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Anesthesia Pharm > Anesthesia Pharm Test 1 Part 1 > Flashcards

Anesthesia Pharm Test 1 Part 1 Flashcards

1
Q

What are the different roles of IV anesthetics

A
  1. sedation spectrum 2. anxiolysis 3. hypnotic 4. general anesthesia
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2
Q

what is an IV anesthetic

A

substance that when administered directly to the patient IV it can be used to induce or maintain a state of general anesthesia

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3
Q

define induction

A

transition from a state of awareness to loss of consciousness

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4
Q

what is a sedative

A

agent used to exert an anxiolytic effect by reducing anxiety and causing calmness

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5
Q

what is a hypnotic

A

agent that causes drowsiness as well as the onset and maintenance of sleep

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6
Q

what is a sedative hypnotic

A

drug class that is capable of anxiety relief (sedation) as well as inducing sleep (hypnosis)

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7
Q

T/F: chemical structure is what classifies a medication as a sedative hypnotic

A

false; it is based on clinical use rather than chemical structure

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8
Q

what are the most frequently used classes of IV anesthetics

A
  1. barbiturates 2. nonbarbiturates 3. benzodiazepines 4. miscellaneous (precedex)
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9
Q

characteristics of the “ideal” IV anesthetic

A
  1. rapid and smooth onset and recovery 2. provides analgesia 3. minimal cardiac and respiratory depression 4. water soluble aqueous base 5. anti-emetic action 6. bronchodilation 7. lack of toxicity or histamine release 8. advantageous PK and PD (i.e. reference to therapeutic index)
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10
Q

T/F: propofol is defined as an “ideal” IV anesthetic

A

false; there is no ideal IV anesthetic (bc they all have their s/e and drawbacks)

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11
Q

the vessel rich group (brain, heart, liver, kidney, endocrine glands) are __________% of body mass and recieve _________% of CO

A

10; 75

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12
Q

IV anesthetics ________________ structure allow them to rapidly penetrate the blood brain barrier to exert central effects

A

lipophillic

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13
Q

T/F: IV anesthetics are inactive once they reach the muscle group

A

TRUE

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14
Q

distribution of a propofol bolus has 3 phases, what are they?

A
  1. rapid distribution (alpha phase) 2. slow distribution (beta phase) 3. elimination
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15
Q

the kinetics of propofol (and other IVA infusions) is described by the ___________________

A

three compartment model

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16
Q

describe the three compartment model

A

IVA infusion when administered begins in the central compartment and then distributes peripherally

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17
Q

IVA “steady state”

A

4 half-lives with administration rate = elimination rate

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18
Q

according to the three compartment model, when can the IVA infusion rate be lowered?

A

when the peripheral compartments begin to saturate an appropriate blood concentration

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19
Q

what is context sensitive half time

A

the time to achieve a 50% reduction in concentration after stopping a continuous infusion

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20
Q

__________________ have a pyrimidine center with either a sulfur or an oxygen in the number 2 position

A

barbiturates

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21
Q

barbiturates are associated with incidence of ________________ in 10-60% of patients

A

myoclonus

22
Q

why did the popularity of barbiturates decline?

A
  1. hang over effect 2. narrow therapeutic index 3. evolution of newer safer drugs
23
Q

what is the oldest IV anesthetic drug?

A

barbiturates

24
Q

addition of a ______________ atom to barbiturates made the drugs more lipid soluble and increased potency

A

sulfur (in place of oxygen) (aka thiobarbiturate)

25
Q

thiopental and methohexital are what types of drugs

A

barbiturates

26
Q

primary metabolism of barbituates occurs in the ______________, but thiopental has some ____________ metabolism too

A

liver; renal

27
Q

1/2 life of thiopental

A

12 hours (10x that of propofol)

28
Q

when a barbiturate is administered as an IV bolus, it exhibits ________________ order kinetics

A

zero

29
Q

1/2 life of methohexital

A

4 hours

30
Q

T/F: barbiturates are not ideal as an infusion

A

true; due to the prolonged context sensitive half life

31
Q

MOA of barbiturates

A

binds at the barbiturate specific site of the GABA-A receptor in the cortex and brainstem & inhibits excitatory pathways at the NMDA receptor

32
Q

which medication class is neuroprotective due to flow metabolism coupling

A

barbiturates

33
Q

_______________ is an ideal neuro protectant and anticonvulsant drug, however, at lower doses can be a pro-convulsants

A

thiopental (barb)

34
Q

which drug is used for ECT due to pro-convulsant effects

A

methohexital

35
Q

_________________ drugs can decrease CMRO2 by 50% with their “flow metabolism coupling” effects

A

barbiturates

36
Q

the flow metabolism coupling of barbiturates leads to a reverse steal effect which is ideal for _____________ neuro injuries but not ___________ neuro injuries

A

focal; global

37
Q

CV effects of barbiturates

A
  1. decrease MAP and CO post induction 2. negative inotropic effects 3. reflex increase in heart rate 2/2 baroreceptor
38
Q

ventilatory response to CO2 2/2 barbiturate administration is noted after _______ minutes

A

6

39
Q

respiratory effects of barbiturates

A
  1. dose dependent respiratory depression 2. apnea within 1 - 1.5 minutes 3. no bronchodilatory effect
40
Q

thiopental has the risk of __________________ 2/2 histamine release

A

bronchospasm/laryngospasm

41
Q

induction dose of thiopental in adults

A

2.5 - 5 mg/kg

42
Q

induction dose of thiopental in children

A

5-6 mg/kg

43
Q

methohexital induction dose IV

A

1-2 mg/kg

44
Q

methohexital induction dose if given rectally

A

25 mg/kg

45
Q

dose of methohexital infusion rate?

A

50 - 150 mcg/kg/min

46
Q

using ____________ or ____________ as a pre-medication before induction with methohexital or thiopental (barbs) can reduce the required induction dose by _________%

A

precedex; versed; 50

47
Q

what situations should the barbiturate dose administered be reduced?

A
  1. elderly 2. HF 3. liver failure 4. shock 5. anemia 6. obesity
48
Q

all barbiturates are contraindicated in what patients?

A

those with intermittent porphyria (exaggerates the sx)

49
Q

erronous thiopental arterial administration can lead to the formation of ______________ which causes ____________ and ______________

A

crystal; vasospasm; thrombus

50
Q

s/e of methohexital

A

pain on injection

Anesthesia Pharm (18 decks)

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