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Mar: prep for clinicals > Anesthesia Medication Overview PPT > Flashcards

Anesthesia Medication Overview PPT Flashcards

1
Q

Which anesthetic gas is the only one capable of providing analgesia?

A

Nitrous Oxide

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2
Q

What two desired effects are produced through the use of inhaled volatile anesthetic agents (VAA’s) ?

A
  • Immobility
  • Amnesia
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3
Q

What MAC will cause 99% of patients to not show a motor response during surgery?

A

1.3 MAC

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4
Q

MAC values are _____ in terms of preventing movement from incisional pain.

A

Additive

Ex. 0.5 MAC Nitrous + 0.5 MAC Isoflurane = 1 MAC VAA

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5
Q

Which anesthetic gas has very low solubility and requires the use of a heated vaporizer?

A

Desflurane

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6
Q

Which VAA is not irritable to the airway and thus useful for pediatric inductions?

A

Sevoflurane

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7
Q

Which anesthetic gas is most likely to result in laryngospasm?

A

Desflurane (Airway irritant that stinks)

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8
Q

What property of Desflurane makes it appropriate for obese patients?

A

Low lipid solubility = absorbs quick and goes away quick

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9
Q

What VAA is very lipid soluble and what are the consequences of this?

A

Isoflurane = Long emergence

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10
Q

What anesthetic gas (removing all other variables) would be appropriate for a thoracotomy patient that the surgeon wants to stay intubated in the ICU?

A

Isoflurane

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11
Q

Which anesthetic gas can precipitate N/V at higher doses?

A

Nitrous Oxide (>50%)

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12
Q

Which VAA can precipitate tachycardia?

A

Desflurane

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13
Q

Which anesthetic gas is not suitable for neuro or bowel surgical cases?

A

Nitrous Oxide (Distending effect from it’s solubility)

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14
Q

The following factors would have what effect on anesthetic requirement?

  • Chronic ETOH
  • Infancy
  • Red hair
  • Hyperthermia
A

These factors would increase anesthetic requirement

AKA Increase MAC

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15
Q

Would hypernatremia increase or decrease anesthetic requirement?

A

Increase

AKA Increase MAC

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16
Q

The following factors would have what effect on anesthetic requirement?

  • Acute ETOH
  • Elderly
  • Anemia (Hgb < 5mg/dL)
  • Hypercarbia
  • Pregnancy
  • Hypoxia
  • Hypothermia
A

These factors would Decrease anesthetic requirement

AKA Decrease MAC

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17
Q

What is the typical induction dose of propofol?

A

1.5 - 2.5 mg/kg IV

2mg/kg IV

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18
Q

What is the sedation dose of propofol?

A

25 - 100 mcg/kg/min

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19
Q

What is the TIVA dose of Propofol?

A

100 - 300 mcg/kg/min

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20
Q

What occurs when Propofol is pushed through a peripheral IV? How is this avoided?

A

Pain, pre-treat with 1- 2% Lidocaine

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21
Q

________ dosing of propofol is necessary for elderly patients.

A

Decreased

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22
Q

What are propofol’s effects on the bronchi?

A

Bronchodilation

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23
Q

Propofol will ______ the SNS response to laryngoscopy.

A

Suppress

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24
Q

What is the deadly result of Propofol Infusion Syndrome?

A

Sudden onset severe bradycardia → asystole

Resistant to treatment

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25
Q

What patients are at risk for developing adverse reactions to propofol?

A
  • Head injuries receiving propofol > 58 hours
  • High dose infusions (5mg/kg/hr)
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26
Q

What is the mechanism of action of propofol?

A

Enhances GABA channels to increase Cl⁻ conductance.

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27
Q

What is the mechanism of action of etomidate?

A

Enhances GABA channels to increase Cl⁻ conductance.

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28
Q

When is etomidate best used?

A

Induction in hemodynamically unstable patients.

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29
Q

What is the dose of etomidate for induction?

A

0.3 mg/kg

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30
Q

What is a rare adverse outcome associated with etomidate?

A

Adrenocortical suppression

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31
Q

Which induction drug is the most causative for PONV?

A

Etomidate (30%)

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32
Q

Is Ketamine a hypnotic?

A

No, it is a Dissociative Anesthetic

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33
Q

What is Ketamine’s MOA?

A

From PP:
- Depresses neurons of cortex & thalamus
- Stimulates Limbic system
- Activates opioid receptors & subcortical neurons of spinal tract.

From previous pharm class/Drugs.com
- NMDA antagonist at the presynaptic terminal
- Ketamine interacts with N-methyl-D-aspartate (NMDA) receptors, opioid receptors, monoaminergic receptors, muscarinic receptors and voltage sensitive Ca ion channels

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34
Q

What is the adult induction dose of ketamine?

A

1.5 mg/kg IV

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35
Q

What is the analgesia dose of ketamine?

A

0.2 - 0.5 mg/kg

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36
Q

What is the IM dose of ketamine used to calm pediatric patients?

A

4 - 8 mg/kg IM

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37
Q

What medication class is a contraindication to ketamine usage?

A

MAOI’s (profound increase in system Epi)

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38
Q

When does delirium occur after ketamine induction?

A

Post-Op (usually in PACU)

39
Q

What pre-treatment is necessary with ketamine induction?

A

Glycopyrrolate

Ketamine is sialagogue, Robinol necessary to pre-treat secretions.

40
Q

What hemodynamic parameter is depressed due to ketamine?

A

Trick question. None.

↑ PVR, SVR, HR, CO, SNS outflow, etc

Further research indicates this is not necessarily true. Ketamine is a myocardial depressant and will drop CO if the patient is catecholamine depleted.

41
Q

How are hallucinations associated with Ketamine administration avoided?

A

Concurrent Benzo administration (versed usually)

Barbs/prop also work but usually patient receiving ketamine won’t tolerate these.

42
Q

What is the MOA of dexmedetomidine?

A

Stimulation of α2 receptors → pre-synaptic SNS inhibition
alpha2 agonist

Dexmedetomidine is a specific and selective alpha-2 adrenoceptor agonist. By binding to the presynaptic alpha-2 adrenoceptors, it inhibits the release of norepinephrine, therefore, terminates the propagation of pain signals. Activation of the postsynaptic alpha-2 adrenoceptors inhibits the sympathetic activity decreases blood pressure and heart rate. Alpha-2 adrenergic receptors mediate the catecholamine-induced inhibition of adenylate cyclase through the action of G proteins

43
Q

What is the loading dose of dexmedetomidine?

A

1 mcg/kg over 10 min

44
Q

What is the infusion dose of dexmedetomidine?

A

0.2 - 0.7 mcg/kg/hr

45
Q

What hemodynamic abnormality can occur if precedex is given too quickly?

A

Hypertension

46
Q

What are the respiratory effects of dexmedetomidine?

A
  • Minimal respiratory depression
  • Anti-sialagogue
  • Obstruction still possible
47
Q

What is the induction dose of methohexital?

A

1.5 mg/kg

48
Q

What barbiturate can be used to treat seizures at high doses but is epileptogenic at lower doses?

A

Methohexital

49
Q

What are the uses for Methohexital?

A

Rapid non-painful procedures

  • ECT (because it does not depress seizure activity)
  • Cardioversion
  • Seizure mapping
50
Q

Morphine has a dose-dependent _______ release.

A

histamine

51
Q

This hemodynamic paramater is typically decreased with administration of higher doses of morphine.

A

PVR

52
Q

What is the induction dose of fentanyl?

A

1.5 - 3 mcg/kg IV

53
Q

What is the infusion dose of fentanyl?

A

3 - 6 mcg/kg/hr

54
Q

What is meperidine’s greatest use?
What dose is utilized?

A

Useful for post-operative shivering

12.5 mg IV

55
Q

Meperidine usage is contraindicated with what two things?

A
  • Seizures
  • MAOI use
56
Q

What is Sufentanil’s MOA?

A

Highly selective μ opioid receptor agonist.

57
Q

What is the IV push dose for sufentanil?

A

0.5 - 1 mcg/kg

58
Q

What is the infusion dose of sufentanil?

A

0.5 - 1 mcg/kg/hr

59
Q

What are the benefits and use cases for sufentanil?

A
  • Good for cardiovascular stability
  • Post-operative pain control (lasts longer than remi)
60
Q

What is the loading dose of Remifentanil?

A

0.5 - 1 mcg/kg over 1 minute

61
Q

What is the MOA of remifentanil?

A

μ opioid agonist

62
Q

What is the infusion dose of remifentanil?

A

0.125 - 0.375 mcg/kg/min

63
Q

What is the benefit of remifentanil?

A

Extremely quick onset and offset

  • turn off 6 min before spontaneous ventilation
  • 70% MAC reduction when using IV drip
64
Q

What are the downsides to remifentanil?

A
  • Fast resp depression
  • Bradycardia
  • Expensive
65
Q

What receptors does naloxone bind to?

A

Antagonistic towards

  • μ
  • κ
  • δ
66
Q

What is the respiratory depression reversal dose of naloxone?

A

40 - 80 mcg IV

67
Q

_____ stimulation can be seen with abrupt reversal of analgesia using naloxone.

A

Cardiac

68
Q

Naloxone has the capability to cause what severe adverse effect?

A

Flash Pulmonary Edema

69
Q

Rank the potency of the following benzodiazepines

  • Midazolam
  • Lorazepam
  • Diazepam
A

Lorazepam > Midazolam > Diazepam

Lorazepam is 5x more potent than midazolam
and midazolam is 5x more potent than diazepam.

70
Q

What are the respiratory side effects of benzodiazepines?

A
  • Hypoxic drive to breath is depressed.
  • Depressed airway reflexes
  • Dose-dependent respiratory depression
71
Q

What patient populations should caution be utilized when giving benzo’s?

A
  • Chronic COPD
  • OSA
  • Morbid Obesity

Benzo’s will decrease respiratory drive in these patients due to hypoxic drive depression.

72
Q

Benzodiazepines are ____ (additive/synergistic) with opioids.

A

Synergistic

73
Q

What are the cardiovascular effects noted with benzodiazepine sedation?

A

Minimal (possible small drop in BP).

74
Q

What is the reversal drug and dose of benzodiazepines?

A

Flumazenil 0.2 mg IV

0.1 mg every minute after to a total of 1mg

75
Q

What is the duration of action of flumazenil?

A

30 - 60 min

Much shorter than most benzo’s

76
Q

Flip for PONV agents information

A
77
Q

What is the structure and MOA of succinylcholine?

A
  • 2 ACh molecules bound together
  • Bind to post-synaptic receptors and produces depolarization and keeps channel open, disallowing repolarization.
78
Q

In what patients should Succinylcholine be avoided?

A
  • Malignant Hyperthermia
  • Burns
  • Paralyzed & bed-bound
  • ↑ K⁺ (particularly renal patients)
79
Q

Why would succinylcholine be dangerous for the bed-bound or renal patient?

A

These patients have upregulated ACh receptors and SCh administration will result in massive K⁺ efflux.

80
Q

What benefits does cisatracurium offer over atracurium?

A
  • No histamine release
  • Safe in renal failure patients
  • No dose change with age or illness
81
Q

What is the infusion dose of Nimbex (cisatracurium) ?

A

0.2 mg/kg

0.1 mg/kg if succinylcholine has been administered.

82
Q

What is the push dose of vecuronium?

A
  • 0.1 mg/kg
  • 0.05 mg/kg if succinylcholine has been given.
83
Q

What is the infusion dose of Vec?

A

1 - 2 mcg/kg/min

Not great for infusion due to accumulation.

84
Q

What are the two induction doses of Roc?

A

0.6 mg/kg

1.2 mg/kg for RSI

85
Q

What dose of rocuronium should be used if succinylcholine has already been administered?

A

0.3 mg/kg

86
Q

What is the infusion dose of rocuronium?

A

5 - 12 mcg/kg/min

Accumulates much less than vecuronium

87
Q

T/F. Neostigmine is a direct inhibitor of non-depolarizing NMB’s.

A

False. Neostigmine is a ACh-esterase inhibitor → ↑ ACh to counteract ND-NMB’s.

Indirect antagonism.

88
Q

What would occur if Succinylcholine and neostigimine were given concurrently?

A

SCh would be augmented.

89
Q

What is the most rapid onsetting AChe inhibitor?

A

Edrophonium (1-2 min)

90
Q

What are the onset and duration of neostigmine?

A

Onset: 7 - 11 min
Duration: 40 - 60 min

91
Q

What is the onset and duration of glycopyrrolate?

A

Onset: 2 - 3 min
Duration: 2 hours

92
Q

What drug is glycopyrrolate given with? Why?

A

Glycopyrrolate is given just prior to neostigmine to counteract bradycardia.

93
Q

What is the dosage range for Sugammadex?

A

2 mg/kg - shallow block
4 mg/kg - moderate block
8 mg/kg - deep block
16 mg/kg - Extreme block (1.2 mg/kg Roc just given)

Mar: prep for clinicals (16 decks)

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