“Where Are Commonly Used IV Sedation Medications Metabolized In The Body?”

6.18.24 Quick Review #152 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #anesthesia #sedation #ivs Of the commonly used medications used for or during IV sedation(s), most are generally metabolized in the same organ. Included is a brief overview of their metabolism: 1. Versed (Midazolam): Primarily metabolized by the liver via the cytochrome P450 enzyme system, particularly CYP3A4. 2. Ketamine: Also primarily metabolized by the liver through the cytochrome P450 enzymes (mainly CYP2B6 and CYP3A4). 3. Fentanyl: Metabolized primarily by the liver, especially by the CYP3A4 enzyme. 4. Propofol: Metabolized mainly by the liver through conjugation with glucuronic acid and hydroxylation by cytochrome P450 enzymes. 5. Etomidate: Etomidate is primarily metabolized by the liver. The major pathway involves hydrolysis by hepatic and plasma esterases to form its carboxylic acid metabolite, which is inactive. 6. Ondansetron: This antiemetic is primarily metabolized by the liver through the cytochrome P450 enzyme system, specifically CYP3A4, CYP2D6, and CYP1A2. Its renal clearance is minimal, and the kidneys play a minor role in its excretion. 7. Dexamethasone (Decadron): This corticosteroid is also primarily metabolized by the liver. It undergoes extensive hepatic metabolism mainly by CYP3A4 enzymes. Renal excretion is not significant for the unchanged drug, but the metabolites are excreted by the kidneys. While the kidneys play a role in the excretion of some metabolites, the primary metabolism of these drugs occurs in the liver. This is an important distinction, especially when considering patients with liver or kidney dysfunction. References: 1. NYSORA. (n.d.). Intravenous Anesthetics. Retrieved June 18, 2024, from https://lnkd.in/eZhGwEBy 2. Reves, J. G., Glass, P. S. A., Lubarsky, D. A., McEvoy, M. D., & Martinez-Ruiz, R. (2009). Intravenous Anesthetics. In R. D. Miller, L. I. Eriksson, L. A. Fleisher, J. P. Wiener-Kronish, W. L. Young, & J. F. Pardo Jr. (Eds.), Miller’s Anesthesia (7th ed., pp. 719-768). Philadelphia, PA: Churchill Livingstone/Elsevier. 3. Goodman, L. S., Brunton, L. L., Chabner, B., & Knollmann, B. C. (2018). Goodman & Gilman’s: The Pharmacological Basis of Therapeutics (13th ed.). New York, NY: McGraw-Hill Education. 4. Lischke, V., Behne, M., Doelken, P., Kessler, P., Keller, C., & Huppe, M. (1994). Pharmacokinetics of midazolam, propofol, and fentanyl in patients with renal failure. British Journal of Anaesthesia, 73(4), 461-465. https://lnkd.in/ee8FZDqS 5. ChatGPT. 2024. #podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency #oralsurgeon #dentist #doctorgallagher