Anesthesia Pharm Test 1 Part 3

Question 1

which IV anesthetic is a carboxylated imidazole

Answer 1

etomidate

Question 2

what drug is a good alternative to propofol due to its stable cardiac profile

Answer 2

etomidate

Question 3

Which isomer of etomidate has sedative properties

Answer 3

(+) isomer

Question 4

metabolism of etomidate

Answer 4

liver primarily, but also lung and kidney

Question 5

excretion of etomidate

Answer 5

kidney

Question 6

which IV anesthetic despite its PK profile, is not ideal for drips d/t rapid redistribution

Answer 6

etomidate

Question 7

MOA of etomidate

Answer 7

allosterically binds to GABA-A[r] increasing the affinity of the receptor to GABA

Question 8

CNS effects of etomidate

Answer 8

1. dose dependent sedation 2. lowers CMRO2, ICP, and CPP (MAP dependent) 3. can cause myoclonus 4. suitable for ECT but no preferred

Question 9

CV effects of etomidate

Answer 9

limited to no effect on MAP, CO/CI, SVR, and/or PA pressures post induction

Question 10

respiratory effects of etomidate

Answer 10

1. dose dep decrease in minute ventilation, and increase in RR 2. relaxes PA vasculature but preserves airway reflexes 3. response to CO2 decreased 4. periods of apnea can occur post-induction

Question 11

etomidate is not approved for use in children < _____________

Answer 11

5

Question 12

induction dose of etomidate in adults

Answer 12

0.2 - 0.3 mg/kg

Question 13

sedation dose of etomidate in adults

Answer 13

5-10 mg PRN; titrate to desired LOC

Question 14

s/e of etomidate

Answer 14

1. pain on injection 2. increased PONV 3. myoclonus in 10-60% pts 4. adrenocortical suppression by inhibition of 11 B hydroxylase

Question 15

which IV anesthetic agent is acknowledged as a “dissociative anesthetic”

Answer 15

ketamine (breaks communication btwn cortex and brainstem)

Question 16

which IV anesthetic has similar structure to PCP

Answer 16

ketamine

Question 17

which enantiomer of ketamine is considered safer?

Answer 17

S(+); however, no major advantage; sold in US as racemic mixture only!

Question 18

low dose ketamine is effective for

Answer 18

1. chronic pain management 2. depression 3. PTSD treatment

Question 19

metabolism of ketamine

Answer 19

liver CYP450 via N-demethylation –> norketamine (active metabolite 1/3-1/5 less potent than ketamine)

Question 20

1/2 life of ketamine is ______________ hours, but is dependent on _________________

Answer 20

2-3; hepatic blood flow

Question 21

MOA of ketamine

Answer 21

non-competetitive NMDA antagonism (inhibiting glutamate)

Question 22

CNS effects of ketamine

Answer 22

1. increases limbic activity with simultaneous loss of consciousness 2. increases BIS 3. increases ICP, CMRO2, IOP, and CBF 4. vivid illusions and combativeness with emergence

Question 23

CV effects of ketamine

Answer 23

cardiac stimulant - increase BP, HR, CI/CO, and CVP

Question 24

respiratory effects of ketamine

Answer 24

1. bronchodilation 2. maintains airway reflexes 3. increased risk of larygngospasm 2/2 increased salivation

Question 25

IV dose of ketamine for induction in adults

Answer 25

1-2 mg/kg

Question 26

IM dose of ketamine for induction in adults

Answer 26

4-6 mg/kg

Question 27

po dose of ketamine for induction in adults

Answer 27

10 mg/kg

Question 28

IM dose of ketamine in pediatrics

Answer 28

6-13 mg/kg

Question 29

TIVA dose of keatmine

Answer 29

1-2 mg/kg/hr (rarely the sole agent)

Question 30

sedation dose of ketamine (when used as adjunct)

Answer 30

0.1-0.3 mg/kg/hr

Question 31

dose of ketamine for pain

Answer 31

1. bolus 10-25 mg PRN up to 0.5 mg/kg

Question 32

s/e of ketamine

Answer 32

1. emergence phenomena 2. nystagmus 3. increased salivation (anti-sialagogue recommended) 4. induces catatonic state

Question 33

which drug belongs to the class of drugs aka imidozaline

Answer 33

dexmedetomidine

Question 34

Alpha2:alpha1 selectivity of dexmedetomidine

Answer 34

1620:01:00

Question 35

primary uses of dexmedetomidine

Answer 35

1. sedation 2. analgesia 3. anxiolysis 4. decreased postoperative shivering & agitation 5. CV sympathomimetic actions

Question 36

which IV anesthetic drug undergoes total biotransformation

Answer 36

dexmedetomidine

Question 37

metabolism of dexmedetomidine

Answer 37

in liver via glucuronidation and CYP450

Question 38

T/F: metabolism of dexmedetomidine does not produce active metabolites

Answer 38

TRUE

Question 39

MOA of dexmedetomidine

Answer 39

selective alpha-2 agonist in the locus coeruleus

Question 40

CNS effects of dexmedetomidine

Answer 40

1. allows pt to remain arousable 2. no alteration to CMRO2 3. decreases CBF but effects on ICP are non-existant to minimal

Question 41

CV effects of dexmedetomidine

Answer 41

1. dose dependent bradycardia and Hotn 2. paradoxical HTN seen with rapid IVP/large doses

Question 42

respiratory effects of dexmedetomidine

Answer 42

1. respiratory drive maintained 2. airway reflexes preserved 3. no risk of histamine induced bronchospasm 4. can decrease airway reactivity in COPD pts

Question 43

dose of dexmedetomidine for sedation

Answer 43

0.3-0.7 mcg/kg/hr

Question 44

bolus of dexmedetomidine dose

Answer 44

0.5-1 mcg/kg over 15 minutes

Question 45

_________________ induced hotn responds really well to fluid and/or vasopressor

Answer 45

precedex

Question 46

which IV anesthetic produces a diuretic effect

Answer 46

dexmedetomidine

Question 47

which IV anesthetic has renal benefits, gastroprotective effects, and anti-inflammatory effects

Answer 47

dexmedetomidine

Question 48

Ketamine "SUPER BRAINS"

Answer 48

1. Stimulates SNS 2. Urinary excretion 3. PCP derivative 4. Emergence Delirium 5. Respiratory depression minimal 6. BronchoDILATOR 7. recreational abuse 8. analgesia 9. increased: BP, HR, CO/CI, CVP, PAP, ICP 10. NMDA receptor antagonist 11. salivation

Question 49

Etomidate "HAMPERS"

Answer 49

1. Hypnotic 2. Adrenocortical Suppression (long term use) 3. Minimal CV effects 4. Pain on injection 5. Esterases (and hepatic metabolism) 6. respiratory depression 7. Seizure activity (myoclonic movements)

Question 50

Dexmedetomidine "AB RASH"

Answer 50

1. Alpha-2 agonist 2. Bradycardia 3. Respiratory depression mild 4. Analgesia, anxiolysis 5. Sedation 6. Hotn