Induction Agent: Etomidate

Question 1

Etomidate has a unique mechanism of action as a GABA modulator that requires:

A) A special carrier protein
B) GABA to be present for activation
C) A lipid base for solubility
D) Continuous infusion to be effective

Answer 1

B) GABA to be present for activation

(does not mimic – has to have GABA present).

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Question 2

Etomidate’s Carboxylated Imidazole ring is similar to the ring in __________, allowing it to be water-soluble in solution and lipid-soluble in the body.

Answer 2

Midazolam

When the ring is open, it is water soluble in solution. The ring closes in the body and becomes very lipid soluble.

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Question 3

What is the primary advantage of using Etomidate as an induction agent? What is the con?

Answer 3

Cardiovascular stability

however..can induce seizures

Question 4

Etomidate is typically prepared as a __________% solution for induction purposes.

Answer 4

0.2%

Question 5

Tex Wes Ref and PP: Etomidate’s dose for induction in adults is typically ____.

Answer 5

0.3 mg/kg

Question 6

Tex Wes Ref: The onset on action of etomidate is about __ minute.

Answer 6

1 minute

Question 7

The duration of action of etomidate is __ to _ minutes.

Answer 7

10 to 20 minutes.

Question 8

True or False

There is no pain on injection with Etomidate

Answer 8

False

Pain on injection

Question 9

True or false

The induction dose of Etomidate is the only dose. There is no change for elderly or sick.

Answer 9

True!

Question 10

Etomidate is commonly used in the following patient scenarios:
Select 2

A) Trauma patients with cardiovascular instability
B) Patients requiring deep, long-term sedation
C) Elderly patients undergoing emergency surgery
D) Patients with adrenal insufficiency
E) Patients with a high risk of postoperative nausea

Answer 10

A) Trauma patients with cardiovascular instability
C) Elderly patients undergoing emergency surgery

Unstable patients

Has a possibly unfair bad reputation due to ICU studies.

Question 11

A rare but significant adverse effect of prolonged Etomidate use is ____ _____.

Answer 11

Adrenocortical Suppression

Question 12

Etomidate can cause adrenocortical suppression due to inhibition of which enzyme?

Answer 12

11-Beta-Hydroxylase

11-B-Hydroxylase converts cholesterol to cortisol

Question 13

Which of the following is true about 11β-Hydroxylase?

A) 11β-Hydroxylase converts cholesterol directly into cortisol.
B) 11β-Hydroxylase results in decreased aldosterone.
C) A deficiency in 11β-Hydroxylase increases cortisol levels.
D) 11β-Hydroxylase is primarily active in the liver.

Answer 13

A) 11β-Hydroxylase converts cholesterol directly into cortisol.

Question 14

The duration of adrenocortical suppression caused by a single dose of Etomidate is ___ hours?

Answer 14

4-8 hours

Lowers post operative cortisol levels in healthy patients

Question 15

In addition to adrenocortical suppression, Etomidate is also associated with a high incidence of ____:

Answer 15

Postoperative nausea and vomiting (PONV)

Corn: sometimes called VOMIDATE

Question 16

Etomidate is considered worst for PONV of all induction drugs, up to ________% of patients.

Answer 16

PONV in 30% of patients (worst of all induction drugs)