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Spr24 Pharm II > Induction Drugs (Gen&Barbs) (Exam II) > Flashcards

Induction Drugs (Gen&Barbs) (Exam II) Flashcards

1
Q

What group of organs utilize the most blood supply?
What organs utilize the least?
What organs are in between these two groups?

A
  • Vessel-rich group = 75% CO (brain, heart, lungs, liver, kidneys)
  • Skeletal muscles & skin = 18% CO
  • Fat = 5% CO
  • Bone, tendons, & cartilage = 2% CO
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2
Q

What are the one-word (ish) summaries of the four stages of anesthesia?

A
  1. Analgesia
  2. Delirium
  3. Surgical Anesthesia
  4. Medullary paralysis (death)
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3
Q

If stage 1 anesthesia is maintained, what is it called?

A
  • Conscious sedation
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4
Q

During induction, when would one most likely see laryngospasm?

A
  • Stage 2
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5
Q

During emergence, when would one most likely need to be re-intubated?

A
  • Stage 2
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6
Q

What is the mechanism of action of barbiturates?

A
  • Direct mimic of GABA causing Cl⁻ influx & cellular hyperpolarization.
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7
Q

What do barbiturates do to CBF & CMRO₂ ?
How is this accomplished?

A
  • ↓ CBF & ↓ CMRO₂ (by 55%) via cerebral vasoconstriction
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8
Q

What drug class is represented by the figure below? How do you know this?

A
  • Barbiturates
  • Rapid redistribution & lengthy context-sensitive half-time (noted by fat build-up over time)
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9
Q

Where is the site of initial redistribution for barbiturates?
When is equilibrium between plasma concentrations & muscle concentrations reached?

A
  • Skeletal muscles
  • 15 min
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10
Q

Where is the main reservoir for barbiturates?
What does this mean clinically?

A
  • Adipose tissue
  • Dose on lean body weight and note cumulative effects of barbiturates.
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11
Q

What is the metabolism and excretion of barbiturates?

A
  • Hepatic metabolism; Renal excretion
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12
Q

How protein bound (in a percentage) are barbiturates?

A
  • 70 - 85% protein bound
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13
Q

What are the characteristics of a non-ionized barbiturate?

A
  • Lipophillic
  • Acidotic environment is favored.
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14
Q

What are the characteristics of an ionized barbiturate?

A
  • Lipophobic
  • Alkalotic-favored
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15
Q

Why might barbiturates be considered cerebro-protective?

A
  • Barbs = ↓CBF & ↓CMRO₂
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16
Q

Regarding barbiturates, are S-isomers or R-isomers more potent?
Which is used clinically?

A
  • S-isomer barbiturates are more potent
  • Trick question. Racemic mixtures are only ones used.
17
Q

How would one differentiate thiobarbiturates vs oxybarbiturates?

A
  • Thiobarbiturates: thiopental, thiamylal.
  • Oxybarbiturates: methohexital, phenobarbital, pentobarbital.
18
Q

What is the dose for Thiopental?
How much is in the brain 30 minutes post-administration? Why?

A
  • 4mg/kg IV
  • 10% in the braine after admin. Rapid redistribution to skeletal muscles occurs.
19
Q

What is the fat/blood partition coefficient of thiopental?
What does this mean?

A
  • 11
  • Dosing needs to be calculated on Ideal Body Weight.
20
Q

What does a partition coefficient describe?

A
  • Distribution of a drug between two substances that have the same temp, pressure, and volume.
21
Q

What is the blood-gas coefficient?

A
  • Number that describes the distribution of an anesthetic between blood and gas at the same partial pressure.
22
Q

What would a high blood-gas coefficient indicate?

A
  • Slower Induction time

Essentially, drug is taken up into the blood and wants to stay in the blood rather than going to tissues like the brain.

23
Q

Which is more lipid soluble, thiopental or methohexital?

A
  • Thiopental (Sodium Pentothal)
24
Q

At a normal pH _____% of methohexital is non-ionized.

At a normal pH ____% of sodium pentothal is non-ionized.

What does this mean in regards to induction for comparing these drugs?

A
  • 76%
  • 61%
  • Methohexital for induction has a faster metabolism and recovery due to its increased lipid-solubility.
25
Q

Which barbiturate causes excitatory symptoms like myoclonus and hiccups?

A

Methohexital

26
Q

How would methohexital infusions differ from induction?

A

Very lipid-soluble so:

  • Drug persists from infusion but clears quickly from induction.
27
Q

What is the IV methohexital dose?
What if it needs to be given rectally?

A
  • 1.5 mg/kg IV
  • 20 - 30 mg/kg PR
28
Q

What is the seizure profile of methohexital?

A

Can induce seizures but is better than etomidate or when used with ECT.

  1. Continuous infusions induce post-op seizures in ⅓ of patients.
  2. Seizures are induced in patients undergoing temporal lobe resection.
  3. Seizure duration reduced 35-45% in ECT patients vs etomidate.
29
Q

What cardiovascular side effects would occur with thiopental administration in a normovolemic patient?

A
  • Transient sBP decrease of 10-20mmHg
  • Transient HR increase of 15-20 bpm
30
Q

What patient conditions could result in poor baroreceptor response after barbiturate administration?

A
  • Hypovolemia, CHF, & β-blockade
31
Q

Thiopental can have a __________ type response due to __________ release coupled with previous exposure to the drug.

A

anaphylactic ; histamine

32
Q

What are the respiratory effects of barbiturates?

A

Dose-dependent medullary & pontine respiratory depression.

(Less sensitivity to CO₂ levels).

33
Q

What would occur with accidental arterial administration of a barbiturate?
What is the treatment?

A
  • Immediate vasoconstriction, excruciating pain.
  • Injecting vasodilators: Lidocaine or Papaverine.
34
Q

When would CYP450 enzyme induction be seen with a barbiturate infusion?
How long could it last?

A
  • 2-7 days post-infusion
  • CYP450 induction could last up to 30 days.
35
Q

What renal effects would one expect to see after barbiturate administration?

A
  • Transient ↓RBF and ↓GFR
36
Q

For Propofol, what are the doses for:
1. Induction
2. Maintenance
3. Conscious sedation

A
  1. Induction = 1.5 - 2.5 mg/kg IV
  2. Maintenance = 100 - 300 μg/kg/min
  3. Conscious sedation = 25 - 100 μg/kg/min

Spr24 Pharm II (32 decks)

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