Induction Agent: Etomidate (Amidate)

Question 1

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

Etomidate binds at an ___ site on the GABA-A receptor.
Etomidate enhances the effect of GABA by increasing ___ conductance and prolonging channel ___. Without GABA present, there is little to no channel opening → ___ effect.

Answer 1

GABA to be present for activation.

Etomidate binds at an allosteric site on the GABA-A receptor.
Etomidate enhances the effect of GABA by increasing chloride conductance and prolonging channel opening. Without GABA present, there is little to no channel opening → minimal effect.

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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

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

How many mg per mL?

Answer 3

0.2%

2 mg per mL

Question 4

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

Answer 4

0.3 mg/kg

Question 5

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

Answer 5

1 minute

Question 6

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

Answer 6

10 to 20 minutes.

Question 7

True or False

There is no pain on injection with Etomidate

Answer 7

False

Pain on injection and it DOES NOT provide analgesia –> need to add something for pain.

Question 8

True or false

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

Answer 8

True!

Question 9

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

Answer 9

Adrenocortical Suppression

Question 10

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

Answer 10

11-Beta-Hydroxylase

11-B-Hydroxylase converts cholesterol to cortisol

Question 11

What is the significance of 11β-Hydroxylase?

Answer 11

11β-Hydroxylase converts cholesterol directly into cortisol.

Question 12

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

Answer 12

4-8 hours

Lowers post operative cortisol levels in healthy patients

Question 13

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

Answer 13

Postoperative nausea and vomiting (PONV)

Corn: sometimes called VOMIDATE

Question 14

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

Answer 14

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