N926 Pharmacology Final Exam Flashcards
1
Q
MAC of Desflurane
A
6%
2
Q
VP of Desflurane
A
669
3
Q
BGC of Desflurane
A
0.42
4
Q
Oil Gas of Desflurane
A
19
5
Q
MOA of Desflurane
A
Unknown
6
Q
MAC of Isoflurane
A
1.2%
7
Q
VP of Isoflurane
A
238
8
Q
BGC of Isoflurane
A
1.4
9
Q
Oil Gas of Isoflurane
A
91
10
Q
MOA of Isoflurane
A
Uknown
11
Q
MAC of Sevoflurane
A
2%
12
Q
VP of Sevoflurane
A
157
13
Q
BGC of Sevoflurane
A
0.65
14
Q
OGC of Sevoflurane
A
47
15
Q
MOA of Sevoflurane
A
Unknown
16
Q
MAC of Nitrous Oxide
A
104%
17
Q
VP of Nitrous Oxide
A
38770mmHg
18
Q
BGC of Nitrous Oxide
A
0.46
19
Q
OGC of Nitrous Oxide
A
1.4
20
Q
MOA of Nitrous Oxide
A
Unknown
21
Q
MOA of Propofol
A
Gamma Aminobutyric acid agonist
22
Q
PK of Propofol
A
First pass effect in Lungs
Hepatic Metabolism CYP450
(4-hydroxypropofol) active metabolite
not influenced by hepatic or renal dysfunction
highly protein bound in blood
pain on inject
decrease dose in eldery, increase dose in children
23
Q
PD of Propofol
A
rapid and pleasant loss and return to consciousness
may induce myoclonus
neuroprotective
decrease in sympathetic tone and vasodilation
mild resp. depression common in induction doses
mild bronchodilation
24
Q
Induction dose of Propofol
A
1.5-2.5MG/kg
25
TIVA dose of Propofol
100-300mcg/kg/min
26
MAC dose of Propofol
25-100mcg/kg/min
27
Vd for propofol
3.5-4.5 L/kg
28
Half-Life of Propofol
0.5-1.5 hour
| Context sensitive half-time <40 mins
29
MOA of etomidate
Gamma-aminobutyric agonist
30
PK of Etomidate
large Vd
75% protein bound
metabolism by hydrolysis and plasma esterases
31
Etomidate inhibits
conversion of cholestrol to cortisol
11B-hydroxylase
causes adrenal cortical suppression
32
Etomidate is contraindicated in
patients with porphyrias
33
PD of Etomidate
rapid onset, return to consciousness 5-15 minutes
CBF and CMRO2 decreased
involuntary myoclonic movements >50% of patients
maintains hemodynamic stability
decrease in MV, but increase in RR
consider for cardiac compromised patients
increased risk for PONV
34
Induction dose of Etomidate
0.2-0.4 mg/kg
35
Vd of Etomidate
2.2-4.5L/kg
36
Half time of Etomidate
2-5 hour
37
MOA of Ketamine
N-methyl D-aspartate (NMDA) antagonist
38
PK of Ketamine
racemic mixture
not significantly protein bound
highly lipid soluble, rapid transfer of BBB
demethylation of CYP450
39
PD of Ketamine
produces dissociative anesthesia
has both amnestic and analgesic properties
increase CBF, CMRO2, and ICP (can be attenuated w/ benzo or opioid)
produces nystagmus, increase IOP
increases HR BP and SVR
Increased oral secretions
maintain spontaneous resp; slightly bronchodilator
risk for emergence delirium (attenuate with benzo)
indicated for trauma patients; possibly asthmatics
40
Induction Dose of ketamine
1-2.5mg/kg IV
| 4-8mg/kg IM
41
Multi-modal pain management of Ketamine
0.5-1mg/kg
42
Vd of Ketamine
2.5-3.5L/kg
43
Half-time of Ketamine
2-3 hours
44
5 Principle Pharmacologic effects of Benzodiazepines
```
anxiolysis
anticonvulsant activity
anterograde amnesia
sedation/hypnosis
skeletal muscle relaxation
```
45
Most common adverse effects of benzodiazepines
unexpected respiratory depression and oversedation
46
MOA of Midazolam
Gamma-Aminobutyric Acid (GABA) agonist
47
PK of Midazolam
water soluble with an imidazole ring (no discomfort on injection)
High lipid solubiltiy
highly pound to plasma proteins
metabolized by hydrolysis (1- hydroxymidazolam/4-hydroxymidazolam)
1-hydroxymidazolam half the activity
metabolism slowed by drugs that inhibit CYP450
48
PD of Midazolam
decreases CMRO2 and CBF
cerebral vasomotor responsiveness to CO2 is preserved
does not attenuate responses to intubation
49
Midazolam is synergisitc with
fentanyl
50
Midazolam at 0.2mg/kg produces
decrease in BP, increase in HR d/t changes in SVR
51
Midazolam should be avoided in patients with
acute porphyrias
52
Dosing of Midazolam
0.02-0.04mg/kg IV
0.4-0.8mg/kg oral
1-7mg/hr postoperative sedation
53
Vd of midazolam
1-1.7L/Kg
| increased in elderly and obese
54
Half time of Midazolam
1.9 hours
| 2-4 Hours
55
MOA of diazepam
Gamma Aminobutyric Acid agonist
56
PK of Diazepam
insoluble in water and painful on injection
highly lipid solubility
crosses the placenta
extensively protein bound
metabolized by oxidation (desmethyl diazepam/oxazepam)
Exhibits a near-linear relationship between elimination half-life and patient age
57
Desmethyl Diazepam
may cause return of drowsiness at 6-8 hours and has a half life of 48-96 hours
58
PD of diazepam
produces minmial depressive effects on ventilation
| minimal decrease in BP, CO, SVR
59
Diazepam has synergistic effects with
fentanyl that decreases BP and SVR
60
Diazepam should be avoided
in patients with acute porphyrias
61
Dosage of Diazepam for Seizures
0.1mg/kg IV effective in abolishing seizure activity
62
Vd of Diazepam
0.8-1.3 L/kg
63
Half time of Diazepam
20-50 hours
64
MOA of Lorazepam
Gamma-aminobutyrc acid agonist
65
PK of Lorazepam
most potent benzo, slowest onset of action
insoluble to water and pain on injection
conjugated with glucuronic acid in the liver (inactive metabolites)
less likely to be influenced by alteration in liver function
66
PD of Lorazepam
Duration of sedative effects last longer (6-10 hours)
| delayed emergence and weaning of ventilator
67
Lorazepam should be avoided in patients with
porphyias
68
Dosage of Lorazepam
50mcg/kg
| max: 4mg
69
Vd of Lorazepam
0.8-1.3L/kg
70
Half time of Lorazepam
10-16 hours
71
MOA of Flumazenil
Selective benzodiazepine antagonist (weak intrinsic agonist of GABA)
72
PD of Flumazenil
not recommended for patients being treated with anti-epileptic meds for seizure control
will not cause acute HTN, tachycardia or anxiety
will not alter MAC requirements
73
Dosing of Flumazenil
0.2mg IV followed by 0.1mg q1min
0.5-1mg completely abolish benzo effects
still unresponsive, have another problem
74
MOA Thiopental
GABA agonist
75
PK Thiopental
Rapid distribution
| metabolized in liver by oxidation (pentobarbital active metabolite)
76
PD Thiopental
Decrease in CRMO2, CBF, ICP
reverse steel effect
decrease MAP and CO (decrease in venomotor tone and neg inotropic effects)
respiratory depression
77
Thiopental is contraindicated
intermittent porphyria
78
When is thiopental an medical emergency
inadvertent arterial administration
79
Induction dose of thiopental
2.5-5mg/kg
80
Vd of Thiopental
Large
81
Half life of Thiopental
relatively long (ten fold of propofol and prolonged in pregnacy d/t protein binding
82
Methohexital is used for
ECT
83
MOA of methohexital
GABA agonist
84
PK of Methohexital
rapid distribution
| metabolized in liver by oxidation (pentobarbital active metabolite)
85
In Methohexital, what increases hypnotic potency but lowers seizure threshold and causes myoclonus
methyl on N
86
PD of methohexital
Decrease in CRMO2, CBF, ICP
reverse steel effect
decrease MAP and CO (decrease in venomotor tone and neg inotropic effects)
respiratory depression
87
INduction dose of methohexital
1-2 mg/kg
88
Vd of Methohexital
large
89
half life of methohexital
relatively long, (10 fold of propofol and prolonged in pregnancy due to protein binding)
90
Morphine MOA
opioid receptor agonist
91
PK of morphine
primary metabolism by conjugation and glucuronic acid
92
metabolite of morphine
morphine 6 glucronide
93
Morphine's metabolite
longer DOA then morphine and higher analgesic potency 65x
94
Renal Function and Morphine
impaired renal function can result in accumulation and unexpected respiratory depression
95
PD of Morphine (CV)
bradycardia with sustained BP
| orthostatic Hypotension
96
Morphine is synergistic with
benzos and N20
97
PD of Morphine (Resp)
```
dose dependent ventilation depression accompanied by compensation in tidal volume
decrease responsiveness to CO2
decreased ciliary action
increased airway resistance
depression of medullary cough centers
```
98
PD of Morphine (CNS)
decreased CBF and ICP
miosis d/t edinger-westphal nucleus of oculomotor nerve
"When pain is relieved, sedation can occur"
99
PD of Morphine- General
muscle rigidity
spasms of biliary smooth muscle and sphincter of oddi
decreased gastric motility and constipation
increased N/V
urinary urgency
warmed flush skin and histamine release
100
Dosing of Morphine
2-4 mg
101
MOA Demerol (Meperidine)
Mu recpetor agonist
| used for post-op shivering
102
PK of Demerol
1/10 as potent as morphine
metabolized by demethylization and hydrolysis (normeperidine)
decreased renal function can result in accumulation of metabolites
103
PD of Demerol
increase HR, mydriasis
delirium and seizures
Crosses the placenta
104
Demerol and patients taking MAOi
serotonin syndrome
105
Fentanyl MOA
opioid agonist
106
Dosing of Demerol
12.5 mg is for post-op shivering
107
PK of Fentanyl
rapid onset and highly lipid soluble
first pass uptake in lungs
metabolized by N-dealkylation and hydroxylation
108
Cirrhosis with Fentanyl
does not prolong elimination half-time
109
PD of Fentanyl
"secondary peaks" from pulmonary uptake
does not evoke histamine release
bradycardia is more prominent
increase ICP
110
Fentanyl is synergistic with
propofol and versed
111
Dosing of Fentanyl
1-3mcg/kg to blunt SNS to response and provide analgesia
112
Vd of fentanyl
large
| >80% leaves the plasma in less than 5 mins
113
Fentanyl Context Sensitive 1/2 time
increases with infusion
| >2hr
114
Sufentanil MOA
opioid agonist
115
PK of Sufentanil
5-10 more potent then fentanyl
extensive protein binding compared to fentanyl
significant first pass pulmonary uptake
Metabolized by N-deakylation and O-demethylation (desmethyl sufentanil)
clearance sensitive to hepatic flow and normal renal function important
116
PD of Sufentanil
decreased CMRO2
decreased HR and CO
may cause chest wall rigidity
117
Dosing of Sufentanil
0.1-0.4mcg/kg for analgesia (longer analgesia and respiratory depression than fentanyl)
118
Vd of Sufentanil
large
119
Context sensitive 1/2 time of Sufentanil
30 minutes
120
MOA Alfentanil
opioid agonist
121
PK of Alfentanil
less potent than fentanyl, shorter duration of action
metabolized by N-dealkylation
rapid onset
122
PD of Remifentanil
seizure like activity
decrease in BP and ventilation
no post-op pain coverage
123
Dosing of Reminfentanil
1-3 mcg/kg induction
| 0.1-0.3 mcg/kg/min infusion
124
Vd of Reminfentanil
small
125
Context sensitive 1/2 time of Reminfentanil
4 mins
126
PD of Alfentanil
acute dystonia; avoid with untreated Parkinson's
| Significant decrease in BP
127
Dosing of Alfentanil
15 mcg/kg
128
Vd of Alfentanil
small
129
Context sensitive 1/2 time fo Alfentanil
60 minutes
130
MOA of Remifentanil
selective Mu agonist
131
PK of Remifentanil
potency is the same as fentanyl
metabolized by non-specific plasma esterase
not affected by pseudocholinersterase deficiency
132
Remifentanil is synergistic with
propofol
133
1/2 Life of Fentanyl
2-4 hours
134
Life Life of Remifentanil
0.1-0.3 hours
135
1/2 Life of Sufentanil
2-5 hours
136
1/2 Life of Alfentanil
1 hour
