Hypnotic Pharmacodynamic

Question 1

Propofol: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V

Answer 1

CVS: BP:Dec HR:Dec** CO:Dec Contract:Dec Vent: Dep RR: Dep HyperCO2: Dep N/V: Dec **

Question 2

Thiopental: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V

Answer 2

CVS: BP:Dec HR:~Inc** CO:Dec Contract:~Dec Vent: Dep; RR: Dep; HyperCO2: Dep N/V: Unchanged

Question 3

Midazolam: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V

Answer 3

CVS: BP: ~dec HR: ~ CO: ~dec Contract: ~ Vent : ~ dec; RR: Unchanged, HyperCO2: Unchanged, Vent drive: dec N/V: Dec/Unchanged

Question 4

Ketamine:BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V

Answer 4

CVS: BP: very Inc HR: very inc CO: None Contract: Dec if no Catecholamine MinVent: Dec, Vent drive: ~ HyperCO2: Unchanged N/V: Unchanged

Question 5

Etomidate: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V

Answer 5

CVS: BP:~dec HR:None CO: Non Contract:Non Vent: ~Depress, RR: ~Depress HyperCO2: Depress N/V: Increased

Question 6

Precedex: BP, HR, CO, Contract Vent, RR, Hypercapnia response, N/V

Answer 6

CVS: BP: inc (bolus) dec (infuse) HR: dec CO: dec Contract: ~ Minute Vent: ~ dec HyperCO2: Unchanged, Vent drive ~dec N/V: Unchanged

Question 7

Propofol: CBF, ICP, CMRO2, AED

Answer 7

CBF: Dep x3 ICP: Dep x3 CMRO2: Dep x3 AED: Depress x3, burst suppression Myoclonus x1

Question 8

Thiopental: CBF, ICP, CMRO2, AED

Answer 8

CBF: Dep x2 ICP:Dep x2 CMRO2: Dep x2 AED: Yes x 3

Question 9

Midazolam: CBF, ICP, CMRO2, AED

Answer 9

CBF: Unchanged ICP: Unchanged CMRO2: Unchanged AED: Yes Anxiety: Yes

Question 10

Ketamine: CBF, ICP, CMRO2, AED, Delirium

Answer 10

CBF: ~Increased ICP: ~Increased CMRO2: ~Increased AED: Maybe plus Delirium: Yes** TX with benzo

Question 11

Etomidate: CBF, ICP, CMRO2, AED, Anxiety, Delirium

Answer 11

CBF: Dep x2 ICP: Dep x 2 CMRO2: Dep x 2 AED: Worsens but treats myoclonus well Painful Injection

Question 12

Precedex: CBF, ICP, CMRO2

Answer 12

CBF: Dec ICP: SAME CMRO2: Dec

Question 13

Ketamine: MOA, AE, Benefits

Answer 13

Provides Analgesia, dissociative hypnosis with present eye and limb movement Dec Opipd requiment postop Preserve CO and Resp fxn via NMDA receptor agonism AE increased card work, oral secretions, when low epi, myocardial depressant psychomiminetic tendency tx wi benzo

Question 14

Propofol MOA, Benefit, AE

Answer 14

MOA: GABA R Benefit: context sensitive half life is 40 min for past 8 hr AE: CV depression, need reduced for elders, ICU, hypovolemic due to dec central distribution vol and dec clearance leading to more myocardial depression Egg yolk lecithin (alkylphenol) -> egg anaphlyaxsis care Lipid emulsion support bacterial growth linked to sepsis, observe aseptic tech and less than 12 hr Propofol infusion syndrome: Prolonged use can lead to arrhythmia, lipemia met acidosis, rhabdomyolysis

Question 15

Etomidate MOA, Benefit, AE

Answer 15

MOA: Benefit: useful in unstable pt due to less myocardial depression, may cause hypotension still AE: Adrenal Supression (esp hydroxylase) limited use as infusion

Question 16

Thiopental MOA, Benefit, AE

Answer 16

MOA: Barbituate with fav neurologic profile (neurprotection via dec cerebral perfusion) Benefit: Better CVC compared to Propofol AE:

Question 17

Precedex MOA, Benefit, AE

Answer 17

MOA: alpha 2 agonist Benefit: sedatitive, analgesic, agnostic, slower onset/offset as comp to propofol useful for icu sedation x 24 hr and fiberoptic intubation Minimal resp depression Decreases periop opioid needs AE: Dose Dependent Hypotension, Bradycardia

Question 18

Fospropofol: MOA, Use, caution, pharmk different

Answer 18

Water soluable prodrug of Propofol, use in procedural sedation have wide intervals due to prodrug metabolism Slower Induction vs Propofol increases duration Decreased Injection Pain,

Question 19

Benzo MOA, Indication, general AE

Answer 19

Gaba receptor potentiator Anticonvulsant like in local anesthetics tox Less respiratory depression vs barbiturates, antagonized by fumazenil

Question 20

Versed Benefit, AE

Answer 20

Produce anxiolytic and antegrade amnesia Fast on, Fast off May Lead to increased delirium, renal excretion of active metabolites Large dose may lead to preload and afterload dec along with prolong sedation

Question 21

Diazepam, Lorazepam particular AE

Answer 21

Pain on inject due to propyl glycol

Question 24

Propofol Opening Practice

Answer 24

Bacterial Contamination with pt rxn; 12 hrs of opening, one vial/pt and not in heme line

Question 25

Hypnotic MOA and Exception

Answer 25

Potentiator of GABA Receptor through Direct. Ketamine inhib NMDA (glu activator) leading to GABA activation

Question 26

Propofol Infusion Syndrome Path

Answer 26

Impairign Free Fatty A Utilization + Mitochondrial activity -> inadequate aerobic metabolism -> anaerobic metabolism -> cell damage esp of cardiac/skeletal muscle

Question 27

Propofol Infusion Syndrome Effect [8]

Answer 27

metabolic lactic acidosis, cardiac failure, renal failure, rhabdomyolysis, hyperkalemia, hypertriglyceridemia, hepatomegaly, and pancreatitis

Question 28

Ketamine Psych AE

Answer 28

Hallucinations, nightmares, altered cognition, short term memory alerted. worsesn with ketamine. Tx with Versed 5 minute prior to giving ketamine

Question 29

Flumazenil Note

Answer 29

When used for Versed (T 1/2 1.7-2.6 hr), expect resedation afterwrds (Flu T/12 is 0.7 to 13 hr). Ergo will need more later. May trigger SZ in Chronic ETOH or benzo use.

Question 30

Precedex Med for Decreasing emergence Delirium

Answer 30

0.15 mcg/kg.

Question 31

Conditions that require Lower Level of Versed

Answer 31

ESRD

Question 32

Preop Lorazepam Effects

Answer 32

No increase in pt satisfication and can prolong extubation

Question 33

a2- agonists concerns preoperative

Answer 33

decrease MAC but inc risk of hypotension and bradyc.

Question 34

Propofol CVS effect

Answer 34

Decrease Venous Return and Symsytemic Return; blunts baroreceptor reflex

Question 35

Midazolam CVS/res effect

Answer 35

Hypotension and Resp Depression in large doses

Question 36

Midazolam lab value affecting dose

Answer 36

HYpoalbuminemia decreases Versed requirement

Question 37

ketamine contra

Answer 37

increased intraocular pressure/open globe, CAD, increased ICP from tumor or hemmorhage.