Barbiturates

Question 0

Any drug derived from __ acid = a barb

Answer 0

Barbituric acid

Question 1

Why have barbs fallen out of favor?

Answer 1

Hangover effect- residual drowsiness lasting many hours

Question 2

Barbs are __ salts and are __ soluble in IV fluids

Answer 2

Sodium salts

Highly soluble

Question 3

Because they are highly alkaline, they easily __ with opioids, catecholamines, and NMB

Answer 3

Precipitate

Question 4

Barbs are only available as a __ % solution due to caustic to vessels

Answer 4

2.5%

Question 5

Substitutions at 2 and 5 carbons gives different effects.

Sulfur at 2 and 5-

Answer 5

Sulfur at 2 and 5- increase lipid solubility

Question 6

Substitutions at 2 and 5 carbons gives different effects.

Phenyl at 2 and 5-

Answer 6

Anti-convulsant

Question 7

Substitutions at 2 and 5 carbons gives different effects.

Methyl group at 2 and 5-

Answer 7

Convulsive activity

Question 8

Prompt awakening from barbs is due to

Answer 8

Redistribution

Test question

Question 9

What ion is associated with GABA receptors?

Answer 9

Chloride

Test question

Question 10

Barbs have a unique ability to depress BOTH __ and __

Answer 10

Reticular activating system

SNS ganglia- leading to hypotension

Question 11

Non ionized fraction exerts pharm effect

Answer 11

Test question

Question 12

Patients on highly protein bound meds such as __ and __ increase barb effects

Answer 12

ASA

phenytoin

Question 13

Patients with cirrhosis and neonates have __ sensitivity to barbs

Answer 13

Greater

Question 14

Maximum brain uptake in __ seconds for thiopental and methohexital

Answer 14

30

Question 15

Initial decreases in plasma concentrations of barbs are due to redistribution to __

Answer 15

Skeletal muscle

Question 16

Barb levels continue to rise in __ 30 minutes post injection

Answer 16

Fat

Question 17

Calculate induction drugs using __ body weight

Answer 17

Lean

Question 18

Acidosis __ barb effects

Answer 18

Increases

Question 19

Alkalosis __ barb effects

Answer 19

Decreases

Due to alterations in the non-ionized fractions

Question 20

Cardiopulmonary bypass __ systemic clearance of barbs

Answer 20

Decreases

Question 21

Oxi-barbiturates are metabolized __

Answer 21

Hepatic only

Question 22

Thio-barbs (with the sulfur) metabolize

Answer 22

Mainly hepatic but also kidneys and CNS

Question 23

Barb metabolism is __.

Answer 23

Slow

Question 24

Enzyme induction may __ the dose requirements but does not modify the duration of action.

Answer 24

Increase

Question 25

Do roach of the liver patients have any difference in barb clearance?

Answer 25

No

Question 26

Methohexital hepatic clearance is __x greater than thiopental, therefore it has the least hangover

Answer 26

4x

Question 27

While redistribution determines awakening, __ determines complete recovery.

Answer 27

Metabolism

Question 28

Old age __ anesthetic effects of barbs

Answer 28

Increases

Question 29

Peds patients recover __ due to more rapid hepatic clearance

Answer 29

Quicker

Question 30

Barbs are cerebral vaso__

Answer 30

Constrictors

Question 31

Barbs __ provide sedation in the presence of pain, they actually can lower the pain threshold.

Answer 31

Cannot

Question 32

Barbs have __ skeletal muscle relaxation

Answer 32

No

Question 33

Methohexital has __ risk of excitatory phenomena like hiccups and myoclonus, which are dose related.

Answer 33

Increased

Question 34

Thiopental induction dose

Answer 34

3-5 mg/kg This is how I remember it, since it clears 4x slower than metho, give 4 mg/kg

Question 35

Methohexital induction dose

Answer 35

1-1.5 mg/kg Same as succs

Question 36

Lower BP with barbs due to peripheral __ due to depressed medullary vasomotor centers, decreased SNS outflow

Answer 36

Peripheral vasodilation

Question 37

Hypovolemic patients are extremely vulnerable to marked decreases in BP from barbs, so __

Answer 37

Don't use barbs with hypovolemic peeps

Question 38

Barbs- give 'em __

Answer 38

Quick

Question 39

Barbs depress ventilation and __ sensitivity to high CO2, but do not depress laryngeal or cough reflexes

Answer 39

Decrease

Question 40

Barbs an evoked potentials?

Answer 40

No interference

Question 41

Barbs __ enzymes to a max of doubling metabolism rates

Answer 41

Induce

Question 42

Barb-related enzyme induction results in increased metabolism of other drugs like __

Answer 42

``` Coumadin Phenytoin Tricyclics Corticosteroids Vit K ```

Question 43

Barbs are contraindicated with __ patients due to stimulation of heme production

Answer 43

Porphyria

Question 44

Should you give barbs intra-arterial?

Answer 44

No | Immediate vasoconstriction and excruciating pain, gangrene, precipitation of crystals leading to arteritis.

Question 45

What barb induces enzymes the most?

Answer 45

Phenobarbital

Question 46

Venous thrombosis after barb admin due to __

Answer 46

Deposition of barb crystals

Question 47

Barb thera index __ with tolerance.

Answer 47

Decreases

Question 48

Allergic reaction to Thio around 1:__,000 , seen more often with prior Thio exposure or chronic atopy, meaning IgE hypersensitivity such as __

Answer 48

1:30,000 ``` Hay fever Asthma Infantile eczema Urticaria Food reactions ```

Question 49

Thio mixtures are highly __

Answer 49

Bactericidal