DIPRIVANLamar University – MSNC 5356Denise Anaya, BSN RN CNOR

DiprivanPrescription Drug:

Propofol Brand Name: DiprivanDrug Class: General

AnestheticFDA Pregnancy

Category: B Propofol is not expected to harm an unborn baby.

Pathophysiological ConditionTreated Invasive Procedures (e.g. Surgery)

Sedation in the ICU

Also used to treat: Severe Migraines Post-operative Nausea and Vomiting Status Epilepticus

Intended Drug Response Minimal Sedation – Normal response Moderate Sedation/ Conscious

Sedation – Purposeful response Deep Sedation – Purposeful response

to repeated or painful stimulation. General Anesthesia - Unconscious

Potential Interactions Hypersensitivity Egg Peanuts Soya Lecithin

Numerous medical conditions warrant Precautions see drug insert

Adverse Drug ReactionsSevere Interactions

MAOIs St John’s Wart

Major InteractionsEthanol Levodopa Tricyclic

Antidepressants

Adverse Drug Reactions Minor Interactions:

Antihypertensives Anxiolytics Sedative Hypnotics Dichlorphenamide Opiates Phenothiazines Pregabalin Vassopressors Warfarin

Side Effects

Burning / Stinging at the injection site. Involuntary Muscle Movement – just after injection. Bradycardia Hypotension Nausea Vomiting Apnea Apnea Anaphylaxis

High lipophilicity (95-99% protein-bound

Stimulates the GABA-a receptors

Perpetuates flow of chloride ions into the neurons of CNS.

Causes an inhibitory effect on the RAS that leads to the cerebral cortex

Mechanism of Action and Binding

Pharmacokinetics

Absorption: Distribution:

CNS CVS Respiratory System

Biotransformation: Liver Final Elimination: Kidney

Improving Communication Accountability

Witness Waste Document Waste Waste must be non-recoverable

Label the Medication Prevents Drug Errors

Administered only by a Qualified Practitioner In the Perioperative setting it is outside the nurse’s scope

of practice to administer Diprivan except in the presence of a Nurse Anesthetist or Anesthesiologist.

Application to the Practice Setting

Data compiled and calculated--analyzed in MS Excel w/StatPack

Linear regression using risk domain and count compliance scores

Chi Square analysis of years experience vs risk and compliance scores

Summary Rapid on set – 40 seconds Rapid Recovery Reduce need for Opiates which results

in less nausea and vomiting But….No Reversal Administered only by an

Anesthesiologist or Nurse Anesthetist in the Perioperative Environment.

References Azdy, A. (2015). Propofol [Video file]. Retrieved from https://www.youtube.com/watch?v=Jw6rpNWUsEk

Clinical Pharmacology. (2015). Diprivan. Retrieved from http://clinicalpharmacology

Coleman, A., McNeil, N., Kovalchuck, A., Wangsa, D., Ried, T., & Wang, H. (2012). Cellular exposure to muscle relaxants and propofol could lead to genomic instability in vitro. Journal of Biomedical Research, 26(2), 117-124.

C-Health. (2015). Diprivan. Retrieved at http://chealth.canoe.com/drug_info_details.asp?brand_name_id=5187

Harvard Health Publications. (2011). Propofol the drug that killed Michael Jackson. Retrieved from: http://www.health.harvard.edu/blog/propofol-the-drug-that-killed-michael-jackson-201111073772

Institute for Safe Medication Practice (2015), Propofol sedation: Who should administer? Retrieved from https://www.ismp.org/newsletters/acutecare/articles/20051103.asp

Jones and Bartlett (2011). Nurse’s Drug Handbook 2011 Edition. Jones and Bartlett Learning

Papaioannou, V., Dragomanus, C., Theodorou, V. & Pneumatikos, I. (2008). The propofol infusion “syndrome” in Intensive Care Unit: From pathophysiology to prophylaxis treatment. Acta Anesthiologica, Belgica (59) 79-86.

Pharmacology 2000. (2015). Diprivan. Retrieved from http://www.pharmacology2000.com/General/Pharmacokinetics/kinobj5.htm

Styles, J. (2015). Personal communication, November 9, 2015.

Texas Board of Nursing. (2015). Position statements for 2014. Retrieved from http://www.bon.texas.gov/pdfs/practice_dept_pdfs/position_statements_pdfs/positionstatements2014.pdf