Etomidate

Question 1

Brand Name

Answer 1

Amidate

Question 2

Broad category

Answer 2

Intravenous anesthetic/ ultrashort-acting nonbarbiturate hypnotic

Question 3

Pharmacological class

Answer 3

carboxylated imidazole derivative
- Single enantiomer formulation (R)

Question 4

MOA (primary)

Answer 4

Binds directly as GABA-A agonists mimicking inhibitory effects of GABA and increases the receptors affinity for endogenous GABA

Question 5

Secondary effects

Answer 5

disinhibitory effects on parts of the nervous system that control extrapyrimidal motor activity (high incidence of myoclonus)

Question 6

Indications

Answer 6

Induction, procedural sedation:
- Cardiac (stable hemodynamic profile)
- Trauma
- Elderly
- Low EF patients
- ECT (proconvulsant)

Question 7

CV effects?

Answer 7

Minimal
- if sudden hypotension patient is likely acutely hypovolemic

Question 8

Respiratory effects

Answer 8

less ventilatory depression than propofol or barbs

Question 9

CNS

Answer 9

Decreased CBF
Decreased ICP
Decreased CMRO2
myoclonus, may reduce seizure threshold (proconvulsant)

Question 10

GI

Answer 10

N/V

Question 11

Burn on injection

Answer 11

Yes significant due to propylene glycol formulation
- pretreat with lidocaine

Question 12

Histamine release?

Answer 12

No

Question 13

Other significant effects

Answer 13

Yes, adrenal corticosuppression through 11-Beta-Hydroxylase inhibition. Decreases ability to turn LDL into cortisol (and aldosterone).
- lasts up to 48hrs

Question 14

Absolute Contraindications

Answer 14

Adrenocortical suppression

Question 15

Relative contraindications (precautions)

Answer 15

cautious in epilepsy and profound hypovolemia

Question 16

Induction Dosing

Answer 16

0.2-0.3 mg/kg

Question 17

Onset

Answer 17

30-60 seconds

Question 18

Duration

Answer 18

3-5 mins

up to
5-15 mins (dose dependent)

Question 19

Concentration

Answer 19

2 mg/mL

Question 20

Metabolism

Answer 20

Hepatic enzymes and plasma esterase hydrolysis

Question 21

Active metabolites

Answer 21

no

Question 22

Elimination

Answer 22

85% renal
10-13% bile/feces

Question 23

Protein binding

Answer 23

76%

Question 24

Elimination Half-life

Answer 24

2-5 hours

Question 25

Redistribution

Answer 25

Rapid (offset) follows 2-3 compartment model