Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NGR6462 Pharm & Chem Anesthesia I > Induction Drugs > Flashcards

Induction Drugs Flashcards

You may prefer our related Brainscape-certified flashcards:
Periodic Table flashcards Chemistry 101 flashcards AP® Chemistry flashcards Organic Chemistry 101 flashcards
1
Q

Gold standard for IV anesthetics

A

Barbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

barbituric acid is composed of

A

urea + malonic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Barbs: sedative & hypnotic properties are determined by alterations in which carbon atoms?

A

2 & #5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name the oxybarbiturates

A

Methohexital
Phenobarbital
Pentobarbital
Secobarbital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The characteristic effect of methohexital due to methyl group on the nitrogen

A

Increased risk of excitatory phenomenon, seizures, and hiccoughs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The phenyl group at the #5 position for Phenobarbital leads to what drug effect?

A

increased anticonvulsant properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do pentobarbital and secobarbital differ in chemical structure from the other oxybarbiturates?

A

O2 atom at the #2 carbon atom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name the two Thiobarbiturates.

A

Thiopental
Thiamylal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does the chemical structure of thiobarbiturates differ, and what does this mean for the drug characteristics?

A

There is sulfur at the #2 carbon atom. This leads to increased lipid solubility and hypnotic potency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Barbs MOA

A

Increase affinity for GABA. Barbs can also mimic GABA and activate chloride channels even with no GABA present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does the metabolism of oxybarbs and thiobarbs differ?

A

Oxybarbs = Liver
Thiobarbs = Liver, Kidney, Brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Intra-arterial injection of which barb can lead to cyanosis and gangrene?

A

Thiobarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What effect does sustained delivery of barbs have on liver enzymes, and which medication is the biggest culprit?

A

Liver enzymes are induced leading to increased metabolism of drugs. Phenobartibal is the most potent liver enzyme inducer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Liver enzyme induction accelerates the metabolism of which drugs?

A

oral anticoagulants
phenytoin
TCA
corticosteroids
bile salts
vitamin K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Porphyria, and what drug class is avoided by patients presenting with it?

A

The autosomal dominant disease leads to defective heme metabolism. This leads to neurological damage, peripheral and autonomic neuropathies, and psychiatric manifestations.
Barbiturates should be avoided.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why are barbiturates bad for patients with AIP?

A

Barbiturates accelerate heme production. AIP presents as a defect in heme metabolism which leads to excessive accumulation of heme, eventually leading to acute attacks and death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Categorize the BZ by their elimination half-life.

A

Short: Midazolam
Intermediate: Lorazepam
Long: diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T 1/2 of Midazolam?

A

<6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

T 1/2 of Lorazepam?

A

6-24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T 1/2 of Diazepam?

A

24-37 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

BZ MOA

A

BZ bind to GABBA-A receptors and modulates their activity (enhances affinity). GABA is required as BZ are unable to open chloride channels without them.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

The imidazole ring found in BZ requires what state to increase lipid solubility, and under what circumstances does this occur?

A

Closed state, and occurs at physiological pH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which BZ are preferred for increased age and liver disease, and why?

A

Lorazepam, oxazepam, temazepam.
These are metabolized by glucuronidation, which is not effected by age or liver disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A symptom of BZ withdrawal in the elderly presents as what?

A

Confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Long-term use of BZ leads to two significant things in the patient population.

A

Tolerance & cognitive decline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

BZ produce more _____ than sedation.

A

amnesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

PO administration of which drug has a high first-pass hepatic extraction.

A

Midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Drugs that inhibit CYP450 enzymes and prolong metabolism include (5).

A

Fentanyl
Erythromycin
CCB
Antifungals
Cimetidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

CNS effects include anterograde amnesia.

A

Midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Respiratory effects of Midazolam

A

decreased TV
increased RR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

May increase cardiac output in CHF patients.

A

Midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Modest CV effects include decreased ABP and increased HR.

A

Midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Most common preoperative sedative in adults and children.

A

Midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Used prophylactically to raise seizure threshold when performing regional blocks

A

BZ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Avoid this bz medication in pregnant patients

A

Midazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Po administration results in 100% bioavailability.

A

Diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Mixing with NS or water for dilution results in cloudiness.

A

Diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

This medication crosses the placenta, resulting in fetal concentrations equal to or greater than the mother

A

Diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which active metabolite of a BZ contributes to sustained drug effects and return of drowsiness 6-8 hours after administration?

A

Desmethyldiazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which drug can decrease LVED pressure with small doses?

A

Diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Minimal CV effects with this drug. They equate to natural sleep.

A

Diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Used to produce skeletal muscle relaxation in lumbar disc disease.

A

Diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

This BZ is the most potent sedative and amnesic.

A

Lorazepam

44
Q

BZ with a slower onset due to lower lipid solubility.

A

Lorazepam

45
Q

This is the only BZ that has no active metabolites.

A

Lorazepam

46
Q

Contraindicated in patients on antiepileptic drugs.

A

Flumazenil

47
Q

Propofol induction dose

A

1.5-2.5mg/kg

48
Q

Propofol onset of action

A

30 seconds

49
Q

This drug promotes bacterial growth

A

Propofol

50
Q

This drug contains metabisulfate, known to exacerbate asthma and trigger sulfate allergies.

A

Generic propofol

51
Q

This drug is a low lipid emulsion that is preservative-free, however, there remains significant pain with injection

A

Ampofol

52
Q

This drug produces formaldehyde byproducts leading to perineum burning.

A

Fospropofol

53
Q

A propofol syringe needs discarding after how many hours?

A

6

54
Q

The mixing of what two drugs lead to fat emboli

A

Propofol + Lidocaine

55
Q

Propofol pKa

A

11

56
Q

Propofol EHL

A

0.5-1.5 hours

57
Q

Propofol Vd

A

1000-4000 L

58
Q

How is the induction dose of propofol adjusted for elderly patients, and why?

A

Decrease the dose by 25-50%. Elderly patients have experience increased drug effects and decreased clearance of the drug.

59
Q

Off-Label uses for Propofol

A

Antiemetic
Antipruritic
Anticonvulsant
diminish bronchoconstriction

60
Q

Which drug contains a preservative resulting in allergies and bronchoconstriction.

A

Propofol (Diprivan)

61
Q

Propofol: MAC v. GA dosages

A

MAC: 25-100mcg/kg/min
GA: 100-300mcg/kg/min

62
Q

Hypnosis with Propfol lasts how long?

A

5-10 minutes

63
Q

Propofol respiratory effects

A

decreased TV, RR, and response to hypoxia

64
Q

How does a propofol dose of 2-2.5mcg/kg impact CV.

A

40% drop in BP, CO, SVR, and reduced myocardial consumption.

65
Q

Propofol CV effects

A

decreased BP, HR unchanged, blunted baroreceptor reflex

66
Q

What is propofol infusion syndrome?

A

high doses of propofol + steroids = multi-organ failure, AKI (rhabdo)

67
Q

Etomidate pKa

A

4.24

68
Q

Etomidate induction dose

A

0.2-0.4mg/kg

69
Q

Etomidate has two isomeric forms. Which isomer has hypnotic/sedative properties?

A

S (+)

70
Q

Etomidate metabolism

A

Liver enzymes & plasma esterases

71
Q

Flumazenil has no effect on this non-barb drug.

A

Etomidate

72
Q

Etomidate EHL

A

2-5 hours

73
Q

Etomidate: special CNS considerations

A

It causes myoclonus and may activate seizures.

74
Q

Drug known for its hemodynamic stability

A

Etomidate

75
Q

Etomidate respiratory effects

A

decreased TV, increased RR, decreased response to CO2, hiccoughs, emergence excitement

76
Q

High incidence of PONV

A

Etomidate

77
Q

Good drug to use for patients with reactive airway disease.

A

Etomidate

78
Q

First choice drug category for alcohol detox.

A

BZ

79
Q

Ketamine induction dose

A

1-2mg/kg

80
Q

Only agent producing dissociate anesthesia

A

Ketamine

81
Q

Drug contains potent analgesic properties

A

Ketamine

82
Q

Ketamine pKa

A

7.5

83
Q

This drug is not extensively protein-bound, unlike other induction agents.

A

Ketamine

84
Q

Commercial preparations given as a racemic mixture

A

Ketamine

85
Q

Ketamine EHL

A

2-3 hours

86
Q

What are the effects of norketamine?

A

1/3-1/5 potency, which leads to prolonged drug effects

87
Q

Ketamine MOA

A

NMDA antagonist
minor GABA action

88
Q

Suppresses inflammatory mediators which improve blood flow

A

Ketamine

89
Q

Ketamine CNS effects

A

increase CBF, CMRO2, ICP
antidepressant, potentiates NDNMB, emergence delirium, nystagmus

90
Q

Emergence delirium with Ketamine is more prevelent in what patient population?

A

Women 15 years of age and older with a history of personality disorder or dreaming, and with doses of 2mg/kg or more.

91
Q

What can attenuate emergence delirium seen with Ketamine?

A

Midazolam

92
Q

Ketamine respiratory effects

A

Bronchodilation
increased secretions

93
Q

Ketamine CV effects

A

increased BP, HR, CO
release of NE, and inhibits uptake
increased PVR and RV workload

94
Q

It acts as a direct myocardial depressant and is not recommended for patients with CAD.

A

Ketamine

95
Q

Ketamine LOC

A

30-60 seconds

96
Q

Ketamine return of consciousness time v. return of awareness

A

consciousness 10-20minutes
awareness 60-90 minutes

97
Q

Ketamine chemical compound is a derivative of?

A

PCP

98
Q

Chronic Ketamine use causes what metabolic phenomenon to occur?

A

Enzyme induction which quickens the metabolism of ketamine leading to drug tolerance

99
Q

Dexmedetomidine MOA

A

Alpha 2 adrenergic agonist

100
Q

Decreased SNS activity seen with dexmedetomidine is caused by?

A

Decrease in NE levels

101
Q

Dexmedetomidine EHL

A

2-3 hours

102
Q

Dexmedetomidine dosing

A

Loading: 1mcg/kg (10min)
maintenance: 0.2-1mcg/kg/hr

103
Q

Dexmedetomidine adverse effects

A

hypotension
hypertension (loading phase)
Nausea
Bradycardia
Anemia
Hypothermia

104
Q

Exercise extreme cause in using this drug with patients diagnosed with severe heart block and/or severe ventricular dysfunction.

A

Dexmedetomidine

105
Q

Dexmedetomidine: CSHF of a 4 min infusion v. a 250 min infusion

A

4 min = 10 min
250 min = 8 hours

NGR6462 Pharm & Chem Anesthesia I (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions