ICU Agents

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What is the brand name of propofol?

Diprivan
What are indications for the use of propofol?
- General anesthesia
- ICU sedation in intubated mechanically ventilated patients
What is the MOA of propofol?
- Agonist at GABA receptors
- Blocks NMDA receptors
What is the LD of propofol?

5 mcg/kg/minute CI (0.3 mg/kg/hr)
Do elderly patients have a higher or lower LD?

Lower--give 80% of adult dose
What weight should be used when calculating a propofol dose in obese patients?

IBW
What are the cardiovascular AE of propofol?
- Hypotension
- Bradycardia
Are injection site reactions more common in peripheral or central lines?

Peripheral
What are AE of propofol?
- CV
- Injection site rxn
- Hypertriglyceridemia
- Propofol-related infusion syndrome
- Infections
At what doses it is more common to see propofol-related infusion syndrome?

> 83 mcg/kg/min for > 48 hours
What are some signs and symptoms of propofol-related infusion syndrome?
- Metabolic acidosis
- Rhabdomyolysis
- Hyperkalemia
- Heart failure
If propofol is given with these types of drugs it will have increased sedative effects?

Narcotics
In propofol distriubtion, which step is slow? Why?
- Slow return from poorly perfused tissue into blood
- Due to saturated clearance
Does propofol cross the BBB?

yes
What is the onset of action of propofol?

30-40 seconds
What is the duration of propofol?
- 3-10 minutes
- dose and rate dependent (if they have been on it longer it might take longer for the affects to wear off)
What is the Vd for propofol?

2-10 L/kg
After a ___ day infusion, the Vd of propofol increases to ___ L/kg.
- 10
- 60
Is the Vd of propofol increased or decreased in elderly patients? Obese patients?
- Decreased: due to decreased CO
- Increased: distributes more into tissues
What is the main type of metabolism of propofol?

Hepatic (2C9)
Are propofol metabolites active or inactive?

Inactive
What type of excretion does propofol undergo?

Renal
What type of half life does propofol have? How long is the 1/2 life?
- biphasic
- 40 minutes initially and 4-7 hours terminal
What are indications for neuromuscular blocking agents?
- Facilitated mechanical ventilation
- Manage increased intercranial pressure
- immobilization during procedures
- Treat muscle spasms (burn victims)
- Decrease oxygen consumption
Do depolarizing agents or non-depolarizing agents activate the Ach receptors?

Depolarizing
What is the MOA of non-depolarizing agents?

Bind to nicotinic Ach receptors and act as competitive antagonists
What is the onset of action of succinylcholine?
- 30-60 seconds (IV)
- 2-3 minutes (IM)
What is the onset of action of Pancuronium?

2-3 minutes
What is the onset of action of Vecuronium?

3-4 minutes
What is the onset of action of rocuronium?

1-2 minutes
What is the onset of action of atracurium?

3-5 minutes
What is the onset of action of cisatracurium?

2-3 minutes
Which neuromuscular blocking agent has a duration of 90-100 minutes?

Pancuronium
What class of nondepolarizing agents do atracurium and cisatracurium fall uncer?

Benzylisoquinolinium
The distriubtion of neuromuscular blockage agents is highly ________ and ________ soluble.
- Ionized
- Water
Which drug has the smallest Vd?

Atracurium
Which drug has the largest Vd?

Pancuronium
How are the aminosteroidal agents metabolized?

Deacetylated in the liver
Do the aminosteroidal agents have active or inactive metabolites?

Active--hhalf as potent as the parent compound
How are the benzylisoquinolinium agents metabolized?

Hydrolysis--degraded spontaneously in plasma at body temp (Hoffman)
Do the benzylisoquinolinium agents have active or inactive metabolites?

inactive
What is the metabolite of benzylisoquinolinium agents?

Laudanosine
Which drug is eliminated 100% renally?

Succinylcholine
Which drugs should not be given in patients with renal or liver failure?

Aminosteroidal agents
What should you monitor when giving neuromuscular blockade agents?
- Vital signs
- Train-of- four
What drugs should be given to patients who have HTN?
- Atracurium
- Vecuronium
What are CV effects of neuromuscular agents?

Hypertension and tachycardia
Why do patients experience hypotension with these drugs?

Histamine release
What drugs should be avoided in patients with hypotensioN?
- Atracurium
- Succinylcholine
What type of drugs most often causes myopathy?

Aminosteroidal
What are the SE of neuromuscular blocking agents?
- CV: hypertension, tachycardia, hypotension
- Myopathy
- Tachyphylaxis
What drugs will interact with NBA and enhance blockade?
- CCBs
- BBs
- Furosemide
- Antibiotics (aminoglycosides)
- Immunosuppressive agents
- Lithium
- Inhaled anesthetics
What drugs will interact with NBA and decrease blockade?
- Carbamazepine
- Phenytoin
- Ranitidine
- Theophylline

Author

rclee06

150931

Card Set

ICU Agents

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Updated

2012-04-29T20:14:20Z

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