4 IV Anesthetics

Question 1

Propofol resp effects

Answer 1

Shifts co2 response down and to right, inhib hypoxic vent drive

Question 2

Risk factors for propofol infusion syndrome

Answer 2

> 4mg/kg/hr (>67mcg/kg/min), gtt >48 hrs, kids, sepsis, inadeq 02 deliv, cerebral injury

Question 3

Presentation of propofol infusion syndrome

Answer 3

Metab acid, rhabdo, fatty liver, renal failure, HLD, lipemia early on, bradycardia

Question 4

How fospropofol is diff

Answer 4

No burning, less microbial growth, slower onset, longer duration. Genital and anal burning

Question 5

Ketamine clearance, excretion of what

Answer 5

Liver p450. Renal excretion of active metabolite

Question 6

When ketamine is a myocardial depressant

Answer 6

Requires an intact sns to inc hr and bp. If depleted catecholamines (sepsis, sympathectomy) will be unmasked

Question 7

Induction agent w smallest amt protein binding, %

Answer 7

Ketamine, 12%

Question 8

Induction agents w largest amt protein binding, %

Answer 8

Prop and valium 98%

Question 9

Induc agent % protein binding: versed, etomidate, precedex, ativan

Answer 9

94, 75, 94, 90

Question 10

Etomidate cv and resp fx

Answer 10

Small dec in SVR/bp, mild resp dep (less than prop and barbs)

Question 11

Induc agent that inc mortality in Addisonian crisis

Answer 11

Etomidate

Question 12

Who to avoid etomidate in

Answer 12

Sepsis or acute adrenal failure

Question 13

Thiobarbs v oxybarb and example

Answer 13

Thio= sulfur, inc potency, TPL. Oxy= 02, methohexital

Question 14

Thiopental: ___ soluble, ph ____, dose, clearance

Answer 14

Water, 9 (alkaline), 2.5 adults 5 peds, liver p450

Question 15

TPL: cv fx

Answer 15

Hypotension, reflex tachy, histamine release

Question 16

TPL resp fx

Answer 16

Bronchoconstriction and co2 response curve shifted right

Question 17

Drugs to avoid w acute intermittent porphyria

Answer 17

Barbs, etomidate, glucocorticoids, hydralazine

Question 18

Acute intermittent porphyria: presentation

Answer 18

Abd pain, psych symptoms, delirium, seizures, neuropathy, coma

Question 19

Acute intermittent porphyria: anes mgmt

Answer 19

Hydration, glucose and heme argininate to dec ala synthase activity, prevent hypothermia

Question 20

Methohexital induc dose

Answer 20

1 mg/kg

Question 21

How precedex resp and cns fx diff from other induc agents

Answer 21

Resp= no change in co2 response curve slope. Dec CBF but nochange in cmro2 and ICP

Question 22

What benzos cant do that prop and barbs can cns wise

Answer 22

Isoelectric eeg

Question 23

Potency benzos greatest to least

Answer 23

Ativan, midaz, valium