Lamar University presentation on Diprivan used in the perioperative setting.

1. DIPRIVAN

2. Diprivan
Prescription Drug:
Propofol
Brand Name: Diprivan
Drug Class: General
Anesthetic
FDA Pregnancy
Category: B Propofol is
not expected to harm an
unborn baby.

3. Pathophysiological Condition
Treated
Invasive Procedures (e.g. Surgery)
Sedation in the ICU
Also used to treat:
Severe Migraines
Post-operative Nausea and Vomiting
Status Epilepticus

4. 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

5. Potential Interactions
 Hypersensitivity
 Egg
 Peanuts
 Soya Lecithin
 Numerous medical conditions warrant
Precautions
 see drug insert

6. Adverse Drug Reactions
Severe Interactions
MAOIs
St John’s Wart
 Major Interactions
Ethanol
Levodopa
Tricyclic
Antidepressants

7. Adverse Drug Reactions
 Minor Interactions:
 Antihypertensives
 Anxiolytics
 Sedative Hypnotics
 Dichlorphenamide
 Opiates
 Phenothiazines
 Pregabalin
 Vassopressors
 Warfarin

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

9.  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

10. Pharmacokinetics
 Absorption:
 Distribution:
 CNS
 CVS
 Respiratory System
 Biotransformation: Liver
 Final Elimination: Kidney

11. 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.

12. 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

13. 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.

14. ReferencesAzdy, 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