Apex IV anesthetics

Question 1

Propofol MOA

Answer 1

Direct GABA-A agonist- increases CL conductance - neuronal hyperpolarization

Question 2

Propofol clearance

Answer 2

Liver p450 enzymes

extrahepatic clearance in the lungs

Question 3

propofol cardiovascular effects

Answer 3

decreased BP
decreased SVR
decreased venous tone-decreased preload
decreased myocardial contractility

Question 4

Propofol respiratory effects (which way of the shift?)

Answer 4

shift co2 response cure down and to the right respiratory depression and or apnea
inhibits hypoxic ventilatory drive

Question 5

propofol CNS effects

Answer 5

decreases cerebral oxygen consumption (CMRO)
decreases cerebral blood flow
decreases intracranial pressure
decreases intraocular pressure
anticonvulsant properties

Question 6

does propofol provide analgesia

Answer 6

NOOOO

Question 7

why does propofol turn urine green

Answer 7

Phenol excretion

Question 8

allergy to consider with propofol

Answer 8

the only person you might be concerned with is people who have allergy to egg. but they are PROBABLY SAFE

Question 9

risk factors for propofol infusion syndrome

Answer 9

propofol dose>75
children>adults
infusion >48hours
inadequate oxygen delivery
sepsis
significant cerebral injury

Question 10

clinical presentation for propofol infusion syndrome

Answer 10

acute refractory bradycardia-asystole-
metabolic acidosis
rhabdomyolysis
enlarged or fatty liver
renal failure
hyperlipidemia
lipemia(cloudy plasma or blood)

Question 11

treatment for propofol infusion syndrom

Answer 11

discontinue propofol
maximize gas exchange
cardiac pacing
PDE inhibitiros
glucagon
ecmo
RRT

Question 12

propofol in a syringe must be discarded after how many hours

Answer 12

6hr

Question 13

propofol infusion must be discarded after how many hours

Answer 13

12hr

Question 14

propofol dose antipruritic

Answer 14

10mg

Question 15

propofol dose antimetic

Answer 15

10-15mg

Question 16

fospropofol

Answer 16

a prodrug

warn your patients of genital and anal burning

Question 17

ketamine class

Answer 17

phencyclidine derivative

Question 18

ketamine MOA

Answer 18

NMDA receptor antagonist antagonizes GLUTAMATE!!

Question 19

ketamine induction dose

Answer 19

1-2mg/kg

Question 20

ketamine duration

Answer 20

10-20 minutes

Question 21

clearance of ketamine

Answer 21

liver p450enzyme

Question 22

ketamine cardiovascular effects

Answer 22

increase SNS tone
increase cardiac output
increase heart rate
increase svr
increase PVR

Question 23

ketamine respiratory effects

Answer 23

bronchodilation
upper airway muscle tone and airway reflexes remain intact
maintains respiratory drive -brief period of apnea may occur
does not significantly shift the co2 response cure
increase oral and pulmonary secretions

Question 24

ketamine CNS effects

Answer 24

increase cerebral oxygen consumption
increase cerebral blood flow
increase intracranial pressure
increase intraocular pressure
increase EEG activity
nystagmus 
Emergence Delirium

Question 25

ketamine and analgesia

Answer 25

provides good analgesia and opioid sparing effect relieves somatic pain>visceral pain blocks central sensitization and windup in the dorsal horn of the spinal cord prevents opioid induced hyperalgesia analgesic properties- good for burn patients

Question 26

ketamine protein binding

Answer 26

12%

Question 27

etomidate dose

Answer 27

0.2-0.4mg/kg

Question 28

etomidate MOA

Answer 28

Gaba-A agonist

Question 29

etomidate key benefit

Answer 29

HEMODYNAMIC STABILITY

Question 30

etomidate CNS effects

Answer 30

``` decrease Cerebral oxygen consumption decrease cerebral blood flow decrease intracranial pressure cerebral perfusion pressure remains stable no analgesia ```

Question 31

etomidate and PONV

Answer 31

it is more common than any other induction agent

Question 32

Name one condition that etomidate can't be used with

Answer 32

porphria

Question 33

etomidate contraindication

Answer 33

adrenal suppression

Question 34

thiopental MOA

Answer 34

GABA-A agonist - depresses the RAS

Question 35

thiopental dose adult

Answer 35

2.5-5mg/kg

Question 36

thiopental dose kid

Answer 36

5-6mg/kg

Question 37

thiopental cardiovascular effects

Answer 37

low BP. HR okay | histamine release

Question 38

respiratory effects thiopental

Answer 38

histamine release (caution with asthma)

Question 39

thiopental CNS effects

Answer 39

``` decreases cerebral oxygen consumption decreases cerebral blood flow decreases intracranial pressure decreases EEG activity no analgesia ```

Question 40

barbiturates are unsafe for what condition

Answer 40

porphyria

Question 41

methohexital is the gold standard for what therapy?

Answer 41

electroconvulsive therapy it decreases the seizure threshold and produces a better quality seizure.

Question 42

methohexital induction dose

Answer 42

1-1.5mg/kg

Question 43

dexmedetomidine cardiovascular effects

Answer 43

bradycardia and hypotension

Question 44

dexmedetomidine and respiratory effects

Answer 44

does not cause respiratory depression

Question 45

dexmedetomidine and CNS effects

Answer 45

decrease CBF

Question 46

dexmedetomidine other effects

Answer 46

it reduces the incidence of emergence delirium in children decreases substance P and Glutamate release has an anti shivering effect

Question 47

benzodiazepines MOA

Answer 47

GABA A agonist

Question 48

benodiazepines clearance

Answer 48

liver p450

Question 49

benzo cardiovascular

Answer 49

decrease BP and SVR induction dose

Question 50

benzo and respiratory effects

Answer 50

opioids potentiate the respiratory depressant effects patients with COPD are more sensitive to the respiratory depressant effects

Question 51

Benzo CNS effects

Answer 51

``` decrease CMRO and CBF anterograde amnesia anticonvulsant anxiolysis no analgesia ```

Question 52

potency greatest to least of benzo

Answer 52

lorazepam-midazolam-diazepam