Anesthesiology Rotation

Front 1

What drug class does Sodium thiopental belong to?

Back 1

Barbiturate used for IV induction agent

Front 2

Mechanism of action of Sodium thiopental

Back 2

Depresses RAS. Acts at GABAa and increases chloride conductance.

Front 3

Onset of action for STP

Back 3

30 seconds

Front 4

Half life of STP

Back 4

3-12 hours

Front 5

STP is ____ soluble

Back 5

Lipid

Front 6

CV effect os STP

Back 6

1) decrease BP 2/2 to increase venous capacitance.
2) tachycardia 2/2 to vagolysis

* do not give to hypovolemic patients.

Front 7

Respiratory effects of STP

Back 7

Central medullary respiratory center. Decreases responsiveness to hypoxia and hypercarbia. Patients become apneic.

Front 8

CNS effect of STP

Back 8

cerbrovascular vasoconstriction and decrease cerebral metabolic oxygen requirement.

Front 9

Caustion and precaution assoicated with STP

Back 9

do not use in patients with porphyria or variegate porphyria.

Front 10

Dosage of STP

Back 10

3-6mg/kg

Front 11

t1/2 alpha

Back 11

rapid redistribution phase of drug

Front 12

t1/2 beta

Back 12

elimination phase (slow) of drug in blood and tissue fall down in tandem)

Front 13

Pharmocokinetics

Back 13

Processess of absorphtion distribution and elimination determines how long a drug will remain at target organ (what body does to drug)

Front 14

Pharmacodynamics

Back 14

Biochemical and physiological effects of drugs on body and the mechanisms of drug action and the relationship between drug concentration and effect. (what the drug does to the body)

Front 15

Volume of distribution

Back 15

relates the amount of drug in the body to concentration in blood or plasma VD= Amount of drug in body/ C

Front 16

Clearance

Back 16

ratio of rate of elimination by all routes to the concentration of drug in a biological field. CL= rate of elimination/C

Front 17

Propofol drug clas

Back 17

2.6 diisopropylphenol. Comes as lipid emulsion. emulsified in soybean oil and glycerol and lecithin)

Front 18

Propofol Mechanism of action

Back 18

Facilitates activity of GABA

Front 19

Propofol onset of action

Back 19

rapid (2-8) minutes. Has high hepatic extraction which leads to rapid clearance.

Front 20

CV effects of Propofol

Back 20

decrease in BP and SVR. (hypotension more profound than with STP). Decreased preload and contractility. Don't give to heart patients.

Front 21

Respiratory effects of Propofol

Back 21

will cause apnea. decrease response to hypoxia and hypercarbia. Suppresses upper airway reflexes--> LMA placement.

Front 22

CNS effects of Propofol

Back 22

Like STP. Decreases CBF. Patients with elevated ICP may experience critical decrease in perfusion. ANTI-EMETIC. SE- myoclonus and hiccuping.

Front 23

Caution and precaution associated with Propofol

Back 23

contaminated propofol. Don't leave out for more than six hours.
BURNING on administration. Use lidocaine.

Front 24

Dose of Propofol

Back 24

2-3mg/kg for induction.

Front 25

Class of drug for Etomidate

Back 25

Non barbiturate IC anesthetic induction agent.

Front 26

Mechanism of action of Etomidate

Back 26

Depresses RAS and mimics inhibitory effects of GABA.

Front 27

Solubility of Etomidate

Back 27

highly lipid soluble= rapid onset of anesthesia

Front 28

Metabolism of Etomidate

Back 28

in liver. 1/2 life 2-5 hours (fast)

Front 29

CV effects of Etomidate

Back 29

CARDIOVASCULAR STABILITY. HR, SV, and CO remain stable. MAP decreases 2/2 decrease in SVR. USED IN TRAUMA!!!!

Front 30

Respiratory effects of Etomidate

Back 30

Less ventilatory depression than STP. Still rapid shallow pattern. Decreases ICP if previously raised.

Front 31

SE associated with Etomidate

Back 31

1) Pain on injection due to propylene glycol
2) Myoclonus
3) assoicated with adrenocortical suppression (bad for sepsis)
4) May activate seizure foci- use with caution in patients w/ focal epilepsy.

Front 32

Non depolarizing muscle relaxants

Back 32

competitive antagonists with ACH

Front 33

Succinylcholine

Back 33

non competitive agonist

Front 34

Non depolarzing muscle reactants 2 examples

Back 34

Isoquinolone derivatives= Tubocurarine, cis-atracurium
Steroid derivatives= pancuronium, vecuronium.

Front 35

Rocuronium class

Back 35

newest non depolarizers muscle relaxant. Rapid onset of action and intermediate duration.

Front 36

Rocuronium side effects

Back 36

unlike isoquinolone derived muscle relaxants does not cause histamine release. Duration of action may be prolongedS in the very young and elderly.

Front 37

Rocuronium use in Rapid Sequence Intubation

Back 37

dose of 1.2 mg/kg. Intubate within 60-90 seconds. WILL CAUSE NM BLOCKADE LASTING 30 MINUTES! after single intubating dose. DO NOT USE IN PATIENT WITH CONCERNS OF INTUBATION.

Front 38

Dose of Rocuronium

Back 38

1.2mg/kg for RSI
0.6 for normal intubation

Front 39

Succinylcholine class

Back 39

DEPOLARZING muscle relaxant

Front 40

Succinylcholine structure

Back 40

2 ACH molecules

Front 41

Succinylcholine metabolism

Back 41

Dependent on hetero, homozygous for pseudocholinesterase. Tested with Dibucaine.

Front 42

CV effects of succinylcholine

Back 42

Stimulates nicotinic receptors located in PS and Sympathetic nervous system can lead to variable changes in HR and BP. PROFOUND BRADYCARDIA w/ second dose.

Front 43

MS effects of Succinylcholine

Back 43

FASICULATIONS!

Front 44

Intraocular pressure effects of succinylcholine

Back 44

Increase. Do not use in eye injury.

Front 45

Intracrainial Pressure effects of Succinylcholine

Back 45

Increases. Attenuated by hyperventilation.

Front 46

Succinylcholine major SAE

Back 46

MALIGNANT HYPERTHERMIA- genetic based predisposition to hypermetabolism. Abnormal Ca utilization by the sarcoplasmic reticulum as a result of a defect in the ryanodine receptor. PROLONG MUSCLE CONTRACTION. Leads to Metabolic acidosis.

Hyperkalemia- my cause cardiac arrest in patients susceptible to hyperkalemia.

Front 47

Tx of Malignant hyperthermia (10)

Back 47

- Get help
- Sodium bicarb 1-2mg/kg
-Dantrolene 2.5mg/kg
- Cooling measures
- treat hyperkalemia- glucose and insulin (procainamide for Ventricular dysrythmias)
- Optimize urine output (alkalinize urine to prevent kidney damage)
-ICU monitoring.
Repeat dantrolene 6-8 hours for 24-72 hours
- dantrolene= severe mucle weakness. Remain intubated.

Front 48

Monitoring of succinylcholine

Back 48

Nerve Stimulator technology- twitch. Single impulse delivered every 1-10 seconds and lasting 200 microseconds.

Front 49

Reversal of non depolarizers (rocuronium)

Back 49

Neostigmine and Edrophonium cholinesterase inhibitors increase ACH in cleft. SE= SLUD. must be given with anticholinergic such as glycopyrrolate or atropine.

Front 50

Morphine Class

Back 50

Opioids

Front 51

MOA for Morphine

Back 51

binds to mu, kappa delta and sigma receptors througout CNS. Inhibit presynaptic release and post synaptic response to excitatory NT such as substance P and acetylcholine.

Front 52

Absorption of morphine

Back 52

IV or IM. Rapid, but undergoes first pass elimination.

Front 53

Distribution of morphine

Back 53

Less lipid soluble. Onset is prolonged as is duration.

Front 54

CV effects of morphine

Back 54

Causes histamine release--> decreases CO 2/2 to decreased preload. Bradycardia, and BP.

Front 55

Respiratory effects of morphine

Back 55

Respiratory depresion. Hypoxic drive decreased. CO2 response blunted

Front 56

CNS effect of morphine

Back 56

decreased Cerebral metabolic oxygen consumption and CBF. Can be used for induction but lack amnestic effects. CARDIAC STABILITY.

Front 57

GI effects of morphine

Back 57

Nausea and vomiting. Relieved with naloxone.

Front 58

Miscellaneous effects of morphine

Back 58

CHEST WALL RIGIDITY

Front 59

Fentanyl MOA

Back 59

As per morphine.