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Cooper AFN Pharm II > Exam I - Anesthetics > Flashcards

Exam I - Anesthetics Flashcards

1
Q

What is the function of the thalamic circuit?

A

-sensory processing

-attention

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2
Q

What is the function of the thalamocortical circuit?

A

-conciousness

-awareness

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3
Q

What is the function of the hippocampal network?

A

-memory

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4
Q

________ Receptors & ________ receptors also mediate fast excitatory impulses but have little anesthetic sensitivity

A

-AMPA

-Kainate

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5
Q

What 2 neurotransmitters bind to NMDA receptors?

A

-Glutamate

-Glycine

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6
Q

What gas effects the NMDA receptor?

A

N2O

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7
Q

Although the NMDA is a _______-gated ion channel, it is also sensitve to the _______ across the membrane containing the receptor

A

-Ligand-gated

-voltage

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8
Q

_______ blocks the ion channel on the NMDA receptor until membrane depolarization occurs

A

-Mg2+

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9
Q

(t/f) NMDA receptors must be activated before they can be antagonized

A

True

*Ketamine binding site is same location as Mg2+ that blocks the ion channel. Have to remove the Mg2+ through activation of the receptor to allow antagonists to bind.

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10
Q

What is the only anesthetic than can be used soley for GA that has analgesic properties?

A

Ketamine

*Dexmedetomidine (Precedex) is the only other sedative that has analgesic properties but it can’t be used as sole agent for GA

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11
Q

The _____ molecular position on barbituate molecules is responsible for the _______ effect of the drug. __________ sidechains have a greater effect than _________ chains

A

-C5

-hypnotic effect

-Branched sidechains > straight chains

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12
Q

What drug has a Phenyl Group @ C5

A

Phenobarbitol

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13
Q

What drug has a Methyl Group @ N1

A

Methohexital

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14
Q

What drug has a Sulfer atom @ C2

A

-Sodium thiopental

*aka Thiobarbituate

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15
Q

__________ was THE intravenous induction agent for anesthesia prior to Diprivan (Propofol).
Production in the U.S. stopped in 2010.

*BLUE BOX

A

Thiopental

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16
Q

Most important determinant of awakening

A

Redistribution to inactive, poorly perfused tissues

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17
Q

Onset of action of Sodium Thiopental (Pentothal)

A

30-60 sec

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18
Q

Onset of action of Methohexital (Brevital)

A

Immediate

*maximal brain uptake in 30 sec

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19
Q

The time to achieve a 50% reduction in concentration after stopping a continous infusion

A

Context-sensitive half-time

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20
Q

What 2 drugs (maybe 3) are contraindicated in Hypersensitivity/Intermittent
Porphyria?

A

-barbiturates

-etomidate

Nagelhout - includes Benzos (word for word)

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21
Q

What 2 drugs cause increased incidence of myoclonus?

A

-Barbiturates (methohexital)

-etomidate

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22
Q

What drugs increases frequency of Cl- channel opening via GABAa receptor stimulation

A

Benzos

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23
Q

Barbiturates have a _____ context-sensitive half-time

A

Prolonged

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24
Q

Barbiturates exhibit ______ order kinetics

A

Zero order

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25
Q

Zero order kenetics means what

A

Drug is eliminated per unit/time

*ex. - 5mg/hr

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26
Q

DOA of thiopental

*Red/bolded in PP

A

5-30 min

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27
Q

DOA of methohexital

*Red/bolded in PP

A

4-7 min

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28
Q

Rectal induction dose of methohexital

*Red/bolded in PP

A

25 mg/kg

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29
Q

Sodium thiopental (pentothal) has ___________ effects

*bolded in red on Dr. B’s PP chart

A

anticonvulsant effects

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30
Q

Methohexital (brevital) _________ the seizure threshold

A

Lowers

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31
Q

What drug is know for histamine release?

A

Sodium thiopental (pentothal)

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32
Q

What are the 3 MOAs of barbiturates?

A

-Potentiate GABA

-Block glutamate @ AMPA receptors

-Block neuronal Nicotinic receptors

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33
Q

Primary anesthetic use of midazolam (versed) is __________

A

premedication

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34
Q

An induction dose of midazolam (versed) would ________ emergence

A

Delay emergence

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35
Q

Midazolam (versed) causes _________ amnesia

A

Anterograde

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36
Q

_________ increase GABAa affinity for GABA

*only one in Dr. B PP that specifies this

A

benzos

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37
Q

Which subunit of the GABAa receptor do benzos bind to to mediate sedative, amnestic & anticonvulsant effects

A

a1 subunits

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38
Q

Which subunit of the GABAa receptor do benzos bind to to mediate anxiolysis, anti-hyperalgesia, & centrally mediated muscle relaxation

A

a2 subunits

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39
Q

Onset of diazepam (valium) IV

A

Almost immediate

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40
Q

Onset of midazolam (versed) IV

A

1-5 min

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41
Q

DOA of diazepam (valium)

A

20-30min

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42
Q

DOA of midazolam (versed)

A

2 hrs

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43
Q

T 1/2 of diazepam (valium)

A

30-50 hrs

*“half-life is equal to pt age in years”

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44
Q

T 1/2 of midazolam (versed)

A

1-4 hrs

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45
Q

Metabolite of midazolam (versed)

A

1-hydroxymidazolam

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46
Q

Metabolism of diazepam (valium)

A

Desmethylmedazolam

to

Nordiazepam

to

Oxazepam (active benzo) –> secondary peak 6-12hrs

to

Inactive metabolite

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47
Q

Diazepam (valium) interacts (C/I) w/ ___________ & ___________

A

-erythromycin

-anti-fungals

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48
Q

Midazolam (versed) C/I w/ _________ & __________

A

-pregnancy

-elderly (all benzos)

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49
Q

(t/f) benzos are ok for neuro cases

A

True

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50
Q

Benzos _______ the seizure threshold

A

increase

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51
Q

(t/f) benzos do not decrease central respiratory system

A

False

*midazolam decreases central respiratory system the most

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52
Q

What drug reverses benzos

A

Flumazenil (Romazicon)

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53
Q

Is flumazenil (romazicon) a competitive or non-competitive antagonist to benzos

A

Competitive

54
Q

Flumazenil (romazicon) is chemically similar to benzos except that the phenyl group
is replaced by a _________ group

A

carboxyl

55
Q

(t/f) DOA of Versed exceeds Romazicon

A

True

*VERNON PP SAYS ONLY LORAZEPAM IS LONGER THAN FLUMAZENIL

*DR. B SAYS VERSED

*EXPECT NEED FOR RE-DOSING!!

56
Q

Flumazenil (romazicon) is C/I in pt w/ ________ disorders

A

Seizure disorders

57
Q

________ is the cardiac stable induction agent

A

Etomidate

58
Q

You give midazolam (versed) to pt in pre-op and you want to run to the restroom real quick before you take the patient to the OR. It will only take a minute. Is this ok?

*BLUE BOX

A

NO

*DO NOT LEAVE PT UNATENDED AFTER VERSED ADMINISTRATION

59
Q

Etomidate causes _________ ___________ r/t to the suppression of cortisol production due to suppression of a the synthesizing enzyme _____-______________ in the adrenal ________

A

-Adrenal suppression

-11β-Hydroxylase

-adrenal cortex

60
Q

(t/f) etomidate can cause burst suppression

A

True

61
Q

(t/f) Etomidate produces just as much respiratory depression as other IV anesthetic agents

A

False

*less than other agents

62
Q

T 1/2 of flumazenil (romazicon)

A

Dr. B = 41-79 min (t 1/2)

Dr. V = 45-90 (DOA)

*SHORTER/LONGER THAN VERSED AND/OR LORAZEPAM –> MAY HAVE TO REDOSE!!

63
Q

Regarding flumazenil (romazicon), if you have to give > ____mg dose to reverse the pt, then there is an underlying issue

A

> 0.6mg

64
Q

Midazolam has a _____ ring as its primary structure which makes is H2O soluble and prevents pain on IV injection d/t not having to use preservatives/solvents

A

Imidazole ring

*iMIDAZOLe = MIDAZOLam

65
Q

_________ ___________ of benzos can prolong duration of benzos in renal failure pts

A

Active metabolites

66
Q

Etomidate MOA

A

Dr. B - mimics inhibitory effects of GABA

Dr. Vernon - allosterically binds GABAa & increases affinity for GABA

67
Q

(t/f) high doses of etomidate, >0.3 mg/kg, can cause decreases in BP & CO

A

True

(even though its considered cardiac stable)

68
Q

Of all of the clinically used IV anesthetics, __________ has the greatest selectivity for GABAA Receptors and has the fewest relevant interactions with other ion channels/receptors.

*BLUE BOX

A

Etomidate (amidate)

69
Q

The excitatory phenomenon (myoclonus) caused by etomidate can be mitigated by concurent administration of _________ or __________

A

Opoids or Benzos

70
Q

Etomidate is a potent cerebral ______________

A

vasoconstrictor

71
Q

Etomidate is not approved for children <____ yrs

A

Dr. B - <10 yrs

Dr. V - <5 yrs

72
Q

(t/f) etomidate is structurally similar to some other anesthetics

A

False

*structurally unrelated to other anesthetics

73
Q

Preservative in Diprivan

A

EDTA

74
Q

Preservatives in Propofol

A

-sodium metabisulfite (bronchoconstriction in Asthma)

-benzyl alcohol

75
Q

Propofol MOA

A

Dr. B - GABA mimetic (direct)

Dr. V - Allosterically binds GABAa & increases affinity for GABA

Other sources: (hold no weight on this test)
Low dose = allosteric
High dose = direct

76
Q

Propofol predominantly binds to the ____ subunits of the GABAa receptors

A

B2 subunits

77
Q

Are there amnestic properties in propofol?

A

Dr. B - No

Dr. V - Yes

Other sources: ???

78
Q

Egg allergies are C/I w/ propofol

A

Technically no

79
Q

Egg lecithin/yolk allergies are C/I w/ propofol

A

Yes

80
Q

The contents of an opened ampule, vial or syringe must be discarded if not used within ___ hours.

*BLUE BOX

A

6 hrs

81
Q

When preparing a syringe, label appropriately with initials, date and _______

*BLUE BOX

A

time of expiration

82
Q

Propofol with ____________ preservative increases bronchial tone and does not blunt the _________ mediated effects leading to _____________.

A

-metabisulfite

-vagally

-bronchoconstriction

83
Q

Sodium metabisulfite – can potentially irritate __________ and/or those allergic to _______ drugs

A

-asthmatics

-sulfa

84
Q

Mixing lido & propofol: No more than ___mg of Lidocaine with ___mL of Propofol

Starts to separate after ___ hour
Risk of _________ _________ ________

*BLUE BOX

A

-20mg Lido w/ 20mL prop

-1 hr

-microscopic fat emboli

85
Q

Propofol is a cerebral _____________

A

vasoconstrictor

*this is how it decreases ICP

86
Q

Primary disatvantage of propofol

A

Depressive effects on CV effects

87
Q

Caution w/ propofol in pts with critical ______ ________ or __________ ________

A

-aortic stenosis

-cardiac tamponade

88
Q

Which is faster onset & offset. Ketamine or propofol

A

Ketamine (per Dr. B)

89
Q

Which med can cause centrally mediated muscle relaxation?

A

Benzos

90
Q

Elderly have ________ volume in their central compartment so you would ________ propofol dose

A

Decreased

Decreased

91
Q

Peds have ________ volume in their central compartment so you would ________ propofol dose

A

Increased

Increased

92
Q

If you don’t have methohexital (brevital) then you can give ___________

A

etomidate

93
Q

Onset of Propofol

A

9-51 sec (average 30 sec)

94
Q

DOA of propofol

A

3-10 min

95
Q

Induction dose of propofol

A

1-2.5 mg/kg

96
Q

Pt w/ high risk PONV & MH. What induction agent should you use?

A

Propofol

97
Q

Symptoms of propofol infusion syndrome

A

-Hypertriglyceridemia
-Metabolic acidosis
-Rhabdomyolysis
-Renal failure
-Hemodynamic instability

98
Q

Propofol infusion syndrome is associated with high dose infusions for > ___ hours

A

48 hrs

99
Q

The Dissociative Anesthetic

A

Ketamine

100
Q

Why does ketamine cause dissociation?

A

Depresses the medial thalamic nuclei & blocks the association between the thalamus and the cerebral cortex

101
Q

Ketamine depresses the ________ _________ __________ & blocks the association between the ________ and the cerebral cortex

A

-medial thalamic nuclei

-thalamus

102
Q

Ketamine is derived from _______

A

PCP

103
Q

(t/f) Ketamine has minimal effects on respiratory drive and airway reflexes

A

True

104
Q

Using ________ can decrease the emergence delirium caused by ketamine by ___%

A

-benzos

-50%

105
Q

Ketamine MOA

A

NMDA Receptor antagonist in the spinal cord and brain

*Selective depression of the medial thalamic nuclei

106
Q

Ketamine causes increased __________ which can lead to ____________ (emergent scenario)

A

-salivation

-laryngospasm

107
Q

Metabolite of ketamine

A

Norketamine

108
Q

Norketamine is ____ -____ as potent as ketamine

A
  • 1/3rd - 1/5th
109
Q

Onset of ketamine

A

1-2 min

110
Q

DOA of ketamine

A

5-15 min

111
Q

Ketamine stimulates endogenous _________ release

A

catecholamine

112
Q

Ketamine induction dose

A

1-2 mg/kg

113
Q

GABA stands for __________

A

Gamma-aminobutyric acid

114
Q

Ketamine is the only true _____________ (think airway)

A

-bronchodilator

115
Q

Hypovolemic pts can benefit from what induction agent especially

A

Ketamine

116
Q

What induction agent has relatively low protein binding when compared to other agents

A

Ketamine

117
Q

What drug commonly causes a cataeleptic state

A

Ketamine

118
Q

You see ur pt w/ eyes open, pupils reactive to light, corneal reflexes intact, lacrimation, blinking, involuntary muscle movement. You induced w/ ketamine. Is this ok?

A

Yes

Normal cataeleptic state caused by ketamine

119
Q

List some big C/I co-morbidities w/ ketamine administration

A

-CHF

-CAD

-uncontrolled HTN

-neuro and cererbral aneurysms

120
Q

Dexmetomidine ratio of α2:α1 = _____:__

A

1620:1

121
Q

Dexmedetomidine MOA causes analgesic effects at the spinal cord and a supraspinal site called the __________ ___________

A

Locus Ceruoleus

122
Q

Name the 3 main MOAs of dexmedetomidine

A

-a2 agonist

-hyperpolarization of neurons via K+ efflux

-Inhibits adenyl cyclase
(decreases cAMP)

123
Q

Dexmedetomidine typically decreases HR & BP, however initially direct effects on peripheral
α2 receptors can predominate
leading to __________ BP

A

Increased BP

124
Q

Dexmedetomidine can cause significant hypotension in patients with increased sympathetic tone such as __________, ___________ and ____________

A

Diabetics

Hypovolemics

Elderly

125
Q

Neuro wise, dexmedetomidine only decreases _______

A

CBF

126
Q

Dexmedetomidine onset

A

5-10 min

127
Q

Dexmedetomidine DOA

A

60-120 min

128
Q

Dexmedetomidine Infusions should not exceed ___ hours

A

24 hrs

129
Q

Loading dose of dexmedetomidine

A

0.5-1 mcg/kg over 10 min

130
Q

Respiratory effects of dexmedetomidine

A

Preserved - possible small to moderate decrease in TV

Decreased salivation

131
Q

Main cardiac effects of dexmedetomidine

A

Bradycardia

Hypotension

132
Q

Dexmedetomidine can be used to tx __________

A

Shivering

Cooper AFN Pharm II (5 decks)

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