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1. produces signifcant ____2. doesn't depress what?3. adverse effects?4. especially good for pts who exhibit what characteristics?
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1. analgesia2. CV or Resp sys3. psychological4.hyperalgesia and opioid tolerance
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Metabolism1. how?2. major pathway3. metabolite? -active?4. what happens to #3?5. excretion?
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1. heptatic microsomal enzymes2. n-demethylation3. Norketamine= active4. hydroxylated to hydroxynorketamine5. water soluble glucuronide derivatives
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1. chemical structure/ form - significance?2. after induction dose, how long does ketamine remain at therapeutic levels?3. commercial preparation a. pH of sol'n b. ___ mixture (concent varies) c. contains which preservative?
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1. 2 sterio-isomers ** S- isomer more potent and less SE; R- bad2. 10-15min3. Ketalora. 3.5-5.5b. Racemicc. benzethonium chloride
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Pharmacokinetics1. distribution2. model used?3. solubility4. vol of dist5. elimination half life6. total body clearance
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1. rapid (short distrib. half life 11-16min)2. two compartment3. highly lipid soluble4. large VofD (3L/kg)5. 2-3hrs (short)6. 1.4L/min (similar to liver bld flow)
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1. effects of concurrent alfentanyl administration2. alternate routes and considerations3. Ketamine known for resulting in what kind of anesthesia experience? ____ state
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1. incr concent. of ketamine in brain, incr VofD, incr clearance2. oral/ intranasal= signif 1st pass effect3. dissociative anesthesia/ cataleptic state
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Dissociative Anesthesia (Cataleptic State)1. profound ___ & ____2. eyes?3. reflexes?4. secretions?5. muscles?
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1. analgesia & amnesia2. open, pupils dilated, nystagmus3. intact, but not protective4. lacrimation and salivation5. increased skeletal musc tone; purposeless mvmt of extrem, head, trunk
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1. Onset of Action2. max effect3. DOA= ___ dependent4. A&O in how long? d/t what?
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1. 30 sec2. 1 minute3. dose dependent (10-15min for 2mg/kg)4. 30min d/t DISTRIBUTION
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Analgesia1. ___ bld levels than LOC - ____ doses2. great for ____ pain3. inhibits ___ ___ hypersensitization4. reduces acute ____5. reduces ____ requirements
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1. lower - subanesthetic2. post-op3. nociceptive central4. tolerance5. opiate
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CNS Site of Action1. which system?2. depresses what 2 areas?3. stimulates what? including what?4. ___ ___ of nonspecific pathways in the ___ & ___ areas
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1. thalamoneocortical projection system2. neuronal fct in parts of the cortex (esp association areas) and thalamus3. limbic system (including hippocampus)4. fuctional disorganization/ midbrain and thalamic areas
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Sites of Action1. ___ receptors in the ___ and ___a. for which enantiomerb. some opioid ___ rec activity2. which receptor activity mediates the anesthesia and maybe some analgesic effects?3. does not interact with which receptors?
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1. opioid/ brain and spinal corda. S-enant.b. mu2. NMDA3. GABA
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CNS effects1. ___ CNS effects2. what type of activity in the hippocampus?3. compare incr in CBF to CMRO2 (blocked by which 2 drugs?4. increases ___5. vascular response to ___ intact
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1. excitatory2. petit-mal seizure-like activity3. CBF>CMRO2- blocked by thiopental and diazepam4. SNS5. CO2
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1. explain emergence runs2. last how long?3. y do these rxns occur?4. occurs in what % of adult patients?
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1. vivid dreaming, extracorporeal experiences, illusions, excitement, euphoria, fear, confusion2. 1st hr of emergence3. postulate there is a depression of auditory/ visual relay nuclei= misperception/ misinterpretation of auditory/ visual stimuli4. 10-30% (some studies 5-100%)
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Factors affecting Incidence of emergence Rxn1. age2. dose3. gender4. psychological5. Tx?
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1. less in pediatrics2. large dose= greater effect3. females more than males4. psychotics/ dreamers5. best tx'd with BZD's
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Respiratory Effects1. _____ effect2. transient drop in ___ after induction3. causes _____ in peds4. good for which pts? why?- as effective as halothane in preventing _____5. increases ____6. peds= ?7. silent _____
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1. minimal2. minute ventilation3. resp depression4. asthmatics (reactive airway Dz); bronchial smooth muscle relaxant (sometimes used to tx status asthmaticus)- bronchospasm5. salivation6. can cause upper airway obstruction and laryngospasm (from incr secretions)7. aspiration
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CV Effects1. incr __, __ , ___ and ___2. use caution in patients with what?3. if ketamine causes neg isotropic effects in vitro, what happens in vivo?- blocked by which drugs?4. ____- like effect
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1. BP, HR, CO, PAP2. mitral valve/ congenital lesions3. SNS over-rides; rls NE - Barbs, BZD, drperidol4. cocaine
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