Names and pronunciation
(pro′poh-fole) Diprivan
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Individual generic drug information
Extracted information for propofol only.
(pro′poh-fole) Diprivan
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Func. class.: General anesthesia
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Chem. class.: Phenol derivative
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Do not confuse: Diprivan/Diflucan/Ditropan
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ACTION: Produces dose-dependent CNS depression by activation of GABA receptor, hypnotic
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USES: Induction or maintenance of anesthesia as part of balanced anesthetic technique; sedation in mechanically ventilated patients
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Extracted information for propofol only.
CONTRAINDICATIONS: Hyper sensitivity to this product or soybean oil, egg, benzyl alcohol (some products) Precautions: Pregnancy, breastfeeding, children, geriatric patients, respiratory depression, severe respiratory disorders, cardiac dysrhythmias, labor and delivery, renal disease, hyperlipidemia
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SIDE EFFECTS CNS: Involuntary movement, headache, fever, dizziness, shivering, abnormal dreams, euphoria, fatigue CV: Bradycardia, hypotension, hypertension GI: Nausea, vomiting, abdominal cramping, dry mouth GU: Urine retention, green urine, phlebi tis, hives, burning/stinging at inj site, rash RESP: Apnea, cough, hiccups SYST: Propofol infusion syndrome
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INTERACTIONS • Do not use within 10 days of MAOIs Increase: CNS depression—alcohol, opi- oids, sedative/hypnotics, antipsychotics, skeletal muscle relaxants, inhalational anesthetics Drug/Herb Increase: propofol effect—St. John’s wort
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TREATMENT OF OVERDOSE: Discontinue product; administer vasopressor agents or anticholinergics, artificial ventilation HIGH ALERT
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Extracted information for propofol only.
DOSAGE AND ROUTES Anesthesia • Adult <55 yr and ASA-PSI or II: IV 40 mg q10sec until induction onset, mainte- nance 100-200 mcg/kg/min or IV BOL 20-50 mg prn, allow 3-5 min between adjustments • Child ≥3 yr: IV induction 2.5-3.5 mg/kg over 20-30 sec when not pre- medicated or lightly premedicated • Child 2 mo-16 yr maintenance: IV 125-300 mcg/kg/min, lower dose for ASA III or IV Monitored anesthesia care (MAC) sedation • Adult <55 yr: IV 100-150 mcg/kg in- fusion or 0.5 mg/kg by slow infusion; maintenance 25-75 mcg/kg/min infusion or boluses of 10-20 mg • Geriatric debilitated, ASA III/IV: IV initial, use slower rates; maintenance use 20% less than adult dose ICU sedation • Adult: IV 5 mcg/kg/min over 5 min; may increase by 5-10 mcg/kg/min over 5-10 min until desired response (Dipri- van or generic)
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Available forms: Inj 10 mg/mL in 20-mL ampule, vials, syringes
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Administer: IV route • Shake well before use; dilution is not necessary, but if diluted, use only D5W to ≥2 mg/mL; give over 3-5 min, titrate to needed level of sedation; use only glass containers when mixing, not stable in plastic; use aseptic technique when transferring from original container • Only with resuscitative equipment available; only by qualified persons trained in anesthesia • Store in light-resistant area at room temperature, use within 6 hr of opening • If transferred from original container to another container, complete infusion within 12 hr (Diprivan), 6 hr (generic propofol) Y-site compatibilities: Acyclovir, alfent- anil, aminophylline, ampicillin, aztreo- nam, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBO- platin, ceFAZolin, cefoperazone, cefotax- ime, cefoTEtan, cefOXitin, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMA- ZINE, cimetidine, CISplatin, clindamycin, cyclophosphamide, cycloSPORINE, cytar abine, dexamethasone, diphenhydrA MINE, DOBUTamine, DOPamine, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, esmolol, famotidine, fentaNYL, fluconazole, fluo- rouracil, furosemide, ganciclovir, glyco- pyrrolate, granisetron, haloperidol, hep- arin, hydrocortisone, HYDROmorphone, hydrOXYzine, ifosfamide, imipenem/ cilastatin, inamrinone, insulin (regular), isoproterenol, ketamine, labetalol, levor- phanol, lidocaine, LORazepam, magne- sium sulfate, mannitol, meperidine, mez- locillin, miconazole, morphine, nafcillin, nalbuphine, naloxone, nitroglycerin, norepinephrine, ofloxacin, PACLitaxel, PENTobarbital, PHENobarbital, piperacil- lin, potassium chloride, prochlorpera- zine, propranolol, raNITIdine, scopol- amine, sodium bicarbonate, sodium nitroprusside, succinylcholine, SUFent- anil, thiopental ticarcillin, ticarcillin/cla- vulanate, vecuronium, verapamil Solution compatibilities: if given together via Y-site: D5W, D5LR, LR, D5/0.45% NaCl, D5/0.2% NaCl
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Extracted information for propofol only.
Assess: • Inj site: phlebitis, burning, stinging • ECG for changes: PVC, PAC, ST segment changes; monitor VS, B/P, pulse, respirations • Neurologic symptoms: excitatory movement, tremors, dizziness, LOC, pu- pil reaction • Avoid general anesthetic use in child <3 yr; may negatively affect the brain • Allergic reactions: hives • Respiratory dysfunction: respiratory depression, character, rate, rhythm; no- tify prescriber if respirations are <10/min, apnea may occur ≥1 min, check airway, ventilation, determine level of sedation • Propofol infusion syndrome: rhabdo- myolysis, renal failure, hyperkalemia, meta- bolic acidosis, cardiac dysrhythmias, heart failure usually between 35 and 93 hr after infusion begun at >5 mg/kg/hr for >48 hr • ICU sedation: test wake up on a daily basis to determine needed dose for seda- P tion, do not discontinue abruptly during test • For lipids: adjust enteral nutrition if receiving; monitor for signs and symp- toms of pancreatitis (elevated lipids); propofol contains 1.1 Kcal/mL • Pregnancy/breastfeeding: use only if clearly needed; avoid breastfeeding, ex- creted in breast milk
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Evaluate: • Therapeutic response: induction of an- esthesia
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That product will cause dizziness, drowsiness, sedation; to avoid hazardous activities until drug effect wears off • That drug may cause burning sensa- tion during administration
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Extracted information for propofol only.
PHARMACOKINETICS Onset 15-30 sec, rapid distribution, half-life 1-8 min, half-life 3-12 hr; 70% excreted in urine; metabolized in liver by conjugation to inactive metabolites, 95%-99% protein binding, crosses placenta, enters breast milk, crosses blood brain barrier
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Filter the extracted dose blocks for this individual drug.
Anesthesia
• Geriatric debilitated, ASA III/IV: IV initial, use slower rates; maintenance use 20% less than adult dose ICU sedation
Candidate age grouping · source page 1098