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Pharm Semester 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Sedative-Hypnotics

A

A drug that reversibly depress the activity of the CNS.

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2
Q

Procedural Sedation/Conscious Sedation/ Monitored Anesthesia Care (MAC)

A

The administration of a combination
of sedative(s) and analgesic(s) to induce a depressed level
of consciousness, allowing patients to tolerate unpleasant procedures and enabling clinicians to perform procedures effectively.

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3
Q

Vessel rich group CO and locations

A

75%
brain
heart
kidney
liver

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4
Q

muscle group CO and locations

A

18%
skm
skin (highly vascular)

(lean tissue)

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5
Q

Fat CO

A

5%

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6
Q

Vessel poor group CO and locations

A

2%
bone
tendon
cartilage

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7
Q

Components of General Anesthesia (Stage 3)

A
  1. Hypnosis- sleep state
  2. Analgesia- pain free
  3. Muscle Relaxation- safe
  4. Sympatholysis- HD stability
  5. Amnesia- don’t remember
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8
Q

Stages of General Anesthesia

A

Stage 1: Analgesia

Stage 2: Delirium

Stage 3: Surgical Anesthesia

Stage 4: Medullary Paralysis

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9
Q

Protective reflexes lower airway

A

cough, gag, swallow

sneeze = upper ariway

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10
Q

Stage 2 characteristics of excitement

A

undesired CV instability excitation, dysconjugate ocular movements, laryngospasm, and emesis.

Response to stimulation is exagerrated and violent.

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11
Q

Medullary paralysis

A

Stage 4 of GA.
May lead to death.

Marked hypotension with weak, irregular pulse

Flaccid paralysis

All reflexes are absent

Associated with cessation of spontaneous respiration and medullary cardiac reflexes.

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12
Q

Gold standard for drugs to compare to

A

Barituates

Thiopental
Derived from barbituric acid

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13
Q

Barbiturates Mechanism of Action (MOA) and cns effects

A

Potentiate GABAAchannel activity; directly mimics GABA
Acts on glutamate, adenosine, and neuronal nicotinic acetylcholine receptors.

Cerebral vasoconstrictor (help w/ sz)
-> decreases CBF and decreases CMRO2 55%
***No analgesia (but has hypnosis and muscle relaxation)

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14
Q

Barbiturates Prolonged infusion

A

lengthy context-sensitive half-time

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15
Q

Thiopental onset

A

30 seconds
rapid awakening d/t rapid uptake/ redistribution from brain to other tissues

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16
Q

Site of initial redistribution for thiophental

A

skm
equilibrium at 15 min to plasma

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17
Q

Dose thiophental based on

A

Lean body wt
IBW

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18
Q

Barbiturates Pediatric consideration

A

Elimination half time is shorter from inc drug clearance/ higher drug metabolism

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19
Q

Thiopental protein binding

A

Albumin 70% to 85% (inactive)— if stays in the blood

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20
Q

Thiopental Dose

A

4 mg/kg IV

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21
Q

Thiopental Elimination ½ time

A

Longer than methohexital

30 minutes only 10% in brain from rapid redistribution to skm

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22
Q

Partition coefficient definition

A

Describes the distribution of a given agents at equilibrium between two substances at the same temp, pressure, and volume

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23
Q

Blood-gas coefficient

A

describes the distribution of a anesthetic between blood and gas at the same partial pressure

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24
Q

Methohexital (Brevital) dose

A

1.5 mg/kg IV

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25
what does a decreased sensitivity to CO2 mean
need more co2 to breath/ trigger medullary / poontine section (need ETCO2 50-55) if more senstive= start breathing at 30.
26
Methohexital (Brevital) Per Rectum (PR) dose
20-30 mg/kg
27
Barbiturates enzyme induction of what meds
anticoagulants, phenytoin, TCAs, digoxin, corticosteroids, bile salts, and vit. K. increase metab = dec drug effect
28
Barbiturates Intra-arterial Injection
Results in immediate, intense vasoconstriction and excruciating pain that radiates along the distribution of the artery obscure distal arterial pulses blanching of the extremity followed by cyanosis gangrene and permanent nerve damage tx; lidocaine or papaverine
29
Prop induction dose
1.5 to 2.5 mg/kg IV children; 3-3.5 mg/kg elderly; 1mg/kg
30
prop conscious sedation dose
25 to 100 µg/kg/min
31
Prop maintenance dose
100 to 300 µg/kg/min
32
Prop Rapid injection (<15 seconds)
Produces unconsciousness within 30 seconds
33
Prop soybean oil
10% 1mg/ml
34
Prop glycerol
2.25%
35
Prop purified egg phosphatide (lecithin)
1.2% egg yolk has the lecithin
36
Prop E1/2
0.5 to 1.5 hours
37
Prop Context-sensitive half-time
40 minutes (8-hour infusions)
38
Prop VOD
3.5-4.5 (L/kg)
39
Prop Clearance
30-60 (ml/kg/min) Through the lungs > hepatic bf Tissue uptake > Cyp450
40
Prop metabolism
Cyp450 to Water-soluble sulfate and glucuronic acid metabolites excreted in the kidneys
41
Prop on systemic bp
decreased Inhibition of SNS…vascular smooth muscle relaxation… ↓ SVR Decreases intracellular calcium Modulated by laryngoscopy stimulus Exaggerated in hypovolemia, elderly, LV compromise avoid in cardiovascular pts.
42
Prop on heart rate
decreased Decreases SNS response May depress baroreceptor reflexes Profound bradycardia and asystole with healthy adult patients
43
Etomidate half time
2-5 hr
44
Etomidate VOD
2.2-4.5 L/kg
45
Etomidate clearance
10-20 ml/kg/min Large Vd; clearance is 5x faster than Thiopental Prompt awakening
46
Etomidate systemic bp
no change to decrease
47
Etomidate on heart rate
no change
48
Ketamine elimination half life
2-5h 2-3 hr
49
Ketamine VOD
2.5-3.5 L/kg (3 L/kg)
50
Ketamine clearance
16-18 ml/kg/min
51
Ketamine on systemic bp
increased
52
Ketamine on hr
increased
53
Barbiturates half life
5 min = 1/2 total dose 30 min = 10% total dose prolonged infusions = contest sensitive half time
54
Bariburates ionized/ non ionized components
Non-ionized drug ( wants to stay in fat/skm) More lipid soluble Acidosis favors Ionized drug Less lipid soluble Alkalosis favors
55
Thiopental fat/ blood partition coefficeint
11 dose calcualted on IBW
56
Methohexital (Brevital) Ionized/ non ionized component
Lower lipid solubility than Pentothal At normal pH, 76% non-ionized (pentothal 61% non-ionized) Faster metabolism More rapid recovery
57
Prop MOA
GABA A agonist -> inc chloride conductance -> hyperpolarized
58
Prop SE
support bacterial growth increased plasma trig concentrations (prolonged infusion) Pain on injection- based on vein size
59
Prop effects on N/V
more effective than zofran moa; depresses subcortical pathways and has direct depressant effect on the vomiting center
60
Prop Sub- hypnotic dose
10-15 mg IV followed by 10 mcg/kg/min
61
Prop dose for truncal puritis
10mg IV usually from neuraxial opioids (morphine) or cholestasis
62
Prop CNS effects
Decreases CMRO2 , CBF, ICP Large doses may decrease Cerebral Perfusion Pressure (support map) Excitatory movements on induction/emergency; myoclonus less effect on EEG compared to other drugs
63
Prop airway effects
Bronchodilator effects; good for asthma, copd, restrictive lung disease
64
Prop anticonvulsant dose
1 mg/kg
65
SSEP
Sensory evoked potentials studies measure electrical activity in the brain in response to stimulation of sight, sound, or touch
66
Prop on Pulmonary
Dose-dependent depression of ventilation-> Apnea With opioids (synergistic) Intact hypoxic pulmonary vasoconstriction response
67
Prop on urine
pheonls cause green urine uric acid cystalization cause cloudy urine but no alteration on renal function
68
Propofol Infusion Syndrome
-High dose infusions of >75 µg/kg/ minute longer than 24H -Severe, refractory, and fatal bradycardia in children -S/sx: Lactic acidosis, Brady-dysrhythmias, Rhabdomyolysis -Dx: ABG and serum lactate concentrations -Reversible in the early stage Cardiogenic Shock: Extracorporeal membrane oxygenation (ECMO).
69
Etomidate MOA
Selective modulator of GABAA receptors
70
Etomidate onset
within 1-minute s/p IV injection
71
Etomidate protein bound
76% albumin bound
72
Etomidate elimination location
85% in urine & 10% - 13% in bile
73
Etomidate dose
0.3 mg/kg IV 0.2-0.4mg/kg
74
Medication with the highest incidence of myoclonus
50% to 80% Etomidate An alteration in balance of inhibitory and excitatory influences on the thalamocortical tract. Can be attenuated by prior administration of opioids or benzos. Fent 1-2 mcg/kg IV
75
Etomidate and adrenocortical suppression
Dose dependent inhibition of the conversion of cholesterol to cortisol . overtime = decreased stress response. result; Severe hypotension, longer Enzyme inhibition lasts 4 to 8 hours after initial dose.
76
Etomidate on CNS
Decreases CBF and CMRO2 35% to 45% Potent, direct cerebral vasoconstrictor Dec ICP Similar to thiopental Caution: patients with history of seizure activity
77
Etomidate on respiratory
VT decreases are offset by compensatory increases in frequency of breathing. Transient: 3 to 5 minutes Stimulates CO2 medullary centers
78
MIV forumula
MIV = Tv x RR
79
Dissociative anesthesia
Resembles a cataleptic state in which the eyes remain open with a slow nystagmic gaze s/s; noncommunicative, but wakefulness is present; hypertonus and purposeful skeletal muscle movements
80
most abundant excitatory neurotransmitter in CNS
Glutamate Gylcine (co agonist)
81
Ketamine MOA
Binds noncompetitively to N-methyl-D-aspartate (NMDA) receptors. Inhibits activation of NMDA receptors by glutamate and decreases the presynaptic release of glutamate. Other receptor sites: opioid (µ, δ, and κ; weak σ), monoaminergic, muscarinic, and voltage-sensitive sodium and L-type calcium channels & neuronal nicotinic acetylcholine receptors. Weak actions at GABAA receptors.
82
Ketamine advantages over prop and etomidate
Lipid emulsion vehicle is not required = no pain @ injection. Profound analgesia at subanesthetic doses use for w/d but can cause abuse
83
Ketamine preservatives
Benzethonium Chloride nachR inhibit effects -> sns stimulation
84
Ketamine onset
Peak plasma concentrations @ 1 minute after IV & 5 mins (IM)
85
Ketamine duration of action
10 – 20 mins
86
Ketamine lipid solublility
High lipid solubility (5x to 10x than Thiopental) Brain -> not plasma bound -> distributed to tissues
87
Ketamine induction dose IV and IM
0.5 - 1.5 mg/kg IV 4 - 8 mg/kg IM
88
Ketamine metabolism
Hepatic, cytochrome P450 enzymes Norketamine: active metabolite (1/3 potency); prolonged analgesia)
89
Ketamine maintenance dose IV and IM
0.2 - 0.5 mg/kg IV analgesia 4 - 8 mg/kg IM
90
Ketamine Subanesthetic (analgesic dose)
0.2 - 0.5 mg/kg IV
91
Ketamine Post Op Sedation and Analgesia dose
1 - 2 mg/kg/hour (pediatric cardiac surgery)
92
Ketamine Neuraxial Analgesia dose
30 mgs Epidural 5 - 50 mg in mL of saline Intrathecal/Spinal/Subarachnoid
93
ERAS
enhanced recovery after surgery
94
Barbiturates Pediatric consideration
Elimination half time is shorter from inc drug clearance/ higher drug metabolism
95
what does a decreased sensitivity to CO2 mean
need more co2 to breath/ trigger medullary / poontine section (need ETCO2 50-55) if more senstive= start breathing at 30.
96
Ketamine induction considerations
Ketamine-induced salivary secretions Use antisialagogue as preoperative medication Glycopyrrolate > Atropine/Scopolamine (emergence delirium)
97
Ketamine Induction LOC effect
30 secs – 1 min (IV); 2 to 5 mins (IM)
98
Ketamine Return of consciousness (ROC)
10-20 min
99
Ketamine Full consciousness
60 to 90 minutes.
100
Ketamine Amnesia persists after ROC
60-90 min
101
Ketamine Clinical Uses
Acutely hypovolemic patients (no hyptotension) Asthmatic & MH patients (bronchdilate) Reversal of opioid tolerance Improvement of psychiatric disorders Restless Leg Syndrome (PO dose)
102
Ketamine Avoid or caution
Pulmonary: Systemic/pulmonary HTN Neuro: Increased ICP
103
Ketamine on the CNS
Potent cerebral vasodilator ↑ CBF by 60% 0.5 to 2 mg/kg IV: no further ↑ ICP Excitatory activity in EEG does not alter seizure threshold. Increased amplitude with SSEP -> reduced by N20
104
Ketamine CV side effects
Resemble SNS stimulation: Increases sBP, PAP, HR, CO, MRO2 Increases plasma Epi & Norepinephrine levels Blunted by pre-med with benzos or inhaled anesthetics & N20 Unexpected drops in sBP and CO…depleted catecholamine stores (cant give ephederine)
105
Ketamine on : Ventilation & Airway
↑ salivary and tracheobronchial mucous gland secretions Bronchodilator activity
106
Ketamine Emergence Delirium and Mia of delirium
AKA Psychedelic Effects in 5% to 30% of patients S/Sx: visual, auditory, proprioceptive, and confusional illusions -> delirium. Morbid & vivid dreams (in color) and hallucinations up to 24H MOA: depression of the inferior colliculus and medial geniculate nucleus (separate reality and fantasy) Prevention: Benzodiazepine IV (5 minutes prior)
107
Ketamine Drug Interactions
Volatile anesthetic -> hypotension NDNMB drugs ->enhanced Succinylcholine -> prolonged
108
What induction agent has the highest analgesic properties
Ketamine

Pharm Semester 2 (6 decks)

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