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Apex > IV Anesthetics > Flashcards

IV Anesthetics Flashcards

1
Q

What is the MOA of propofol?

A

It increases the duration of time Cl ion channels remain open in GABA-A receptors

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2
Q

What is the cardinal indictor of propofol infusion syndrome?

A

Refractory bradycardia that progresses to asystole

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3
Q

Most people with egg allergies are allergic to:

A

the albumin in the egg whites

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4
Q

When is propofol infusion syndrome most likely?

A

In children receiving doses > 4mg/kg/hr for greater than 48 hrs

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5
Q

What is the treatment for propofol infusion syndrome?

A

Pacing
PDE inhibitors
ECMO

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6
Q

Which preservative is present in diprivan?

A

EDTA, which does not have any side effects

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7
Q

Which preservatives are present in off brand propofol?

A

Metabisulfate, which can cause asthma attacks
OR
Benzyl alcohol, which should be avoided in infants

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8
Q

What dose of propofol can resolve itching?

A

As little as 10 mg

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9
Q

What is the onset time for fospropofol?

A

5-10 minutes

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10
Q

What is the duration of fospropofol?

A

15-45 minutes

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11
Q

What preservatives are present in fospropofol?

A

None! Its an aqueous solution and doesn’t require preservatives

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12
Q

What enzyme converts fospropofol to propofol?

A

Alkaline phosphatase

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13
Q

What is the IV induction dose of Ketamine?

A

1-2 mg/kg

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14
Q

What is the IM induction dose of Ketamine?

A

4-8 mg/kg

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15
Q

What is the PO induction dose of ketamine?

A

10mg/kg

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16
Q

What is the induction dose of etomidate?

A

0.2-0.4 mg/kg

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17
Q

What is the recommended opioid-sparing dose of ketamine?

A

0.2-0.5mg/kg

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18
Q

What should always be given with an etomidate induction?

A

It will not suppress the SNS response to laryngoscopy, so you should also use an opioid or esmolol

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19
Q

Which induction agent has the highest rate of PONV?

A

Etomidate

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20
Q

Does etomidate cause seizures?

A

In a person without epilepsy, no.

In a person with epilepsy, it can create epileptiform activity, which makes it useful for mapping seizure foci

21
Q

WHY does etomidate cause adrenal depression?

A

It inhibits 11 beta hydroxylase, which is the enzyme that catalyzes cortisol production

22
Q

How long does a single dose of etomidate produce adrenal suppression?

A

5-8 hours

23
Q

What is Thiopental’s MOA?

A

GABA-A agonist

24
Q

What are the respiratory effects of Thiopental?

A

It decreases respiratory drive and causes histamine release, which can lead to bronchoconstriction

25
Q

What are the CV effects of Thiopental?

A

It causes hypotension and myocardial depression, but the baroreceptors remain intact so you get rebound tachycardia

26
Q

Which anesthetic is the gold standard for ECT therapy?

A

Methohexital

27
Q

What is Thiopental’s drug classification?

A

It’s a barbituate

28
Q

What happens if Thiopental is injected intra-arterially?

A

Vasoconstriction and crystal formation

Need a vasodilator and/or an SGB

29
Q

What are the two classes of barbituates?

A
30
Q

Which produces more hypotension: thiopental or propofol?

A

Propofol

31
Q

Thiopental provides neuroprotection in which circumstances?

A

Focal ischemia (CEAs)

NOT

Global (infarct, MI)

32
Q

What is usually the first symptom of acute intermittent porphyria?

A

GI pain and N/V

33
Q

What should be done preop in a patient with known porphyria?

A

Reduced NPO time and IV hydration prior to induction

Glucose supplementation

Heme Arginate

34
Q

Which meds are safe in patients with porphyria?

A

Pretty much none of the IV induction agents, but:

Opioids
Inhalation agents
NMBs and NMB reversals
Midazolam
Vasopressors
Beta blockers

35
Q

Which vasodilator should be used in the event of intra-arterial thiopental administration?

A

Phenoxybenzamine
OR
Phentolamine

36
Q

What is the induction dose for methohexital?

A

1-1.5 mg/kg

37
Q

Precedex does not reliably provide ________

A

Amnesia

38
Q

What is the nasal dose of precedex in children for anxiolysis?

A

3-4 mcg/kg 1 hr before surgery

39
Q

What is the PO versed sedation dose for anxiolysis in children?

A

0.5-1 mg/kg

40
Q

Rank in potency:

Midazolam
Diazepam
Lorazepam

A
  1. Lorazepam
  2. Midazolam
  3. Diazepam
41
Q

Why is midazolam suspended in water and not lipid?

A

It has an imidazole ring

At physiologic pH it is lipophilic

In acidic environments (in the vial) it is hydrophilic

42
Q

How do benzodiazepines impact the GABA-A receptor?

A

Increase the NUMBER OF TIMES it opens and closes (vs. the duration of opening)

43
Q

What is the initial dose of flumazenil?

A

0.2 mg

44
Q

If the initial dose of flumazenil is insufficient, what is the follow up dose?

A

Additional 0.1mg increments until desired effect

45
Q

What happens physiologically in response to flumazenil reversal?

A

Pretty much nothing

Unlike narcan, there’s no amplified SNS state

46
Q

Does flumazenil reverse amnesia?

A

Usually no. Just the sedation.

47
Q

What is the duration of action of flumazenil?

A

30-60 minutes

48
Q

What is the induction dose of fospropofol?

A

6.5 mg/kg

49
Q
A

Apex (46 decks)

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