Chapter 10, Part 2- Review Exam #3

Front 1

What are four characteristics of etomidate?

Back 1

1. Hypnosis
2. No analgesic properties
3. CV stability
4. Carboxylated imidazole derivative

Front 2

What are three side effects of etomidate?

Back 2

1. pain on injection
2. myoclonus
3. adrenal cortical suppression

Front 3

Which isomer has hypnotic properties?

Back 3

+

Front 4

How is etomidate metabolized?

Back 4

in the liver by hepatic microsomal enzymes and plasma esterases

Front 5

What is etomidates primary mode of metabolism?

Back 5

ester hydrolysis

Front 6

What accounts for the extremely short duration of action?

Back 6

The rapid distribution half-life

Front 7

Is etomidate lipid soluble? Characteristics of Vd.

Back 7

Yes, has a volume of distribution several times greater than its body weight

Front 8

The total body clearance of etomidate is rapid, how many times greater than thiopental?

Back 8

5x

Front 9

WHat is the hepatic extraction ratio of etomidate?

Back 9

67%

Front 10

Awakening occurs how many minutes after initial bolus administration?

Back 10

7-14 min

Front 11

What % protein bound is etomidate?

Back 11

76%

Front 12

What receptor does etomidate work at?

Back 12

GABA a

Front 13

Does etomidate cause histamine release?

Back 13

yes

Front 14

What is the induction dose of etomidate?

Back 14

0.2-0.4 mg/kg

Front 15

What effects does etomidate have on the CNS?

Back 15

decrease CRMO2, CBF, ICP

Front 16

Although ICP is reduced what is maintained?

Back 16

CPP

Front 17

What may myoclonus may be caused by?

Back 17

uneven drug distribution into the brain stem or deep cerebral structures and not to CNS stimulation

Front 18

Myoclonus is decreased with pretreatment of what two drugs?

Back 18

fentanyl and diazepam

Front 19

Does etomidate decrease IOP?

Back 19

yes

Front 20

Why is etomidate not used with SSEPs?

Back 20

increases wave amplitude

Front 21

Although, etomidate has no effect on CV, when has a decrease in BP been caused by?

Back 21

aortic and mitral valve disease

Front 22

What is the order of cardiorespiratory depression?

Back 22

Propofol>thiopental>etomidate

Front 23

What are the respiratory effects of etomidate?

Back 23

reduction in minute ventilation while respiratory rate is increased

Front 24

What may be blunted by etomidate?

Back 24

response to CO2, may cause brief periods of apnea followed by a period of hyperventilation

Front 25

Etomidate causes what else?

Back 25

Adrenocortical suppression

Front 26

How long does the adrenalcortical suppression last?

Back 26

4 days

Front 27

Does etomidate cause pain on injection?

Back 27

yes

Front 28

With etomidate what is common on onset?

Back 28

myoclonia

Front 29

Does etomidate increase N/V?

Back 29

yes

Front 30

3 features of ketamine

Back 30

1. pKa of 7.5
2. partially water soluble
3. slightly acidic

Front 31

Chemical structure of ketamine

Back 31

Optically active drug with chiral center. It exists as two optical isomers

Front 32

Which isomer has less side effects?

Back 32

S(+) isomer

Front 33

What is the primary site of analgesic action of ketamine?

Back 33

thalamoneocortical system

Front 34

What is the mechanism of action of ketamine?

Back 34

antagonism at N-methyl-D-aspartate amino acid (NMDA) receptors in the brain

Front 35

Characteristics of NMDA receptor

Back 35

ligand-gated ion channel where anions Ca+2 and Na+ are voltage dependent

Front 36

What is the most important excitatory NT in the CNS?

Back 36

L-glutamate

Front 37

What does L-glutamate do at the NMDA receptor?

Back 37

it causes opening of the channel causing rapid influx of NA+, Ca2+ and K+ cause depolarization of normally negative postsynaptic membrane that initiates action potential

Front 38

With ketamine the cortical area are depressed what is still stimulated?

Back 38

limbic system (causes excitatory behavior)

Front 39

Ketamine also induces electrophysiologic changes that reduce _________ turnover

Back 39

acetylcholine

Front 40

What drug can reverse ketamine sedative effects but not analgesic?

Back 40

Physostigmine

Front 41

Ketamine may act as an agonist at which receptors?

Back 41

opiate

Front 42

What biotransform ketamine?

Back 42

Hepatic microsomal enzymes

Front 43

Primary pathway for ketamine metabolism by P-450 is?

Back 43

demethylation to form metabolite I, norketamine

Front 44

Pharmacological activity of the metabolite norketamine is approx?

Back 44

20-30%

Front 45

With IV ketamine peak plasma concentrations are reached within?

Back 45

5 min of IV injection

Front 46

Termination of ketamine is ____ min.

Back 46

10-15

Front 47

Which drug does not have cumulative effects?

Back 47

etomidate

Front 48

Hepatic extraction of ketamine is ____. Ketamine is dependent on what for its extraction?

Back 48

high (therefore ketamine extraction is dependent on hepatic blood flow)

Front 49

Ketamine IM reaches peak plasma concentrations at ?

Back 49

22min

Front 50

What is the IM dose of ketamine?

Back 50

4-6mg/kg to 5-10mg/kg

Front 51

What is the onset of ketamine IM?

Back 51

2-3 minutes

Front 52

What analgesic dose is required for ketamine?

Back 52

0.44 mg/kg

Front 53

Does ketamine cross the placenta?

Back 53

yes, highly lipid soluble

Front 54

What dose of ketamine does not cause CNS depression in the newborn?

Back 54

0.2 to 1mg/kg

Front 55

Ketamine causes?

Back 55

dissociative anesthesia

Front 56

CNS effects of ketamine?

Back 56

Increase CRMO2, CBF, CSP

Front 57

What can attenutate the CNS effects of ketamine?

Back 57

hyperventilation

Front 58

What EEG waves are seen?

Back 58

alpha waves transition to theta waves

Front 59

What reduce the occurrence of emergence delerium associated with ketamine?

Back 59

benzo's

Front 60

What are the CV effects of ketamine?

Back 60

-↑BP, HR, CO, CVP
--↑PVR(42%), PAP(47%), right ventricular stroke work.

Front 61

Ketamine activates?

Back 61

the SNS, results in endogenous catecholamine release

Front 62

What may blunt cardiac stimulation?

Back 62

inhalational anesthetics and benzos

Front 63

Respiratory effects from ketamine

Back 63

Respiratory depression which is reflected in decrease in tidal volume over respiratory rate. Begins 2-3 minutes after parental administration

Front 64

What positive effect does ketamine produce related to respiratory system?

Back 64

bronchodilation

Front 65

Ketamine is a ________ derivative.

Back 65

Phencyclidine

Front 66

Use caution in these patients when using ketamine. 7

Back 66

HTN, angina, CHF, ↑ICP and IOP, psychiatric disease and airway problems

Front 67

Ketamine may be used for induction of anesthesia what 5 high risk patients?

Back 67

-Shock
-Severe dehydration
-Severe anemia
-Bronchospasm
-One-lung ventilation

Front 68

Onset of ketamine is....

Back 68

slow

Front 69

What is the chemical structure of propofol?

Back 69

2,6-diisopropyl phenol

Front 70

Propofol is prepared in a milky white emulsion of?

Back 70

10% soybean oil, 2.25% glycerol, and 1.2% purified egg lecithin

Front 71

Rapid distribution to the central to the peripheral compartments produces a?

Back 71

rapid awakening after sedative and anesthetic doses

Front 72

What characteristic of propofol differentiates from thiopental?

Back 72

its rapid metabolic clearance, which actually exceeds hepatic blood flow

Front 73

What disease may prolong effects of propofol?

Back 73

liver disease

Front 74

Elderly require what type of doses of propofol?

Back 74

reduced

Front 75

Children require what type of doses?

Back 75

larger

Front 76

What is the mechanism of action of propofol?

Back 76

Acts on GABA inhibitory neurotransmitter and GABAa receptor

Front 77

Does intraarterial injection of propofol cause injury?

Back 77

no

Front 78

What are the CNS effects of propofol?

Back 78

↓CMRO2, CBF, ICP and CPP
-cerebral autoregulation and reactivity change in CO2 are intact

Front 79

EEG shows?

Back 79

delta waves, burst suppression with higher doses

Front 80

Propofol may produce spontaneous excitatory movements secondary to?

Back 80

selective disinhibition of subcortical areas

Front 81

Does propofol reduce IOP?

Back 81

yes

Front 82

What else has been associated with propofol?

Back 82

Opisthotonos

Front 83

CV effects from propofol?

Back 83

Produces significant cardiac depression

Front 84

Respiratory effects of propofol?

Back 84

↓ in TV are more prominent than ↓ in respiratory rate, apnea is common on initial administration of induction doses.

Front 85

What are contraindication of propofol?

Back 85

a. Hypersensitivity reactions
b. Caution with elderly, debilitated, cardiac-compromised
c. Generic contains sodium metabisulfite, sulfite sensitivitymore common in asthmatic patients.

Front 86

What is the induction dose of propofol?

Back 86

0.5 to 2.5mg/kg

Front 87

What is the induction dose of propofol for a child?

Back 87

2.5-3mg/kg

Front 88

What is the common denominator of propofol infusion syndrome?

Back 88

impaired systemic microcirculation with tissue hypoperfusion and hypoxia

Front 89

What occurs in propofol infusion syndrome?

Back 89

Fatty acid metabolism and mitochondrial activity is impaired which creates an oxygen supply-demand mismatch that results in cardiac and peripheral muscle necrosis

Front 90

What are the symptoms of propofol infusion syndrome? 7

Back 90

metabolic acidosis, refractory cardiac failure, persistent bradycardia refractory to treatment, fever, lipemia, rhabdomyolysis and possible renal failure

Front 91

Reformulation of propofol that retards bacterial growth?

Back 91

EDTA

Front 92

Is propofol a bronchodilator?

Back 92

no

Front 93

Does propofol have antiemetic properties?

Back 93

yes