Brainscape's Knowledge GenomeTM

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


See full index

Anesthesia Pharm > Megan's Guide > Flashcards

Megan's Guide Flashcards

1
Q

parenteral routes of drugs

A

IV, IM, SC,etc

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

volatile anesthetics: cerebral blood flow

A

increase vasodilation, decrease vasc resistance, increase CBF, increase ICP

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

opioids: metabolism

Fent, Remi, Morphine, Meperidine

A

fentanyl 75% lungs
remi: plasma/tissue
morphine: gluc acid hepatic/renal
meperidine 90% hepatic

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

midazolam: first pass metabolism

A

50% first pass

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

local anesthetics: target channels

A

Na channels

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

volatile anesthetics: coronary blood flow

A

iso is a potent coronary vasodilator

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

desflurane and CO2 absorber

A

carbon monoxide, from dry dessicated absorber

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

bupivicaine toxicity

A

A lower dose of bupivicaine than lidocaine will produce Cardiovascular collapse
Pregnant patients may be more sensitive
Cardiac resuscitation is more difficult after bupivacaine Cardiotoxicity potentiated by acidosis and hypoxia

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

uptake and distribution: alveolar PP

A

uptake = solubility x CO x (PA-PV)

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

opioids: side effects

A

pruritis, N/V, urinary retention, vent despression

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

local anesthetics: metabolism

A

amides: liver CYP450
esters: cholinesterase enzymes

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

opioids:best for neurological assessment post-op

A

remifentanyl

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

desflurane and heart rate

A

increased due to SNS stimulation

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

local anesthetics: nodes of ranvier

A

2-3 blocked will stop the action potential

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

compound A formation

A

sevo interation with CO2 absorbers, higher levels seen in Baralym vs soda lime, nephrotixin in rates, use flows higher than 2

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

EMLA components

A

5% lidocaine, 5% prilocaine

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

Induction drugs: hiccups

A

methohexital (brevitol), etomidate

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

benzodiazepine-ion channel effect

A

hyperpolarization

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

induction drugs: cortisol secretion

A

etomidate

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

inhaled agents: bone marrow suppression

A

nitrous oxide

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

Induction drugs: propofol method of action

A

decrease GABA dissociation

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

opioids: histamine release

A

morphine, meperidine

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

opioids: potency

A

MMHAFRS

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

opioids: remi metabolism

A

plasma cholinesterase

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

opioids: seizure

A

meperidine or normeperidine with renal failure

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

local anesthetics: cardiotoxicity

A

circumoral numbness, tinitus

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

dibucaine number

A

80

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

propofol: additives

A

glycerol burns, disodium edetate is bacteriostatic

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

opioid: side effects, glucagon

A

tx biliary coloc 2mg IV

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

ketamine: tx for emergence delirium

A

benzos

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

thiopental redistribution

A

effects 5-10 minutes bc of redistribution

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

benzodiazepine: clinical effect

A

20%: anxiolytic, 30% sedation, amnestic 60% unconscious

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

opioid: dynorphon receptors

A

kappa

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

inhaled agents: metabolism

A

exhalation, biotransformation, transcutaneous loss(hal - sevo - iso - des - n20)

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

opioids: renal failure

A

alfentanyl

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

dose of etomidate

A

0.2-0.3mg/kg

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

induction drugs: causes analgesia

A

ketamine

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

duration of naloxone

A

30-45 minutes

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

local anesthetic: effect of epinephrine

A

increase duration due to vasoconstriction

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

inhaled anesthetics: MH

A

don’t use

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

local anesthetics: cauda equina syndrome

A

serious potential complication of spinal anesthesia

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

local anesthetics: methemoglobemia

A

benzocaine/prilocaine (ortholuidine is the metabolite that causes methemoglobinemia); decreases oxygen carrying capacity of hemoglobin, oxidation of hemoglobin to methemoglobibemia, neonates at higher risk, normal metHbB is less than 1%, pulse ox will read 85, treat with methylene blue 1-2 mg/kg

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

induction drugs: effect of ICP

A

thio and etom decrease ICP, prop and ketamine increase ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

chloroprocraine: contraindicated in

A

spinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

premedication in children

A

0.5mg/kg versed PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

midazolam: drug interactions

A

synergistic with opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

induction drugs: myoclonus

A

etomidate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

volatile anesthetics: preservatives

A

halothane has thymol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

volatile anesthetics: reactive airway

A

don_t use des, use sevo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

maximum dose of bupivacaine

A

225mg with epi, 175 mg w/out epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

flumazenil metabolism

A

quick, doesn_t last = resedation

52
Q

mechanism of action for barbiturates

A

decrease GABA dissociation

53
Q

propofol CV effects

A

decrease BP and increase HR

54
Q

alpha 1 glyco protein (protein binding)

A

basic

55
Q

benzodiazepine: contraindications

A

PO no grapefruit, pregnancy

56
Q

division of CO

A

75% VRG (10% of body mass), 19% muscle (50% of body mass) 6% fat (20% body mass) 0% VPG (20% body mass)

57
Q

isoflurane CV effects

A

decrease SVR, increase HR, no effect of CO, coronary steal

58
Q

desflurane, physical properties

A

liquid at room temp

59
Q

iso and des

A

increase heart rate

60
Q

inhaled anethetics: cerebral metabolic rate of oxygen

A

decrease CMRO2

61
Q

MAC additive properties

A

MACs are additive

62
Q

thiopental pH

A

10.5

63
Q

induction drugs: does not interact with GABA

A

ketamine

64
Q

thiopental concentration

A

2.50%

65
Q

inhaled anesthetic: analgesic properties

A

NO only

66
Q

propfol in ICU

A

3 days then hyper lipidemia

67
Q

routes of administration: onset times

A

IV, intraosseous, endotracheal, inhalational, sublingual, IM

68
Q

indirect agonist definition

A

acting receptor agonist _ drug that produces its physiologic response by increasing the concentration of ENDOGENOUS substrate (neurotransmitter or hormone) at receptor site

69
Q

local anesthetics: ion trapping

A

refers to a phenomenon that occurs when a difference on pH exists in two body compartments. The more acidotic the pH, the greater the fraction of local, which is a basic compound, that ionizes. Ionized compounds are water soluble and cannot easily pass biologic membrands. when a local becomes more ionized and water soluble it becomes less able to leave the body compartment. If a patient who has CNS toxicity due to local overdose, is improperly managed, and becomes hypoxic with accompanying acidosis, the local becomes trapped in the CNS worsening the toxicity. Can also occur in pregnant patients because fetal pH is lower than maternal pH.

70
Q

racemic mixture

A

50-50 entantiomers

71
Q

CPP=

A

CPP = MAP - ICP

72
Q

propofol metabolism

A

hepatic metabolism, glucuronidation is the major pathway

73
Q

propoful IV sedation dose

A

25-100 mcg/kg/min

74
Q

propofol GA TIVA dose

A

100-200 mcg/kg/min

75
Q

solubility definition

A

_Relative affinity of an anesthetic for two phases and therefore the partitioning of that anesthetic between the two phases at equilibrium

76
Q

inhaled anesthetics: what is equilibrium

A

no difference in partial pressure exists

77
Q

partial pressure

A

the pressure which is the pressure the gas would have if it alone occcupied the volume

78
Q

two ways to increase initial concentration of gas and the uptake

A

concentration effect, 2nd gas effect

79
Q

effect of solubility on gas uptake

A

decreased solubility increases PA/PI so induction is quicker, increased solubility slows induction time

80
Q

inhaled anesthetics: CO effect

A

increased CO means increased solubility and slower induction

81
Q

what changes pharmacokinetics?

A

age, lean muscle, body fat, hepatic fxn, pulmonary gas exchange, CO

82
Q

What do we want GA to do?

A

Minimize deleterious direct and indirect effects of agents, Sustain physiologic homeostasis during procedure, Improve postop outcomes

83
Q

what MAC prevents mvmt in 95%

A

1.3

84
Q

MAC and hypothermia

A

For each decrease in core temp 1 degree C_MAC is decreased by 5%

85
Q

MAC and chronic alcohol abuse

A

MAC unaltered

86
Q

MAC and acute alcohol intox

A

MAC decreased

87
Q

Agents that decrease myocardial contractility and CO

A

halothane and enflurane

88
Q

Which agents decrease SVR?

A

iso, des, sevo

89
Q

Which agents decrease PVR?

A

all, blunt hypoxic pulmonary vasoconstriction response, (N2O known to increase PVR in pts with hypertension)

90
Q

Inhaled agents and arrythmias

A

halothane desensitizes the myocardium to catecholamines, exogenous epi can cause vtach and pvc, sinus brady and av rhythms bc of direct depressive effect on SA node / halo, iso, des and sevo prolong QT interval

91
Q

Inhaled agents and MV

A

increase RR decrease TV, rapid shallow breathing which causes and increase in PaCO2, drugs probably inhibit medullary vent center. Des and Sevo produce apnea around 1.5, 2 mac (decrease in vent response to hypoxemia, decrease in airway resistance, except for des, decrease in FRC)

92
Q

inhaled anesthetics and renal effects

A

decrease renal blood flow, decrease GFR, decrease urine output, nephrotoxicity

93
Q

inhaled anesthetics and hepatic effects

A

decrease hepatic blood flow, decrease hepatic clearance, hepatic toxicity

94
Q

inhaled anesthetics in vitro

A

can cross placenta, baby usually ok until 1 mac

95
Q

inhaled anesthetics and skeletal muscle

A

ether derived produce more relaxation than halothane, NO does not produce relaxation and may produce rigidity

96
Q

opioid agonist/antagonist

A

nalbuphine- used for people who are narcotic dependent or weaning off opioids (agonist at kappa, antagonist at mu)

97
Q

opioid: mechanism of action

A

Bind specific G protein-coupled receptors that are located in brain and spinal cord regions involved in the transmission and modulation of pain

98
Q

opioid receptors: Mu1

A

analgesia, euphoria, N/V, pruritis, low abuse potential, bradycardia

99
Q

opioid receptors: Mu2

A

(spinal) hypoventilation, analgesia, euphoria, sdeation, physical dependence, constipation

100
Q

opioid receptors: kappa

A

(supraspinal, spinal) analgesia, respiratory depression <mu, dysphoria, diuresis, dynorphins, agonist-antagonist work here, resistant to high intensity pain

101
Q

opioid receptors: delta

A

(supraspinal, spinal) analgesia, resp despression, physical dependence, urinary retention, enkaphalins

102
Q

opioid overdose triad

A

respiratory depression, CNS depression, pin point pupils

103
Q

opioid miosos

A

edinger-westphal nucleua of the oculomotor nerve, toolerance does not develop

104
Q

opioid withdrawal

A

chills, gooseflesh, hyperventialtion, hyperthermia, vomiting, diarrhea, hostility

105
Q

morphine

A

potency 1, onset 15-30 minutes, 2-10mg, peak effect 45-90 minutes, duration 3-4 hours, metabolized bia conjuction with glucuronic acid, metabolite morphine 6-glucaronide (accumulation in kidney failure pts can lead to prolonged narcosis and vent depression), histamine realease

106
Q

meperidine (demerol)

A

0.1 potency of morphine, peak effect 5-7 minutes, duration 2-4 hours, local/atropine side effects (block Na channels, tachycardia, dry mouth, mydriasis), 90% hepatic metabolism to normeperidine which is renally eliminated, tx for post-op shivering

107
Q

fentanyl

A

75-125 more potent than morphine, peak effect 3-5 minutes, duration 30-50, 75% undergoes 1st pass pulmonary uptake, highly lipid soluble and protein bound, hemodynamic stability,

108
Q

induction dose of fentanyl

A

2-6 mcg/kg with a sedative hypnotic

109
Q

sufentanil

A

5-10x as potent as fentanyl, 1000x more potent than morphine, greater affinity for opioid receptor, peak 3-5 minutes, duration 30-60 (dosing 0.3-1.omcg/kg 1-3 minutes before DL)

110
Q

alfentanyl

A

1/5 to 1/10 as potent as fentanyl, duration 10-20 minutes, peak 1.5-2 minutes, renal failure doesn_t alter clearance, rapid on/off, good for RBB, DL, 5-10mcg/kg

111
Q

remifentanyl

A

similar potency to fentanyl, peak effect 1.5-2 minutes, duration 6-12 minutes, metabolized by plasma and tissure esterases, good for RBB, continuous gtt, MAC vs general, quick recovery cases (0.5-1mcg/kg + propofol for FL then 0.25-.5mcg/kg/min)

112
Q

codeine

A

antitussive, analgesia for mild to moderate pain

113
Q

methadone

A

long term relief of chronic pain and opioid withdrawal

114
Q

hydromorphone

A

8x as potent as morphine but shorter acting

115
Q

pentazocine, butorphanol, nalbuphine

A

partial agonist and or comp antagonist, produce analgesia with limited resp depression, ceiling effect

116
Q

local anesthetics

A

bind Na channels in activated state, rate of depolarization is decreased, resting potential and threshold are not altered, blockade of Na channels prevent achievement of the threshold potential; action potential is not progagated

117
Q

lipophilic groups have a

A

benzene ring

118
Q

hydrophilic groups hav a

A

tertiary amine

119
Q

what effects potency of local

A

fiber size, type, myelination, pH, frequency of stimulation

120
Q

metabolites of esters

A

para-aminobenzoic acid (PABA) **allergies

121
Q

local inj sites and vascularity

A

IV>tracheal>intercostal>caudal>paracervical>epidural>BP>sciatic>subcutaneous

122
Q

toxicity dosages of locals

A

bupi is 2.5, lido is 5, lido with epi is 7

123
Q

CV effects of systemic toxicity

A

hypotension, decreased cardiac conduction, ventricular arrythmias

124
Q

dose of intralipid

A

1.5mg/kg iv over 10 minutes

125
Q

brain stem anesthesia

A

Accidental injection into the CSF can occur during the block due to perforation of the meningeal sheaths that surround the optic nerve. The patient may experience disorientation, aphasia, hemiplegia, unconsciousness, convulsions, and respiratory or cardiac arrest. The incidence of this is estimated in studies to be 0.13%. Direct injection intravascularly via the optic nerve sheath or local anesthesia carried by the ophthalmic and internal carotid artery by retrograde flow to the thalamus and midbrain can also present the same way. This situation requires prompt recognition and treatment (including airway control, respiratory support, possible cardiac intervention, etc.)

126
Q

drugs used for topical anesthesia

A

tetracaine, cocaine, lidocaine (with oxymetazoline)

Anesthesia Pharm (11 decks)

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