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Pharm 2 > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

What are the 3 elements of anesthesia?

A

akinesia, amnesia, analgesia

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2
Q

Define akinesia

A

immobility, motionless

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3
Q

Define analgesia

A

deadening or absence of the sense of pain without loss of consciousness

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4
Q

Define amnesia

A

loss of memory (anterograde- loss of memory moving forward)

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5
Q

Define anesthesia

A

total or partial loss of sensation, especially tactile

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6
Q

Chemical name of propofol

A

2,6-diisopropylphenol (think “prop”)

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7
Q

Chemical name of etomidate

A

R-1-methyl-1-(a-methylbenzyl) imidazole- 5 carboxylate (carboxylate rhymes with etomidate)

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8
Q

Chemical name of ketamine

A

2-(o-chlorophenyl)-2 (methylamino) cyclohexanone HCl (ketaMINE rhymes with methaylaMINo)

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9
Q

Chemical name of benzodiazepines

A

8-chloro-6-(2-flurophenyl)-1-methyl-4 H-imidazo [1,5-a][1,4] benzodiazepine

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10
Q

Induction dose of propofol

A

1-2 mg/kg

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11
Q

induction dose of etomidate

A

0.2-0.3 mg/kg

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12
Q

induction dose of Versed

A

0.1-0.2 mg/kg (clinical is 1-2 mg)

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13
Q

Induction dose of ketamine

A

2-4 mg/kg (clinical is 10-50 mg)

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14
Q

Induction dose of thiopental

A

5 mg/kg

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15
Q

What drugs are GABA agonists?

A

benzos, barbiturates, propofol, etomidate

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16
Q

Benefits of propofol

A

rapid induction and awakening, amnestic, antipruritic, antiemetic, antiepileptic

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17
Q

Propofol and egg allergy?

A

most people are allergic to protein in egg whites- propofol has egg lecithin from egg yolk

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18
Q

How long can you use a propofol syringe vs tubing?

A

syringe- 6 hours tubing- 12 hours

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19
Q

What drug causes pain on injection?

A

propofol- can premedicate with lidocaine

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20
Q

Where is propofol metabolizes and does it have active metabolites?

A

liver, lungs- no

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21
Q

Symptoms of propofol infusion syndrome?

A

metabolic acidosis, hypertriglyceridemia, hypotension, rhabdo, acute renal failure, hepatomegaly

22
Q

risk factors for propofol infusion syndrome

A

dose >4 mg/kg/hr, infusion >48 hours, pressors, steroids, low glycogen stores, mitochondrial disorders, neuro compromise

23
Q

Effects of propofol on organ systems

A

CV- tachycardia on induction, negative inotrope respiratory- apnea, depress normal response to hypercarbia, lower incidence of wheezing Cerebral- decreased CBF and ICP

24
Q

CNS effect that may occur with induction by propofol?

A

excitatory phenomena- muscle twitching, spontaneous movement, opisthotonus, hiccupping

25
Q

Mechanism of action for etomidate

A

depresses RAS and mimics GABA

26
Q

Potential consequence of using etomidate?

A

adrenal corticoid suppression with long term infusions

27
Q

What is common with induction by etomidate?

A

myoclonus

28
Q

Will a standard induction dose of etomidate fully inhibit ventilation?

A

no

29
Q

Effects of etomidate on organ systems

A

CV- minimal effects (good for HD unstable patients) Respiratory- may induce apnea when used with opioids cerebral- decreased CMR, CBF, ICP

30
Q

Relationship of fentanyl with etomidate

A

fentanyl inreases plasma levels and prolongs elimination half life but decreases myoclonus

31
Q

MoA of barbiturates

A

depress RAS, enhance GABA, suppress Ach

32
Q

Duration of action of most induction drugs is determined by?

A

redistribution, not metabolism/elimination

33
Q

Effects of barbiturates on organ systems

A

CV- increased HR, decreased BP, vasodilation (effects vary depending on volume status, autonomic tone, CV disease) Respiratory- depresses Cerebral- decreased CBF, ICP renal- decreased RBF and GFR Hepatic- decreased hepatic BF, can trigger porphyria

34
Q

Barbiturates are highly ? and are incompatible with opioids and NMBs because…

A

alkaline; they will precipitate

35
Q

What SE is associated with ketamine at high doses?

A

nausea

36
Q

What is the MoA for ketamine?

A

NMDA receptor antagonist (blocks glycine and glutamate)

37
Q

Metabolite of ketamine

A

norketamine- ACTIVE!

38
Q

Effects of ketamine on organ systems

A

CV- increased BP, HR, CO (avoid in those with cardiac disease respiratory- bronchodilator (good for asthma), increased salivation, does not depress ventilatory drive cerebral- increased CMRO2, CBF, ICP

39
Q

Psychedelic effects of ketamine

A

emergence delirium- visual, auditory, proprioceptive illusions dreams and hallucinations can occur up to 24 hours

40
Q

Drug interactions with ketamine

A

-NMBA are potentiated -valium attenuates CV effects and prolongs elimination -versed and prop can decrease psychedelic effects

41
Q

Benzo reversal

A

romazicon (flumazenil)

42
Q

Which benzos are oil based and which are water based?

A

oil based- valium and ativan water- versed

43
Q

5 effects of benzos

A

anxiolysis, sedation, anticonvulsant, anterograde amnesia, spinal cord mediated muscle relaxant

44
Q

MoA of benzos

A

enhances inhibitory effects of various NTs, especially GABA

45
Q

elimination half life of benzos

A

versed- 2 hours ativan- 15 hours valium- 30 hours

46
Q

Effect of benzos on organ systems

A

CV- minimal, slight drop in BP and increase in HR Respiratory- depress vent response to CO2 cerebral- prevents seizures, amnesia

47
Q

Characteristics of thiopental (from study guide)

A

anterograde amnesia, 2 hour elim 1/2 life, minimal CV and resp effects, raises seizure threshold, potentiated by other CNS depressants

48
Q

How soon does awakening occur from propofol and what is its eliminatino half time?

A

2-8 minutes; 0.5-1.5 h

49
Q

Elimination half time of etomidate

A

2-5 hours

50
Q

elimination half time of ketamine

A

2-3 hours

51
Q

The “perfect induction process”

A

“pleasant loss of sensation”, from awake to level of surgical anesthesia -uses Versed, fentanyl, lidocaine, propofol, NMB

Pharm 2 (7 decks)

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