Pharmacodynamics and Pharmacokinetics of Propofol
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Questions and Answers

Which induction agent is preferred in shock, for long procedures, or when extra analgesia is important?

  • Propofol
  • Etomidate
  • Ketamine (correct)
  • Midazolam

    • Which induction agent is good in haemodynamically unstable patients, but is not available in Australia?

  • Etomidate (correct)
  • Propofol
  • Midazolam
  • Ketamine

    • Which induction agent is good for haemodynamically stable patients or short procedures?

  • Ketamine
  • Propofol (correct)
  • Etomidate
  • Midazolam

    • Which induction agent has excellent amnesic properties?

    <p>Midazolam</p> Signup and view all the answers

    Which induction agent has bronchorelaxant properties making it useful in critical asthma, but also increases bronchial secretions?

    <p>Ketamine</p> Signup and view all the answers

    Which induction agent is best for longer, painful procedures, particularly in children?

    <p>Ketamine-midazolam</p> Signup and view all the answers

    What is the duration of action for ketamine when administered intravenously?

    <p>5 - 15 minutes</p> Signup and view all the answers

    Which of the following is an adverse effect associated with ketamine administration?

    <p>Lacrimation and salivation</p> Signup and view all the answers

    What is the usual dose of ketamine for induction of anaesthesia intravenously?

    <p>1.5 - 2 mg/kg</p> Signup and view all the answers

    What led to the change in scheduling for ketamine from Schedule 4 to 8 in 2005?

    <p>Increasing illicit use and diversion</p> Signup and view all the answers

    What effect does ketamine have on the patient's eyes?

    <p>They often remain open</p> Signup and view all the answers

    What is the mechanism of action of ketamine as an analgesic?

    <p>Blocks NMDA receptors</p> Signup and view all the answers

    What adverse effect is associated with ketamine administration in children under 2 years of age?

    <p>Hypotension</p> Signup and view all the answers

    What is the most common cardiovascular effect of ketamine administration?

    <p>Increased heart rate and blood pressure</p> Signup and view all the answers

    What adverse effect can occur if the total intravenous dose of ketamine exceeds 5 mg/kg?

    <p>Vomiting</p> Signup and view all the answers

    True or False: Ketamine has a rapid onset of action when administered intramuscularly.

    Signup and view all the answers

    What is the primary mechanism of action of propofol in altering neuronal function?

    <p>Potentiation of GABAergic inhibition</p> Signup and view all the answers

    What is the most significant route of metabolism for propofol in the body?

    <p>Glucuronidation</p> Signup and view all the answers

    What is the approximate half-life of distribution for propofol?

    <p>10-15 minutes</p> Signup and view all the answers

    What is the primary reason for the anti-emetic effect of propofol?

    <p>Potentiation of GABAergic inhibition in the brainstem</p> Signup and view all the answers

    What is the usual dose of propofol for induction of anaesthesia in adults?

    <p>2 mg/kg</p> Signup and view all the answers

    Which adverse effect is associated with propofol related infusion syndrome?

    <p>Bradycardia</p> Signup and view all the answers

    What is the main disadvantage of using propofol?

    <p>Risk of hypotension</p> Signup and view all the answers

    What is the distribution half-life of etomidate?

    <p>3 minutes</p> Signup and view all the answers

    What is the duration of effect of etomidate?

    <p>5-10 minutes</p> Signup and view all the answers

    What adverse effect is associated with etomidate administration in up to 70% of cases?

    <p>Myoclonus</p> Signup and view all the answers

    What is the main advantage of using remifentanil?

    <p>Rapid onset and offset</p> Signup and view all the answers

    What is the metabolism of remifentanil?

    <p>&lt; 50% excreted unchanged</p> Signup and view all the answers

    What special use is associated with fentanyl in hypovolaemic conditions?

    <p>Causes less hypotension than thiopentone, propofol, and morphine</p> Signup and view all the answers

    What adverse effect can occur if the total intravenous dose of ketamine exceeds 5 mg/kg?

    <p>Anion gap metabolic acidosis</p> Signup and view all the answers

    What effect does ketamine have on the patient's eyes?

    <p>Mydriasis</p> Signup and view all the answers

    What led to the change in scheduling for ketamine from Schedule 4 to 8 in 2005?

    <p>Concerns about its potential for abuse and dependence</p> Signup and view all the answers

    Study Notes

    Induction Agents

    • Etomidate is preferred in shock, for long procedures, or when extra analgesia is important.
    • Ketamine is good in haemodynamically unstable patients, but it's not available in Australia.
    • Propofol is good for haemodynamically stable patients or short procedures.

    Properties of Induction Agents

    • Ketamine has excellent amnesic properties.
    • Ketamine has bronchorelaxant properties, making it useful in critical asthma, but it also increases bronchial secretions.
    • Ketamine is best for longer, painful procedures, particularly in children.

    Ketamine

    • The duration of action of ketamine when administered intravenously is 10-15 minutes.
    • One adverse effect associated with ketamine administration is hallucinations.
    • The usual dose of ketamine for induction of anaesthesia intravenously is 1-2 mg/kg.
    • The change in scheduling for ketamine from Schedule 4 to 8 in 2005 was due to its abuse potential.
    • Ketamine causes the patient's eyes to become dilated and unreactive.
    • The mechanism of action of ketamine as an analgesic is NMDA receptor antagonism.
    • In children under 2 years of age, ketamine administration is associated with increased secretions and respiratory problems.
    • The most common cardiovascular effect of ketamine administration is increased heart rate and blood pressure.
    • If the total intravenous dose of ketamine exceeds 5 mg/kg, it can cause respiratory depression.

    Propofol

    • The primary mechanism of action of propofol in altering neuronal function is GABA receptor activation.
    • The most significant route of metabolism for propofol in the body is liver metabolism.
    • The approximate half-life of distribution for propofol is 2-8 minutes.
    • The primary reason for the anti-emetic effect of propofol is its antagonism of dopamine receptors.
    • The usual dose of propofol for induction of anaesthesia in adults is 1-2 mg/kg.
    • Propofol-related infusion syndrome is associated with cardiovascular and metabolic acidosis.
    • The main disadvantage of using propofol is its cost.

    Etomidate

    • The distribution half-life of etomidate is 2-5 minutes.
    • The duration of effect of etomidate is 3-5 minutes.
    • Up to 70% of cases of etomidate administration are associated with myoclonus.

    Remifentanil

    • The main advantage of using remifentanil is its rapid onset and offset of action.
    • Remifentanil is metabolized by esterases in the blood.

    Fentanyl

    • Fentanyl is specially used in hypovolaemic conditions due to its vasopressor effects.
    • If the total intravenous dose of ketamine exceeds 5 mg/kg, it can cause respiratory depression.

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    Description

    Test your knowledge of the pharmacodynamics and pharmacokinetics of propofol, a very short-acting induction agent used in anesthesia. Explore its exact mechanism of action, pharmacokinetic properties, and effects on the body.

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