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2nd Quarter > Pharm Quiz #9 > Flashcards

Pharm Quiz #9 Flashcards

1
Q

What is the hallmark characteristic of Propofol as an induction agent?

A

Most rapid and complete awakening of any induction drug
It has a rapid return of consciousness
Minimal residual CNS effects

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2
Q

What is the #1 adverse affect of Propofol?

A

Pain on injection when a small vein is used

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3
Q

How can you minimize the #1 adverse affect of Propofol?

A

Minimize pain of injection by using larger veins, lidocaine or an opioid

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4
Q

What is responsible for the prompt awakening after receiving Etomidate?

A

prompt awakening due to REDISTRIBUTION from brain to inactive tissues although rapid metabolism plays a secondary role

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5
Q

Does Etomidate have any post op affects?

A

It has a GREATER INCIDENCE OF PONV

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6
Q

Does Etomidate have any negative affects on specific patient populations?

A

Greater frequency of excitatory spikes on EEGs, may activate seizure foci, so USE WITH CAUTION IN EPILEPSY PATIENTS—>avoid in patients with history of seizures!!

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7
Q

How does Etomidate affect the adrenal-cortical?

A

Etomidate causes adrenocortical suppression via dose dependent inhibition of the conversion of cholesterol to cortisol
Specific enzyme inhibited is 11-bets-hydroxylase

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8
Q

What illegal drug is Ketamine chemically related to?

A

PCP derivative that produces dissociative anesthesia—>”the lights are on but nobody is home”

It is a “dirty drug”

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9
Q

What is the #1 mechanism for the CV effects of Ketamine?

A

Greater SNS outflow—>patients with depleted catecholamine reserves may drop BP with ketamine as direct myocardial depressant effects are blocked by increased SNS outflow.

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10
Q

By what mechanism does Ketamine cause emergence delirium?

A

Due to depression of inferior colliculus and medial geniculate nucleus

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11
Q

What is the chemical class of propofol?

A

Alkyl phenols

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12
Q

What is the chemical name for propofol?

A

2,6-diisopropylphenol

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13
Q

Which drug has the most rapid and complete awakening of any induction drug?

A

propofol

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14
Q

Propofol has pain on injection when____veins are used. Minimize pain by _____, _____ and _____.

A

Small
large veins
Lidocaine
Opioids

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15
Q

Propofol interacts with _____, the principal inhibitory neurotransmitter.

A

GABA

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16
Q

Propofol leads to a slower rate of dissociation for GABA from receptors allowing increased durations of opening of ____ channels and hyper polarization of cell membranes.

A

Chloride

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17
Q

How is propofol cleared/metabolized in the body?

A

Hepatic and extra-hepatic metabolism
Tissue uptake by the vessel rich group
Very rapid clearance

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18
Q

Less than ____ of propofol is excreted unchanged in urine?

A

0.3%

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19
Q

All metabolites of propofol are pharmacologically ___?

A

Inactive(water soluble sulfate & glucuronic acid compounds excreted in urine)

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20
Q

What is the elimination 1/2 time of propofol?

A

0.5 to 1.5 hours

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21
Q

Does the length of infusion alter the context sensitive 1/2 time?

A

no

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22
Q

T or F: Propofol has a long effect-site equilibration time like Thiopental.

A

False—>it is short

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23
Q

Does cirrhosis and ESRD impair propofol elimination?

A

No it does not

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24
Q

There is an impairment of elimination with patients over ___ years old.

A

60

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25
Q

Propofol crosses the ___ but rapidly cleared from fetal circulation.

A

placenta

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26
Q

Give propofol ___ to avoid cardiovascular adverse effects

A

incrementally

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27
Q

True or False: Propofol is a trigger agent for malignant hyperthermia?

A

falso; it is not

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28
Q

For total intravenous anesthesia, we can dose the patient based off of ___ for sedation:

A

IBW

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29
Q

Consciousness in sedation doses range from ___ to ___ mcg/kg/min.

A

25 - 300(minimal analgesia effects, excellent amnesia effects)

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30
Q

What is the propofol intravenous dose for post-op heart patients to blunt tachycardia and hypertension?

A

25 - 75 mcg/kg/min

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31
Q

For induction of anesthesia, 1 to 2.5 mg/kg produces blood levels of ___ mcg/ml.

A

2 - 6

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32
Q

Children need greater doses of propofol (___) due to larger ___ and greater ___.

A

2.5 - 3.5
Larger central distribution volumes
greater clearance rates

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33
Q

Elderly patients need ___ to ___ % smaller doses of propofol due to smaller ___ and smaller ___.

A

25 - 50%
Central distribution volumes
Clearance rates

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34
Q

List three advantages of using propofol for intravenous sedation.

A

Prompt recovery
no residual sedation
low incidence of nausea and vomiting

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35
Q

T or F, propofol will reduce nausea and vomiting in doses that do not produce anesthesia?

A

True

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36
Q

Is propofol a good choice of drug for patients receiving electro convulsive therapy?

A

No, propofol has anti-convulsant properties dut to GABA mediated pre and post synaptic inhibition(decreased seizure activity 35-45%)

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37
Q

A patient has Pruitis from post epidural/intrathecal opioid administration. Should they receive propofol?

A

Yes, propofol treats prates of neuroaxial opioids due to decreased spinal cord activity(intrathecal opioids give prates by segmental excitation within the spinal cord).

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38
Q

T or F, propofol decreases cerebral metabolic oxygen requirements, cerebral blood flow and ICP.

A

True

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39
Q

How does propofol effect EEGs?

A

Similar to thiopental including burst suppression in high doses. Doesn’t change evoked potential monitoring.

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40
Q

What does propofol do to sympathetic vasoconstrictor nerve activity?

A

Inhibits it(decreases in BP)

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41
Q

How does propofol effect inotropic activity?

A

Negative inotropic effects by decreasing intracellular Ca levels

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42
Q

Propofol increases the ___ in pediatrics strabismus surgery.

A

Oculocardiac reflex(5 and dime baby!!!)

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43
Q

___ stimulation reverses blood pressure drops of propofol, although to a lesser degree than blood pressure drops seen with thiopental.

A

Laryngoscopy

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44
Q

Propofol 2 mg/kg does NOT blunt ___ responses to rapid increases in desflurane.

A

Cardiovascular

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45
Q

List four factors that effect hypotension with propofol.

A

hypovolemia
elderly
depressed LV function
dehydration(hypovolelmia!!!)

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46
Q

Propofol does not change the heart conduction system thus the ___ is often unchanged.

A

heart rate

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47
Q

For respiratory effects, propofol decreases both ___ and ___.

A

Tidal volume and respiratory rate

48
Q

Ventilatory responses to ___ and ___ are blunted.

A

Co2 and arterial hypoxemia

49
Q

How does propofol effect the patient airway?

A

bronchodilation
reduces intraoperative wheezes in asthma patients
Hypoxic pulmonary vasoconstriction remains intact(HPV-hyperventilatory response that protects our breathing response)

50
Q

What causes green urine with propofol?

A

Due to excreted phenols and cloudy urine from uric acid excretion.

51
Q

Propofol has addiction potential, may cause(3 items).

A

intense dreams
amorous behavior
hallucinations

52
Q

Propofol supports ___ and ___ growth.

A

E. coli

Pseudomonas

53
Q

What is the most common adverse effect to Propofol?

A

Pain on injection

54
Q

How do you avoid propofol pain on injection?

A

Use large vein, use opioids and lidocaine

55
Q

T or F, Propofol may abolish Parkinson tremors so use cautiously in stereotactic near tremor ablation surgeries.

A

True

56
Q

What chemical characteristic makes Etomidate different than any other intravenous induction agent?

A

a carboxylated imadazole ring(makes etomidate water soluble at acidic pH and lipid soluble at physiologic pH

57
Q

What is the mechanism of action for etomidate?

A

Enhances the effects of CNS inhibitory neurotransmitter GABA

58
Q

Aqueous solutions of Etomidate are unstable at physiologic pH-so formulated in 0.2% solution with 35% ___.

A

propylene glycol

59
Q

Etomidate has a high incidence of ___.

A

Pain with intravenous injection(more painful than Propofol)

60
Q

What is the pKa of Etomidate?

A

4.2

61
Q

Etomidate’s volume of distribution is ___ due to ___ tissue uptake.

A

large, large

due to moderate lipid solubility

62
Q

Regardless of plasma etomidate levels, etomidate is normally ___ plasma protein bound.

A

76%

63
Q

T or F, etomidate has rapid brain penetration.

A

True

64
Q

Prompt awakening from Etomidate is due to what?

A

redistribution(rapid metabolism plays a secondary role)

65
Q

On a chemical structure level, how is etomidate metabolized?

A

Hydrolysis of ethyl ester side chain to carboxylic acid ester, a water soluble and inactive compound

66
Q

How does the body metabolize and excrete etomidate?

A

97% metabolism by hepatic microsomal enzymes and plasma esterase’s
85% urine excretion and 15% bile excretion
(5 times greater clearance than thiopental, elimination 1/2 time 2-5 hours)

67
Q

Etomidate uses-What is onset? What is frequently seen?

A

Onset- 1 arm to brain circulation time Frequent involuntary myoclonic movements(Kramer-can use in unstable CV patients)

68
Q

Etomidate has ___ psychomotor recovery than Thiopental but ___ than Methohexital.

A

Quicker

slower

69
Q

Does Etomidate have analgesic properties?

A

No

70
Q

Would you rather use Etomidate for ECT or Thiopental/Propofol?

A

Etomidate

71
Q

What is the principle reason and indication for the use of Etomidate?

A

Unstable CV patients

72
Q

One of the downsides of etomidate is what?

A

Transient suppression of adrenocortical function

73
Q

What is post operative complication of Etomidate?

A

greater incidence of PONV

74
Q

Because Etomidate has a greater frequency of excitatory spikes on EEGs and may activate seize foci, it is contraindicated to give it to a patient with what type of neuro history?

A

Caution in epilepsy patients

75
Q

Even though you should not give etomidate in epilepsy patients, etomidate can terminate ___?

A

Status epilepticus

76
Q

Etomidate is an induction drug of choice for patients with minimal ___ due to minuscule ___ effects.

A

cardiac reserve, inotrope

77
Q

Unlike most induction drugs, Etomidate may stimulate ___ ___ centers that respond to CO2, making it a useful induction agent when spontaneous ventilation is desired.

A

medullary ventilatory

78
Q

With Etomidate, myoclonus, dystonia and tremor occur in ___ % of non-premeditated patients.

A

50

79
Q

The specific enzyme that is inhibited by etomidate that causes adrenal-cortical suppression is what?

A

1-beta-hydroxylase(last 4-8 hours after induction dose)

80
Q

Etomidate is a bad drug for those needing preserved cortisol response such as patient with ___ or in ___.

A

bleeding

sepsis

81
Q

Ketamine, what type of chemical structure is it?

A

phencyclidine derivative(similar to PCP)

82
Q

T or F, Ketamine gives skeletal muscle rigidity, intense analgesia, emergence delirium(possible) and be non communicative despite a wakeful look.

A

True

83
Q

Is Ketamine a racemic mixture?

A

yes

84
Q

T or F, Ketamine S isomers have greater analgesia properties, metabolize faster, and have a less incidence of emergence delirium.

A

True

85
Q

T or F, Ketamine increases uptake of catecholamines into post-ganglionic sympathetic nerve endings like cocaine?

A

False, inhibits

86
Q

What receptors do Ketamine act on?

A 
N-methyl-D-aspartate
opioid
monaminergic
muscarinic
voltage sensitive calcium channels(everything but GABA)
87
Q

Does Ketamine have analgesic properties?

A

Yes it is a potent analgesic

88
Q

Ketamine is partially antagonized by ___?

A

Physiostigmine

89
Q

How is Ketamine metabolized?

A

High hepatic clearance(1/2 time of 2-3 hours)

Metabolized by hepatic microsomal enzymes including demethylation by cytochrome P-450 to form norketamine.

90
Q

Ketamine causes ___ in ICP?

A

increases

91
Q

When administrating Ketamine, does a patient maintain their pharyngeal/laryngeal reflexes?

A

yes

92
Q

Ketamine is not for patients with CAD, sympathomimetic function ___ myocardial oxygen needs.

A

increases

93
Q

Ketamine is useful in asthmatic inductions due to ___.

A

bronchodilation

94
Q

Can you use Ketamine on patients prone to malignant hyperthermia?

A

yes

95
Q

If you use Ketamine in a patient with head injury, what must you do?

A

hyperventilate

96
Q

The number one mechanism of action for greater cardiovascular effects with Ketamine is what?

A

greater sympathetic nervous system outflow

97
Q

Does Ketamine significantly depress ventilation?

A

No, it does not significantly depress ventilation

98
Q

What effect does Ketamine have on non-depolarizer relaxants?

A

enhances the effects of non-depolarizers

99
Q

Ketamine is known for visual, auditory, proprioceptive, confusional hallucinations and dreams due to depression of what?

A

due to depression of the inferior colliculus and medial geniculate nucleus

100
Q

Emergence delirium is increased for those over ___ years old, ___, doses over ___ mg/kg, and ___.

A

15
women
2
psychiatric illness history

101
Q

What is the BGP of Isoflurane?

A

1.46

102
Q

What is the BGP of Nitrous Oxide?

A

0.46

103
Q

What is the BGP of Desflurane?

A

0.42

104
Q

What is the BGP of Sevoflurane?

A

0.69

105
Q

The Oil Gas Partition parallels what?

A

It parallels anesthetic potency and the MAC value

106
Q

What is the minimum alveolar concentration of anesthetic required to prevent skeletal muscle movement in response to a supra maximal painful stimulus in 50% of patients.

A

MAC; movement does not correlate will with awareness

107
Q

What is the MAC value of Isoflurane?

A

1.17 %

108
Q

What is the MAC value of Desflurane?

A

6.6 %

109
Q

What is the MAC value of Sevoflurane?

A

1.8 %

110
Q

What is the MAC value of Nitrous Oxide?

A

104 %

111
Q

What is the % of metabolism for Sevo?

A

5%

112
Q

What is the % metabolism for Nitrous?

A

.004

113
Q

What is the % metabolism for Iso?

A

0.2%

114
Q

MAC value for Iso?

A

1.2%

115
Q

At what dose does Iso lead to apnea?

A

2 MAC

116
Q

What is the MaC BAR of iso?

A

1.3 MAC

117
Q

Can Iso cause post-anesthesia hepatitis?

A

yup

2nd Quarter (27 decks)

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