IV Anesthetics

Question 1

Redistribution

Answer 1

Onset and offset have to do with redistribution, not metabolism

First redistributes to vital organs, then muscle, then fat

Question 2

Alpha half life

Answer 2

Initial rapid drop in drug concentration because it is leaving blood and going into tissues

Question 3

Beta Half Life

Answer 3

Once evenly distributed, blood level doesn’t drop as fast, now being metabolized and eliminated

Question 4

GABA-mimetic

Answer 4

Inhibitory transmitter.
Controls the amount of chloride that goes into a cell. When activated, causes channel to open, Cl flows in and makes cell more negative (hyperpolarizes it) and makes it more difficult to reach AP

Drug: benzos, barbs, etomidate, propofol

Question 5

Glutamate and NMDA receptor antagonist

Answer 5

Cause inhibition of excitatory receptor

Drugs: ketamine

Question 6

Presynaptic A2 receptor agonist

Answer 6

Causes nerves to release less NE from negative feedback (sympatholytic)

Dexmedetomodine

Question 7

Don’t give to asthmatics or children with egg allergy (proven wrong)

Answer 7

Propofol: d/t sulfates in formula

Question 8

Effect on CMRO2 and CBF

Answer 8

Dose dependent decrease

EXCEPT KETAMINE! (Increase CMR)

Question 9

Ketamine Effect on BP, HR, and lungs

Answer 9

Increases BP/HR

Bronchodilates

Question 10

Agent of choice in wheezing pt

Answer 10

Ketamine—> bronchodilates d/t NE release

Question 11

Propofol Infusion Syndrome

Answer 11

Presence of impaired systemic micro circulation with issue hypoperfusion and hypoxia

Fatty acid metabolism and mitochondrial activity are impaired creating an oxygen supply and demand mismatch that results in cardiac and peripheral muscle necrosis

Rhabdomyolysis: gets bad then clogs kidneys

Metabolic acidosis

Question 12

Causes Dissociative Amnesia

Answer 12

Ketamine

Pt is in catatonic state and appears separated from the environment and has analgesic and amnesic effect but retains most protective reflexes

Question 13

Ketamine Effects

Answer 13

Increased CMR, CBF, ICP
Nystagmus
Increased ICP
Increased BP/HR
Bronchodilator
Maintain respirations and airway reflexes
Increased salivation and secretions
Increased muscle tone
Emergence delirium (give benzos)
*analgesia

Question 14

Causes Acute Adrenal Suppression

Answer 14

Etomidate: inhibits 11 B h. Preventing synthesis of steroids and aldosterone in the body. Pt can’t tolerate stress

Question 15

Benzo SE

Answer 15

Anticonvulsant
Anxiolytics, sedation, anterograde amnesia
Minimal CV effects
Depression of airway/muscle reflexes
Respiratory depression at high doses
Centrally mediated muscle relaxation
Depressed cellular immunity

Question 16

Propofol SE

Answer 16

Anticonvulsant
Antiemesis
Sedation
Decreased CMRO2
EEG burst suppression
Decreased SVR
Pain on injection
Hyper triglyceridemia
Depression of airway
Myocardial depression
Rhabdymolysis with infusion syndrome

Question 17

Etomidate SE

Answer 17

EEG burst suppression
Sedation
Decreased CMRO2
Respiratory depression
Myoclonus
Adrenal suppression
Pain on injection
Minimal vasodilation
Minimal cardiac depression
N/V
Anticonvulsant

Question 18

Ketamine SE

Answer 18

Dissociative sedation
Emergence delirium
Analgesia
Nystagmus
Increased salivation
Bronchodilation
Indirect myocardial stimulation
Increased SVR from sympathetic outflow

Question 19

Precedex SE

Answer 19

Analgesia
Sedation
Decreased salivation
Preserved respiratory drive
Decreasing shivering
Variable hyper/hypotension
Bradycardia