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Anes Pharm Final > Anes Pharm Final > Flashcards

Anes Pharm Final Flashcards

1
Q

Midazolam Onset and Duration

A

Onset 30-60 seconds

Duration 15-80 minutes

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2
Q

Benzodiazepines mechanism of action

A

GABA (cerebral cortex)
20% = anxiolysis
30-50% = sedation
60% = unconsciousness

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3
Q

Lorazepam onset and duration

A 
Onset = 1-2 minutes
Duration = 6-10 hours
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4
Q

Peds dose of midazolam

A

0.5 mg/kg PO (15mg max)

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5
Q

How are benzos metabolized?

A

CHP450 by LIVER, Alcohol increases clearance

50% lost to 1st pass metabolism

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6
Q

How are benzos reversed?

A

Flumazenil (0.1-0.2mg ->3mg)

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7
Q

The relationship of protein binding to volume of distribution

A

Inversely correlated

Protein binding UP / Volume of distribution DOWN

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8
Q

Benzos are used for

A 
sedation
anxiety
anti-convulsant
anterograde anesthesia
etoh withdrawal
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9
Q

Thiopental facts

A 
Barbituate
ph 10.5
Burns / precipitates in IV
80% protein binding
GARLIC TASTE
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10
Q

Thiopental metabolism

A

metabolized in liver

excreted in kidneys

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11
Q

Thiopental side effects

A

increased heart rate
HISTAMINE RELEASE
Hangover
Acute intermittant porphyria

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12
Q

Thiopental dose and onset/duration

A

IV 3-5mg/kg
Onset: 30-40 sec
Duration: 5-8 minutes

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13
Q

How do barbituates work

A

Work on GABA
Decrease sympathetic nervous system transmission
Inreased lipid solubility, protein binding, uptake (fast onset)

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14
Q

Cerebral physiology of Barbituates

A

DECREASES CEREBRAL METABOLISM
which reduces bloodflow
Most blood goes to gray matter
Cerebral blood flow is affected by temperature

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15
Q

What is normal CPP

A

80-100mmHg

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16
Q

What is normal ICP

A

8-12 mmHg

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17
Q

Methohexital (brevital) dose

A

IV 1-1.5mg/kg Induction

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18
Q

Methohexital facts

A 
Barbituate
More lipid soluble than pentothal
previously used for short outpatient ECT
HICCUPS during induction
Can be given rectally
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19
Q

Propofol (Diprivan) Site and dose

A

GABA
IV 1-2.5 mg/kg
MAC 25-100mcg/kg/min
TIVA 100-200mcg/kg/min

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20
Q

Propofol facts / metabolism

A

Oil at room temp
Lasts 6 hours (12 with EDTA)
98% protein bound
Metabolized in LIVER

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21
Q

Propofol onset / duration

Distribution half life

A

Onset 30 sec
Duration 5-10 minutes
H/L - 2-8 minutes

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22
Q

Propofol Side effects

A

Bacterial growth, pain on injection, allergy
REDUCED PONV
Crosses placenta - babyy clears quickly

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23
Q

Propofol INDIVIDUAL PARTS

A 
0.005% Disodium edetate-  bacteriostatic
1% Propofol
10% soybean oil
2.25 % glycerol- burns
1.2% egg phosphatide
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24
Q

Etomidate site and dose

A

GABA
IV 0.2-0.6 mg/kg
(Supplied 2mg/ml)

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25
Q

Etomidate Onset and duration / metabolism

A

Onset 30 sec
Duration 3-5 min
HEPATIC metabolism

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26
Q

Etomidate FACTS

A

MINIMAL CV EFFECTS heart smart
Mimics inhibitory effects of GABA
H20 Soluble @ acidic pH
75% protein bound

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27
Q

Etomidate side effects

A 
Pain on injection
Myoclonus
Adrenocortical supression
Increased PONV
Careful with seizure patients
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28
Q

Ketamine site and dose

A

NMDA, Opioid, MAO, Muscarinic
NOT GABA

IV 1-2 mg/kg
IM 4-8 mg/kg
Subanesthetic 0.1-0.5mg/kg/hr

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29
Q

Ketamine onset and duration / metabolism

A

IV Onset 30-60 seconds
IV Duration 5-10 minutes

IM Onset 2-4 minutes
IM Duration 12-25 minutes

Metabolism = HEPATIC
Renal excretion

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30
Q

Ketamine FACTS

A

Diassociateive anesthesia, emergence delierium
INCREASES - ICP, BP, HR, CMRO2
No ventilatory depression, increased secretions

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31
Q

Inhaled anesthetics solubility

A

more soluble = longer induction / slower emergence

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32
Q

Time constants

A

1 63%
2 86.5%
3 95%
4 98%

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33
Q

Concentration effect

A

Inspired partial pressure of agent INCREASES the rate of rise of partial pressures of alveolus

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34
Q

2nd gas effect

A

INCREASE volume of one gas, INCREASE rate of increase of pA of the companion gas (N20 increases sevo on induction)

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35
Q

Uptake formula

A

Solubility x CO X (PA-Pv)

PA = PI - uptake

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36
Q

Increase in CO equates to

A

INCREASE in solublity (slower induction)

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37
Q

Blood gas of agents / solubility

A 
HISDN
H 2.4
I 1.4
S .65
D .42
N .47
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38
Q

Elimination of inhaled agents

A

Biotransformation, transcutaneous, exhalation

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39
Q

Most and least metabolized inhaled

A

HALOTHANE - MOST METABOLIZED

N2O - LEAST METABOLIZED

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40
Q 
Inhaled agent
INCREASE metabolism
INCREASE SVR
INREASE MAP
DECREASE CPP
A

N20

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41
Q

Inhaled agent
INCREASE Airway resistance
INCREASE HR

A

Desflurane

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42
Q

Things that change inhaled pharmacokinetics

A

Age, muscle, fat, liver, CO, pulm fibrosis, gas exchange

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43
Q

MAC awake / MAC bar

A

MAC awake 10% (sevo .2)

MAC bar - 1.3 or 1.5

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44
Q

Things that increase MAC

A

Hyperthermia
INCREASED catecholamines
INCREASED Sodium

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45
Q

Things that DONT EFFECT MAC

A 
Metabolism
CHRONIC EtOH
Gender
Duration
PAO2 15-95mmHG
K (potassium)
Thyroid dysfunction
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46
Q

Things that LOWER MAC

A 
Hypothermia
Advanced age
Preop meds
ACUTE EtOH
Pregnancy
Lithium
Lidocaine
Opioids
REDUCED SODIUM
CPB
BP <40mmHg
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47
Q

CNS effects of inhaled

A

INCREASE Cerebral blood flow
INCREASE Intracranial pressure
REDUCED CSF

Fix with hyperventilation CBF

Burst suppression 1.5 mac with ISO

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48
Q

Agent most likely to cause Coronary Steal

A

Isoflurane

Coronary dilator

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49
Q

Renal effects of inhaled

A

Reduced gfr
reduced urine output
reduced renal flow
Sevo - compound A - nephrotoxic

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50
Q

Halothane info

A 
Thymol
0.7 MAC
HEPATITIS
INCREASED metabolism
BRONCHODILATOR
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51
Q

Isoflurane info

A 
1.1 MAC
DECREASED metabolism
2 mac = ISO EEG
NOT TOXIC
Limited cardiovascular change
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52
Q

Sevoflurane info

A

2 MAC
Compound A
Inhaled induction

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53
Q

Desflurane info

A 
6 MAC
AIRWAY REACTIVE
Carbon MONOXIDE FORMATION
Hot vaporizers
TACHYCARDIA
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54
Q

N20 info

A

104% MAC
Diff hypoxia
NO enclosed spaces
Decreased bone marrow

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55
Q

Inhaled Blood Brain

A 
H 2.9
I  2.6
S 1.7
D 1.3
N 1.1
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56
Q

Inhaled Muscle blood

A 
H 3.5
I 4.0
S 3.1
D 2.0
N 1.2
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57
Q

Inhaled MAC

A 
H 0.7
I 1.1
S 2
D 6
N 104
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58
Q

Opioid receptors

Mu1

A 
Supraspinal &amp; Spinal
Analgesia*
euphoria
NV
pruritis
bradycardia
low abuse potential*
endorphins
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59
Q

Opioid rececptors

Mu2

A 
Spinal - ONLY ONE WITH JUST SPINAL
Hypoventilation*
Analgesia
euphoria
physcial dependence*a
constipation
endorphins
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60
Q

Opioid receptors

Kappa

A 
Supraspinal &amp; Spinal
analgesia
less respiratory depression
Dysphoria*
Dynorphins*
Diuresis
resistant to high intensity pain
agonist/antagonist site
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61
Q

Opioid receptors

Delta

A 
Supraspinal &amp; Spinal
Analgesia
respiratory depression*
physical dependence*
urinary retention
encephalins
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62
Q

Opioid mechanism of action

A

Bind G-Protein coupled receptors
mimic effects of endogenous ligands
DECREASE neurotransmitter release (sympathetic output)

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63
Q

Neuraxial opioids are and where

A

Mu receptors in spinal cord

Analgesia = dose related & visceral (NOT SOMATIC)

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64
Q

Neuraxial opioids side effects

A

Pruritis
NV
Urinary retention
ventilatory depression

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65
Q

Opioid side effects

A

DECREASED Resp, Minute vent, Blood pressure, HR
INCREASED Tidal vol

Cough suppression
Reduces MAC
NV
Constipation
Biliary colic
Urinary retention
fetal delivery
meiosis
truncal rigididy
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66
Q

Special side effects of Morphine

A

Histamine release

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67
Q

Special side effects of Meperidine

A

Anti muscarinic effects, Histamine release

NORMEPERIDINE = SEIZURES

68
Q

Opioid overdose

A

Meiosis, Resp depression, Coma

69
Q

Opioid agonist does what to receptors

A

Activates
Mu
Kappa

70
Q

Opioid partial agonist

A

Deactivates Mu

Activates Kappa

71
Q

Opioid antagonist

A

blocks Mu

Blocks Kappa

72
Q

Meperidine potency/Onset/duration

A

0.1x
Onset 5-7 min
Duration 2-4 hours

73
Q

Meperidine important info

A

treatment for post op shivering
90% hepatic
MAKES NOMEPERIDINE - SEIZURES
Atropine like side effects

74
Q

Morphine potency/onset/duration

A

1x
onset 45-90 min
duration 3-4 hours

75
Q

Morphine important info

A

Histamine release
pro-drug
delayed resp depression

76
Q

Methadone potency / important info

A

3-4x
NMDA and MAO antagonist properties
Half life 25-52 hours
Prolong QT interval

77
Q

Hydromorphine (dilaudid) potency/onset/duration

A

8x
onset 15-30 min
duration 2-3 hours

78
Q

Alfentanyl potency/dose/onset/duration

A

10x
25-100mcg/kg - 0.5-2/kg/min
onset 1.5-2 min
duration 10-20 min

79
Q

Alfentanyl imporant info

A

quick recovery
Right Bundle Branch
DL
(renal failure doesn’t alter clearance)

80
Q

Remifentanyl potency/onset/duration

A

100x
1-2 mcg/kg 0.1-1mcg/kg/min
onset 1.5-2 min
duration 6-12 min

81
Q

remifentanyl imporant info

A

quick recovery

PLASMA ESTERASE METABOLISM

82
Q

Fentanyl potency/onset/duration

A

100x
4-20mcg/kg 2-10mcg/kg/hr
onset 3-5 min
duration 30-60 min

83
Q

Fentanyl important info

A

75% 1st pass pulm uptake**

interacts with versed

84
Q

Sufentanyl potency/onset/duration

A

1000x
0.25-2mcg/kg 0.5-1.5mcg/kg/hr
onset 3-5 min
duration 30-60 min

85
Q

Sufentanyl important info

A

NEURO*
very potent
greater affinity for receptors

86
Q

Drugs that are Agonist/antagonist / info

A

Analgesia w/ limited resp depression
Activate kappa
Deactivate mu
more for chronic use
CEILING EFFECT - Increased doses have less effect
Nalbuphine - onset 15-30 min - duration 2-3 hours

87
Q

Opioid antagonists

A 
Naloxone
Naltrexone (po)
Mu antagonist
1-4mcg/kg
DUration 30-45 min = CAREFUL OF RESEDATION
88
Q

Local anesthetics resting potential/threshold

A

-70mv / -60mv

89
Q

What channels do LAs bind to?

A

Na (sodium) in activated state

90
Q

Which are easier to block

A

Myelinated/proximal easier to block/2-3nodes of ranvier

91
Q

What LAs are metabolized in teh liver

A

amides (+cocaine, which is an ester)

92
Q

what LAs are metaboiolized by plasma cholinesterases

A

Esters

93
Q

Where do ester allergies come from

A

PABA metabolites

94
Q

LA facts

A 
esters usually more potent
bicarb buffers &amp; speeds onset
Infected (acidotic) tissues hard to block
Potency = lipid solubility
Onset = lipid solubility &amp; pka
95
Q

Methemoglobinemia is caused from

treated with?

A

prilocaine / benzocaine
pulse ox 85
treatment methylene blue 1-2 mg/kg

96
Q

Epi and local anesthetics

A

INCREASE duration
DECREASE toxicity
NO FINGERS - Lidocaine more sensititive

97
Q

Cocaine facts

A 
Vasocinstricts (ent)
INCREASES HR
blocks reuptake of dopamine &amp; norepi
Delpeted norepi stores (epinephrine wont work)
Peak 30-40 (nose)
5 min otherwise
98
Q

Acidotic baby and LA

A

holds onto LA

99
Q

Signs of LA toxicity

A 
Circumoral numbness
tinnitus
lightheaded
visual
twitching
unconsciouis
convulsions
resp depression
cv collapse
100
Q

Bupivicaine facts

A

toxic dose 2.5 mg/kg
MORE CARDIOTOXIC
Lasts 2-2.5 hours

101
Q

Lidocaine facts

A

5mg/kg
7mg/kg (w/ EPI)

Lasts <1.5 hours***SHORTEST

102
Q

Tetracaine facts

A

Lasts longest

lasts 2-3 hrs (5 with epi)

103
Q

EMLA stands for

A

Eutectic mixture of local anesthetic

104
Q

Neuromuscular blockers Clinical uses

A 
intubation
surgical working conditions
90% response suppression
mechanical vent
laryngospasm
105
Q

Adductor policis mimics

A

Diaphragm

106
Q

How are neuromuscular blockers metabolized + Facts

A

highly ionized, limited lipid solubility
Plasma clearance & elimination (age/voll agents DECREASE liver blood flow)

Effects on CNS, renal, fetus, oral admin
Hang around longer in COLD patients

107
Q

Where do Neuromusclar blockers work?

A

Interrupt transmission of nerve impulses @ neurmuscular junction

Sux activates receptor
NDNMB Blocks receptor

108
Q

Two types of NDNMB are

A

Benzylisoquinolinium “curiums

Aminosteroid “roniums”

109
Q

Phase I blockage

A

NO FADE
SUX
ABSENCE OF POST TETANIC

110
Q

Phase II blockage

A

FADE
*gets smaller with each twitch
Post-tetanic potentiation
Transition from Phase I to phase II abrupt *tachyphylaxis?

111
Q

Remember duration order of NDNMDs SHORT TO LONG

A

MCRVAP

112
Q

Mivacurium duration/dose/facts

A

12-20 minutes
0.25 mg/kg
Plasma cholinesterase clearance, not made anymore

113
Q

Cisatracurium duration/dose/facts

A

20-35 min
0.1 mg/kg
KIDNEY PATIENTS - HOFFMAN DEGRADATION

114
Q

Rocuronium duration/dose/facts

A

20-35 min

0.6-1.2 mg/kg

115
Q

Vecurionium duration/dose/facts

A 
20-35 min
0.08-0.1 mg/kg
metabolized by liver
excreted by kidney
INCREASE IN PEDS
DECREASE IN ELDERLY
116
Q

Atracurium duration/dose/facts

A 
20-35 min
0.4-0.5 mg/kg
HISTAMINE
don't push fast
Cold potentiates
117
Q

Pancuronium duration/dose/facts

A

50-90minutes
0.1 mg/kg
NO ESRD
TACHYCARDIA

118
Q

Depolarizing NMB

Succinylcholine duration/dose/facts

A 
3-5 minutes
1-2 mg/kg
Low lipid solubility
Plasma cholinesterase metab
Low metabolism increases duration
metaclopramide &amp; anticholinesterase prolong*
119
Q

Reversal of blockade drugs

A

reverse effects of NDNMB
Treatment for Myasthenia gravis/glaucoma
Antagonize CNS effects of other drugs

120
Q

Anticholinesterase kinetics

A

RENAL CLEARANCE 50-75%

121
Q

Edrophonium vs neostigmine vs pyridostigmine onset

A 
Edrophinum = FASTEST
Neostigmine = 6-7 minutes
Pyridostigmine = 12-15 minutes SLOWEST
122
Q

Side effects of Anticholinesterase

A

BLUDS, PNS activation, good for glaucoma

123
Q

Anticholinesterase OD *usually from pesticides

A

Nicotinic and muscarinic sites

treatment with ATROPINE and PRALIDOXIME

124
Q

Neostigmine dose/facts

A

0.04-0.07 mg/kg
Must have 1 twich
can cause ACH block with too much dose

125
Q

Anticholinergics : prevent ach binding @ muscarinic receptors

BBB question for Atropine, scope, glyco

A

Atropine & scopalamine cross BBB
GLYCO DOES NOT

Careful with baby

126
Q

Anticolinergic effects

A 
sedation (atropine/scop)
antisialogogue
INCREASED HR
relax smooth muscle
Myoriasis (pupils)
motion sickness
DECREASED gasric ion secreation
HR INCREASE Glyco ^
HR INCREASE Atropine ^^^
DO NOT GIVE TO GLAUCOMA
127
Q

Reversal couples

A

Atropine Edrophonium onset 1 min

Glycopyrrolate Neostigmine - 2-3 min/ for 1hr

128
Q

Central anticholinergic syndrome caused from

A

ATROPINE

treatment - PHYSOSTIGMINE

129
Q

Sugammadex

A

Binds drug itself

DONT NEED MUSCARINIC ANTAGONIST

130
Q

Most abundant skin flora

A

Staph aureus

131
Q

Patients at INCREASED risk for Surgical Infection

A 
Extremes of age
Malnourished
obese
diabetic
recent operation
corticosteroid therapy
immunocompromised
132
Q

Wound classification Clean

A

closed/elective procedures

133
Q

Wound classification lean contaminated

A

a1, av, biliary, re-operation

134
Q

Wound classification contaminated

A

ACUTE INFLAMMATORY, PENETRATING TRAUMA

135
Q

Wound classification dirty

A

infection, perf gi, trauma

136
Q

Subaortic bacterial endocarditis HIGH RISK

A

prior history
prosthetic heart valves
cyanotic gongenital heart disease

137
Q

Subaortic bacterial endocarditis MODERATE risk

A

other conj heart malformation
acquired valvular dysfunction
mitral valve prolapse
hyper obstructive cardiomyopathy

138
Q

Subaortic bacterial endocarditis low risk

A

murmur
AtrialSeptalDefect, VentricularSeptalDefect, Patent ductus arteriousos _ hole in heart
AD, Rheumatic fever, stent, pacemaker

139
Q

Choice of antibioic Clean procedure

A

Cefazolin 1-2 gram

NONE FOR ORTHO

140
Q

Choice of antibioitic thoracic

A

cefuroxime 1.5g

141
Q

Choice of antibioitic bowels

A

cefoxitin 1-2g
cefazolin + metronitazole
ampicillin/solubactam

142
Q

Choice of antibioitic neuro

A

ancef, vanc, nafcillin 1-2g

143
Q

Choice of antibioitic gi appendix

A

cefoxitin
vivasyn
ancef + metronidazole

144
Q

Choice of antibioitic BIG ORTHO

A

ancef or vanc/clenda

145
Q

Choice of antibioitic PCN allergy

A

vancomycin 1gm

clindamycin 600-900mg

146
Q

Gram - additon to antibioic

A

gentamycin
ciproflox
levoflox
aztreonam

147
Q

Choice of antibioitic ENT

A

ancef

clinda + gent

148
Q

Choice of antibioitic cardiac**

A

Cefuroxime 1.5gm

149
Q

Choice of antibioitic colorectal

A

neomycin_erythro/metro
ancef metro
cef or cef
vinaysin

150
Q

Antibiotic PEARLS

Redman from

A

REDMAN vanco

hypotension, pruritis, flushing

151
Q

Antibioitc PEARLS

Ototoxicity from

A

gentamycin given to fast

152
Q

SBE Treatment

A

ampicillin & gentamycin

153
Q

blood glucose where its dangerous / infection

A

200

154
Q

Antibiotic class Gentamycin

A

aminoglycoside

155
Q

antibiotic class vancomycin

A

glycopeptide

156
Q

antibioitic class floxacin

A

fluoroquinilone

157
Q

when was diabetes first described

A

1500bc

158
Q

whaen was insulin discrovered

A

1922 bowting and best?

159
Q

INSULIN facts

A

50% lost to first pass

lasts 30-60 minutes

160
Q 
LISPRO Rapid
REGULAR Fast
NPH Intermediate
ULTRALENTE long acting
Detour
A 
Lispro 4-5 hours
Regular 6-10 hours
NPH 10-20 hrs
SPIDER LOOKING GRAPH
LISPRO TALLEST PEAK
THEN REGULAR etc
161
Q

Hyperglycemia

A

Polydipsia, polyphria, pholyphasia

162
Q

Hba1c goal

A

over 3 months

7%

163
Q

How much does 1 unit insulin help?

A

25-30

164
Q

Sunfolureas

A

stimulate insulin secretion/production
90-95% protein binding
hypoglycemia

165
Q

Biguanides (metformin)

A

Inhibit glucose production in liver
renal clearance, lactic acidosis
12 hours before surgery

Anes Pharm Final (1 decks)

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