Home Drug Guide Ketamine Hydrochloride

Drug Guide

Generic Name

Ketamine Hydrochloride

Brand Names Ketalar, Ketamine Hcl

Classification

Therapeutic: Anesthetic, Analgesic

Pharmacological: NMDA receptor antagonist, dissociative anesthetic

FDA Approved Indications

  • Induction and maintenance of anesthesia in procedures requiring sedation, profound analgesia, and amnesia
  • Diagnostic and surgical procedures in hospitalized patients

Mechanism of Action

Ketamine primarily acts as an NMDA receptor antagonist, blocking glutamate receptors in the brain, which results in dissociative anesthesia, analgesia, and sedation.

Dosage and Administration

Adult: Typically 1-4.5 mg/kg IV for induction; maintenance doses vary based on procedure, often 0.1-0.5 mg/kg IV or 2-4 mg/kg IM

Pediatric: Dosing is similar to adults, with adjustments based on weight and age; dosing must be carefully controlled due to variability in response

Geriatric: Lower initial doses recommended due to increased sensitivity and potential for cardiovascular effects

Renal Impairment: Use with caution; no specific dose adjustment established but patient monitoring is advised

Hepatic Impairment: Adjust dosing as needed; metabolism may be prolonged

Pharmacokinetics

Absorption: Rapid IV absorption; IM absorption is also effective but slightly slower

Distribution: Widely distributed in body tissues, crosses the blood-brain barrier and placental barrier

Metabolism: Extensively metabolized in the liver via CYP450 enzymes to norketamine and other metabolites

Excretion: Metabolites are excreted primarily in urine

Half Life: Approximately 2-3 hours

Contraindications

  • History of or suspected increased intracranial pressure, brain tumors or aneurysms
  • History of psychosis or schizophrenia

Precautions

  • Use with caution in patients with cardiovascular diseases, hypertension, or hepatic impairment; monitor for emergence reactions, including hallucinations and agitation

Adverse Reactions - Common

  • Emergence reactions (hallucinations, nightmares, delirium) (Moderate)
  • Increased blood pressure, tachycardia (Common)
  • Nausea and vomiting (Common)

Adverse Reactions - Serious

  • Airway adverse events, respiratory depression (rare with appropriate dosing) (Rare)
  • Cardiovascular instability, myocardial ischemia in susceptible individuals (Rare)

Drug-Drug Interactions

  • CNS depressants may enhance sedative effects
  • Sympathomimetics may potentiate cardiovascular effects

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor vital signs closely; evaluate airway patency and breathing; assess for psychological effects before and after administration

Diagnoses:

  • Ineffective airway clearance
  • Risk for injury related to altered mental status

Implementation: Administer under controlled conditions with emergency equipment available; titrate dose carefully; provide adequate oxygenation

Evaluation: Ensure effective anesthesia with minimal adverse effects; monitor for emergence phenomena and manage appropriately

Patient/Family Teaching

  • Inform about possible emergence reactions and the need for calm, quiet environment afterward
  • Advise about the temporary effects on mental function and coordination
  • Instruct not to operate heavy machinery or drive until fully recovered

Special Considerations

Black Box Warnings:

  • Potential for respiratory depression and emergence reactions

Genetic Factors: No specific genetic predictors identified for response or adverse effects

Lab Test Interference: None documented

Overdose Management

Signs/Symptoms: Extreme sedation, respiratory depression, hypertension or hypotension, hallucinations, agitation

Treatment: Supportive care, airway management, benzodiazepines for agitation or hallucinations, vasodilators or vasopressors as needed for blood pressure issues

Storage and Handling

Storage: Store in a secure, upright container at controlled room temperature (20–25°C)

Stability: Stable under recommended storage conditions, discard unused portion after 24 hours in the vial

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.