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Pharm Exam 2 > Induction Agents > Flashcards

Induction Agents Flashcards

1
Q

what are the names of the stages of anesthesia according to unit 2

A

analgesia, delirium, surgical anesthesia, and medullary paralysis

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2
Q

a patient in stage 1 of anesthesia should be able to

A

open their eyes on command, breathe normally, maintain airway, and tolerate mild stimuli

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3
Q

what might you see during stage 2: delirium of anesthesia

A

cv instability, rapid ocular movements, laryngospasm, emesis

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4
Q

how long does stage 2 of anesthesia typically last

A

30s-1 min

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5
Q

5 components of surgical anesthesia

A

hypnosis, analgesia, muscle relaxation, sympatholysis, and amnesia

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6
Q

in stage 4 of anesthesia the patient is experiencing

A

loss of all reflexes, marked hypotension and flaccid paralysis

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7
Q

what is the gold standard induction agent

A

barbiturates

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8
Q

MOA of barbiturates

A

potentiate GABA A activity; mimics GABA with activity on glutamine, adenosine, and neuronal nach receptors

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9
Q

barbiturates do what to CBF and CMRO2

A

decreases by 55%

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10
Q

cerebral vasoconstriction is a positive attribute of barbs because

A

it decreases CBF and CMRO2 and has anticonvulsant properties

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11
Q

barbiturates have no

A

analgesic properties

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12
Q

barbiturates have a rapid onset and awakening due to

A

rapid redistribution

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13
Q

with prolonged infusion, barbs have

A

a long context sensitive half time

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14
Q

at 30 minutes, how much barbiturate is left in the brain

A

10%

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15
Q

what is the site of initial redistribution of barbs

A

skeletal muscle

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16
Q

we dose barbiturates on

A

ibw

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17
Q

excretion of barbiturates is through

A

kidneys

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18
Q

where are barbs metabolized

A

hepatocytes

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19
Q

what do barbiturates preferentially bind

A

albumin 70-85%

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20
Q

a non ionized drug favors an

A

acidic environment

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21
Q

an ionized drug favors an

A

alkalotic environment

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22
Q

what is the fat/blood coefficient for thiopental

A

11

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23
Q

E 1/2 time of thiopental is longer than

A

prop and etom

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24
Q

methohexital has a ______ lipid solubility than pentothal despite having a _____ non ionized form

A

lower; 76%

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25
Q

What excitatory phenomena is methohexital associated with

A

hiccoughs and myoclonus

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26
Q

a continuous infusion of methohexital could cause

A

post op sz activity

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27
Q

methohexital causes seizures in patients undergoing temporal lobe resections d/t lowering the seizure threshold; but during this procedure, it may decrease sz duration

A

ECT

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28
Q

list the most important CV side effects of methohexital and the dose associated with it

A

when given 5 mg/kg, we can see a decrease in sbp 10-20 mmhg, a decrease in hr 15-20 bpm; we can see histamine release and may need to have vasopressin ready; and we can see lack of baroreceptor response in patients with CHF, hypovolemia, and beta blockade

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29
Q

list the most important pulmonary effects of methohexital

A

depresses medulla and pontine causing apnea; makes patient less sensitive to CO2 causing slow return to spontaneous ventilation

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30
Q

in someone who has a decreased ventilatory drive, how would we prepare for extubation

A

slow the frequency of the vent, decrease tidal volume, and let CO2 build up to trigger spontaneous respiration

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31
Q

what kind of monitoring is required for administration of barbiturates

A

somatosensory evoke potential or SSEP

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32
Q

what is one side effect to be wary of that may occur days after the administration of barbs

A

enzyme induction appx 2-7 days post infusion; especially can deactivate anticoagulants

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33
Q

rapid injection of propofol will can unconsiousness in

A

30s

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34
Q

lecithen is associated with

A

egg yolk

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35
Q

MOA of propofol

A

modulator of GABA A receptor causing transmembrane chloride conductance to increase

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36
Q

where is propofol cleared the most

A

the lungs

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37
Q

main metabolism of prop is

A

cyp450

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38
Q

e 1/2 time of propofol

A

30 mins to 1 1/2 hours

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39
Q

context sensitive half time of an 8 hour propofol infusion

A

40 minutes

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40
Q

the context sensitive half time of prop is shorter than

A

barbiturates

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41
Q

what are props’ metabolites

A

glucuronide and sulphate

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42
Q

what is cleared the fastest between ketamine, propofol, and etomidate

A

propofol

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43
Q

propofol will do what to blood pressure and heart rate

A

decrease it

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44
Q

etomidate will do what to blood pressure and heart rate

A

have no effect

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45
Q

ketmine will do what to blood pressure and heart rate

A

increase it

46
Q

are we concerned about giving propofol to people with renal disease, liver disease, or pregnancy? why?

A

the drug can be metabolized elsewhere besides the liver; there is no influence on the kidneys for clearance; the fetus can rapidly clear propofol

47
Q

TIVA stands for

A

total IV anesthesia or balanced anesthesia

48
Q

children require higher doses of propofol because

A

they have a larger distribution volume and clearance rate

49
Q

what % would we consider lowering the dose of prop for elderly patients

A

25-50%

50
Q

propfol has these unconventional benefits

A

anti itch, antiemetic, antioxidant properties

51
Q

list the CNS side effects of propofol

A

decreases CMRO2 , CBF, and ICP; large doses may decrease CPP; myoclonus; no SSEP suppression

52
Q

list the CV side effects of propofol

A

decreased SBP, SVR, SNS response, intracellular calcium, and baroreceptor reflexes - may have profound bradycardia and asystole with healthy adult patients; some s/e can be modulated by DL stimulus

53
Q

list pulm side effects of propofol

A

dose dependent suppression of ventilation; lungs maintain hypoxic drive; painful surgical stimulation counteracts ventilatory depressant effects

54
Q

surigcal infusions of propofol don’t cause any hepatic or renal issues; however, prolonged infusions may cause

A

hepatocellular injurt, PRIS, green urine from phenols, and cloudy urine

55
Q

what is PRIS and what elements are involved

A

propofol infusion syndrome; > 75 mcg/kg/min doses; can cause fatal bradycardia in children; lactic acidosis, bradydysrhythmias, and rhabdo

56
Q

name some miscellaneous s/e of propofol

A

decrease IOP, pain on injection, inhibition of platelet aggregation, allergic reactions, prolonged myoclonus

57
Q

Oxybarbituates such as methohexital have an oxygen in their second position; thiopental has what element in its second position that makes it more lipid soluble

A

sulfur

58
Q

what ring is present in etom

A

imidazole

59
Q

etom is ___ soluble in acid and ____ soluble in physiologic pH

A

water; lipid

60
Q

what percent of etom is propylene glycol

A

35%

61
Q

etom has a high incidence of

A

myoclonus

62
Q

etom onset

A

1 minute

63
Q

what percent bound is etom to albumin

A

76%

64
Q

how is etom metabolized

A

hydrolized by hepatic microsomal enzymes

65
Q

e 1/2 time of etom

A

2-5 hours

66
Q

how is etom eliminated

A

in the urine

67
Q

etom is cleared 5x faster than

A

thiopental

68
Q

etom is best for patients with an

A

unstable cv system

69
Q

does etom have analgesic properties

A

no

70
Q

from greatest to least, list some induction agents by myoclonus incidence

A

etom, thiopental, methohexital, propofol

71
Q

how can we offset the incidence of myoclonus with admin of etom

A

give 1-2 mcg/kg fentanyl

72
Q

adrenocortical suppression is common in what drug? what does it cause

A

etom; severe HPN and increase in mechanical ventilation time

73
Q

enzyme inhibition of etom can last

A

4-8 hours after initial dose

74
Q

caution in giving etom to

A

sepsis and hemorrhaging patients; sz patients d/t myoclonic effect

75
Q

list the most significant cns effects of etom

A

decreases cbf and cmro2 by 35-45%; decreases ICP; more frequent excitatory spikes on eeg; may activate sz foci and increase amplitude of SSEP

76
Q

list the most significant cv effects of etom

A

minimal changes in hr, sv, co, and contractility; at high doses, may cause sudden hpn with hypovolemia

77
Q

list the most significant pulm effects of etom

A

less potent ventilatory depressant than thiopental; rapid iv injection will cause apnea; decreases in Vt are offset by compensatory increase in respiratory rate; stimulates co2 medullary centers

78
Q

ketamine is a derivative of

A

pcp - phenylcyclidine

79
Q

ketamine has both ____ and ____ properties

A

analgesic and amnestic

80
Q

what would you expect to see in a pt after administration of ketamine

A

slow nystagmus; wakefulness, but noncommunicative; hypertonus and purposeful skeletal muscle movement

81
Q

etom has no ____ __ _______ like propofol does

A

no pain on injection

82
Q

what is the preservative behind ketamine

A

benzothonium chloride

83
Q

S-ketamine has what better analgesic effects

A

2x greater than racemic and 4x greater than r-ketamine

84
Q

racemic ketamine acts like which illicit drug? in what way?

A

cocaine in that it blocks reuptake of catecholamines

85
Q

primary excitatory nt in the cns

A

glutamate

86
Q

which kind of binding does ketamine do and where does it bind

A

non competitive to the nmda receptor and opioid receptors

87
Q

ketamine has weak action here

A

gaba and sigma receptors

88
Q

peak plasma concentration of ketamine in

A

1 minute

89
Q

duration of action of ketamine

A

10-20 mins

90
Q

ketamine is _x more lipid soluble than thiopental

A

5-10

91
Q

Vd of ketamine

A

3 L

92
Q

e 1/2 time of ketamine

A

2-3 hours

93
Q

ketamine is cleared and metabolized by

A

the liver

94
Q

active metabolite of ketamine

A

norketamine

95
Q

ketamine is excreted by

A

the kidneys

96
Q

tolerance to ketamine is most likely to develop in

A

burn patients

97
Q

5 different dosages of ketamine are for

A

induction, maintenance, subanesthetic (analgesic), neuraxial, post op pedi hearts

98
Q

ketamine increases salivation; what can we give to combat this

A

glycopyrrolate

99
Q

full consciousness returns after how many minutes after admin of ketamine

A

60-90 mins

100
Q

clinical uses for ketamine

A

asthmatics, MH, hypovolemia; CAD cocktail; burn dressing changes; psychiatry; restless leg syndrome; reversal of opioid tolerance;

101
Q

avoid using ketamine in

A

pulm and systemic htn and patients at risk for high icp

102
Q

list the cns effects of ketamine

A

potent cerebral vasodilator –> increased icp, and increases cbf by 60%; myoclonus; increased amplitude of SSEP

103
Q

list the cv effects of ketamine

A

resembles sns stimulation; unexpected drops in sbp due to depleted catecholamine stores

104
Q

list the pulm effects of ketamine

A

no sig depression of ventilation; ventilatory response to co2 is maintained; upper airway skeletal muscle tone and reflexes remain intact; bronchodilator activity

105
Q

psychedelic effects of ketamine are? due to? how long might they last?

A

morbid vivid colored dreams and hallucinations; due to depression of the inferior colliculus and medial geniculate nucleus; may last 24 hours

106
Q

we can prevent emergence delirium by giving

A

benzos before ketamine

107
Q

name some miscellaneous s/e of ketamine

A

inhibition of plt aggregation, free ca, and plasma cholinesterase

108
Q

ketamine may enhance the effects of these drugs

A

succs - prolonged apnea; nmdbs - prolonged paralysis; volatile anesthetics - decrease sns stimulus

109
Q

we can blunt the effects of ketamine on the sns by

A

administering benzos, volatiles, or n20 (nitrous)

110
Q

ketamine may be good for osa because

A

it maintains upper airway reflexes

Pharm Exam 2 (7 decks)

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