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Pharmacology > Lecture # 02 _Fall_IV Anesthetics > Flashcards

Lecture # 02 _Fall_IV Anesthetics Flashcards

0
Q

List the 10 factors of an i

deal anesthetic.

A
  1. water soluble and stable
  2. no pain on injection;no tissue damage w/extravasation
  3. low incidence of histamine release or hypersensitivity
  4. rapid smooth onset
  5. rapid metabolism to inactive metabolites
  6. steep dose response curve
  7. minimal cardiac/respiratory depression
  8. decreases ICP/CMRO2
  9. rapid smooth recovery
  10. minimal side effects: PONV, amnesia, HA, dizziness
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1
Q

Are Barbiturates acidic or alkaline?

A

very alkaline (pH>10)

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2
Q

Intra-arterial injection of _____ ->crystals-> thrombosis, necrosis?

What is the treatment?

A

thiobarbiturates (thiopental and thioamylal)

Treat: papaverine, lidocaine, stellate ganglion block, heparin

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3
Q

What is the mechanism of action of barbiturates?

A

depress the RAS (reticular activating system ) - consciousness center in the brain stem

Suppress excitatory neurotransmitters (Ach)

Enhance inhibitory (GABA)

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4
Q

Which of the following is true regarding barbiturates - indicate all that apply

A. water soluble
B. stable
C. no pain on injection
D. no pain on extravasation 
E. acidic
A 
A. water soluble - T
B. stable - F
C. no pain on injection - T
D. no pain on extravasation  - F
E. acidic - F
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5
Q

What is the difference between Thiobarbiturates and Oxybarbiturates? Give an example of each.

A

Thiobarbs (thiopental, thioamylal)
higher lipid solubility->greater potency, rapid onset, shorter duration

Oxybarbs (methohexital)
lower lipid solubility->less potency, slower onset, longer duration

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6
Q

Are barbiturates a good choice for maintenance of anesthesia?

A

No bc the elimination half-life is 3-12hrs after multiple doses - saturate the peripheral compartments and have slower redistribution

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7
Q

What are the routes of absorption of barbiturates?

A

IV for GA; rectal/IM for premedication

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8
Q

T or F. Thiopental has high hepatic extraction, perfusion-limited metabolism, and a shorter elimination half life than Methohexital

A

False. Thiopental has low hepatic extraction, capacity-limited metabolism, and a longer elimination half life than Methohexital

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9
Q

T or F. Methohexital has high hepatic extraction, perfusion-limited metabolism, and a shorter elimination half life than thiopental

A

T

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10
Q

T or F. 2-4mg/kg/hr of Thiopental can be given for treatment of intracranial HTN or intractable seizures?

A

T

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11
Q

What is the half-life of Methohexital?

A

3.9 hrs

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12
Q

What is the half-life of thiopental?

A

11.6 hrs

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13
Q

T or F. Barbiturates increase BP and decrease HR.

A

False

Barbiturates decrease BP and increase HR (central vagolytic effect); venous pooling

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14
Q

T or F. CO is maintained with barbiturates except in hypovolemia, CHF, and beta blockade.

A

True.

CO is maintained with barbiturates except in hypovolemia, CHF, and beta blockade - this leads to very decreased CO and BP

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15
Q

T or F. Barbiturates do not blunt hypercapnic or hypoxic respiratory drive.

A

False.

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16
Q

T or F. Bronchospasm and laryngospasm are associated with barbiturates.

A

T

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17
Q

Porphyria is associated with what class of induction agents?

A

barbiturates

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18
Q

T or F. Barbiturates are anti-epileptics.

A

T

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19
Q

T or F. Barbiturates decrease CBF and ICP but increase CMRO2.

A

False. They decrease all and decrease CMRO2 to burst suppression on EEG

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20
Q

T or F. Barbiturates are renal protective bc they increase RBF.

A

False. They decrease RBF due to hypotension

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21
Q

Which of the following are lipid soluble

A. Barbiturates
B. Propofol
C. Etomidate
D. Ketamine
E. Versed
A

Lipid soluble = Propofol and Etomidate

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22
Q

Which of the following are water soluble

A. Barbiturates
B. Propofol
C. Etomidate
D. Ketamine
E. Versed
A

Barbs, Ketamine, Versed

23
Q

Which induction agents cause burning on injection?

A

Propofol and etomidate

24
Q

Describe Propofol Infusion Syndrome

A
  • lactic acidosis usually after prolonged high dose infusions
  • lipemia, rhabdomyolysis, metabolic acidosis, death
25
Q

T or F. Patients allergic to eggs should not get propofol.

A

False.
Propofol is emulsion in intralipid (soybean, glycerol, egg lecithin)

Lecithin is from egg yolk and most allergies are to egg white

26
Q

Which of the following are anti-epileptics?

A. Barbiturates
B. Propofol
C. Etomidate
D. Ketamine
E. Versed
A

A. Barbiturates
B. Propofol
E. Versed

27
Q

In which of the following groups would higher plasma levels of barbiturates be seen? (choose all that apply)

A. hypovolemic
B. hypoalbuminemia
C. acidosis
D. elderly

A

All of the above

28
Q

T or F. Thiopental contains sulfur and therefor may evoke histamine release

A

True

29
Q

What acute condition is associated with barbiturates and is characterized by the following:

abd pain, vomiting, neuropathy, weakness, seizures, hallucinations, depression, anxiety, paranoia

cardiac arrhythmias, pain, constipation/diarrhea

A

Acute porphyria

30
Q

T or F. Propofol is renally excreted and doses should be decreased for pts with chronic renal failure.

A

False. It is renally excreted but is not effected by chronic renal failure

31
Q

When placing a pt on a propofol infusion for GA, what is your target plasma concentration (in mcg/mL)?

A

4-6 mcg/mL

32
Q

T or F. Propofol causes hypotension because it decreases SVR, myocardial contractility, and preload.

A

True

33
Q

What are 3 ways to prevent pain caused by the burning on injection of propofol?

A
  1. Bier Block (lido + tourniquet)
  2. pre-treat with IV opioid
  3. mix lido with propofol (to acidify emulsion)
34
Q

What drug has been associated with abuse and addiction due to its characteristic side effects of euphoria on emergence, intense dreaming and amorous behavior .

A

propofol

35
Q

T or F. There is little evidence of tolerance developing with propofol.

A

True

36
Q

T or F. One reason propofol is used in MAC cases is because it causes very little depression of upper airway reflexes.

A

False. causes PROFOUND depression of upper airway reflexes.

37
Q

Where is etomidate metabolized?

A

liver (hepatic hydrolysis) and plasma esterases

even if you have no liver, you can metabolize etomidate, just slower

38
Q

T or F. Myoclonus is a side effect of etomidate.

A

True

39
Q

T or F. Etomidate causes minimal respiratory depression.

A

True

40
Q

Transient inhibition of cortisol/aldosterone synthesis can be seen after one dose of what induction agent?

A

etomidate

41
Q

T or F. Etomidate is a good induction agent in hemodynamically unstable pts because it has minimal CV effects.

A

True

42
Q

Dissociative amnesia is associated with which induction agent?

A

Ketamine. It dissociates the thalamus for the limbic system = “cataleptic state”

43
Q

Which induction agent has analgesic properties?

A

Ketamine

44
Q

What is the mechanism of action of Ketamine?

A

Inhibition + excitation; NMDA antagonist

45
Q

What are the routes of absorption for ketamine?

A

IV and IM

46
Q

Which IV induction agent is associated with the following:

bronchodilator, salivation, hallucinations, minimal respiratory depression,

A

Ketamine

47
Q

T or F. Ketmaine is the drug of choice for neuro cases.

A

False. It increases CMRO2, CBF, and ICP

48
Q

T or F. Versed causes respiratory depression.

A

True

49
Q

T or F. Versed should be avoided in neuro cases or is seizure patients.

A

False

50
Q

What is dependence?

A

onset of physical or psychological symptoms after reduction in dose

51
Q

T or F. Patients that are on benzodiazepines may experience withdrawal symptoms that are so severe it can be fatal.

A

True

52
Q

What can be given for a benzodiazepine over dose and how does it work?

A

Flumazenil - high affinity for receptor with minimal activity

53
Q

T or F. Flumazenil acts as a non-competitive antagonist.

A

False. It is a competitive antagonist

54
Q

What is dexmedetomidine?

A

(Precedex) Highly elective alpha-2 receptor agonist used for sedation.

55
Q

What are some advantages and disadvantages of Precedex?

A

Adv: minimal resp depression, calm sedation with rousability, anxiolysis, some analgesia

Disadv: hypotension, bradycardia, expensive

Pharmacology (22 decks)

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