic Dz
    • Renal Dz
    • Urinary obs
    • Epileptic/myelography
  40. Advantages of Ketamine (5):
    • Minmal CVS Depression
    • Minimal Respiratory Depression
    • Anti-hyperalgesic Effect
    • Wide Safety Margin
    • Wide range of Species
  41. Disadvantages of Ketamine (10):
    • Tachycardia
    • Salivation
    • Painful IM or SQ
    • Poor m relaxant
    • Corneal relaxant
    • Slow recovery
    • Emergence Rxns (excitement, euphoria, confusion, fear)
    • Increased Intraocular P
    • Increased Intracranial P
    • Seizures
  42. Telazol/Zoletil is a combo of:
    Tiletamine and Zolazopam (which is a benzodiazapine)
  43. What effects do the Telazol components have?
    • Tiletamine: cataleptic/dissociative Agent
    • Zolazopam: sedatoin, hypnosis, muscle relaxation, anxiolysis and sedation
  44. In dogs and cats, the recovery from telazol is characterized as...
    • Long
    • Rough
    • Poss convulsions
    • Esp violent/noisy in dogs b/c Tiletamins outlasts Zolazapam
  45. Telazol combined with an Alpha 2 is commonly used in ___
    pigs
  46. Contraindications of effects of Telazol/Zoletil (12):
    • Severe Cardiac or Respiratory compromised animals
    • Pancreatic Deficiency
    • (rest are similar to Ketamine)
    • Head Trauma/Neuro Sx
    • Sole Anesthetic for visceral surgery
    • Glaucoma
    • CVS Dz (HCM, Valvular Stenosis, CHF)
    • Hyperthyroid cats
    • Hepatic Dz
    • Renal Dz
    • Urinary obs
    • Epileptic/myelography
  47. Etomidate...
    Protein Binding:
    Onset:
    Recovery D/T:
    Elimination 1/2 Life:
    Clearance:
    Duration of Action:
    • Protein Binding: Highly
    • Onset: Rapid
    • Recovery D/T: Redistribution
    • Elimination 1/2 Life: Short
    • Clearance: Rapid
    • Duration of Action: Linearly related to dose
  48. The Rapid Elimination and Clearance rate of Etomidate, allow for....
    Single or Mult doses, or CRI
  49. Etomidate is metabolized by ____
    the liver
  50. Etomidate CVS Fx:
    • Minimal Fx
    • No Contractility, CO, no histamine, minimal sympathetic and baroreceptor)
  51. Etomidate Respiratory Fx:
    • Minimal
    • Apnea RARE
  52. Etomidate Endocrine Fx:
    Temporary Suppression of Adrenocortical Function
  53. Adverse Fx of Etomidate(3):
    • Pain on injection
    • Phlebitis
    • Unpleasant Myoconus on Injection
    • (Hiccups, nausea, vomiting, retching, and sneezing in Humans)
  54. What is given with Etomidate?
    • Ace/Benzodiezapine/opioid
    • (heavy sedation before or with)
  55. Etomidate is reserved for P with (6):
    • Cardiovascular Dz
    • Haemodynamically unstable P
    • Trauma P
    • P w/ severe systemic diseases, including liver dz
    • Caesarean section
    • Neuro Sx
  56. Advantages of etomidate (4):
    • Min CVS/Resp depression
    • Rapid Onset/Recovery
    • Can be admin as CRI
    • Cerebral Protection in animals with brain Dz or injury
  57. Disadvantages of etomidate (6):
    • Expensive
    • Painful
    • No analgesia
    • Violent recovery
    • Temp supression of Adrenal Gland
    • Vomiting
  58. Which drug has adverse endocrine effects?
    Etomidate

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