Anesthesia Pharm Test 1 Part 1

Question 1

What are the different roles of IV anesthetics

Answer 1

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

Question 2

what is an IV anesthetic

Answer 2

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

Question 3

define induction

Answer 3

transition from a state of awareness to loss of consciousness

Question 4

what is a sedative

Answer 4

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

Question 5

what is a hypnotic

Answer 5

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

Question 6

what is a sedative hypnotic

Answer 6

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

Question 7

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

Answer 7

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

Question 8

what are the most frequently used classes of IV anesthetics

Answer 8

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

Question 9

characteristics of the “ideal” IV anesthetic

Answer 9

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)

Question 10

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

Answer 10

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

Question 11

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

Answer 11

10; 75

Question 12

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

Answer 12

lipophillic

Question 13

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

Answer 13

TRUE

Question 14

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

Answer 14

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

Question 15

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

Answer 15

three compartment model

Question 16

describe the three compartment model

Answer 16

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

Question 17

IVA “steady state”

Answer 17

4 half-lives with administration rate = elimination rate

Question 18

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

Answer 18

when the peripheral compartments begin to saturate an appropriate blood concentration

Question 19

what is context sensitive half time

Answer 19

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

Question 20

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

Answer 20

barbiturates

Question 21

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

Answer 21

myoclonus

Question 22

why did the popularity of barbiturates decline?

Answer 22

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

Question 23

what is the oldest IV anesthetic drug?

Answer 23

barbiturates

Question 24

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

Answer 24

sulfur (in place of oxygen) (aka thiobarbiturate)

Question 25

thiopental and methohexital are what types of drugs

Answer 25

barbiturates

Question 26

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

Answer 26

liver; renal

Question 27

1/2 life of thiopental

Answer 27

12 hours (10x that of propofol)

Question 28

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

Answer 28

zero

Question 29

1/2 life of methohexital

Answer 29

4 hours

Question 30

T/F: barbiturates are not ideal as an infusion

Answer 30

true; due to the prolonged context sensitive half life

Question 31

MOA of barbiturates

Answer 31

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

Question 32

which medication class is neuroprotective due to flow metabolism coupling

Answer 32

barbiturates

Question 33

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

Answer 33

thiopental (barb)

Question 34

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

Answer 34

methohexital

Question 35

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

Answer 35

barbiturates

Question 36

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

Answer 36

focal; global

Question 37

CV effects of barbiturates

Answer 37

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

Question 38

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

Answer 38

6

Question 39

respiratory effects of barbiturates

Answer 39

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

Question 40

thiopental has the risk of __________________ 2/2 histamine release

Answer 40

bronchospasm/laryngospasm

Question 41

induction dose of thiopental in adults

Answer 41

2.5 - 5 mg/kg

Question 42

induction dose of thiopental in children

Answer 42

5-6 mg/kg

Question 43

methohexital induction dose IV

Answer 43

1-2 mg/kg

Question 44

methohexital induction dose if given rectally

Answer 44

25 mg/kg

Question 45

dose of methohexital infusion rate?

Answer 45

50 - 150 mcg/kg/min

Question 46

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

Answer 46

precedex; versed; 50

Question 47

what situations should the barbiturate dose administered be reduced?

Answer 47

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

Question 48

all barbiturates are contraindicated in what patients?

Answer 48

those with intermittent porphyria (exaggerates the sx)

Question 49

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

Answer 49

crystal; vasospasm; thrombus

Question 50

s/e of methohexital

Answer 50

pain on injection