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Induction & Opiate Rx
Induction & Opiate Rx
40
Medical
Graduate
07/17/2013

Additional Medical Flashcards

 


 

Cards

Term

Propofol (brand name)

 

 

Induction Dose

 

Duration (α) half life

 

Contraindications

Definition

Diprovan

 

2mg/kg

 

 

3-8 minutes

 

Contraindications: hypotension,resp depress, egg/peanut allergy,decreased GFR, Inj Pain. Sulfite brand dependent. Bacterial contamination Propofol Infusion Syndrome

 

Term

Etomidate (Brand Name)

 

Induction Dose

 

Onset -Duration (α) half life

 

Contraindications

Definition

Amidate

 

0.2 mg/kg

 

O: <30 seconds

 D: 5-10 minutes

 

Contraindications: myoclonus, adrenal supression,

injection pain, PONV, Prophyria-Induct: ALA synth

Adrenal supression from blocking of- 11 beta hydroxylase

Term

Ketamine (Brand Name)

 

Action

 Induction Dose

 

Duration (α) half life

 

Onset

 

Contraindications

Definition

Ketalar


NMDA antagonist: Has analgesic properties, bronchodialator

 

 1-2 mg/kg IV

 

D 10-20 minutes

O: 10


Contraindications: Emergence reaction, ↑ ocullar, ICP & CBF,PONV, nystagmus,  secretions

 

Term

Midzolam (Brand Name)

 

Induction Dose

 

Duration (α) half life

 


Contraindications:

Definition

Versed

 

0.3mg/kg

 

15-30 min

 

Contraindications: resp depression, ↓ CBF & CMR

Term

Morphine 

 

Potency

 

Intraoperative Anesthetic Dose

 

Duration (Alpha) Half Life

Definition

 

 

1

 

 

0.1-1mg/kg

 

 

3-5 hrs

Term

Remifentanil (Brand Name)

 

Potency

 

Intraoperative Anesthetic Dose

 

Duration (Alpha) Half Life

Definition

Ultiva

 

100

 

1mck/kg

 

2-5 minutes

Term

Fentanyl(Brand Name)

 

Potency

 

Intraoperative Anesthetic Dose

 

Duration (Alpha) Half Life

Definition

Sublimaze

 

100 

 

2-150mcg/kg

 

1-1.5 hrs

Term

Sufentanil(Brand Name)

 

Potency

 

Intraoperative Anesthetic Dose

 

Duration (Alpha) Half Life

Definition

Sufenta

 

1000

 

0.25-30 mcg/kg

 

0.8-1.3hrs

 

 

Term

Alfentanil(Brand Name)

 

Potency

 

Intraoperative Anesthetic Dose

 

Duration (Alpha) Half Life

Definition

Alfenta

 

20

 

100-200mcg/kg

 

20 minutes

Term

Hydromorphone(Brand Name)

 

Potency

 

Intraoperative Anesthetic Dose

 

Duration (Alpha) Half Life

Definition

Dilaudid

 

8

 

0.03mg/kg

 

 

2-3 hrs

 

 

Term

Dexmedetomidate (Brand Name)

 

Class

Receptor

Dose (Loading & Infusion)

Onset

 

Considerations

Definition

Class: Sedative

 

Receptor: Alpha 2 agonist

 

Dose

Loading 1mcg/kg over 10min

Infusion 0.3-0.7 mcg/kg/hr

 

Onset 10min

 

+analgesia, +neuro cases (decreased NE in brain) brady 

Considerations, inital bolus - transient HTN

Term

Droperidol

 

Black Box Warning

 

Anti-emetic? (How and Where)

 

Class (related Rx)

Definition

BB: Can cause QT prolongation → Torsades De Pointes

 

 

Dopamine blocker

 

Butyrophnones

 

Extrapyramidal side effects

Term



Describe extrapyramidal side effects-

what they are, which drugs can produce them.

Definition

bradykinesia, dystonia, tremors, restlessness




Ketamine

 Droperidol

Normeperidine toxic metabolite of demerol

Term

Describe GABA stimulation and the results? 


What ion works on the GABA receptors? 

Definition

Stimulation of the GABA receptors has an inhibitory




Cl


HYPERPOLARIZING the post-synaptic neuron 

Term
Which drug/drugs are dopamine antagonists?
Definition




droperidol

Term
Which induction agents produce analgesia?
Definition
Etomidate and Ketamine
Term

Why does propofol put you to sleep?

 

 

 

 

 

Wake you up?

Definition

Gaba mimetic

 

Hyperpolarized cell is inhibited

Cl- Influx causing hyperpolar membrane potential

90-150mv

 

 

 

Wakes you up because it is widley distributed ↑ Vd volume of distribution

Term

Versed is classified as a?

 

 

 

 

 

 

Others

Definition

Benzodiazepine

 

Versed 

induction 0.2-0.4 mg/kg

 

 

Diazapam: 0.3-0.6 mg/kg, 20-50hr 1/2 life

Lorazepam: 0.03-0.06 mg/kg 10-16 hr 1/2 ife
  

 

Term
Elimination 1/2 life of Propofol
Definition





1-5 hrs

Term
Redistribution half life of propofol
Definition
4-8 minutes.
Term
Induction agent producing nausea and vomitting?
Definition
Etomidate and Ketamine
Term
Prosepctive patient fot the use of etomidate
Definition
cardiovascular/hypovolemic
Term

Side effects of etomidate?

 

Dosage

 

 

Administered

 

 

Definition

Adrenal supression via the 11-hydroxylase

 

 

 

0.3 mg/kg

 

IV Push for induction

Term
30 minutes after induction highest amounts of propofol ware found in?
Definition

Musclles

 

 

 

 

order of enterance:

 

blood, organs, muscle, fat

Term
Which drugs are dopamine antagonists?
Definition
Butyrophenones: Droperidol
Term
Induction agent with the highest cardio/resp depression
Definition

Propofol

 

Term

Opiate agonists are?


Endogenous opiate agonists are?

Definition

act at opiate receptors


mu,    delta,                         kappa,

                              ↓        ↓                                 ↓

                 enkephalins   beta-endorphin          dynorphins

 

             

Term
Opiate Agonists cause what side effects?
Definition

Analgesia                                                          Constipatio

respiratory depression                                        Rash

sedation                                                            Urinary Retention

euphoria                                                           Tolerance

vasodilation                                                       Dependence  

bradycardia                                                       Itiching 

cough suppression                                             Shivering

miosis  

skeletal muscle rigidity (Fent,Remi,Sufent) 

smooth muscle spasm/biliary spasm

Term
How do opiates block pain?
Definition

agonism of opiate receptors on the pre-synaptic neurons of target cells decrease the release of substance P.  Substance P does not bind it’s receptors on the post-synaptic neuron, and the nociceptors do not sense pain. 



Decreased RR drive in the CNS


Can cause decreased BP by relaxation or histamine release. 

Term
What therapeutic measures can you take to decrease the ICP in an anesthetized patient?
Definition

No Ketamine!

 

Prop/Etom are good as they decrease CMRO2/ICP

 

Manitol

 

Hypervent: to get CO2 to low end of normal

 

Make sure head is not tilted or constricted

 

Proper analgesia

Term
What opiate produces bad effect with MAOI's
Definition

Demerol

 

Seretonin Syndrome

Term
Opiate tolerance
Definition

Chronic use causes down regulation:

 

Needing higher dose to produce the same result

Term

Opiates metab

 

 

 

Demerol Metabolism

Definition

In liver via Phase 1-2 reactions

 

Remifent metab'd by Non-Esterase Dependent Hydrolosis

 

 

 

Metab into toxic normeperidine

 

 

 

Term
Know the half of each narcotic
Definition

Morphine 3-5hrs

Hydromorph 1-3hrs

Oxycodone   3.2-4.5hrs

Methadone   15-30hrs

Fentanyl       2-4hrs

Alfentanil      1.5hrs

Remifentanil 9 min

Sufentanil     6hrs

 

Naloxone      10.8hrs duration 20-60mins

 

Term
What narcotics are lipid/H2o soluble
Definition

Lipid: Fentanyl, sufentinil, remifentinil, alfentinil

           



Water : morphine, methadone,

 

           



Both: hydromorphone, demerol

Term

Flumazanil 

 

Mechanaism:

Use:

Lenght of action:

Definition

Mech:

benzo antagonist that binds competitively at the benzo site on the GABA receptor inhibiting hyperpolarization


Use: Reversal of benzodiazapines only!


Length of Action:  β half-life is 41-79 minutes

Term

What does GABA stand for? 

Definition

Gamma amino butyric acid.

Term
What receptors does ketamine work on? 
Definition



Blocks (antagonism) NMDA (n-methyl d-aspartate) receptors

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