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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
Q

what does a decreased sensitivity to CO2 mean

A

need more co2 to breath/ trigger medullary / poontine section (need ETCO2 50-55)

if more senstive= start breathing at 30.

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26
Q

Methohexital (Brevital) Per Rectum (PR) dose

A

20-30 mg/kg

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27
Q

Barbiturates enzyme induction of what meds

A

anticoagulants, phenytoin, TCAs, digoxin, corticosteroids, bile salts, and vit. K.

increase metab = dec drug effect

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28
Q

Barbiturates Intra-arterial Injection

A

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

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29
Q

Prop induction dose

A

1.5 to 2.5 mg/kg IV
children; 3-3.5 mg/kg
elderly; 1mg/kg

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30
Q

prop conscious sedation dose

A

25 to 100 µg/kg/min

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31
Q

Prop maintenance dose

A

100 to 300 µg/kg/min

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32
Q

Prop Rapid injection (<15 seconds)

A

Produces unconsciousness within 30 seconds

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33
Q

Prop soybean oil

A

10%
1mg/ml

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34
Q

Prop glycerol

A

2.25%

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35
Q

Prop purified egg phosphatide (lecithin)

A

1.2%
egg yolk has the lecithin

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36
Q

Prop E1/2

A

0.5 to 1.5 hours

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37
Q

Prop Context-sensitive half-time

A

40 minutes (8-hour infusions)

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38
Q

Prop VOD

A

3.5-4.5 (L/kg)

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39
Q

Prop Clearance

A

30-60 (ml/kg/min)
Through the lungs > hepatic bf
Tissue uptake > Cyp450

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40
Q

Prop metabolism

A

Cyp450 to Water-soluble sulfate and glucuronic acid metabolites
excreted in the kidneys

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41
Q

Prop on systemic bp

A

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.

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42
Q

Prop on heart rate

A

decreased
Decreases SNS response
May depress baroreceptor reflexes
Profound bradycardia and asystole with healthy adult patients

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43
Q

Etomidate half time

A

2-5 hr

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44
Q

Etomidate VOD

A

2.2-4.5 L/kg

45
Q

Etomidate clearance

A

10-20 ml/kg/min
Large Vd; clearance is 5x faster than Thiopental
Prompt awakening

46
Q

Etomidate systemic bp

A

no change to decrease

47
Q

Etomidate on heart rate

A

no change

48
Q

Ketamine elimination half life

A

2-5h
2-3 hr

49
Q

Ketamine VOD

A

2.5-3.5 L/kg
(3 L/kg)

50
Q

Ketamine clearance

A

16-18 ml/kg/min

51
Q

Ketamine on systemic bp

A

increased

52
Q

Ketamine on hr

A

increased

53
Q

Barbiturates half life

A

5 min = 1/2 total dose
30 min = 10% total dose

prolonged infusions = contest sensitive half time

54
Q

Bariburates ionized/ non ionized components

A

Non-ionized drug ( wants to stay in fat/skm)
More lipid soluble
Acidosis favors
Ionized drug
Less lipid soluble
Alkalosis favors

55
Q

Thiopental fat/ blood partition coefficeint

A

11
dose calcualted on IBW

56
Q

Methohexital (Brevital) Ionized/ non ionized component

A

Lower lipid solubility than Pentothal
At normal pH, 76% non-ionized (pentothal 61% non-ionized)
Faster metabolism
More rapid recovery

57
Q

Prop MOA

A

GABA A agonist -> inc chloride conductance -> hyperpolarized

58
Q

Prop SE

A

support bacterial growth
increased plasma trig concentrations (prolonged infusion)
Pain on injection- based on vein size

59
Q

Prop effects on N/V

A

more effective than zofran

moa; depresses subcortical pathways and has direct depressant effect on the vomiting center

60
Q

Prop Sub- hypnotic dose

A

10-15 mg IV followed by 10 mcg/kg/min

61
Q

Prop dose for truncal puritis

A

10mg IV
usually from neuraxial opioids (morphine) or cholestasis

62
Q

Prop CNS effects

A

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
Q

Prop airway effects

A

Bronchodilator effects; good for asthma, copd, restrictive lung disease

64
Q

Prop anticonvulsant dose

A

1 mg/kg

65
Q

SSEP

A

Sensory evoked potentials studies measure electrical activity in the brain in response to stimulation of sight, sound, or touch

66
Q

Prop on Pulmonary

A

Dose-dependent depression of ventilation-> Apnea
With opioids (synergistic)
Intact hypoxic pulmonary vasoconstriction response

67
Q

Prop on urine

A

pheonls cause green urine
uric acid cystalization cause cloudy urine

but no alteration on renal function

68
Q

Propofol Infusion Syndrome

A

-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
Q

Etomidate MOA

A

Selective modulator of GABAA receptors

70
Q

Etomidate onset

A

within 1-minute s/p IV injection

71
Q

Etomidate protein bound

A

76% albumin bound

72
Q

Etomidate elimination location

A

85% in urine & 10% - 13% in bile

73
Q

Etomidate dose

A

0.3 mg/kg IV
0.2-0.4mg/kg

74
Q

Medication with the highest incidence of myoclonus

A

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
Q

Etomidate and adrenocortical suppression

A

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
Q

Etomidate on CNS

A

Decreases CBF and CMRO2 35% to 45%
Potent, direct cerebral vasoconstrictor
Dec ICP
Similar to thiopental
Caution: patients with history of seizure activity

77
Q

Etomidate on respiratory

A

VT decreases are offset by compensatory increases in frequency of breathing.
Transient: 3 to 5 minutes
Stimulates CO2 medullary centers

78
Q

MIV forumula

A

MIV = Tv x RR

79
Q

Dissociative anesthesia

A

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
Q

most abundant excitatory neurotransmitter in CNS

A

Glutamate
Gylcine (co agonist)

81
Q

Ketamine MOA

A

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 GABAAreceptors.

82
Q

Ketamine advantages over prop and etomidate

A

Lipid emulsion vehicle is not required = no pain @ injection.
Profound analgesia at subanesthetic doses
use for w/d but can cause abuse

83
Q

Ketamine preservatives

A

Benzethonium Chloride
nachR inhibit effects -> sns stimulation

84
Q

Ketamine onset

A

Peak plasma concentrations @ 1 minute after IV & 5 mins (IM)

85
Q

Ketamine duration of action

A

10 – 20 mins

86
Q

Ketamine lipid solublility

A

High lipid solubility (5x to 10x than Thiopental)
Brain -> not plasma bound -> distributed to tissues

87
Q

Ketamine induction dose IV and IM

A

0.5 - 1.5 mg/kg IV
4 - 8 mg/kg IM

88
Q

Ketamine metabolism

A

Hepatic, cytochrome P450 enzymes
Norketamine: active metabolite (1/3 potency); prolonged analgesia)

89
Q

Ketamine maintenance dose IV and IM

A

0.2 - 0.5 mg/kg IV analgesia
4 - 8 mg/kg IM

90
Q

Ketamine Subanesthetic (analgesic dose)

A

0.2 - 0.5 mg/kg IV

91
Q

Ketamine Post Op Sedation and Analgesia dose

A

1 - 2 mg/kg/hour (pediatric cardiac surgery)

92
Q

Ketamine Neuraxial Analgesia dose

A

30 mgs Epidural
5 - 50 mg in mL of saline Intrathecal/Spinal/Subarachnoid

93
Q

ERAS

A

enhanced recovery after surgery

94
Q

Barbiturates Pediatric consideration

A

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

95
Q

what does a decreased sensitivity to CO2 mean

A

need more co2 to breath/ trigger medullary / poontine section (need ETCO2 50-55)

if more senstive= start breathing at 30.

96
Q

Ketamine induction considerations

A

Ketamine-induced salivary secretions
Use antisialagogue as preoperative medication
Glycopyrrolate > Atropine/Scopolamine (emergence delirium)

97
Q

Ketamine Induction LOC effect

A

30 secs – 1 min (IV); 2 to 5 mins (IM)

98
Q

Ketamine Return of consciousness (ROC)

A

10-20 min

99
Q

Ketamine Full consciousness

A

60 to 90 minutes.

100
Q

Ketamine Amnesia persists after ROC

A

60-90 min

101
Q

Ketamine Clinical Uses

A

Acutely hypovolemic patients (no hyptotension)
Asthmatic & MH patients (bronchdilate)
Reversal of opioid tolerance
Improvement of psychiatric disorders
Restless Leg Syndrome (PO dose)

102
Q

Ketamine Avoid or caution

A

Pulmonary: Systemic/pulmonary HTN
Neuro: Increased ICP

103
Q

Ketamine on the CNS

A

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
Q

Ketamine CV side effects

A

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
Q

Ketamine on : Ventilation & Airway

A

↑ salivary and tracheobronchial mucous gland secretions
Bronchodilator activity

106
Q

Ketamine Emergence Delirium and Mia of delirium

A

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
Q

Ketamine Drug Interactions

A

Volatile anesthetic -> hypotension
NDNMB drugs ->enhanced
Succinylcholine -> prolonged

108
Q

What induction agent has the highest analgesic properties

A

Ketamine

Pharm Semester 2 (6 decks)

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