Exam 1

Question 1

Meperidine

Answer 1

Demerol
50mg q4h pain and shivering
Super long HT
Histamine release
Caution w MAOIs- seratonin syndrome
Normeperidine metabolite causes myoclonus, tremors, seizures

Question 2

Remifentanil

Answer 2

Mu agonist, ester side chain
Infusion: 0.05-2mcg/kg/min
Cases that require immediate awakening and no postoperative pain
Context sensitive ht of 4 minutes
IBW
Can cause OIH

Question 3

Methadone

Answer 3

Mu agonist, NMDA antagonist
2.5-10mg q24h
Prolonged QT with high doses

Question 4

Dilaudid

Answer 4

Intaop: 0.01-.02 mg/kg
Pain postop: 0.1-0.25 mg q10-15min
No histamine
UGT 2d6

Question 5

Sufentanil

Answer 5

0.1-0.4 mcg/kg
Renal and fecal
Pulmonary first pass

Question 6

Alfentanil

Answer 6

Mu agonist (what causes muscle rigidity)
15mcg/kg before laryngoscopy
150-300mcg/kg uncoucious
Infusion: 25-150mcg/kg/hr
Most likely to cause muscle rigidity
Crosses BBB fast
Use for retrobulbar block

Question 7

Codeine

Answer 7

Morphinian structure (phenanthrene core)
Black box for peds and breastfeeding mothers
Histamine release
Antitussive
Variability in effects d/t CYP2D6

Question 8

Dextromethorphan

Answer 8

NMDA antagonist, glutamate antagonist, no mu
30-90mg PO ( 30-60 min postop)
Low risk

Question 9

Nalbuphine

Answer 9

Partial kappa and mu agonist
Treat pruitis due to opioids
5-10mg q3h (Ceiling effect 30mg)

Question 10

Butorphanol

Answer 10

2-3mg IM
Postop shivering and migraines

Question 11

Naloxone

Answer 11

1-4mcg/kg q2-3min
Gtt: 5mcg/kg/hr
Sympathetic response

Question 12

Halothane

Answer 12

3 fluorine
Most potent, most metabolism
Significant bradycardia

Question 13

Isoflurane

Answer 13

5 fluorine
Highly pungent
Stable

Question 14

Desflurane

Answer 14

6 fluorine
Fastest off
CO risk with bad absorber
Most pungent- bronchospasm, layngospasm, coughing
Tachycardia and HTN
Good for obese due to low oil gas

Question 15

Sevoflurane

Answer 15

8 fluorine
Compound A- avoid rebreathing by increasing FGF (2l for cases >1 hour)
Can prevent bronchoconstriction if asthma super reactive
Preferred with high ICP
Not pungent

Question 16

N2O

Answer 16

Teratogenic
Rapidly accumulates in dead spaces- pneumonia, BO, intracranial, intaocular
PONV limit less than 30-60 minutes
2nd gas effect
No cardiac depression

Question 17

Succs

Answer 17

Competitive block, 2 alpha ach molecules
Depolarizer
Non competitive
1mg/kg
Plasma cholinesterase
Metabolite-succinylmonocholine (bradycardia)
Myalgia in young females without muscle
Normal k increase .5-1mEq
Increased gastric pressure
MH trigger
Black box: Duchenne

Question 18

Atracurium

Answer 18

Laudenosine causes seizures- histamine release

Question 19

Vec

Answer 19

0.08-0.1mg/kg
Maintenance: 0.01-0.05 mg/kg

Question 20

Cisatracurium

Answer 20

0.1-0.2 mg/kg (maintenance: 0.05-0.1)
No histamine
Low seizure risk
Hofmann elimination and renal elimination
Less potency if removed from the fridge
NO RSI bc of onset

Question 21

Roc

Answer 21

0.6-0.9mg/kg (maintenance: 0.06-0.6)
Infusion: 5-15 mcg/kg/min
RSI: 1.2mg/kg
Renally safe

Question 22

Roc

Answer 22

0.6-0.9mg/kg (maintenance: 0.06-0.6)
Infusion: 5-15 mcg/kg/min
RSI: 1.2mg/kg
Renally safe