Anesthesia Pharm Test 1 Part 2

Question 1

what are the most popular benzos for IV anesthetics

Answer 1

1. diazepam 2. lorazepam 3. midazolam

Question 2

structure of benzos

Answer 2

heterocyclic ring structure with benzene & diazepene ring

Question 3

_________________ is the one benzodiazepine that has a imidazole ring as primary structure allowing it to dissolve in aqueous solutions

Answer 3

midazolam

Question 4

midazolam undergoes conformational change once in the blood stream making it more _________________

Answer 4

lipophillic

Question 5

_________________ rose to popularity for their anterograde amnesia, anxiolytic, and sedative effects with miminal s/e

Answer 5

benzodiazepines

Question 6

which benzo has the greatest incidence of causing phlebitis

Answer 6

diazepam

Question 7

benzos are highly _________________, and ___________________ protein bound

Answer 7

lipophilic; highly

Question 8

metabolism of benzodiazepines

Answer 8

liver via CYP450

Question 9

excretion of bz

Answer 9

renal

Question 10

MOA of benzodiazepines

Answer 10

bind to allosteric site of GABA-A receptor in the cortex and brainstem causing Cl- channels to open more frequently

Question 11

CNS effects of benzos

Answer 11

1. dose dependent CNS effect 2. small amount of centrally mediated muscle relaxation 3. higher dose = sedation 4. lower dose = anxiolytic

Question 12

CV effects of benzo

Answer 12

1. induction dose –> decrease of SVR and BP 2. otherwise HD stable

Question 13

respiratory effects of benzos

Answer 13

1. depress upper airway reflexes (esp with other sed/opioids) 2. caution in those with OSA/compromised airway

Question 14

benzos are primarily used for what

Answer 14

pre-medication for sedation

Question 15

which drug is primarily used as pre-medication for sedation

Answer 15

midazolam

Question 16

what drug is typically used as a first line therapy for status epilepticus

Answer 16

lorazepam

Question 17

for peds, if you give midazolam pre-procedure you give ________ mg/kg via __________ route, _________ min prior to procedure

Answer 17

0.5; p.o; 30

Question 18

s/e of benzos

Answer 18

1. irritation and phlebitis 2. delirium in elderly and critically ill

Question 19

_______________ is a benzodiazepine reversal agent

Answer 19

flumazenil

Question 20

MOA of flumazenil

Answer 20

competitive antagonist with high affinity to the “benzo” receptor site on the GABA-A receptor

Question 21

dose of flumazenil

Answer 21

administer 0.2 mg then redose at 0.1 mg as needed

Question 22

typically ________ mg of flumazenil is enough to reverse sedation, but you may need ___________ mg to reverse bz toxicity

Answer 22

1; 3

Question 23

flumazenil will act within __________ min and has a duration of action of __________ min

Answer 23

1-2; 45-90

Question 24

c/i of flumazenil

Answer 24

1. seizure d/o 2. Bz dependance

Question 25

T/F: flumazenil has a short 1/2 when compared to bz

Answer 25

TRUE

Question 26

propofol "SHARP LAD"

Answer 26

1. stimulates GABA 2. hypotension 3. antiemetic qualities 4. respiratory depression 5. pain on injection 6. lipid soluble 7. avoid in allergies 8. decreases CBF and ICP

Question 27

what is the most widely used IV anesthetic drug

Answer 27

propofol

Question 28

T/F: propofol is recognized as "essential medicine"

Answer 28

TRUE

Question 29

what feature of propofol allows for "fast-on, fast-off"

Answer 29

highly lipophillic structure

Question 30

propofol is formulated as an emulsion of ?

Answer 30

soybean oil, glycerol, and egg lecithin

Question 31

all vials of propofol are single use and syringes should be discarded after __________ hours, and vials after __________ hours

Answer 31

6; 12

Question 32

propofol formulation adds what preservatives to reduce the infection risk in the vial?

Answer 32

ETDA + sodium metabisulfite or benzyl alcohol

Question 33

propofol is metabolized in the liver by _____________, _____________, & ______________

Answer 33

CYP2B6; UGTHP4; CYP2C6

Question 34

plasma clearance of propofol is high and exceeds hepatic blood flow, therefore ____________________ metabolism is vital

Answer 34

extra-hepatic sites of

Question 35

what are the extrahepatic sites of metabolism for propofol

Answer 35

lungs and kidneys

Question 36

MOA of propofol

Answer 36

allosterically binds to GABA-A in brainstem and cortex increases the receptor affinity for GABA (thus increasing more GABA to the bind to the receptors)

Question 37

which IV anesthetic can cause a total isoelectric EEG with higher dose

Answer 37

propofol

Question 38

CNS effects of propofol

Answer 38

1. dose dependent anxiolysis 2. sedation 3. amnesia 4. lowers CMRO2, ICP, and CPP 5. aniemetic effect 6. anti-epileptic effect

Question 39

__________________ is used as neuroprotective agent when combined with other agents

Answer 39

propofol

Question 40

CV effects of propofol

Answer 40

induction --> decrease BP, MAP, and CO

Question 41

respiratory effects of propofol

Answer 41

1. bronchodilatory 2. dose dependent apnea 3. decreases TV and response to hypoxia/hypercarbia

Question 42

T/F: in diprivan there is a preservative than can predispose pts to bronchospasm

Answer 42

false; only in generic propofol is there a preservative that predisposes to bronchospasm, not diprivan

Question 43

uses of propofol

Answer 43

1. induction of anesthesia 2. TIVA 3. sedation 4. PONV

Question 44

induction dose of propofol for adults

Answer 44

1-2.5 mg/kg

Question 45

induction dose of propofol in children

Answer 45

2.5-3.5 mg/kg

Question 46

infusion rate of propofol for TIVA

Answer 46

100-200 mcg/kg/min

Question 47

infusion rate of propofol for sedation

Answer 47

25-75 mcg/kg/min

Question 48

dose of propofol infusion for PONV prevention

Answer 48

10-30 mcg/kg/min

Question 49

s/e of propofol

Answer 49

1. pain on injection 2. allergic response 2/2 egg lecithin 3. PRIS

Question 50

PRIS is seen in icu patients on propofol at dose of > ________ mg/kg/hr for more than ___________ hours

Answer 50

4; 48