Apex-IV anesthetics Flashcards
1
Q
2,-6 Diisopropylphenol
A
Propofol
Diso-PROPYL-phenol
2
Q
What is the preservative in generic propofol that can precipitate bronchospasm in asthmatics?
A
Sodium metabisulfate
3
Q
What is disodium edetate
A
The preservative found in diprivan
4
Q
Why should generic propofol be avoided in infants?
A
Bc it’s preservative benzyl alcohol cant be given to infants
5
Q
Induction dose of Propofol
A
1.5-2.5mg/kg IV
6
Q
Antiemetic effects of propofol are seen at what dose?
A
10mcg/kg/min
(or 10-20mg IVP)
7
Q
Onset of propofol
A
30-60 seconds
8
Q
Duration of propofol
A
3-8 minutes
9
Q
Metabolism of propofol
A
Liver (P450 enzymes)
+extrahepatic metabolism (lungs)
10
Q
The active metabolite of propofol
A
none
11
Q
Why is propofol likely safe to administer in those with egg allergies?
A
Bc most people with egg allergies are allergic to the albumin in the egg whites.
Egg lechin is derived from the YOLK (think yellow cap)
12
Q
Is propofol safe to give in someone with a soy allergy? why or why not?
A
bc any soy proteins capable of producing an immune response are removed during the refining process
soy safe and peanut safe
13
Q
3 ways to decrease burning of propofol
A
- Inject into a larger/more proximal vein
- Lidocaine prior or mixed
- Opioid prior
14
Q
What is wakening from propofol due to?
A
Redistribution out of the brain
15
Q
When must propofol in a syringe be discarded?
What about in a vial/tubing?
A
syringe- 6 hours
vial/tubing = 12 hours
16
Q
Risk factors for Propofol infusion syndrome (6)
A
Prop > 4mg/kg/hr (67mcg/kg/min) [dose]
Inufsion > 48 hours [length]
Sepsis (inadequate o2 delivery)
continuous catecholamine infusions
High dose steroids
Significant cerebral injury
17
Q
Explain propofol infusion syndrome
A
Prop contains long chain triglycerides (LCT)
increased LCT load impairs oxidative phosphorylation and fatty acid metabolism
- this starves cells of o2 > esp in cardiac and skeletal muscle
18
Q
S/S PIS
A
*Refractory bradycardia > asystole + at least one of the following:
- metabolic acidosis (base deficit > 10mmol/L)
- Rhabdo
- Enlarged or fatty liver
- Renal failure
- HLD
- Lipemia (cloudy plasma or blood) - may be an early sign
19
Q
Tx of PIS (7)
A
D/C propofol
*Maximize gas exchange
-cardiac pacing
PDE inhibitors
Glucagon
ECMO
CRRT
20
Q
Which drug?
A
Propofol
21
Q
Respiratory effects of propofol
A
Decreased respiratory drive
22
Q
CV effects of propofol (4)
A
Decreased BP, SVR, preload, contractility
23
Q
CNS effects of propofol (5)
A
decreased CMRO2 (cerebral o2 consumption
decreased CBF, ICP, and IOP
*anticonvulsant properties (very rare reports of it inducing seizures)
24
Q
T/F - Propofol has minor analgesic effects
A
False- none
25
PKA of propofol
11
26
Does propofol affect the CO2 response curve?
Yes, it shifts it to the right (less sensitive to CO2) \> resp depression &/or apnea
27
T/F: Propofol inhibits hypoxic ventilatory drive
True
28
Propofol vials must be cleansed with \_\_\_\_% isopropyl alcohol first.
70%
29
What turns urine green or cloudy with propofol infusion?
\*Does it indicate renal impairment or dysfunction?
Green = phenol exretion
Cloudy = increased uric acid secretion
\*does not suggest renal impairment or dysfunction
30
Does propofol at the gaba-A receptor reduce or increase RMP?
reduces RMP (moves it further away from TP)
31
What organs are primarily responsible for propofol metabolism?
Liver (P450) & lungs
32
Does propofol increase or decrease the apneic threshold?
Increases it (more likely to become apneic)- closer to threshold = more likely to happen
33
What drug is Lusedra?
Fospropofol
34
Phosophono-O-methyl-2,5-Dissopropylphenol
Fospropofol
35
MOA of fospropofol +(onset and duration)
Prodrug - it's metabolized into propofol by the enzyme Alkaline Phosphatase (in the blood)
\*slower onset (5-10 mins), longer duration (15-45 mins)
36
T/F: Fospropofol is prepared as an aqueous solution
True - doesn't burn or support microbial growth like propofol
37
Side effect of Fospropofol
Genital and anal burning
38
Initial and repeat bolus's of fospropofol and frequency
initial: 6.5mg/kg
repeat bolus: 1.6mg/kg
(not more than q4min)
39
Active metabolite of fospropofol
Propofol
40
Fospropofol --\> Propofol + _______ + \_\_\_\_\_\_\_\_
how is it metabolized?
Propofol + Formaldehyde + Phosphate
Formaldehyde is metabolized to formate and excreted in the urine
41
What drug?
Fospropofol
42
Primary MOA of Ketamine
NMDA antagonist (antagonizes glutamate, causes of dissociative state)
43
What are the secondary MOAs by which ketamine works (6)
Opioid (treats pain)
MAO (treats depression)
Serotonin (treats depression)
NE (SNS stimulant)
Sodium channels (SNS stimulant)
Muscarinic (increased secretions)
\*think: pain, depression (2), SNS (2) & secretions
44
What happens when glutamate binds to the NMDA receptor?
Where does ketamine bind to the receptor and what happens when it does?
The mag core pops out and calcium and sodium enter the cell (depolarization)
Ketamine binds to the PCP receptor and when that happens, glutamate can no longer bind. Therefore, Calcium and sodium can't enter the cell so no depolarization takes place
45
Ketamine causes **dissociative anesthesia** at the __________ (place in brain)
Thalmus
46
T/F: ketamine leaves airway reflexes intact
True
47
Ketamine onset:
IV:
IM:
PO:
IV: 30-60 seconds (same as propofol, etomidate)
IM: 3-5 minutes
PO: variable
48
Clearing organ of ketamine
Liver
49
Ketamine induction doses:
IV, IM, PO
IV: 1-2mg/kg
IM: 4-8mg/kg
PO: 10mg/kg
50
Bolus dose of ketamine
onset/duration
0. 2-0.5mg/kg
onset: 1-2 minutes
duration- 10-20 minutes
51
How long may it take after dosing ketamine to return to full orientation?
60-90minutes
52
T/F: Ketamine has an active metabolite
True : Norketamine
53
Opioid-sparing doses of ketamine
0.1-0.5mg/kg
1-3mcg/kg/min
54
Clearance of Ketamine
Liver- P450 enzymes
55
Excretion of ketamine
Renal \*caution- active metabolite can build in renal impairment
56
T/F: Ketamine does not alter respiratory drive
true
57
Which IV anesthetic increases oral secretions
Ketamine (muscarinic effect)
58
CV effects of ketamine (4)
increased SNS tone, SVR, HR, CO
59
CNS effects of ketamine (4)
increased ICP, IOP, nystagmus, analgesia
60
Which IV anesthetic causes emergence delirium and lowers the seizure threshold
Ketamine
61
T/F: Ketamine should be avoided in patients with a seizure hx
True - lowers seizure threshold (TP drops closer to RMP)
62
True/Fale: Ketamine is a safe drug to give in someone with acute intermittent porphyria
False
63
2-(o-cholophenyl)- 2 (methylamino) cyclohexanone hydrochloride
Ketamine
\*It's called ketamine because it has a ketone group and an amine group
2-(o-cholophenyl)- 2 (methyl**amino**) **_cyclohex_**an**one** hydrochloride
(you can also maybe use cyclohexanone thinking your brain feels like a cyclone on ketamine)
64
Which Iv induction agent is a Aryl**_cyclohex_**yl**amine**
## Footnote
**(amine group + cyclone)**
Ketamine
65
Which drug is a phencyclidine derivative?
Ketamine (PCP derivitive)
66
PKA of ketamine
7.5 (basic bitches love ketamine)
67
T/F: ketamine is a racemic mixture
True
68
Which drug
Ketamine
69
5 patient populations to avoid ketamine in
1. CAD (indirect sympathomimetic - increases cardiac workload and O2 consumption)
2. Pt's with hx seizures (lowers threshold for seizures)
3. Increased ICP
4. Hypertensive patients
5. Pt's with RV failure (increases pulm vas resistance)
(sub hypnotic doses \<0.5mg/kg usually don't activate the SNS)
70
2 ways ketamine effects the lungs
1. bronchodilation (good for asthma/COPD)
2. increased pulm. vasc resistance (caution in severe RV failure/pulm HTN)
71
T/F: ketamine is direct myocardial depressent
True! It will be seen in patients with depleted catecholamine stores (sepsis, hf, sympathectomy) - need an intact SNS to have the sympathomimetic effects
72
How does ketamine affect the CO2 response curve
It doesn't
73
T/F ketamine is a good choice for ocular surgery
False- causes nystagmus
74
Best way to prevent emergence delirium and hallucinations associated with ketamine
Benzos (midaz \> diaz)
75
Risk factors for emergence delirium from ketamine (4)
age \> 15
female
ketamine dose \> 2mg/kg
hx personality disorder
76
Does ketamine relieve somatic or visceral pain more?
Somatic
77
What agent prevents opioid-induced hyperalgesia as seen after remi infusions?
Ketamine
78
Which induction agent blocks central sensitization and wind-up in the dorsal horn of the spinal cord?
Ketamine
79
Plasma protein binding of:
Dexmedetomidine, Midazolam, Diazepam, Lorazepam, Propofol, Etomidate, Ketamine
Propofol & Diazepam = 98%
Midazolam & Dexmedetomidine = 94%
Lorazepam = 90%
Etomidate = 75%
\*Ketamine = 12%
80
MOA of etomidate
GABA-A agonist
81
Onset of Etomidate
30-60 seconds (same as propofol and ketamine)
82
Duration of Etomidate
3-8 mins (slightly shorter than prop due to metablism by liver + esterases)
83
Clearance/Metabolism of Etomidate
Liver AND plasma **E**sterases
84
3 E's of Etomidate
Etomidate
Emetic
Esterases
85
Induction dose of Etomidate
0.2-0.4mg/kg
86
Respiratory effects of etomidate
mild respiratory depression
87
CV effects of etomidate
minimal
88
CNS effects of Etomidate (4)
decreased CMRO2
decreased CBF (cerebral vasoconstriction)
decreased ICP
may activate seizure foci
89
Which drug
Etomidate
90
Active metabolite of etomidate
None
91
T/F - rapid awakening following etomidate is due to metabolism, not redistribution
False - it's due to redistribution
92
R-1-Methyl-1 (a-methylbenzyl) imidazole-5-carboxylate
Etomidate
R-1-Methyl-1 (a-methylbenzyl) **imidazole**-5-carboxylate
93
Class of etomidate
Imidazole
Aciditic pH \> ring opens \> increased water solubility
physiologic pH \> ring closes\> increased lipid solubility
(open and water goes in, closes and can cross lipid membranes)
94
Mechanism by which etomidate causes adrenocortical supression
Inhibits 11-beta hydroxylase
| (no cortisol or aldosterone synthesis)
95
Which anesthetic agent increases mortality in patients with Addisonian crisis?
Etomidate
96
A single dose of etomidate suppresses adrenocortical function for how long?
5-8 hours (some texts say up to 24 hours)
97
T/F- etomidate does not cause seizures if the patient does not have a history of seizures
True
-but can be useful for mapping seizure foci
98
T/F: etomidate can cause acute intermittent porphyria
True
99
T/F- etomidate can cause myoclonus
True
100
T/F- etomidate is a good agent for septic patients
False- septic patients rely on the intrinsic stress response to keep them alive, don't want to knock it out
101
Which induction agents have a sulfur molecule in the second position? (2)
What does that do?
Thiopental, Thiamylal
-increases lipid solubility and potency
102
Anesthetic management of acute intermittent porphyria
1. Liberal hydration
2. Glucose (reduces alasynthase activity)
3. Heme Arginate
4. Prevent hypothermia
103
which agents are unsafe to give in patients with a history of acute intermittent porphyria (7)
BBEACKK
Barbituates, Birth control pills, Etomidate, Amiodarone, CCBs, Ketamine, Ketorolac
(everything else is safe- volatiles, nitrous, NMB, reversals, narcotics, midaz, ondansetron, vasopressors, betablockers)
104
What is a key enzyme in porphyrin metabolism
(what condition)
Alasynthase
| (acute intermittent porphyria)
105
MOA of thiopental and where specifically
GABA-A agonist
106
Onset of thipental
30-60 seconds (same as prop, etomidate, ketamine)
107
duration of thiopental
5-10 minutes
108
Clearance/metabolism of thiopental
Liver
109
Induction dose of thiopental
2.5-5mg/kg IV
110
Respiratory effects of thiopental (2)
Decreased resp drive & HISTAMINE RELEASE \> bronchoconstriction
111
CV effects of thiopental
Hypotension and myocardial depression
112
T/F - thiopental preserves the baroreceptor reflex
True (unlike propofol, so lesser degree of hypotension bc HR will increase)
113
CNS effects of thiopental (2)
Decreased ICP
hyperalgesia
114
Active metabolite of thiopental
none- except in really high does > pentobarb i think
115
What can intra-arterial injection of thiopental cause?
Intense vasoconstriction and crystal formation leading to tissue necrosis
(tx of vasodilator - phentolamine or stellate ganglion block)
116
What is the gold-standard for ECT and why?
Methohexital- it decreases seizure threshold and produces a better quality seizure
117
What does adding a methyl group on the nitrogen do to barbituates? Example?
Decreases seizure threshold, increase potency
Methohexital
118
2 Oxybarbituates and their chemical composition
Methohixital and PENTObarbital
\*there is an oxygen molecule in the 2nd position
119
Best way to determine which position is what (barbiuate structure)
5 = R\>R; then cockwise to 6, 1 , 2, 3, 4
120
What does hypotension of thiopental mainly a result from
Venodilation (decreased preload)
(myocardial depression is a secondary cause)
121
How does thiopental affect the CO2 response curve?
Shifts it to the right
122
5-ethyl-S-(1-methybutyl)- 2- thiobarbituric acid
Thiopental
5-ethyl-S-(1-methybutyl)- 2- **thiobarbituric** acid
123
What drug?
Thiopental (Sulfur molecule in second position)
(increased lipid solubility and potency)
124
Active metabolite of thiopental
after normal dose - none
after high dose - pentobarbital
125
PKA of thiopental
water soluble or lipid soluble
9 (highly alkaline)
water soluble
126
5 CNS effects of thiopental
Decreased CMRO2
decreased CBF (cerebral vasoconstriction)
decreased ICP (used to treat increased ICP)
decreased EEG activity (can cause burst suppression or isoelectric EEG)
no analgesia (may increase pain perception)
127
Does thiopental provide neuroprotection?
For focal ischemia - yes (CEA, temporary occlusion of cerebral arteries)
Global ischemia- no (cardiac arrest)
128
Acute interittent porphyria is made worse by what 4 things
1. ALA synthase stimulation
2. Emotional stress
3. Prolonged NPO status
4. CYP450 induction
129
What is caused by a defect in heme synthesis that promises accumulation of heme precursors?
Acute Intermittent porphyria
130
S/S of acute intermittent porphyria (3 body systems)
1. GI: Severe abdominal pain (most common and usually first), N/B
2. CNS: anxiety, confusion, seizures, psychosis, coma
3. PNS: skeletal muscle weakness (risk of resp failure), bulbar weakness (risk of aspiration)
131
Barbituates: What does adding a phenyl group at the carbon in the 5 position do? Example?
132
T/F regional anesthesia is contraindicated in those with a history of acute intermittent poryphria
False- but many clinicians avoid it bc it may be difficult to distinguish block-related complications from an acute porphyria attack
133
Induction dose of methohexital
1-1.5mg/kg
134
Which barbituate is excreted unchanged in the urine?
Phenobarbital (P450 enzymes metabolize all the others- this one is an outlier)
135
T/F: Precedex produces reliable amnesia
False
136
MOA of precedex and where
Alpha-2 agonist
\>decreases cAMP
\>inhibits the locus coeruleus in the PONS (sedation)
\>agonizes alpha 2 in the dorsal horn of the spinal cord (analgesia)
137
Onset and duration of precedex
onset 3-5 mins
Peak 5-10 mins
duration 10-20 minutes
138
Clearence/metabolism of Precedex
Liver
139
Active metabolite of precedex
None
140
Loading and maintenance dose of precedex
Loading: 1mcg/kg over 10 minutes
Maintenance: 0.4-0.7mcg/kg/hr
141
T/F - precedex preserves respiratory drive
True
142
CV effects of precedex
Bradycardia and hypotension
(transient HTN can occur with rapid administration due to peripheral alpha 2 receptors and increase calcium response)
143
T/F: precedex decreases ICP
False- no effect on ICP
144
Which induction agent has antishivering properties?
Precedex
145
T/F: precedex has limited effects on evoked potentials
True
146
(s)-4-1 [1-(2,3- Dimethylphenylethyl)- 1H- imizole - monohydrochloride
(s)-4-1 [1-(2,3- **D**imethylphenylethyl)- 1H- **imidazole** - monohydrochloride
D+ imidazole = Dexmedetomidine
147
Precedex PKA
acid or base
7.1 - acid
water soluble
148
What drug
Precedex
149
How does precedex produce analgesia?
By alpha-2 stimulation in the dorsal horn of the spinal cord
\>reduces substance P and glutamate release
150
What IV anesthetic is useful for a "wake-up" test (ie scoliosis surgery)
Precedex
151
How can you give dexmedetomidine to a child without an IV?
Via nasal or buccal route
1-2mcg/kg 1 hour before surgery
152
Rank the half life of each (longest to shortest):
Lorazepam, diazepam, midazolam
Diazepam, Lorazepam, Midazolam
(think we use midaz for this reason and diaz is a disaster bc of its long elimination half life )
153
What explains the long half life of diazepam and what is it?
~ 48 hours
and because it undergoes enterohepatic recirculation
154
8-chloro-6-2(2-flurophenyl)-1-methyl-4-H-imidazol [1,5-a][1,4] benzodiazepine
8-chloro-6-2(2-flurophenyl)-1-methyl-4-H-**imidazol** [1,5-a][1,4] **benzodiazepine**
Midazolam
155
MOA of midazolam
how does it differ from other IV anesthetics
GABA-A agonist
\*increases FREQUENCY of channel opening \> neuronal hyperpolarization
(other agents usually increase the amount of time the channel is open)
156
Midazolam IV sedation vs IV induction doses
Sedation : 0.01- 0.1mg/kg
Induction: 0.1-0.4mg/kg
157
Dose of PO sedation of midaz in kids
0.5-1mg/kg
158
PO bioavialability of Midazolam
50% due to significant first past metabolism
159
Onset and duration of Midazolam
Onset: 30-60 seconds (same as most others)
Duration: 30-60 minutes
160
Clearence/Metabolism of Midazolam
Liver (P450 enzymes) and Intestines (P450 enzymes)
161
Active metabolite of Midazolam
1- hydroxymidazolam
(1/2 potency of midaz, rapid conjugated itno inactive compound, renal failure prolonged the effect)
162
T/F- sedation doses of midazolam bare little effect on CNS, Resp , and CV systems
True
163
T/F - benzos cause retrograde amnesia
False- anterograde
164
Can midaz produce isoelectric EEG?
No- prop and barbituates can
165
T/F- midazolam provides minimal analgesia
False
166
Which IV anesthetic provides spinally mediated skeletal muscle relaxation that can be useful in CP patients
Benzos/Midaz
167
Why is propylene glycol added to diazepam and lorazepam but not midazolam?
To increase water solublity
but midaz contains an imidazole ring which makes it water soluble inside the vial and lipid soluble inside the bloodstream
168
What limits the usefulness of lorazepam as an anticonvulsant?
It's slow onset
169
What is an ultra-short acting benzo with high affinity for the GABA-A receptor and is indicated for induction and maintenance for adults undergoing procedural sedation lasting less than 30 minutes (endoscopy, bronchoscopy)
Remimazaolam
170
T/F benzodiazepems can cause a syngergystic respiratory depression when combined with other sedatives/opioids
True \* pts with COPD are more sensitive to this
171
Which Drug?
Midazolam
172
Order of potency from greatest to least: Midazolam, Diazepam, Lorazepam
Lorazepam \> Midazolam \> Diazepam
173
Which benzo must be protected from light after being removed from its packaging?
Remimazolam
174
What is similar to remifentanyl but provides no analgesia and is used for sedation but is metabolized by the non-specific plasma esterases?
Remimazolam
175
Remimazolam is contraindicated in patients with a history of severe hypersensitivity to what?
Dextran 40
176
T/F: Remimazolam can be reversed with flumazenil
True
177
Primary metabolite of Remimazolam and how is it excreted?
CNS 7056 - excreted in urine
178
After reconsitution, the single-use vial must be discarded if not used within how many hours for remimazolam?
8 hours
179
t 1/2life of remimazolam
0.5-2 minutes
180
Peak sedation occurs in how many minutes after administration of Remimazolam?
3-3.5 minutes
181
Induction of procedural sedation for Remimazolam
Maintenance infusion rate
5mg Iv over 1 minute
(can reduce to 2.5-5mg in sicker patients)
Maintenance- 2.5mg IV over 15 seconds with time lapse of 2 minutes between doses
182
A patient is experiencing a prolonged recovery from midazolam sedation. What is the initial dose of flumazenil (mg)?
0.2mg IV
then titrated in 0.1mg increments until desired response is achieved
183
How does flumazenil work?
It is a competitive antagonist of the GABA-A receptor and used to reverse sedative effects of benzos
184
What's the caution with flumazinil?
It can cause seizures in benzo dependent patients
185
Duration of action of flumazinil
30-60 minutes (which is why repeat dosing may be necessary)
186
T/F: flumazinil does NOT increase the SNS tone, anxiety or neuroendocrine evidence of stress
True (unlike narcan)
187
Administering an induction dose of which agent is LEASt likely to produce a rise in PaCO2?
Midaz, ketamine, prop, etomidate
Ketamine
188
Which anesthetic agent changes from a water-soluble drug to a lipid-soluble drug after IV injection?
Midazolam
-has an imidazole ring, which gives it it's hydrophilic and lipophilic properties
189
What is the primary pathway of etomidate metabolism?
Hydrolysis
Biotransformation is the result of ester hydrolysis at the ethyl-ester side chain.
Plasma esterases and hepatic microsomal enzymes drive the reaction
\*Remember - Etomidate = esterases; esterases = hydrolysis !
190
How long will an oral dose of lorazepam maintain a therapeutic plasma concentration?
A. 2-4 hours
B. 6-12 hours
C. 12-24 hours
D. 24-48 hours
D. 24-48 hours
PO lorazepam:
Dose = 50mcg/kg 0.05mg/kg
Cp Peak = 2-4 hours
Cp Therapeutic = 24- 48 hours
IV Lorazepam
Dose = 1-4mg
Cp peak = 20-40 minutes (hours vs minutes)
Cp Theraputic = 6-10 horus
191
The excretion of an acidic drug will be faster if
A. the urine output is decreased
B. the urine is alkaline
C. the urine is acidic
D. the liver blood flow is decreased
B. the urine is alkaline
192
The absorption and distribution of a drug would fall under the study of
A. pharmacokinetics
B. distributive science
C. pharmacogenomics
D. pharmacodynamics
A. pharmacokinetics
193
If you divide the LD50 (lethal dose for 50% of the population) by the ED50 (effective dose for 50% of the population), you are calculating the
A. plasma concentration
B. therapeutic index
C. efficacy index
D. safety margin
B. therapeutic index
194
Which body fluid normally has a higher concentration of protein?
A. intracellular fluid
B. interstitial fluid
C. urine
D. plasma
A. intracellular fluid
195
The plasma half-life of a drug is directly proportional to its
A. molecular weight
B. rate of metabolism
C. volume of distribution
D. rate of clearance
C. volume of distribution
(and decreased clearance (inversely related)
196
Presystemic elimination would be most likely to occur in a drug administered
A. orally
B. intramuscularly
C. subcutaneously
D. intravenously
A. orally
197
The termination of action of thiopental is due to
A. metabolism
B. renal excretion
C. biliary excretion
D. redistribution
D. redistribution
198
Which of the following plasma proteins binds preferably to acidic drugs?
A. Albumin
B. Transcortin
C. Beta-globulin
D. Alpha-1 acid glycoprotein
A. Albumin
199
Which one of the following is a Phase II reaction?
A. Oxidation
B. Hydrolysis
C. Reduction
D. Conjugation
D. conjugation
| (Phase 1 HORs)
200
What is the major intracellular anion?
A. chloride
B. phosphate
C. sodium
D. potassium
Phosphate
\*don't get tripped up; Anion = a negatively charged ion
201
Ideally, a medication used for a transdermal application has
A. a pH between 10 and 12
B. a daily dose requirement between 15 and 20 mg
C. absolutely no water-solubility characteristics
D. a molecular weight less than 1000 daltons
D
Daily dose <10mg
