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1
Q

Route of administration with most rapid onset and 100% bioavailability

A

IV

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2
Q

GABA receptors responding to all members of benzodiazepine drug class demonstrates

A

Selectivity

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3
Q

Stimulated mu opiod receptors always produce effects of analgesia and respiratory depression is an example of

A

Specificity

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4
Q

Receptor response is always the same

A

Specificity

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5
Q

Required drug concentration to elicit an effect

A

Sensitivity

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6
Q

Potency aka

A

Affinity

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7
Q

Maximum effect that a drug may produce

A

Efficacy

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8
Q

Chronic antagonist administration results in up-regulation

A

Receptor up-regulation

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9
Q

Number and sensitivity of receptors increases
Tolerance occurs
Requires larger doses of antagonists ot counteract larger numbers of receptors

A

Receptor up-regulation

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10
Q

From continued stimulation of cells by agonists

A

Receptor down regulation

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11
Q

Exposure of constant concentration of drug leads to diminished effects

A

Down regulation

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12
Q

Substance that binds to specific receptors and trigger cellular responses

A

Agonist

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13
Q

Mimics action of endogenous ligands binding to same receptors

A

Agonist

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14
Q

Drug that binds to receptors without causing conformational change

A

Antagonist

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15
Q

Bind to receptors but exert partial effects. May block effects of pure agonists

A

Agonist/antagonist

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16
Q

Stage of anesthesia: from beginning of induction of GA to loss of conciousness

A

Stage 1

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17
Q

Stage of inhalation anesthesia- from loss of consciousness to onset of automatic breathing

Excitement or delirium

A

Stage 2

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18
Q

From onset of automatic respiration to respiratory paralysis

Divided into four planes

A

Stage 3

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19
Q

Plasma concentration of drug exceeds capacity of metabolizing enzymes.

Results in a constant amount of drug metabolized per unit of time

A

Zero order kinetics

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20
Q

Constant fraction of available drug is metabolized in a given time.

Greatest amount of drug is cleared when plasma concentrations are greatest

A

First order kinetics

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21
Q

Time necessary for plasma concentration to decrease by 1/2

A

Elimination 1/2 time

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22
Q

Elimination 1/2 time is ________ r/t Vd

__________ to clearance

A

Directly released to Vd

Inversely proportional to clearance

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23
Q

Are elimination 1/2 times dependent on dose?

A

No. Independent of dose

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24
Q

The greater the inspired concentration of a volatile agent, the sooner alveolar and brain concentrations approach inspired concentrations

A

Concentration effect

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25
Influences concentration of any gas given concomitantly with N2O
Second gas effect
26
Second gas effect- greatest kinetic advantage with ______ soluble volatile inhalation agents
More
27
The higher the BGPC the ______ soluble an anesthetic
More soluble
28
``` Slow or hasten FA/FI equilibration Second gas Concentration effect Decreased CO Increased MV Lower BGP Decreased tissue uptake ```
Hasten FA/FI
29
``` Slow or hasten FA/FI- Increased CO Decreased ventilation Higher BGP Increased tissue uptake ```
Slow FA/FI equilibration
30
First body compartment to equilibrate with FA
VRG Heart, lungs, brain, liver, kidney
31
VRG % body mass % CO
10 75
32
Muscle % body mass % CO
50 | 19
33
Fat % body mass % CO
20 6
34
VPG % body mass % CO
20 0
35
Desflurane BGPC
0.42
36
Sevoflurane BGPC
0.69
37
Isoflurane BGPC
1.46
38
FA/FI approaches 1 faster with what
Faster with most insoluble anesthetic
39
Used to compare the potencies of inhalation anesthetic to each other
MAC
40
MAC is measured in ________
Alveoli
41
Alveolar concentration approximates _________
Brain concentration
42
Suppression of bucking and/or laryngospasm in 50% of patients
MAC tracheal stimulation
43
Clinical MAC is _______ greater than MAC
10-30% greater than regular MAC
44
Block autonomic response to surgical stimulation in 50% of patients
MAC BAR
45
OGPC is _________ proportional to MAC
Inversely proportional Higher OGP = lower the MAC
46
When 50% of pt open eyes
MAC awake
47
5 causes of Compound A formation
``` Low FGF High absorbent temp High CO2 production Greater sevo concentration Baralyme/soda lime ```
48
Compound A renal injury is
Dose and time dependent Transient
49
Desflurane and 3 causes of carbon monoxide
Dry CO2 absorbent High absorbent temp Prolonged high FGF
50
Which produces more carbon monoxide iso or des?
Desflurane
51
Contraindication of N2O administration
Closed gas spaces - bowel obstruction - pneumocephalus - Pneumothorax - air emboli Severe disturbance/deficit in B12 or folic acid metabolism
52
Abrupt increases in Desflurane concentration results in Max response reached at _____%
SNS and renin-angiotensin activities -transient increase in HR and BP >8%
53
Volatile agents and ICP Dose required to cause ICP change
Increase ICP 0.8-1.1 MAC
54
To opposes volatile agents increase in ICP do what?
Hyperventilate to 30mmHg ETCO2
55
Volatiles and ventilation and ventilatory response to hypoxia and CO2
Depress both
56
To lessen ventilatory depressant effects of volatile agents
Substitute N2O for equal MAC fraction
57
Volatile agents increase PaCO2 due to
Lower TV and greater deadspace
58
Spontaneous breathing pattern with volatile agents
Increased RR | Decreased TV
59
All volatile agents cause concentration related decreased in BP r/t what
Decreased SVR
60
Response to abrupt increase in Desflurane concentration abated by
Fentanyl and beta blockers
61
Volatile agents and NMB
Enhance actions
62
Volatiles decrease uterine smooth muscle contractility and blood flow. Effect minimal at _____ MAC and significant at ______ MAC
0.5 MAC 1 MAC
63
Blunts post op tachycardia and hypersention effects in heart patients
Propofol
64
Decreases BP greater than other induction agents
Propofol
65
Negative inotropic effects of propofol caused by
Decreasing intracellular Ca levels
66
Most common adverse effect of propofol
Pain on injection
67
Frequently involuntary myoclonic movements due to impbalance of thalamocortical tract inhibitory and excitatory influences. Blunted by what?
Etomidate Blunted by opioids
68
Potent direct cerebral vasoconstrictor, reduces CMRO2 by 35-45%
Etomidate
69
Greater frequency of excitatory spikes on EEGs, may activate seizure foci, so use caution in epilepsy patients
Etomidate
70
Higher incidence of PONV
Etomidate
71
Causes adrenocorticoid suppression.
Etomidate
72
Early awakening is due to
Redistribution
73
Potent anesthetic. Racemic mix.
Ketamine
74
Produces intense analgesia at low doses and induces anesthesia at high doses
Ketamine
75
Anesthesia induction dose of ketamine
1-2 mg/kg IV 4-8 mg/kg IM
76
Dose of ketamine for subanesthetic yet intense analgesic effects
0.2 mg/kg
77
Visual, auditory, proprioceptive, confusional hallucinations, morbid dreams, cortical blindness associated with ketamine due to what
Depression of inferior colliculi and medial geniculate nucleus
78
Not for CAD patients bc increases myocardial O2 needs and reduces filling of coronaries
Ketamine
79
Do not use if pt has systemic HTN Unless
Ketamine Given with propofol
80
#1 mechanism for CV effects of ketamine
Greater SNS outflow Increased plasma concentration of epi and NE in 2 minutes
81
What blunts ketamine induced CV stimulation
Inhalation agents and benzodiazepines

Pharmacology (6 decks)

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