Pharm-Iv Anesthetics

Front 1

What is the mechanism of action for barbiturates?

Back 1

-enhance the effects of GABA

Front 2

What does enhancing the effects of GABA do?

Back 2

-increases transmembrane chloride conductance

Front 3

What does hyperpolarization do to the cell?

Back 3

-hyperpolarization of the post-synaptic cell membrane functionally inhibits the post-synaptic neuron

Front 4

Where does Barbituates work in the brain? What do they do?

Back 4

Work in the RAS to depress.

Front 5

What is the other name for Sodium Thiopental?
Concentration?

Back 5

pentothal
2.5% solution (25mg/ml)

Front 6

What is the other name for Methohexital?
Concentration

Back 6

Brevital
10% solution (10mg/ml)

Front 7

What is the most commonly used barbiturate for induction of general anesthesia?

Back 7

sodium thiopental (pentothal)

Front 8

What barbiturate has the shortest mechanism of action?

Back 8

Methohexital (Brevital)

Front 9

What are some procedures Methohexital is used for?

Back 9

-Electroconvulsant therapy
-Cardioversion
-AICD Checks

Front 10

What is the induction dose for Sodium Thiopental?

Back 10

3-5mg/kg

Front 11

What is the induction dosage for Methohexital?

Back 11

1-2mg/kg

Front 12

How long does it take to produce unconsciousness for Methohexital and Sodium Thiopental?

Back 12

30-60seconds

Front 13

Methohexital and Sodium Thiopental return to consciousness time?

Back 13

5-15 minutes after the inital bolus

Front 14

How is the duration of action of Sodium Thiopental and Methohexital determined by?

Back 14

-Redistribution of drug away from the CNS to inactive tissue depots

Front 15

Are Sodium Thiopental and Methohexital lipid soluable?

Back 15

Yes they are highly lipid soluable

Front 16

What organs do the Barbituates equilbrate with?

Back 16

The VRG, organs that recieve a high % of cardiac output.

Front 17

Describe what happens once plasma: brain equilbrium is reached.

Back 17

The drug will diffuse out of the brain (VRG) and redistributes to less vascular tissues including the msucle and fat group, and the vessle poor group.

Front 18

What makes a single dose of barbiturate short acting?

Back 18

-because of its rapid distribution of drug away from the brain

Front 19

What is the termination of action of barbiturates the result of?

Back 19

-redistribution

Front 20

How do these barbiturates move in its pressure gradient?

Back 20

It moves down pressure or concentration gradients

Front 21

How do barbiturates affect the cerebral and CNS?

Back 21

-potent anticonvulsants
-except methohexital

Front 22

What are barbiturates effect on cerebral flow and pressure?

Back 22

-Potent cereberal vasoconstrictors
-decrease cerebral blood flow
-decrease ICP
-decrease CMRO2

Front 23

What are some negative effects of sodium thiopental?

Back 23

-can have a hangover affect
-increase incidence of PONV compared to Propofol
-no amnesia
-no analgesia
(thought to be anti-analgesic-increase resopnse to stimuli)

Front 24

The barbiturates effect on BP and why?

Back 24

-Decreases blood pressure secondary to peripheral vasodilation and decreased venous return

Front 25

Is cardiac output affected by bariturates?

Back 25

-it is typically maintained due to barorecptor mediated reflex increase in HR

Front 26

What is the affect to myocardial contracility from barbiturates?

Back 26

minimal to no depression of myocardial contractility

Front 27

Use barbiturates with caution in this type of pts.

Back 27

Cardiovascularly compromised
-hypovolemic
-acidotic
-cardiomyopathy

Front 28

what kind of effects do barbiturates have on the resp system?

Back 28

-decreased response to hypercarbia (increased PaCO2)
-decreased response to hypoxia
-usually produces apnea

Front 29

What is the mechanism of action for benzos?

Back 29

-facilitate the action of GABA in the CNS
-GABA inhibits normal neuronal outflow

Front 30

What is another name for midazolam?

Back 30

-versed

Front 31

What is another name for Diazepam?

Back 31

Valium

Front 32

What is another name for Lorazepam?

Back 32

Ativan

Front 33

What are some clinical uses for benzos?

Back 33

-sediation and anxiolysis prior to surgery
-Component of MAC for conscious or deep sedation.
-Rarely used for induction for GA.

Front 34

What is the dose of sedation for benzos for children preoperatively?

Back 34

-0.5mg/kg po (give 30min prior to procedure)

Front 35

What is the responsible for awakening after a single dose of benzos?

Back 35

redistribution

Front 36

What is the elimination half-life of diazepam?

Back 36

-30hours

Front 37

What is the elimination half-life for desmethyldiazepam?

Back 37

48-96 hrs

Front 38

Where are benzos metabilized?

Back 38

liver

Front 39

Where is benzos excreted?

Back 39

kidney

Front 40

What are the effect of benzos on cerebral and CNS?

Back 40

-potent anticonvulsants
-provide anterograde amnesia

Front 41

Benzos effect on cerebral flow and pressure.

Back 41

-Cerebral vasoconstrictors
-Reduce CBF
-Reduce ICP
-Reduce CMRO2

Front 42

Benzo effects on CV system

Back 42

-Minimal CV Depression
-Careful in compromised pt

Front 43

What are the effects of Benzos on the resp system?

Back 43

-dose dependent ventilatory depression
-lg doses may cause apnea or obstruction (expecially in MO or OSA)

Front 44

What is another name for propofol?

Back 44

Diprivan

Front 45

What is the mechanism of action for propofol?

Back 45

Facilitates GABA mediated inhibitory neurotransmission

Front 46

What is propofol used for?

Back 46

-induction of GA (most commonly used)
-continuous infusion for maint of GA
-Deep procedural sedation (MAC)

Front 47

Chemical make-up of propofol.

Back 47

Oil in water emulsion containing oil, glycerol and egg lecithin.

Front 48

Use propofol in caution with?

Back 48

Egg allergies
(low reaction risk, but HUGE legal risk)

Front 49

When injecting propofol what should you be aware of?

Back 49

Can cause pain on injection. Either pre-treat or alert pt.

Front 50

Propofol's storage limits and why this is so important.

Back 50

-Use aseptic technique and discard after 6 hrs after drawing into a syringe.
-Supports bacterial growth and has had reported overwhelming septicemia and death.

Front 51

T or F propofol is a potent antiemetic.

Back 51

-True it possesses antiemetic properties

Front 52

What is the onset of propofol?
Similar to what other IV anesthetic?

Back 52

30-60seconds
Sodium Thiopental

Front 53

What is the duration of action for propofol?

Back 53

2-8 minutes

Front 54

What is awakening the result of for propofol?

Back 54

redistribution of drug away from CNS

Front 55

Where is propofol metabolized?

Back 55

the liver

Front 56

Where is propofol excreted?

Back 56

Kidneys as inactive metabolites

Front 57

T or F propofol has shorter awakening times following continuous infusion or multiple boluses.

Back 57

False-longer awakening times following continuous infusion

Front 58

What is the induction dose of propofol?

Back 58

1-3mg/kg

Front 59

What is the maintenance infusion for GA w/ propofol?

Back 59

50-200 mcg/kg/min

Front 60

What is the infusion dose for deep sedation with propofol?

Back 60

-10-200mcg/kg/min

Front 61

Concentration of Propofol

Back 61

10mg/ml

Front 62

How does propofol affect CBF and ICP?

Back 62

-cerebral vasoconstriction
-Decreased CBF
-Decreased ICP
-decreased CMRO2

Front 63

Cerebral and CNS effects of Propofol

Back 63

-Anticonvulsant
-No analgesia
-Similar degree of amnesia compared to Versed

Front 64

CV effects with Propofol.

Back 64

-Decreased BP
-Decreased SVR
-Decreased myocardial contracility
-Profound bradycardia and asystole in even healthy adults

Front 65

Resp effects with Propofol

Back 65

-resp depressant
-decrease response to hypercarbia
-decreased response to hypoxia
-airway obstruction is common

Front 66

What is another name for Etomidate?

Back 66

Amidate

Front 67

What is the mechanism of action for etomidate?

Back 67

-facilitates the effects of GABA
-depresses RAS

Front 68

What are some clinical uses for etomidate?

Back 68

-induction of GA
-Procedural sedation:
Cardioversions
AICD Check
Out of OR intubation

Front 69

What agent is the most benign in respect to hemodynamic effects of the induction drugs?

Back 69

Etomidate

Front 70

What is the induction dose for etomidate?

Back 70

-0.2-0.4mg/kg
-Supplied in 2mg/ml concentration

Front 71

What is a common SE of etomidate after administration?

Back 71

-30-60% incidence of myoclonic activity
-pain on administration

Front 72

Induction dose of etomidate causes transient __________suppression?

Back 72

adrenocortical suppression (suppression of stress response)

Front 73

Etomidate PONV

Back 73

Increased incidence when compared to other barbiturates

Front 74

What is the onset of etomidate?

Back 74

30-60seconds

Front 75

What is responsible for awakening from etomidate?

Back 75

redistribution

Front 76

Where is etomidate metabolized?

Back 76

liver

Front 77

Where is etomidate excreted?

Back 77

Kidney

Front 78

Etomidate Cerebral effects:

Back 78

-weak amnestic
-no analgesia
-NO ANTICONVULSANT prop.

Front 79

Etomidate CBF and ICP effects

Back 79

-Cerebral Vasoconstriction
-Decreased ICP
-Decreased CMRO2

Front 80

Etomidate CV effects

Back 80

very stable
-min change in HR, SV or CO
-min change in MAP

Front 81

What is the effects to the respiratory system from Etomidate?

Back 81

-less respiratory depression than propofol or barbiturates
-may be useful when maintenance of spont vent is desired
-lg doses may produce apnea or airway obstruction

Front 82

What is another name for Ketamine?

Back 82

Ketalar

Front 83

What is the mechanism of action for ketamine?

Back 83

-produces dissociative anesthesia
-no GABA interactions
-Dissociates the thalamus from the limbic cortex

Front 84

What type of appearance does the pt who gets ketamine have?

Back 84

Conscious but unable to process or respond to sensory input.
catatonic type appearance

Front 85

What are the uses for Ketamine?

Back 85

-induction of general anesthesia
-IV sedation of adult and ped population
-trauma

Front 86

Ketamine is the sole anesthetic for ________patients and __________compromised pts?

Back 86

trauma, hemodynamically

Front 87

What is the induction dose of ketamine?

Back 87

1-2mg/kg IV for GA
3-5mg/kg IM for Induction/sedation

Front 88

What is the IM dose for Ketamine?

Back 88

3-5mg/kg IM for induction/sedation

Front 89

Ketamine is a structural analogue of what?

Back 89

phencyclidine (PCP)

Front 90

Why does Ketamine have a bad rap?

Back 90

-can cause emergence delerium or hallucinations and nightmares during emergence

Front 91

what does ketamine do to secretions?

Back 91

causes tremendous increase in oropharyngeal secretions

Front 92

What is the onset of action of Ketamine?

Back 92

Rapid onset after IV
2-5 minutes after IM

Front 93

What is responsible for awakening after one bolus dose of Ketamine?

Back 93

redistribution

Front 94

Where is ketamine metabolized?

Back 94

extensively in liver with some weakly active metabolites

Front 95

Where is ketamine excreted?

Back 95

Kidney

Front 96

What does ketamine do to cerebral and CNS?

Back 96

-increased CBF
-increased ICP
-increased CMRO2

Front 97

Does ketamine provide analgesia or amnesia?

Back 97

-yes profound analgesia
and amnesia

Front 98

At what doses will ketamine give excellent analgesia?

Back 98

0.2-0.5mg/kg

Front 99

What are effects of Ketamine on CV system?

Back 99

-increased MAP
-increase HR
-Increased CO
-Increased myocardial O2 demand
Direct CNS stimulation causing increased SNS activity

Front 100

Is the ventilatory drive affected by ketamine?

Back 100

-minimally affected
-vent response to PaCO2 maintained
-Upper airway reflexes remain intact
-beware of airway obstruction

Front 101

What is the main affect of ketamine to respiratory system?

Back 101

-potent bronchodilator

Front 102

what is another name for Dexmedetomidine?

Back 102

Precedex

Front 103

What is the mech of action for Precedex?

Back 103

highly selective and very potent alpha-2 agonist

Front 104

How does precedex work to reduce BP?

Back 104

-works centrally and peripherally

Front 105

what is the loading dose of precedex?

Back 105

-1mcg/kg over 10minutes

Front 106

What is the infusion dose of precedex?

Back 106

0.2-0.7mcg/kg/hr

Front 107

Precedex 3 specific actions

Back 107

1) Decreased BP and HR
2) analagesia
3) sedation/anxiolysis

Front 108

Precedex mech of action for sedation.

Back 108

Hyperpolarization of neurons in the locus cereleus

Front 109

Precedex mech of action for analgesia

Back 109

Alpha-2-receptors in the spinal cord (dorsal horn)

Front 110

Precedex effect on MAC

Back 110

Linear decrease in MAC

Front 111

Precedex use in what situations

Back 111

-Awake fiberoptic intubation
-MO-gastric bypass
-Fast track CV cases