Pharm Induction Agent

Question 1

What neurotransmitter binds to NMDA receptors and what does binding do?

Answer 1

Glutamate, causes influx of positively charged ions(na and ca), causing excitatory effect

Question 2

Ketamine blocks

Answer 2

NMDA receptor and glutamate from bonding causing failed initiations in action potential

Question 3

Precedex works where

Answer 3

Alpha 2 agonist, acts as false norepinephrine, body blocks release of norepinephrine causing sedation. Chlonidine does same

Question 4

What do chemoreceptors do?

Answer 4

Pick up increase levels of co2 and send signals to breath

Question 5

Induction agents have an average onset time of ______ and one dose without any agents will give up to

Answer 5

30seconds and up to 9min

Question 6

With induction agents CO does what to onset of action?

Answer 6

Increases

Question 7

Single dose termination __________ determined by extent or speed of metabolism

Answer 7

iS NOT

Question 8

Who are still on barbiturates for seizures?

Answer 8

Typically elderly

Question 9

What substitutions on barbituric acid cause the hypnotic sedative and anticonvulsant effect?

Answer 9

N1, carbon2, carbon5

Question 10

Thipental substitutes what part of barbiruric acid?

Answer 10

Sulfur on C2

Question 11

Why do some drugs cause myoclonic movements with inductions?

Answer 11

Natural response of body d/t sympathetic outflow, fentanyl and esmolol help block

Question 12

What does methohexital substitute on barbituric acid?

Answer 12

Oxygen on c2

Question 13

Difference between barbs and benzia with gaba?

Answer 13

Benzos need gaba to work, barbs do not with longer and higher doses

Question 14

Caused of decreased plasma protein concentration? Barbs

Answer 14

Uremia,hepatic disease, 3rd trimester of pregnancy

Question 15

Drugs that compete with barbs for protein binding sites

Answer 15

Aspirin
Naproxen 
Indomethacin 
Warfarin
Can potential kick barbs off binding sites and increase barb toxicity

Question 16

Metabolism of barbs

Answer 16

Primarily oxidation
Secondarily  by n-dealkylation
Desulfuration
Destruction of barb acid ring
Results in inactive metabolites excreted urine

Question 17

Long term barb use can induce?

Answer 17

Cyp450 microtonal system and increase barb metabolism

Question 18

Barba analgesia?

Answer 18

No

Question 19

Barbs cns effect?

Answer 19

Can be titrated to produce mild to complete loc.
Significant post anesthesia drowsiness.
Dose dependent decrease CMRO2 and CBF
Decrease ICP and IOP
Anticonvulsant

Question 20

Barb cv effects

Answer 20

Induced depression of medullary vasomotor center, decrease in sympathetic systems outflow of CNS.
Modest decrease in peripheral blood pressure d/t peripheral vasodilation.
May see increase in heart rate if baroreceptors are still active.
Decreased venous return.
Hypotension and decreased CO in some patients.

Question 21

Barb exaggerated hypotension response observed in following scenarios?

Answer 21

Large induction dose
Rapid injection
Hipovolemia
Cardiac tamponado
Cardiomyopathy
CAD
Cardiac Valvular Disease

Question 22

Respiratory effects barbs

Answer 22

Dose related.
Respiratory depression
Decrease in minute ventilation 
Laryngospasm
Bronchospasm
Transient apnea induction
Decrease in stimulation by CO2 to breath( mediated by medullary and pontine vent centers)
Decrease ventilators response to hipercapnia and hypoxia
Suppression laryngeal reflexes and cough

Question 23

Which induction agent may cause immunosuppression?

Answer 23

Barbs, case studies only

Question 24

Anaphylactic reactions 1:30,000

Answer 24

Barbs

Question 25

Dose dependent histamine release?

Answer 25

Barbs

Question 26

What’s the purpose of histamine release?

Answer 26

Vaso dilates for transport of bulky molecules that attack/destroy toxins

Question 27

What happens with inadvertent infra arterial injection of barbs

Answer 27

Immediate vasospasm 
Severe vasoconstriction
Intense pain
Blanching of entire extremity
High risk for ischemic gangrene

Question 28

Interventions for intra arterial injection of barbs

Answer 28

Dilute with normal saline injections
Treat vasospasm with papaverine 40-80mcg
Stella te ganglion or brachial plexus block to increase circulation to affected extremity
Systemic heparin if not c/o

Question 29

What is porphyria and symptoms

Answer 29

Blood proteins that build up causing ans mediated neuro disturbance, abdomin pain, n/v, skin lesions, Htn, tachycardia, seizures

Less than 20,000 cases in us

Question 30

Absolute contraindications to barbs

Answer 30

Hx allergic reaction to barbs and porphyria

Question 31

First benzo

Answer 31

Librium 1955

Question 32

Laryngospasm and bronchospasm

Answer 32

Barbs