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Spring '20/ L. PHARM TEST 2 - opioids, anticholinergics, cholinesterase > Apex IV anesthetics > Flashcards

Apex IV anesthetics Flashcards

1
Q

Propofol MOA

A

Direct GABA-A agonist- increases CL conductance - neuronal hyperpolarization

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2
Q

Propofol clearance

A

Liver p450 enzymes

extrahepatic clearance in the lungs

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3
Q

propofol cardiovascular effects

A

decreased BP
decreased SVR
decreased venous tone-decreased preload
decreased myocardial contractility

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4
Q

Propofol respiratory effects (which way of the shift?)

A

shift co2 response cure down and to the right respiratory depression and or apnea
inhibits hypoxic ventilatory drive

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5
Q

propofol CNS effects

A 
decreases cerebral oxygen consumption (CMRO)
decreases cerebral blood flow
decreases intracranial pressure
decreases intraocular pressure
anticonvulsant properties
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6
Q

does propofol provide analgesia

A

NOOOO

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7
Q

why does propofol turn urine green

A

Phenol excretion

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8
Q

allergy to consider with propofol

A

the only person you might be concerned with is people who have allergy to egg. but they are PROBABLY SAFE

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9
Q

risk factors for propofol infusion syndrome

A 
propofol dose>75
children>adults
infusion >48hours
inadequate oxygen delivery
sepsis
significant cerebral injury
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10
Q

clinical presentation for propofol infusion syndrome

A 
acute refractory bradycardia-asystole-
metabolic acidosis
rhabdomyolysis
enlarged or fatty liver
renal failure
hyperlipidemia
lipemia(cloudy plasma or blood)
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11
Q

treatment for propofol infusion syndrom

A 
discontinue propofol
maximize gas exchange
cardiac pacing
PDE inhibitiros
glucagon
ecmo
RRT
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12
Q

propofol in a syringe must be discarded after how many hours

A

6hr

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13
Q

propofol infusion must be discarded after how many hours

A

12hr

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14
Q

propofol dose antipruritic

A

10mg

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15
Q

propofol dose antimetic

A

10-15mg

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16
Q

fospropofol

A

a prodrug

warn your patients of genital and anal burning

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17
Q

ketamine class

A

phencyclidine derivative

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18
Q

ketamine MOA

A

NMDA receptor antagonist antagonizes GLUTAMATE!!

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19
Q

ketamine induction dose

A

1-2mg/kg

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20
Q

ketamine duration

A

10-20 minutes

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21
Q

clearance of ketamine

A

liver p450enzyme

22
Q

ketamine cardiovascular effects

A 
increase SNS tone
increase cardiac output
increase heart rate
increase svr
increase PVR
23
Q

ketamine respiratory effects

A

bronchodilation
upper airway muscle tone and airway reflexes remain intact
maintains respiratory drive -brief period of apnea may occur
does not significantly shift the co2 response cure
increase oral and pulmonary secretions

24
Q

ketamine CNS effects

A 
increase cerebral oxygen consumption
increase cerebral blood flow
increase intracranial pressure
increase intraocular pressure
increase EEG activity
nystagmus 
Emergence Delirium
25
Q

ketamine and analgesia

A

provides good analgesia and opioid sparing effect
relieves somatic pain>visceral pain
blocks central sensitization and windup in the dorsal horn of the spinal cord
prevents opioid induced hyperalgesia
analgesic properties- good for burn patients

26
Q

ketamine protein binding

A

12%

27
Q

etomidate dose

A

0.2-0.4mg/kg

28
Q

etomidate MOA

A

Gaba-A agonist

29
Q

etomidate key benefit

A

HEMODYNAMIC STABILITY

30
Q

etomidate CNS effects

A 
decrease Cerebral oxygen consumption
decrease cerebral blood flow
decrease intracranial pressure
cerebral perfusion pressure remains stable
no analgesia
31
Q

etomidate and PONV

A

it is more common than any other induction agent

32
Q

Name one condition that etomidate can’t be used with

A

porphria

33
Q

etomidate contraindication

A

adrenal suppression

34
Q

thiopental MOA

A

GABA-A agonist - depresses the RAS

35
Q

thiopental dose adult

A

2.5-5mg/kg

36
Q

thiopental dose kid

A

5-6mg/kg

37
Q

thiopental cardiovascular effects

A

low BP. HR okay

histamine release

38
Q

respiratory effects thiopental

A

histamine release (caution with asthma)

39
Q

thiopental CNS effects

A 
decreases cerebral oxygen consumption
decreases cerebral blood flow
decreases intracranial pressure
decreases EEG activity
no analgesia
40
Q

barbiturates are unsafe for what condition

A

porphyria

41
Q

methohexital is the gold standard for what therapy?

A

electroconvulsive therapy it decreases the seizure threshold and produces a better quality seizure.

42
Q

methohexital induction dose

A

1-1.5mg/kg

43
Q

dexmedetomidine cardiovascular effects

A

bradycardia and hypotension

44
Q

dexmedetomidine and respiratory effects

A

does not cause respiratory depression

45
Q

dexmedetomidine and CNS effects

A

decrease CBF

46
Q

dexmedetomidine other effects

A

it reduces the incidence of emergence delirium in children
decreases substance P and Glutamate release
has an anti shivering effect

47
Q

benzodiazepines MOA

A

GABA A agonist

48
Q

benodiazepines clearance

A

liver p450

49
Q

benzo cardiovascular

A

decrease BP and SVR induction dose

50
Q

benzo and respiratory effects

A

opioids potentiate the respiratory depressant effects patients with COPD are more sensitive to the respiratory depressant effects

51
Q

Benzo CNS effects

A 
decrease CMRO and CBF
anterograde amnesia
anticonvulsant
anxiolysis
no analgesia
52
Q

potency greatest to least of benzo

A

lorazepam-midazolam-diazepam

Spring '20/ L. PHARM TEST 2 - opioids, anticholinergics, cholinesterase (8 decks)

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