Induction Agent - Etomidate

Question 1

What is the chemical characteristic of Etomidate that contributes to its hydrophilic and lipophilic properties?

A) Ester linkage
B) Carboxylated imidazole ring
C) Phenyl group
D) Hydroxyl group

Answer 1

B) Carboxylated imidazole ring

Question 2

At which pH level does Etomidate’s imidazole ring open, making it hydrophilic?

A) Acidic pH
B) Basic pH
C) Neutral pH
D) Variable pH

Answer 2

A) Acidic pH

Question 3

What is the primary action of Etomidate in the context of anesthesia?

A) Analgesic
B) Muscle relaxant
C) GABAA receptor agonist
D) Anticonvulsant

Answer 3

C) GABAA receptor agonist

Question 4

What is the typical intravenous (IV) dose range for Etomidate used for induction?

A) 0.1-0.2 mg/kg
B) 0.2-0.4 mg/kg
C) 0.5-0.7 mg/kg
D) 0.8-1.0 mg/kg

Answer 4

B) 0.2-0.4 mg/kg

Tx Wes Reference:
0.3 mg/kg

Question 5

What concentration is Etomidate typically available in for intravenous use?

A) 1 mg/mL
B) 2 mg/mL
C) 5 mg/mL
D) 10 mg/mL

Answer 5

B) 2 mg/mL

Question 6

Which of the following is NOT a property of Etomidate?

A) Hydrophilic at acidic pH
B) Lipophilic at physiologic pH
C) Histamine release
D) No analgesic effect

Answer 6

C) Histamine release

Question 7

For which type of cardiovascular system is Etomidate particularly well-suited?

A) Stable cardiovascular systems
B) Unstable cardiovascular systems
C) Systemic hypertension
D) Systemic hypotension

Answer 7

B) Unstable cardiovascular systems

Question 8

Which drug is Etomidate an alternative to for intravenous induction?

A) Fentanyl
B) Propofol or barbiturates
C) Succinylcholine
D) Midazolam

Answer 8

B) Propofol or barbiturates

Question 9

What is a notable feature of Etomidate related to its side effects?

A) It releases histamine, leading to potential allergic reactions.
B) It has significant analgesic effects.
C) It does not cause histamine release.
D) It commonly causes respiratory depression.

Answer 9

C) It does not cause histamine release.

Question 10

In addition to being a GABAA receptor agonist, what makes Etomidate suitable for induction in certain patients?

A) It provides analgesia.
B) It has a long duration of action.
C) It is effective for patients with unstable cardiovascular conditions.
D) It produces rapid muscle relaxation.

Answer 10

C) It is effective for patients with unstable cardiovascular conditions.

Question 11

What is the typical onset time for Etomidate when administered intravenously?

A) 10-20 seconds
B) 30-60 seconds
C) 1-2 minutes
D) 2-3 minutes

Answer 11

B) 30-60 seconds

Question 12

What is the duration of effect for Etomidate?

A) 1-3 minutes
B) 3-10 minutes
C) 10-20 minutes
D) 20-30 minutes

Answer 12

B) 3-10 minutes

Tx Wes Reference:
onset 1 min
duration 3-10 min

Question 13

What primarily causes the quick offset of Etomidate’s effects?

A) Rapid metabolism
B) Redistribution to fat and muscle
C) Increased renal clearance
D) Increased hepatic metabolism

Answer 13

B) Redistribution to fat and muscle

Question 14

What is the half-life of Etomidate?
A) 1-2 hours
B) 2-3 hours
C) 3-5 hours
D) 6-8 hours

Answer 14

C) 3-5 hours

Question 15

What is the protein binding percentage of Etomidate?

A) 50%
B) 60%
C) 70%
D) 80%

Answer 15

D) 80%

Question 16

How is Etomidate primarily eliminated from the body?

A) Through metabolism by CYP enzymes and plasma esterases
B) Through renal excretion only
C) Through biliary excretion only
D) Through pulmonary excretion

Answer 16

A) Through metabolism by CYP enzymes and plasma esterases

Question 17

What percentage of Etomidate is excreted in the urine?

A) 50%
B) 60%
C) 70%
D) 85%

Answer 17

D) 85%

Question 18

Which of the following conditions is a contraindication for the use of Etomidate?

A) Hypertension
B) Diabetes mellitus
C) Adrenal insufficiency (Addison’s disease)
D) Asthma

Answer 18

C) Adrenal insufficiency (Addison’s disease)

Question 19

Etomidate can increase the production of which substance, leading to a potential contraindication in Acute Intermittent Porphyria?

A) Porphyrins
B) ALA (aminolevulinic acid)
C) Bilirubin
D) Cortisol

Answer 19

B) ALA (aminolevulinic acid)

increases ALA synthase making more precursors for ineffective heme conversion = build up toxic

Acute intermittent porphyria is a rare autosomal dominant disease characterized by a deficiency of hydroxymethylbilane synthase (HMBS). It presents with abdominal pain, nausea, vomiting, peripheral neuropathy, and seizures. Treatment for acute attacks is intravenous heme. Definitive treatment is an orthotopic liver transplant.

Porphyria’ has been derived from the ancient Greek word porphura, meaning purple. Porphyrins are precursors of heme, an essential component of hemoglobin.

Question 20

contraindicated in

Answer 20

seizure hx

Question 21

In which condition should Etomidate be used with caution due to potential effects on the HPA (hypothalamic-pituitary-adrenal) axis?

A) Chronic obstructive pulmonary disease (COPD)
B) Sepsis and hemorrhage
C) Hyperthyroidism
D) Gastroesophageal reflux disease (GERD)

Answer 21

B) Sepsis and hemorrhage

Question 22

What percentage of propylene glycol is present in Etomidate, and what issue does this cause?

A) 10%, causing nausea
B) 25%, causing headache
C) 35%, causing pain at the injection site
D) 50%, causing hypotension

Answer 22

C) 35%, causing pain at the injection site

Question 23

What can rapid injection of Etomidate lead to?

A) Severe hypotension
B) Prolonged sedation
C) Brief apnea
D) Acute respiratory distress syndrome

Answer 23

C) Brief apnea

Question 24

Which side effect of Etomidate can be attenuated with opioids, benzodiazepines, or 1-2 mcg/kg of fentanyl?

A) Pain at the injection site
B) Involuntary myoclonic movements
C) Nausea and vomiting
D) Bradycardia

Answer 24

B) Involuntary myoclonic movements

Question 25

What is a common postoperative side effect associated with Etomidate? A) Hypotension B) Delirium C) Postoperative nausea and vomiting (PONV) D) Headache

Answer 25

C) Postoperative nausea and vomiting (PONV)

Question 26

How long does the enzyme inhibition caused by Etomidate typically last? A) 1-2 hours B) 2-4 hours C) 4-8 hours D) 8-12 hours

Answer 26

C) 4-8 hours ... limit use as infusion

Question 27

caution with ... In which clinical conditions should Etomidate be used with caution due to its effect on the HPA axis? A) Diabetes and hypertension B) Sepsis and hemorrhage C) Hyperthyroidism and hypothyroidism D) Asthma and chronic bronchitis

Answer 27

... sepsis and hemorrhage B) Sepsis and hemorrhage

Question 27

Adrenocortical Stress Response: Etomidate inhibits which enzyme involved in the cortisol synthesis pathway? A) 11-beta hydroxylase B) 21-hydroxylase C) 17-alpha hydroxylase D) 3-beta hydroxysteroid dehydrogenase

Answer 27

A) 11-beta hydroxylase (conversion of cholesterol to cortisol)

Question 28

Why is the use of Etomidate as an infusion limited? A) Due to its short duration of action B) Because it causes prolonged sedation C) Due to its inhibition of cortisol synthesis D) Because it frequently causes allergic reactions

Answer 28

C) Due to its inhibition of cortisol synthesis

Question 29

Which of the following effects is associated with the central nervous system (CNS) response described? Select 3 a) Decreased cerebral blood flow (CBF) b) Decreased intracranial pressure (ICP) c) Decreased cerebral metabolic rate of oxygen (CMRO2) d) Decreased activation of seizure foci

Answer 29

a) Decreased cerebral blood flow (CBF) b) Decreased intracranial pressure (ICP) c) Decreased cerebral metabolic rate of oxygen (CMRO2) May activate seizure foci (good for figuring out EEG aspects)

Question 30

What cardiovascular effect is described in relation to the given condition? a) Decrease in mean arterial pressure (MAP) due to decreased stroke volume (SV), not HR b) Slight decrease in MAP due to decreased systemic vascular resistance (SVR) c) Decrease in MAP due to increased heart rate (HR) d) Decrease in MAP due to decreased cardiac output (CO)

Answer 30

b) Decrease in MAP due to decreased systemic vascular resistance (SVR), not HR, SV CO, inotropy Does not block SNS response to laryngoscopy. An opioid or esmolol will help.

Question 31

What pulmonary effect occurs transiently according to the described condition? a) Decrease in tidal volume (VT) lasting 10-15 minutes b) Increase in tidal volume (VT) with a decrease in respiratory rate (RR) c) Transient decrease in VT for 3-5 minutes with increased CO2 medullary center stimulation d) Long-term decrease in CO2 medullary center stimulation

Answer 31

c) Transient decrease in VT for 3-5 minutes with increased CO2 medullary center stimulation (inc RR)