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Pharm1Test3IVAnes
Pharm1 Test3 IV Anesthetics
| Question | Answer |
|---|---|
| Zaleplon(Sonata), Zolpidem(Ambien), and Eszopiclone(Lunesta) all have similar half-lives(<8 hrs) so that they don't interfere with the next day's activities. What are their relative potencies? | Zaleplon(Sonata) potency of 1, Zolpidem(Ambien)potency of 1, and Eszopiclone(Lunesta) potency of 7X. |
| Zaleplon(Sonata), Zolpidem(Ambien), and Eszopiclone(Lunesta)act similarly to Benzos on the GABA-A receptor complex. How do they act? | Bind to specific GABA receptor (alpha-1) subpopulations better and have greater effects on sleep (alpha-2 agonists anti-anxiety and anticonvulsant effects). |
| Propofol(Diprivan) belongs to a new class of anesthetics, called... | 2,6-diisopropylphenol. |
| How does Propofol(Diprivan) act? | Acts by interaction with GABAA receptor, decreasing the rate of GABA dissociation from the receptor. |
| True or false: Propofol(Diprivan) is fairly selective with few perceivable effects at other receptors. | True. |
| Propofol(Diprivan) is not very water soluble, so it's prepared in an emulsion vehicle which contains what two potential allergens? | Soybean oil and egg lecithin(reactions are rare). |
| True or false: a patient with an allergy to the egg in Propofol(Diprivan) is allergic to the yolk portion. | False. It is the white portion. |
| What does the brand-name Diprivan use as a preservative? | Disodium edenate. |
| What does the generic Propofol use as a preservative? | Sodium metabisulfate. |
| What is a potential problem of the preservative sodium metabisulfate used in the generic Propofol? | Patients with sulfite allergies. |
| What is Fospropofol(Lucedra)? | A Propofol prodrug recently approved by the FDA which is cleaved to Propofol on administration by endothelial alkaline phosphatases. |
| What cleves Fospropofol(Lucedra) to Propofol on administration? | Endothelial alkaline phosphatases. |
| Why does Fospropofol(Lucedra) have no pain on injection? | It is water soluble. |
| Propofol(Diprivan) causes induction in 15-30 seconds. Why should it be administered more slowly than Thiopental? | It causes burning on administration. |
| What two things can we do to reduce Propofol(Diprivan)'s burning on administration? | Using a large vein, preadministering 1% Lidocaine. |
| Why can't we mix Lidocaine and Propofol(Diprivan) in the same syringe? | Co-mixing with Lidocaine may increase risk of pulmonary embolism due to breaking emulsion and the formation of soybean oil droplets. |
| True or false: patients awake faster from Propofol(Diprivan) than those induced with other agents. | True. |
| True or false: patients wake up from Propofol(Diprivan) with a hangover. | False. Patients often report an elevated post-op mood. |
| Why does Propofol(Diprivan) rapidly distribute to the brain? | High blood flow. |
| In addition to being a great IV anesthetic, what are some other benefits of Propofol(Diprivan)? | Also possesses antiemetic, antipruritic, and anticonvulsant actions. |
| Does Propofol(Diprivan) increase pain sensitivity? | No. |
| How does Propofol(Diprivan) decrease BP? | Blood pressure is decreased due to decreased cardiac output and vascular resistance. |
| Why does Propofol decrease BP more than Thiopental? | Blood pressure is decreased more than seen with Thiopental by inhibition of sympathetic vasoconstriction. |
| Use of Propofol has a higher risk of bradycardia-related death. Why? | Inhibition of cardiac sarcolemmal calcium release. |
| Propofol depresses respirations, with apnea reported in what percentage of patients? | 30%. |
| Propofol-induced apnea may be increased with with use of what other drug class? | Opioids. |
| Does Propofol trigger MH? | No. |
| Why are we in a Propofol shortage? | One mfg. discovered particulate matter in vials and at the same time, another mfg. recalled vials due to possible microbial contamination (and has not stated when shipments will resume). |
| What is Propoven? | Propofol in a different vehicle formulation – more lipids, but no preservative, so short vial life, approved by FDA. |
| Propofol pumps utilize syringe infusion pumps. They can be combined with what monitor? | Bis. |
| What are the two anesthetic uses of Propofol? | Induction and continuous infusion. |
| Propofol may be administered as part of a balanced anesthesia plan or alone. It may increase plasma <blank> levels. | Triglyceride. |
| Lactic acidosis has been reported in patients receiving continuous Propofol administration for greater than... | 24 hours. |
| What can be a problem with mixing Lidocaine with Propofol in an attempt to reduce pain on injection? | May cause lipid oil droplet formation by breakdown of emulsion and subsequent pulmonary embolism. |
| Propofol's SE of bradycardia, pain, and hypertriglyceridemia all attributed to... | Its lipid emulsion vehicle. |
| Etomidate(Amidate) has a structure unlike any other anesthetic. What is its MOA? | Mechanism believed to be via GABA-activity enhancement like barbiturates and benzodiazepines. |
| Etomidate(Amidate) is a weak base. What percentage is unionized at physiological pH? | 99% unionized at physiological pH. |
| What is Etomidate(Amidate) mixed with for injection? | Propylene glycol. |
| True or false: Termination of Propofol anesthesia due to redistribution to fatty tissues and metabolism. | True. |
| How is Propofol metabolized? | Hepatic and extrahepatic P-450 oxidative metabolism and phase II glucuronide and sulfate conjugation. |
| True or false: Propofol has high levels of lung cell and is primarily metabolized by lung tissue. | False: High levels of lung cell uptake but released mainly unchanged. |
| What is Propofol's duration of effect? | Duration of effect typically 5-10 minutes. |
| How does Propofol compare to Thiopental? | Half life of 2-3 hours, so it does not accumulate as much as Thiopental, and can be used for maintenance by continuous infusion. |
| How does Propofol affect the fetus? | Easily crosses placenta to fetus, but is rapidly metabolized by fetus. |
| How do liver and kidney disease affect Propofol metabolism? | Liver and renal disease do not appear to appreciably affect elimination. |
| What percentage of Propofol is protein bound? | Highly protein bound (95% - 99%). |
| About what percentage of Etomidate(Amidate) is protein bound? | 75%. |
| True or false. Etomidate(Amidate) has a small volume of distribution. | False. Vd is large (tissue distribution). |
| How long for Etomidate(Amidate) to reach peak brain concentration. | Reaches peak brain concentration within one minute following IV administration. |
| Why does Etomidate(Amidate) have rapid recovery? | Rapid recovery due to rapid lipid redistribution and partly due to metabolism. |
| How is Etomidate(Amidate) metabolized? | Metabolized rapidly mainly via hydrolysis of side chain ester group by plasma esterases and hepatic P-450 system. |
| Etomidate(Amidate)'s induction is as rapid as Thiopental's, with emergence in... | 5-10 minutes. |
| What is Etomidate's elimination half-life? | 2-5 hours. |
| Etomidate has minimal cardiovascular effects, which makes it a better choice than barbiturates or propofol for patients with... | Cardiovascular instabilities. |
| Etomidate has less ventilatory depression than with barbiturates or propofol, however occasional apnea with... | Rapid administration. |
| What percentage of patients experience myoclonus with rapid administration of Etomidate? | About 80%. |
| What is myoclonus? | A clonic spasm of a muscle or muscle group. |
| Why is Etomidate not recommended for long-term use? | Depresses steroid (cortisol) synthesis in adrenals. |
| There is increased risk of Etomidate-induced steroid (cortisol) synthesis depression in what two situations? | Sepsis and hemorrhage. |
| What is an alpha-2 agonist indicated for the control of stress, anxiety and pain? | Dexmedetomidine (Precedex). |
| When used alone, Dexmedetomidine(Precedex) produces sedation with the ability to... | Rouse the patient, allowing the medical staff to communicate with the patient if needed. |
| What is the volume of distribution of Dexmedetomidine(Precedex)? | Vd ~ 118 liters. |
| What is the half-life of Dexmedetomidine(Precedex)? | t1/2 ~ 2 hrs. |
| What is the clearance of Dexmedetomidine(Precedex)? | Cl ~ 39 L/hr. |
| About what percentage of Dexmedetomidine(Precedex) is protein bound? | Approximately 95% protein bound. |
| Metabolism of Dexmedetomidine(Precedex) is almost complete, mainly via... | Glucuronidation and P-450 hydroxylation. |
| The dosage requirements of Dexmedetomidine(Precedex) is unchanged with age, however adjustments may be necessary in patients with... | Hepatic disease. |
| How is Dexmedetomidine(Precedex) administered? | Via continuous IV infusion. |
| What is Midazolam(Versed)? | A benzodiazepine with strong hypnotic properties. |
| What is Midazolam(Versed)'s duration of effects? | Duration of effects approximately 15 minutes. |
| True or false: Midazolam(Versed) is a good amnesiac but significantly drops BP. | False. Midazolam(Versed) is a good amnesiac with minimal CV effects. |
| How much protein binding for Midazolam(Versed)? | 95% plasma protein bound (similar to other benzodiazepines). |
| Ketamine(Ketlar) is used for rapid induction with IV duration of approximately... | 15 minutes. |
| What does Ketamine(Ketlar) do to the CV system? | Increases heart rate, cardiac output, and blood pressure. |
| How does Ketamine(Ketlar) affect pain and memory? | It is a good analgesic and amnesiac. |
| How does Ketamine(Ketlar) work? | Blocks glutamate excitatory NMDA receptors in CNS. |
| Ketamine(Ketlar) is <blank> lipid soluble and has <blank> protein binding. | HIGHLY lipid soluble with MINIMAL protein binding. |
| What is catalepsy? | Dissociative amnesia. The appearance of being awake, although patients are unresponsive. |
| Why should patients who've received Ketamine(Ketlar) be kept in a quiet place upon emergence? | It stimulates the CNS in the recovery phase. |
| What is Ketamine(Ketlar)'s active metabolite? What is it's relative potency? | Norketamine. 0.25(25%). |
| What breaks Ketamine down into Norketamine? | P450. It is N-demethylated. |
| What is the metabolite of Norketamine? Is it active? | Hydroxynorketamine. It is inactive. |
| How is Norketamine broken down into Hydroxynorketamine? | P450. It is hydroxylated. |
| What happens to Hydroxynorketamine? | It is glucuronated and excreted in urine. |
| Ketamine is used for induction and... | Maintenance. |
| What is the nature of the dangers associated with Ketamine? | Based on the potential of overdosing the patient and the irrevocable nature of IV administration. |
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