Pharm propofol

Question 1

What is the most frequently administered drug for induction of anesthesia

Answer 1

propofol

Question 2

possible toxicity when used with_____ due to _______

Answer 2

benzos, propylene glycol

Question 3

Propofol is ______ and requires a _______ vehicle for _________

Answer 3

insoluble, lipid, emulsification

Question 4

molecular structure of propofol

Answer 4

substituted isopropylphenol

Question 5

potential allergens

Answer 5

egg and soy bean

Question 6

Preservative of diprivan made by AstraZeneca

Answer 6

disodiumedenate (EDTA)

Question 7

Preservatives inhibit bacterial growth up to hours?

Answer 7

12 hours

Question 8

Preservative of generic propofol made by Baxter, Pfizer

Answer 8

Sodium metabisulfite

Question 9

What causes allergy with sodium metabisulfite preservative?

Answer 9

sulfites

Question 10

Generic propofol can cause negative effects such as

Answer 10

sulfite allergy,
anaphylaxis,
asthmatic episodes in pts with known hx of asthma

Question 11

How does Aquavan(not approved), water-soluble propofol work?

Answer 11

propofol is liberated after hydrolysis of the parent compound by endothelial cell surface alkaline phosphatases. The prodrug has a larger volume of distribution and a higher potency than propofol. (Takes longer and last longer)

Question 12

What propofol brand was cancelled and associated with more pain on injection?

Answer 12

Ampofol, low lipid emulsion, does not require preservative

Question 13

GABA has ____ subunits made up of what three?

Answer 13

5, alpha, beta, gamma

Question 14

Induction drugs work on different receptors of GABA?

Answer 14

True, receptor sites for specific drugs

Question 15

Propofol is a CYP _____ and _____

Answer 15

substrate and inhibitor, 3A4

Question 16

Will a one time dose of propofol or other induction agents inhibit enzymes?

Answer 16

No, not likely

Question 17

Rapid clearance of propofol from the plasma exceeds hepatic blood flow and is responsible for less

Answer 17

“hangover effect”

Question 18

CNS effects of propofol

Answer 18

Decrease CBF, CMRO2, ICP, IOP,
neuroprotective during focal inflammation(similar structure to vit e which is neuroprotect),
anti-epileptic properties (decrease seizure activity 35-35%)
may observe myoclonic movement on induction

Question 19

Respiratory effects of propofol

Answer 19

Respiratory depressant,
apnea after induction,
maintenance decrease mv by decrease tv and RR,
decrease response to hypercapnia and hypoxia,
significant reduction in upper airway reflexes,

Question 20

Propofol is good for intubating and LMAs because

Answer 20

less laryngospasm, bronchospasm, and wheezing than barbs and benzos

Question 21

CV effects of propofol

Answer 21

profound decrease in systemic blood pressure,
BP exaggerated in elderly, hypovolemia, rapid injection,
Dramatic inhibition of baroreceptors,
Bradycardia and hypotension

Question 22

Propofol potentiate muscle relaxants?

Answer 22

No

Question 23

Anti-emetic dose of propofol

Answer 23

10-20mg IV intermittent or 10mcg/kg/min

Question 24

Propofol has _____ activity and ______ properties.

Answer 24

antipyretic and antioxidant

Question 25

dose of propofol and time for risk of PIS

Answer 25

> 24-48hrs and >67(70)mcg/kg/min

Question 26

If unexpected tachycardia occurs while on propofol check

Answer 26

for metabolic/lactic acidosis,
serum lactate,
ABG

Question 27

Treatment of PIS

Answer 27

Discontinue,
treat lactic acidosis,
support multi-system failure

Question 28

Presentation of PIS in children

Answer 28

Anion gap metabolic acidosis,
bradyarrhythmia, (do not get tachy like adults)
liver dysfunction,
rhabdomyolysis of cardiac and skeletal muscle leading to organ failure,
hyperkalemia,
acute kidney injury,
cardiac dysfunction,

Question 29

PIS more profound in kids due to

Answer 29

enters mitochondria easily because of high lipophilicity. Disrupts electron transport chain leading to failure of ATP production which inhibits fatty acid metabolism. Fatty acid buildup occurs.

Question 30

Patients with _______ deficiency and ______ disorders are at higher risk of PRIS

Answer 30

carbohydrate deficiency (energy supply relies on lipolysis, children are more prone due to lower glycogen stores and greater dep. on fat metabolism)

clinical and subclinical mitochondrial disorders frequently in pediatrics (disorders related to fatty acid metabolism, lack ability to metabolize fatty acids and combined with long-chain fatty acids in propofol can accumulate )

Question 31

Fospropofol different from propofol

Answer 31

slower onset time with stronger and longer duration of sedation,
No lipids,
Attached molecule of propofol released when metabolism breaks