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Anesthesia Pharm > Anesthesia Pharm Test 1 Part 3 > Flashcards

Anesthesia Pharm Test 1 Part 3 Flashcards

1
Q

which IV anesthetic is a carboxylated imidazole

A

etomidate

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2
Q

what drug is a good alternative to propofol due to its stable cardiac profile

A

etomidate

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3
Q

Which isomer of etomidate has sedative properties

A

(+) isomer

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4
Q

metabolism of etomidate

A

liver primarily, but also lung and kidney

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5
Q

excretion of etomidate

A

kidney

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6
Q

which IV anesthetic despite its PK profile, is not ideal for drips d/t rapid redistribution

A

etomidate

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7
Q

MOA of etomidate

A

allosterically binds to GABA-A[r] increasing the affinity of the receptor to GABA

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8
Q

CNS effects of etomidate

A
  1. dose dependent sedation 2. lowers CMRO2, ICP, and CPP (MAP dependent) 3. can cause myoclonus 4. suitable for ECT but no preferred
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9
Q

CV effects of etomidate

A

limited to no effect on MAP, CO/CI, SVR, and/or PA pressures post induction

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10
Q

respiratory effects of etomidate

A
  1. dose dep decrease in minute ventilation, and increase in RR 2. relaxes PA vasculature but preserves airway reflexes 3. response to CO2 decreased 4. periods of apnea can occur post-induction
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11
Q

etomidate is not approved for use in children < _____________

A

5

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12
Q

induction dose of etomidate in adults

A

0.2 - 0.3 mg/kg

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13
Q

sedation dose of etomidate in adults

A

5-10 mg PRN; titrate to desired LOC

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14
Q

s/e of etomidate

A
  1. pain on injection 2. increased PONV 3. myoclonus in 10-60% pts 4. adrenocortical suppression by inhibition of 11 B hydroxylase
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15
Q

which IV anesthetic agent is acknowledged as a “dissociative anesthetic”

A

ketamine (breaks communication btwn cortex and brainstem)

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16
Q

which IV anesthetic has similar structure to PCP

A

ketamine

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17
Q

which enantiomer of ketamine is considered safer?

A

S(+); however, no major advantage; sold in US as racemic mixture only!

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18
Q

low dose ketamine is effective for

A
  1. chronic pain management 2. depression 3. PTSD treatment
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19
Q

metabolism of ketamine

A

liver CYP450 via N-demethylation –> norketamine (active metabolite 1/3-1/5 less potent than ketamine)

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20
Q

1/2 life of ketamine is ______________ hours, but is dependent on _________________

A

2-3; hepatic blood flow

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21
Q

MOA of ketamine

A

non-competetitive NMDA antagonism (inhibiting glutamate)

22
Q

CNS effects of ketamine

A
  1. increases limbic activity with simultaneous loss of consciousness 2. increases BIS 3. increases ICP, CMRO2, IOP, and CBF 4. vivid illusions and combativeness with emergence
23
Q

CV effects of ketamine

A

cardiac stimulant - increase BP, HR, CI/CO, and CVP

24
Q

respiratory effects of ketamine

A
  1. bronchodilation 2. maintains airway reflexes 3. increased risk of larygngospasm 2/2 increased salivation
25
Q

IV dose of ketamine for induction in adults

A

1-2 mg/kg

26
Q

IM dose of ketamine for induction in adults

A

4-6 mg/kg

27
Q

po dose of ketamine for induction in adults

A

10 mg/kg

28
Q

IM dose of ketamine in pediatrics

A

6-13 mg/kg

29
Q

TIVA dose of keatmine

A

1-2 mg/kg/hr (rarely the sole agent)

30
Q

sedation dose of ketamine (when used as adjunct)

A

0.1-0.3 mg/kg/hr

31
Q

dose of ketamine for pain

A
  1. bolus 10-25 mg PRN up to 0.5 mg/kg
32
Q

s/e of ketamine

A
  1. emergence phenomena 2. nystagmus 3. increased salivation (anti-sialagogue recommended) 4. induces catatonic state
33
Q

which drug belongs to the class of drugs aka imidozaline

A

dexmedetomidine

34
Q

Alpha2:alpha1 selectivity of dexmedetomidine

A

1620:01:00

35
Q

primary uses of dexmedetomidine

A
  1. sedation 2. analgesia 3. anxiolysis 4. decreased postoperative shivering & agitation 5. CV sympathomimetic actions
36
Q

which IV anesthetic drug undergoes total biotransformation

A

dexmedetomidine

37
Q

metabolism of dexmedetomidine

A

in liver via glucuronidation and CYP450

38
Q

T/F: metabolism of dexmedetomidine does not produce active metabolites

A

TRUE

39
Q

MOA of dexmedetomidine

A

selective alpha-2 agonist in the locus coeruleus

40
Q

CNS effects of dexmedetomidine

A
  1. allows pt to remain arousable 2. no alteration to CMRO2 3. decreases CBF but effects on ICP are non-existant to minimal
41
Q

CV effects of dexmedetomidine

A
  1. dose dependent bradycardia and Hotn 2. paradoxical HTN seen with rapid IVP/large doses
42
Q

respiratory effects of dexmedetomidine

A
  1. respiratory drive maintained 2. airway reflexes preserved 3. no risk of histamine induced bronchospasm 4. can decrease airway reactivity in COPD pts
43
Q

dose of dexmedetomidine for sedation

A

0.3-0.7 mcg/kg/hr

44
Q

bolus of dexmedetomidine dose

A

0.5-1 mcg/kg over 15 minutes

45
Q

_________________ induced hotn responds really well to fluid and/or vasopressor

A

precedex

46
Q

which IV anesthetic produces a diuretic effect

A

dexmedetomidine

47
Q

which IV anesthetic has renal benefits, gastroprotective effects, and anti-inflammatory effects

A

dexmedetomidine

48
Q

Ketamine “SUPER BRAINS”

A
  1. Stimulates SNS 2. Urinary excretion 3. PCP derivative 4. Emergence Delirium 5. Respiratory depression minimal 6. BronchoDILATOR 7. recreational abuse 8. analgesia 9. increased: BP, HR, CO/CI, CVP, PAP, ICP 10. NMDA receptor antagonist 11. salivation
49
Q

Etomidate “HAMPERS”

A
  1. Hypnotic 2. Adrenocortical Suppression (long term use) 3. Minimal CV effects 4. Pain on injection 5. Esterases (and hepatic metabolism) 6. respiratory depression 7. Seizure activity (myoclonic movements)
50
Q

Dexmedetomidine “AB RASH”

A
  1. Alpha-2 agonist 2. Bradycardia 3. Respiratory depression mild 4. Analgesia, anxiolysis 5. Sedation 6. Hotn

Anesthesia Pharm (18 decks)

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