Vent Anesthetics and Sedatives - QUIZ

Question 1

Ketamine exerts its sedative and anesthetic effects through which of the following?

a) Acting on NMDA receptors to prevent calcium and sodium influx into the cell
b) Acting on the NMDA receptors to increase calcium and sodium influx into cell
c) Acting on the NMDA receptors to prevent calcium and sodium efflux out of cell

Answer 1

a)
Note: Blocks the NMDA cation channel preventing the binding of glutamate. As a consequence, it prevents glutamate-simulated sodium and calcium influx into the cell, and potassium efflux

Question 2

Which IV anesthetic demonstrates preservation of response to respiratory stimuli?

Answer 2

Ketamine

Question 3

Which of the following is a consequence of Ketamine’s action on Calcium movement?

a) Bronchodilation
b) Increased Inotrope
c) Increased ICP
d) Increased secretions

Answer 3

a) Bronchodilation
Note: occurs by a mechanism independent of the NMDA receptor, it appears to interfere with a calcium-dependent step in histamine-induced bronchoconstriction resulting in bronchodilation. Can be used for status asthmaticus.

Question 4

Propofol has the lowest volume of distribution of any induction agent.

True or False?

Answer 4

False

Note: Propofol is 98% protein bound = the highest volume of distribution of any induction agent

Question 5

Which of the following IV anesthetics are metabolized hepatically by the CYP450 system? Select ALL that apply.

a) Ketamine
b) Dexmedetomidine
c) Midazolam
d) Propofol

Answer 5

a) Ketamine
b) Dexmedetomidine
d) Propofol

Question 6

Propofol mechanism of action for sedation is related to GABAA agonism, but it also shows which of the following non-sedation related effects? Select ALL that apply.

a) Antiemetic
b) Enhanced histamine
c) Anticonvulsant
d) Increased cerebral blood flow
e) Impaired response to hypoxia and hypercapnia
f) Green urine

Answer 6

a) Antiemetic
c) Anticonvulsant
e) Impaired response to hypoxia and hypercapnia
f) Green urine

Question 7

Which of the following is true regarding IV anesthetics and their effects on cardiac contractility?

a) Propofol exerts negative inotropic effects through its effects on Chloride
b) Ketamine exerts negative inotropic effects through its effects on Calcium
c) Propofol negatively effects inotrope at standard dosing
d) Ketamine enhances inotrope through its effects on Calcium

Answer 7

b) Ketamine exerts negative inotropic effects through its effects on Calcium

Question 8

Features of PRIS (Propofol Infusion Syndrome) include all of the following, except?

a) Tachycardia
b) Cardiogenic shock
c) Anion Gap Metabolic Acidosis
d) Rhabdomyolysis

Answer 8

a) Tachycardia

Question 9

Midazolam exerts its sedatives effects through agonism of which of the GABA receptors?

Answer 9

GABAAa

Question 10

Midazolam has adequate bioavailability in IV, IM, PO, and intranasal administration. True or False?

Answer 10

True

Question 11

All of the following IV anesthetics preserve airway reflexes, except for:

a) Dexmedetomidine
b) Propofol
c) Etomidate
d) Ketamine

Answer 11

b) Propofol

Question 12

When considering effects of the various agents, which of the following is less suitable for patients with increased ICP due to its minimal effects on cerebral metabolism?

a) Midazolam
b) Propofol
c) Barbiturates
d) Etomidate

Answer 12

a) Midazolam
Note: Cerebral metabolism is affected, but not to the same extent as by barbiturates or propofol. Additionally, they do not decrease the cerebral oxygen demand as much as other sedating agents, therefore less suited for the sedation of patients with raised intracranial pressure; in the sense that they will not decrease the ICP

Question 13

Which of the following IV sedatives exerts its effects through alpha 2 agonism?

a) Ketamine
b) Etomidate
c) Dexmedetomidine
d) Propofol

Answer 13

C) Dextmedetomidine

Question 14

Dexmedetomidine is both highly lipid and water soluble. True or False?

Answer 14

True

Question 15

Which of the following is true regarding the hemodynamic effects of Dexmedetomidine:

a) Sustained increase in blood pressure due to its effects on vascular smooth muscle
b) Increased heart rate due to sympathetic nervous system stimulation
c) Bradycardia with maintained cardiac output due to intact contractility
d) Sustained decrease in cardiac output due to increased vascular tone and impaired inotrope

Answer 15

c) Bradycardia with maintained cardiac output due to intact contractility

Question 16

Which of the following is true regarding the systemic effects of Etomidate?

a) Maintained sympathetic tone and myocardial function
b) Unaltered pharmacodynamics and pharmacokinetics in hemorrhagic shock
c) Reduction in cerebral blood flow and metabolic rate
d) All choices

Answer 16

d) All choices

Question 17

Etomidate causes which of the following adverse effects:

a) Acute kidney injury
b) Adrenal cortical inhibition
c) HLH
d) Delirium

Answer 17

b) Adrenal cortical inhibition