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Pharm exam 2 > PPT and BOOK sedative hypnotics chapter 5 > Flashcards

PPT and BOOK sedative hypnotics chapter 5 Flashcards

1
Q

What do Barbiturates depress?

A

Reticular Activating System (RAS)

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2
Q

What does hypoproteineimia do in regards to barbiturates?

A

intensifies the response to barbiturates bc the free fraction of the drug is increased, causing more to diffuse from blood to brain.

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3
Q

Is thiopental lipid soluble?

A

Lipid soluble, 60 % unionized in plasma, good entry into the brain; rapid onset.

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4
Q

Name three barbiturates that we do not use but we need to know for boards?

A

Thiopental, methohexital, thiamylal

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5
Q

Methohexital has prominent excitatory effects, what does this do?

A

hiccups, seizures

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6
Q

Thiopental, what can it stop? (anti-what)

A

anticonvulsant and amnestic actions

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7
Q

Does thiopental have analgesic effect?

A

Poor analgesic, may cause hyperalgesic (increased sensitivity to pain)

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8
Q

What body system and organ function does thiopental depress?

A

depresses respiratory system, myocardial contractility

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9
Q

Could thiopental be considered a drug of choice for head injury, why?

A 
Yes,
it increases cerebral vascular resistance 
decreases cerebral blood flow 
decreases intracranial pressure
decreases cerebral metabolism
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10
Q

Who should avoid thiopental?

A

severe asthmatics bc it may cause a histamine release

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11
Q

what patients is thiopental contraindicated in?

A

Patients with porphyria.
(Porphyria is a group of diseases where a substance called porphyrins builds up in your body which negatively affects the skin and nervous system. )

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12
Q

Oral and injectable barbiturates have been replaced by?

the same drug has replaced barbiturates for there anticonvulsant effects as well.

A

Benzodiazepines

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13
Q

Thiopental a barbiturate, does it cause a change in HR or BP?

A

Transient decrease in BP and increase in HR, due to peripheral vasodilation.

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14
Q

The term sedative refers to a drug that induces?

A

a state of calm or sleep

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15
Q

The term hypnotic refers to a drug that induces?

A

hypnosis or sleep

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16
Q

Drugs that reversibly depress the activity of the central nervous system are referred to as?

A

sedative-hypnotics

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17
Q

Typical dose for IV propofol for induction?

A

1.5-2.5mg/kg IV

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18
Q

Rapid injection of Propofol causes unconsciousness in about how long?

A

30 seconds

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19
Q

What is unique about Propofol when compared to all other drugs used for rapid IV induction of anesthesia?

A

Awakening is more rapid and complete.

Rapid return to consciousness with minimal residual CNS effects is one of its most important advantages.

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20
Q

What receptors does propofol act on?

A

GABA and also glycine receptors. specifically GABA A which are Chlorine channels.

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21
Q

Propofol does it cause a decrease in BP or HR?

A

Causes a greater decrease in BP than thiopental (decrease in CO and SVR) HR often unchanged (bradycardia and asystole have occured in healthy adults according to the book)

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22
Q

Does propofol have ventillatory depression effects?

A

Yes, more profound than thiopental

Opioids will increase this ventillatory depression with propofol.

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23
Q

Would you give propofol for pain?

A

NO, propofol has no analgesic effect!

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24
Q

What are some conditions that propofol helps with but it would never be your first choice for those issues?

A

It has antiemetic properties and antipruritic. (anti Nausea and anti itching)

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25
Q

Go to drug for conscious sedation according to the book?

A

Propofol

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26
Q

Should propofol be mixed with any other drugs?

A

NO, it is not recommended to mix propofol with any other drugs. Commonly it is mixed with lidocaine for burning at injection, but this is not recommended bc it does pose the risk of creating oil droplets which pose the risk of pulmonary embolism.

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27
Q

Why is thiopental mixed and stored in a solution with pH = 10-11?

A

To keep thiopental in ionized form.

Ionized form is more water soluble. A precipitate will not form when thiopental is stored in a solution with a high pH

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28
Q

Because Propofol decreases CO and SVR what other drug could you use in place of it during induction?

A

Etomidate

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29
Q

Is propofol known as an anticonvulsant?

A

Yes it does have anticonvulsant effects

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30
Q

Which Benzo will you use the most in anesthesia?

A

Midazolam

31
Q

How do Benzo’s work and name the three short acting ones in the PPT.

A

Enhance actions of GABA which increase entry of Cl- causing hyperpolarization (do not activate GABA receptors directly but bind to specific site then act allosterically to enhance the affinity of the receptors for GABA)

Short-acting: diazepam, lorazapam, midazolam

32
Q

Does thiopental have a high or low pH? and based on this what kind of pH solutions should it NOT be mixed with?

A

Thiopental = high pH thus it should not be mixed with low pH to avoid precipitation.

33
Q

can you build up a tolerance to propofol?

A

Yes!

34
Q

what drug class is responsible for antianxiety and amnestic properties?

A

benzodiazepines

35
Q

are Benzo’s used for pain?

A

poor analgesics, not for pain.

36
Q

which two of the three benzo’s are used for seizures?

A

diazepam and lorazepam

37
Q

Do benzo’s effect the cardiovascular system?

A

little effect on CV system unless patient is hypovolemic, if hypovolemic profound hypotension.

38
Q

If you are going to give someone benzo’s what should you make sure has occured?

A

make sure they are hydrated, this can start in pre-op.

39
Q

If you are going to put an epidural in a pregnant lady you should do what first?

A

give a liter of fluid (make sure hydrated) to offset decreased BP.

40
Q

benzo’s do what in relation to cerebral blood flow, ICP, metabolism and vasculature?

A

cause cerebral vasoconstriction- lowers cerebral blood flow, metabolism and intracranial pressure.

41
Q

how protein bound is diazepam?

A

98-99% protein bound

42
Q

does diazepam dissolve in water?

A

poorly water soluble

43
Q

how is diazepam dissolved?

A

dissolved in organic solvent and pain may occur at injection.

44
Q

Ketamine! what does it produce and where does it act?

A

produces amnesia and profound analgesia by interacting with NMDA-type glutamate receptor.

45
Q

is ketamine a cerebral vasodilator or vasoconstrictor?

A

Ketamine = cerebral vasodilation

46
Q

is ketamine good for head injuries? why or why not?

A

contraindicated in head injuries.

Cerebral vasodilator— increases cerebral blood flow and metabolism and increases intracranial pressure.

47
Q

what should you always give with ketamine?

A

versed, this decreases delirium upon waking up. If they do wake up freaking out from ketamine, then give more versed.

48
Q

Importantly Thiopental does what to cerebral blood flow?

A

decreases cerebral blood flow, thus a good drug choice for head injury!

49
Q

Who would you NOT give ketamine to? (mentally wise, not physiologically)

A

patients with PTSD or delirium (dementia)

50
Q

what does Keatmine cause?

A

hypertonus (rigid) and nystagmus (shaky eyes)

51
Q

patient was administered a drug that resulted in rigidity and shaky eyes what may have he been given?

A

ketamine

52
Q

a patient has a blood pressure of 180/90 what drug should they not have?

A

ketamine, not for people with high blood pressure

53
Q

what does ketamine stimulate and enhance (increase)? (bodily systems)

A 
stimulates the sympathetic nervous system. 
Cardiovascular enhancement (increased HR, CO, BP)
54
Q

can ketamine be given IM ?

A

YES IV OR IM

55
Q

Emergence with ketamine can be severe, what might you see?

A

dreams, hallucinations, N/V

56
Q

In what patients should you avoid ketamine in?

A

Avoid in glaucoma patient, patient with elevated ICP (bc it raises their BP)

In cardiac patient may cause ischemia.

57
Q

which sedative/hypnotic is not a chiral compound?

A

propofol

58
Q

how exactly does propofol, etomidate and barbiturates interact with the GABA a receptors?

A

decreases the rate of dissociation of the inhibitory neurotransmitter, GABA from the receptor thereby increasing the duration of GABA-activating opening of the chloride channel with resulting hyperpoloriztion of cell membrane.

59
Q

propofol metabolized by who and excreted by who?

A

hepatic metabolism

excreted by kidneys

60
Q

a propofol infusion lasting up to 8 hours has a half time of what?
typically accepted half life of propofol is?

A

less than 40 minutes

typically accepted is .5 hour to 1.5 hours

61
Q

is HR and BP effected by propofol?

A

yes both are decreased according to chart in book on page 161 but according to the PPT and other places in the book HR is typically not changed.

62
Q

is systemic BP and HR effected by etomidate?

A

blood pressure is not changed or minimally decreased and HR is not changed.

63
Q

systemic BP and HR effected by ketamine?

A

increased and increased

64
Q

with which drug is respiratory resistance after intubation highest and with which drug is it the least?

A

highest with etomidate and lowest with propofol

65
Q

what is propofol infusion syndrome? (prolonged high dose infusions of propofol for 24 hours or more)

A

hepatocellular injury accompanied by lactic acidosis, bradydysrhythmias, and rhabdo.

66
Q

most commonly reported adverse effect of propofol in awake patients?

A

burning at injection site.

67
Q

when would you use etomidate in induction?

A

alternative to propofol or barbiturates for the IV induction especially in the presence of an unstable cardiovascular system!

68
Q

what does etomidate transiently depress?

and what patients are most effected by this?

A

adrenocortical function and patients in sepsis or hemorrhage may require intact cortisol response, thus a disadvantage to these pateint’s if etomidate is used.

69
Q

what is the reversal of benzo’s?

A

Flumazenil

70
Q

dose for flumazenil, onset time, and additional dosing?

A

0.2mg IV, works in 2 min. if additional dose is needed give 0.1mg in 60 sec intervals.

71
Q

Scopolamine what kind of drug is it?

A

naturally occurring anticholinergic derived from belladonna (also known as hyoscine). crosses BBB and binds to Muscarinic cholinergic- receptors.

72
Q

patients with what issues should avoid scopolamine?

A

glaucoma

73
Q

what is scopalamine good at doing?

A

sedation, drying up secretions, prevent N&V, (also causes mydriasis and cycloplegia)

74
Q

what is the treatment for OD on anticholinergic?

A

Physostigmine 15-60 micrograms/kg IV (this is an anticholinestrase drug) may need repeat doses.

Pharm exam 2 (4 decks)

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