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98 Cards in this Set
- Front
- Back
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Which class of drugs does midazolam belong to?
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Midazolam is a short-acting benzodiazepine.
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What is the mechanism of action of midazolam?
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Midazolam is a short-acting benzodiazepine.
As a benzo, it works as a GABA-receptor agonist. |
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What is the dose of and route of administration of midazolam for sedation?
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0.03 - 0.08 mg/kg IV
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How long does it take for midazolam to kick in?
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Onset in 3-5 minutes
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What is the half-life of midazolam?
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1-4 hours
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What are the effects of midazolam?
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1) Anxiolysis/hypnosis
2) Amnesia |
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What is the mechanism of action of propofol?
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Not precisely known, but may act as a GABA receptor agonist and a Na+ channel blocker.
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What is the mechanism of action of ketamine?
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NMDA receptor antagonist
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What is the IV dose of ketamine?
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2 mg/kg
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What is the IM dose of ketamine?
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5 mg/kg
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What class of drugs does sodium thiopental belong to?
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Sodium thiopental is a short-acting barbiturate.
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What is the adult dose of sodium thiopental?
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3-5 mg/kg IV
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To which class of drugs does succinylcholine belong?
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Depolarizing muscle relaxants
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What is the mechanism of action of succinylcholine?
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Binds to nicotinic cholinergic receptors at neuromuscular junction causing depolarizing and subsequently blocking any re-stimulation by acetylcholine.
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Name three volatile gases employed in the maintenance phase of general anesthesia.
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Desflurane
Isoflurane Sevoflurane |
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What is the relationship between the solubility of a gas in blood and its rate of onset/offset?
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Nitrous oxide, which is less soluble in blood, builds up its MAC quickly and thus has a very quick onset and offset.
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What does nitrous oxide smell like?
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Odourless
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What does isoflurane smell like?
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Pungent
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What does sevoflurane smell like?
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Sweet
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What does desflurane smell like?
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Pungent
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Which volatile agent smells sweet?
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Sevoflurane
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What is the route of elimination of the body of the volatile gases?
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Lungs
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Name an absolute contraindication for the use of volatile gases desflurane, isoflurane, and sevoflurane.
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Patient with known or suspected malignant hyperthermia.
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What is the intubating dose of rocuronium?
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0.6-1 mg/kg
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What is the maintenance/repeat dose of rocuronium?
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0.1 mg/kg
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How long till onset of rocuronium?
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1-1.5 minutes
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What is the duration of rocuronium after the initial intubation dose is given?
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30-60 minutes
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How are NDMR agents reversed?
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Anticholinesterase drugs
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Name three anticholinesterases used as reversal agents.
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Edrophonium
Neostigmine Pyridostigmine |
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Describe the distribution of cardiac output between the liver, kidneys, muscle, and brain.
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Liver 27%
Kidneys 22% Muscle 15% Brain 15% |
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What does "metabolism" mean in the context of pharmacokinetics.
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Metabolism is the alteration of the parent drug
More here. |
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What is elimination?
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Elimination is the permanent removal of the parent drug or its metabolites from the body.
Most drugs are eliminated through the kidney or the liver. |
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Name the barbiturate that used to be used as an inducing agent.
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Sodium thiopental
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Name a common side-effect of propofol.
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Pain at injection site during injection
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Propofol is contra-indicated in patients with which allergy?
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Soy, eggs
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What are the effects of opioids on the respiratory system?
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Respiratory depression
Suppression of cough reflex |
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What are the effects of opioids on the cardiovascular system?
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Bradycardia
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What are the effects of opioids on the GU system?
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Urinary retention
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Which type of receptor is on the muscle of skeletal muscle?
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Nicotinic? Muscarinic?
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What is the mechanism of NDMRs?
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Bind to acetylcholine receptor without causing depolarizing
Blocking of receptor |
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Which class of drugs does neostigmine belong to?
What is it used for? |
Anticholinesterase
Used for reversal of paralysis. Anticholinesterase agents block acetylcholinesterase, allowing acetylcholine to compete for the receptor and cause depolarization. |
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What are the systemic effects of neostigmine throughout the body?
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Increased acetylcholine throughout the body, increased action on both muscarinic and nicotinic receptors
Effects on muscarinic receptors: -bradycardia -salivation and increased airway secretion -bronchoconstriction -GI hyperactivity -Miosis |
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What agent is paired with neostigmine and why?
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Glycopyrrolate to combat the effects of acetylcholine on muscarinic cholinergic receptors.
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What is minimum alveolar concentration MAC?
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The minimum alveolar concentration (MAC) is the concentration (in volume %) of anesthetic agent in the alveoli that prevents 50% of people from moving in response to a standard surgical stimulus (incision).
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What are the two most commonly available local anesthetics?
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Lidocaine (Xylocaine)
Bupivacaine (Marcaine) |
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What is the main difference between lidocaine and bupivacaine?
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Lidocaine: rapid onset, short-acting
Bupivacaine: moderate onset, long-acting |
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What are the three concentrations that bupivacaine is routinely available in?
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0.25%, 0.5%, and ....
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Which two organ systems are most commonly affected by the Na+ channel blockade of local anesthetics?
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CNS (brain)
CVS (heart) |
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What are the neurologic symptoms/signs of lidocaine toxicity/
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Paraesthesia (classically numbness around the lips)
Tinnitus Copper taste in mouth Seizure Coma Death |
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Between lidocaine and bupivacaine, which is most likely to cause neurologic toxicity?
Toxic cardiovascular effects? |
Neuro - lidocaine
Cardio - bupivacaine |
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What can you do to increase your dose of local anesthetic without increasing toxicity?
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Add the vasoconstrictor epinephrine to prevent the drug from going systemic
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What is the toxic dose of lidocaine?
What about when it's paired with epinephrine? |
Without epi: 5mg/kg
With epi: 7mg/kg |
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What is the toxic dose of bupivacaine?
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Without epi: 2.5 mg/kg
With epi: 3 mg/kg |
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What is Xylocaine?
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Lidocaine
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What is Marcaine?
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Bupivacaine
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Do anesthetic drugs cross the placenta?
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Most do.
The exceptions are the muscle relaxants. You must consider the fetal effects of drugs administered to the mother. |
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Have anesthetic drugs given during pregnancy been shown to be teratogenic?
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Not definitively
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Is the MAC increased or decreased in the obstetric patient?
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Decreased due to hormonal changes
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Describe a difference in the airway of the obstetric patient.
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More edema, increased adipose tissue may make airway more difficult to visualize
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How is minute ventilation different in the obstetric patient?
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Minute ventilation increased
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How is the FRC different in the obstetric patient?
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Decreased FRC due to cephalad displacement of diaphragm
This means they have decreased oxygen reserve. They will desaturate easily. |
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Give three special considerations in the obstetric patient.
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1) Increased sensitivity to anesthetic agents
2) Difficult intubation 3) Potential for reflux and intubation 4) Increased susceptibility to hypoxemia on induction 5) Presence of aortocaval compression in supine position 6) Two patients: fetus and mother, one's health is affected by the other. |
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What is the adult dose of propofol?
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2-2.5 mg/kg
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What is the paediatric dose of propofol?
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3-4 mg/kg
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What is the time of onset of propofol?
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Within one arm-brain circulation time (very quickly)
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Describe the metabolism and elimination of propofol.
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Hepatically metabolized, eliminated by kidney
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How long does a single induction dose of propofol last?
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5-8 minutes
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What affect does propofol have on the cardiovascular system?
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Cardiovascular depression causing hypotension
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Name a common adverse effect of propofol.
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Pain at injection site during injection
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Name a common contraindication for propofol.
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Egg or soy allergy
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What is the intubating dose of rocuronium?
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0.6-1 mg/kg
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What is the repeat dose of rocuronium?
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0.1 mg/kg
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How long until the onset of rocuronium?
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1.5 minutes
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How long does the intubating dose of rocuronium last?
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30-60 minutes
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Describe the potential adverse effects of an anticholinesterase agent (e.g. neostigmine)
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Increase of acetylcholine at muscarinic receptors as well as nicotinic receptors results in a cholinergic toxicity picture:
1) Increased salivary and respiratory secretions, pupilary constriction 2) Bronchospasm 3) Bradycardia and heart block 4) Intestinal spasm 5) Increased bladder tone |
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What is pathologic constriction of the pupil referred to as?
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Miosis
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What is pathologic dilation of the pupil referred to as?
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Mydriasis
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What is mydriasis?
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Pathologic dilation of the pupils
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What is miosis?
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Pathologic constriction of the pupils
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With which class of drug are anticholinesterase agents such as neostigmine given and why?
Give two commonly used examples from this drug class. |
Anticholinergics to combat the increased cholinergic activity on muscarinic receptors
Glycopyrrate Atropine |
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What is the dose of neostigmine?
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0.025 - 0.075 mg/kg
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How long till onset of neostigmine?
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Intermediate onset (around 5 minutes)
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How long does neostigmine last?
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50-75 minutes
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When are opioid analgesics typically introduced into the patient?
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As a loading dose prior to intubation
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What is the induction dose of sufentanil?
What is the induction dose of remifentanil? |
0.25 - 2 micrograms/kg
1 - 2 microgram/kg |
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What is the intra-op maintenance dose of sufentanil?
Remifentanil? |
Sufentanil:
0.25 - 2 micrograms/kg/hr Remifentanil 0.1 - 1 micrograms/kg/min |
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How quick is the onset of action of sufentanil?
Remifentanil? |
Sufentanil:
4-6 minutes Remifentanil: 1-2 minutes |
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How long do the effects of sufentanil last?
Remifentanil? |
45 - 90 minutes
1-4 minutes |
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What are the effects of opioids on the cardiovascular system?
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Bradycardia
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What are the effects of opioids on the respiratory system?
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Depressed respiratory rate
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What effects do opioids have on the pupils?
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Miosis
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1 MAC of sevoflurane contains ___% sevoflurane.
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2%
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1 MAC of desflurane contains ___% desflurane.
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6%
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1 MAC of nitrous oxide contains ___% nitrous oxide.
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104%
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1 MAC of isoflurane contains ___% isoflurane.
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1.15%
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Describe the additive effects of inhalational agents.
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A total of 1 MAC is needed... this MAC doesn't belong to any particular inhalational agent so it's a bit confusing.
For example, if the alveolar concentration of gas contains 52% nitrous oxide, that's 1/2 a MAC of nitrous oxide. If the same solution contains 1% sevoflurane, that's 1/2 a MAC of sevoflurane. The total is 1/2 + 1/2 for a total of 1 MAC! |
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What are the effects of volatile inhalational agents on the cardiovascular system?
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Hypotension
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What are the effects of volatile inhalational agents on the respiratory system?
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Rapid, shallow respiratory pattern
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