COCO Tips

Question 1

How is Flumazenil Metabolized

Answer 1

By liver enzymes

Question 2

Thiopental: Pharmacokinetics

Answer 2

Redistribution and absorption typically happens instantaneously through IV injection

Question 3

Side effects of Flumazenil

Answer 3

None of the above (does not cause seizures/anxiety, hypertension, or Tachycardia)

Question 4

Clinical effects of Midazolam

Answer 4

Being bipolar is a relative contraindication whereas pregnancy is not a relative contraindication

Question 5

Onset times for drugs based on route of administration

Answer 5

IV Thiopental = 30-40 seconds (peaks at 1 minute)
Etomidate = 30 seconds (1 minute peak)
Propofol = 15 - 30 seconds
Midazolam = 2 minutes (peaks at 5 - 10 minutes)

Question 6

Midazolam solubility

Answer 6

Water soluble outside and lipid soluble inside

Hydrophilic when pH is lower than 6
Lipophilic when pH is greater than 6

Question 7

Why put someone on a daily aspirin therapy?

Answer 7

In people with high risks of heart attacks, a daily aspirin regimen can act as an antiplatelet drug to allow better perfusion to the heart.

Question 8

Target sites for Local Anesthetics

Answer 8

Sodium Channels (Na+)

Question 9

Barbiturate mechanism of action

Answer 9

Works directly on the CNS by stimulating the release of the inhibitory neurotransmitter GABA. GABA will bind to GABA receptors and cause the Cl- ion gated channels to stay open for a prolonged period of time. This in turn hyperpolarizes the cells and decreases the possibility of an effective action potential by raising the threshold. Thiopental also decreases the flow of calcium through cell membranes

Can control seizures and help maintain a state of sleep

Question 10

Physical properties of induction drugs

Answer 10

Propofol = oil at room temperature, insoluble in aqueous solution and 98% protein binding

Etomidate = Water soluble at acidic pH and lipid soluble at physiologic pH, 35% glycerol, racemic mixture, and 76% protein binding in the bloodstream.

Ketamine = derived from PCP, with 27% protein binding

Question 11

Effects of Propofol

Answer 11

Can decrease BP and increase HR

Question 12

Induction drug that can cause hiccups

Answer 12

Etomidate

Question 13

Alpha-1 (protein binding)

Answer 13

Basic drugs will bind to this acidic glycoprotein

Question 14

Concentration of epinephrine in Local Anesthetics

Answer 14

0.5% = 1:200,000 epi

1% = 1:200,000 epi

1.5% = 1:200,000 epi

2% = 1:200,000 epi

1% = 1:100,000 epi

2% = 1:100,000 epi

Question 15

Propofol additives

Answer 15

Glycerol = burns

bacteriostatic? I thought this was etomidate? = disodium edetate?

Question 16

Clinical effects of Midazolam

Answer 16

Does Do:
Sedation and Hypnosis, Anxiolysis, Anticonvulsant, Anterograde Amnesia

Does Not Do:
Analgesia, Antidepressant, Antipsychotic, Protection from intubation

Question 17

pH for ionization of basic drugs

Answer 17

pH must be below the pK for that drug

Question 18

Contraindications of Benzodiazepines

Answer 18

Contraindicated in patients with narrow angle glaucoma and patients with hypersensitivity to the drug. Do not use at all in pregnant women.

Question 19

Effect of aspirin on platelets

Answer 19

Low-dose, long-term aspirin use irreversibly inhibits platelet cyclooxygenase 1 preventing the formation of prostaglandin H2, and therefore thromboxane A2 in platelets, which are responsible for platelet aggregation. Aspirin is an antiplatelet drug.

Question 20

Thiopental for burst suppression

Answer 20

Can be used to lower the CMRO2 and therefore CBF requirements to poorly perfused areas of the brain. Will result in an EEG flatline.

Question 21

Hoffman elimination - temp and pH dependence

Answer 21

As pH and temperature decrease, Hoffmann Elimination also decreases. As pH and temperature increase, Hoffmann Elimination also increases. So febrile patients require higher doses of Atracurium.

Question 22

Thiopental side effects - pain on injection

Answer 22

ongoing drowsiness;
weak or shallow breathing;
slow heartbeats;
chills or shivering;
sneezing, coughing, tight feeling in your throat; or.
bronchospasm (wheezing, chest tightness, trouble breathing).

Question 23

Nipodimine Drug Class

Answer 23

A calcium channel blocker used to reduce brain damage caused by a bleeding blood vessel.

Question 24

Peripheral Blood Lymphocyte - simvastatin

Answer 24

A “statin” used to treat high cholesterol and triglyceride levels. It can impair humoral and cell-mediated immunity by inhibiting lymphocyte homing, T-cell activation, and antigen cross-presentation.

Question 25

Pharmacodynamics and protein binding

Answer 25

Protein binding has a large impact on the available active drug in the body. The larger the percentage of protein bound drug, the less of that drug is available to act on the body.