EXAM 1 PQ Flashcards
1
Q
Mu opiod receptor activation leads to supraspinal analgesia via
A
Decrease release of GABA from periaqueductal gray matter
2
Q
Activatoin of opiod receptors leads to activation of which intracellular transduction mechanism
A
G protein
3
Q
most hydrophillic opioid
A
Morphine
4
Q
Altered duration and potency with reduced renal function due to this metabolite
A
Morphine 6 glucuronide
5
Q
Clinical effect of fentanyl terminated by
A
Redistribution
6
Q
OPIOD with LONGEST CONTEXT sensitive half time
A
FENTANYL
7
Q
OPIOD with longest duration after EPIDURAL
A
MORPHINE
8
Q
Fentanyl to a low dose bupivacaine decrease
A
Failed block incidence
9
Q
Best opiods for patient with combined hepatic and renal impairment
A
REMIFENTANYL
10
Q
Converted from product to active
A
CODEINE
11
Q
OPIOD that cause TACHYCARDIA
A
MEPERIDINE
12
Q
Decrease the risk of respiratory depression
A
CLONIDINE
13
Q
Biliary spasm side effect of
A
MORPHINE
14
Q
OPIOD metabolite to cause seizure
A
Normeperidine ( from meperidine)
15
Q
Prolonged administraton lead to loss of drug effect
A
tolerance
16
Q
Best choice for patients taking MAOI
A
Morphine to prevent serotonin syndrome
17
Q
OPIOD for surgery requiring quick recovery
A
REMIFENTANYL
18
Q
Primary mechanism of waking following induction dose of thiopental
A
Redistribution of drug to lean tissues
19
Q
Compared to thio, the reason patient awakens more rapidly form IV methohexital is
A
Metho has higher rate of hepatic clearance
20
Q
Short acting barbiturate to accelerate elimination of for exmple phenobarbital give
A
SODIUM BICARBONATE
21
Q
Following administration CV effect of thiopental
A
PERIPHERAL VENODILATION
22
Q
Barbiturates on pulmonary
A
brief apnea lasting 30-45 sec
23
Q
Uremia increases free fraction of thiopental by
A
100%
24
Q
Thiopental cannot reduce the CMRO2 below 50% because
A
it only affects the neuron’s functional cellular processes
25
Barbiturates are the classic anesthetic trigger agent for
PORPHYRIA
26
PROPOFOL rapid termination of action due to
Redistribution to the periphery
27
Organ responsible for extra hepatic metabolism of propofol is
Kidneys
28
Propofol increase elimination half time in elderly due to
age related
29
Which hemodynamic decreases the most after induction of anesthesia with propofol
Systolic BP
30
Which IV anesthetic , causes the greatest decrease in mean BP
Propofol
31
After propofol most frequent effect on Resp system
APNEA
32
IV anesthetics causing EPILEPTOGENIC ACTIVITY
Methohexital
33
Most common side effect of propofol during induction
HYPOTENSION
34
PROPOFOL infusion syndrome is characterized by
Rhabdomyolysis
35
Causes ADRENOCORTICAL SUPPRESION
ETOMIDATE
36
Not associated with ETOMIDATE
increase IOP
37
ETOMIDATE on CNS
Decrease CMRO2, decrease CBF, Increase CPP
38
To increase water solubility of ETOMIDATE formulated with
PROPYLENE GLYCOL
39
Metabolism of etomidate
Liver by ester hydrolysis
40
Not a pharmacological effect of benzo
ANALGESIA
41
MOA of midazolam
allosteric modulation of GABA binding to GABAa receptor
42
Significantly increase metabolism of midazolam
Chronic alcohol consumptino
43
Benzo with inactive metabolite
Lorazepam
44
Midazolam hemodynamic changes
Decrease CIFm
45
Flumazenil reverse effects of
benzo
| competitive antagonists
46
elimination directly proportional to drug clearance, and concentration
1st order elimination
47
HIGHLY lipid soluble
ETOMIDATE
48
ETOMIDATE INDUCTION DOSE
0.2-0.3 mg/kg
49
May attenuate CV stimulating effects of ketamine
Benzos
50
Net effect of ketamine induction is
Increase BP, HR, CO and Myocardial oxygen consumption.
51
Ketamine in critically ill patient
decrease in BP and CO , who have depleted their catecholamines stores and lack ability to compensate via the SNS
52
Catalepsy
Ketamine
53
Dissociative anesthesia
Ketamine
54
Contraindicated in brain injury
KETAMINE (increase ICP)
55
Potent stimulator of bronchial secretion______give?
Ketamine; give with glycopyrrolate
56
Emergence Delirium
Ketamine
57
Prolong effect of ketamine
Diazepam
58
Change in hepatic blood flow affect
KETAMINE metabolism
59
Use in burn patients
KETAMINE
60
What is emergence delirium attenuated by
Benzodiazepines
61
Ketamine IV dose
1-2mg/kg
62
Ketamine redistribution is
WITHIN 10 MIN
63
Minimal effect of RR, mV
Ketamine
64
Use to induce seizures
Methohexital
65
Allergic to propofol use
Barbiturates
66
Decrease BP and Increase HR
Barbiturates
67
Dose dependent respiratory Depression
Barbiturates
68
Decrease ICP aand CBF
Barbiturates
69
Lack histamine release
ETOMIDATE
70
NO alteration in HR, CO CVP or PWCP
ETOMIDATE
71
Benzo with perfusion limited clearance (high hepatic ratio)
Midazolam
72
Capacity limited clearance
Lorazepam and diazepam
73
Benzo containing propylene glycol
Diazepam and lorazepam
74
Dose related reduction in CMRO2
Benzos
75
Relatively safe drug
Benzo
76
Depress swallowing reflex and upper airway reflex
Benzos
77
Most likely to be un-ionized (uncharged) at physiological pH
Alfentanyl
78
swallow and corneal reflexes present with this med
Ketamine
79
Morphine vs fentanyl solubility
Morphine is LOW lipid solubility
80
Thrombophlebitis associated with
Etomidate
81
myoclonus associated with
Etomidate
82
nausea and vomiting associated with
ETOMIDATE
83
inhibition of steroid synthesis
ETOMIDATE
84
not approved in the U.S. for sedation of pediatric ICU patients
PROPOFOL
85
______administration may increase intraoperative wheezing in patients with asthma (causes bronchodilation)
Propofol (Diprivan)
86
EEG activation, consistent with possible epileptogenic activity
ETOMIDATE
87
More likely to require fentanyl (Sublimaze) to reduce hemodynamic effects caused by direct laryngoscopy
ETOMIDATE
88
More likely to cause anterograde amnesia
Midazolam
89
Suppression of recall for events before amnestic drugs are administered:
Retrograde amnesia
90
Suppression of recall for events after amnestic drugs are administered:
Anterograde amnesia
91
Reduction the cerebral edema following surgery; useful in head injury cases and management of cerebral ischemia:
barbiturates
92
Main tissue reservoir for opiods
SKELEtAL MUSCLE
93
Anatomical sites of opioid action: pain-modulating descending pathways --
rostral ventral medulla
locus ceruleus
periaqueductal gray
94
Principal alkaloid in opium (derived from opium poppy)
morphine
95
Most reliable indicator of opioid-mediated respiratory depression:
depressed patient response to a carbon dioxide challenge
96
Opioid direct action on neurons:
may close a voltage-gated calcium channel on presynaptic nerve terminals, resulting in reduced transmitter release
97
Contraindications/caution for opioid use:
Addison's disease
impaired pulmonary function
patients with head injury
98
Morphine effect/effects on bronchomotor status.
Bronchoconstrictive secondary to histamine release.
| Worsening of asthmatic attacks
99
Meperidine administration results in effects generally similar to those caused by
morphine
100
Analgesic effects associated with codeine occurs because of its
conversion of morphine.
101
Morphine, principally as morphine-3-glucuronide, is eliminated by
renal glomerular filtration
102
2 are examples of drugs that increase meperidine induced respiratory depression.
Chlorpromazine and tricyclic antidepressant medications (first-generation agents)
103
Opiods exhibits local anesthetic properties which can be observed following epidural administration.
Meperidine
104
Increased cerebral blood flow with increased cerebrospinal fluid pressure secondary to drug-induced respiratory depression leading to increased carbon dioxide levels.
meperidine
105
IV administration of _________is likely to produce a notable elevation in heart rate.
meperidine
106
OPioids may induce delayed resp depression
Fentanyl or sufentanil administration may induce delayed respiratory depression
107
principal, primary anesthetic in cardiac surgery or for patients with pre-existing poor cardiac status because of LIMITED CARDIOVASCULAR ACTIVITY
Fentanyl or sufentanil
108
Slowest time to peak analgesic effect following IV administration:
MEPERIDINE
109
Administration of nonsteroidal anti-inflammatory drugs may induce pain relief comparable to that provided by about
60 mg codeine.
110
The major ion channel affected by benzodiazepine sedative-hypnotics is:
Chloride
111
T/F Benzodiazepine administration results in comparable degrees of neuronal depression as barbiturates.
false
112
T/F Benzodiazepines are not GABA type A receptor activators but rather modulate GABA effects at the receptor.
True
113
T/F Benzodiazepine sedative hypnotic drugs are examples of patients which even at high doses do not induce by themselves surgical anesthesia.
True
114
T/F Benzodiazepines at higher doses appropriately qualify as anaesthetics.
False
115
Midazolam has been associated with
both decreased respiratory rate in tidal volume, even given without accompanying CNS depressant agents.
116
The major receptor system targeted by clinically used benzodiazepines is:
GABA
117
T/F At normal benzodiazepine doses cardiovascular effects are usually minor in normal individuals.
TRUE
118
Highly plasma protein bound
Benzo
119
Which one of the following benzodiazepines is classified as an intermediate-acting drugs
Lorazepam
120
Refers to drug concentration producing 50% of that drug's maximal effect:
EC50
121
This type of drug, even at doses that fully saturate the receptor, does not elicit a response as great as that seen with a full agonist
partial agonist
122
TI
TD50/ED50
123
In women, morphine associated with
Greater analgesic potency
124
Greatest amount of ROSTRAL SPREAD into intrathecal space (cephalad migration into the CSF)
Morphine
125
Most common side effect of opioids
Pruritus
126
Route associated with the reactivation of the HSV
Epidural
127
Mu receptor activation associated with
Bradycardia
128
Morphine does not
Cause MYOCARDIAL DEPRESSION
129
2 medications that are most effective at reducing OPIOID INDUCED HYPERANALGESIA caused by REMIFENTANYL?
Ketamine
| Magnesium
130
Which benzodiazepine is more effective in preventing emergence delirium?
Midazolam is more effective than diazepam
131
Which barbiturate has a greater lipid solubility and what does it result in?
Thiobarbiturates, results in greater hypnotic potency, faster onset and shorter duration of action.
132
Which agent produces modest decreases in hepatic blood flow?
Thiopental.
133
Which agent is useful for induction of anesthesia in patients with increased ICP?
Thiopental
134
What is the opioid receptor activity of ketamine?
Interacts with mu, delta, and kappa receptors. May be an antagonist at mu receptors and an agonist at kappa receptors.
135
Which agent is the only barbiturate with actions sufficiently different from the thiobarbiturates to offer an alternative to other IV induction agents?
Methohexital.
136
What is the modest fall in renal blood flow and glomerular filtration rate due to?
Decrease in BP and CO.
137
Which agent is the most potent enzyme inducer of the barbiturates?
Phenobarbital
138
Which agent is contraindicated in hypovolemic
| patients?
Thiopental
139
Which agent causes anaphylaxis in 1:30,000 patients?
Thiopental
140
Which agent can be mixed with propofol for production of TIVA and has more stable hemodynamics than propofol and fentanyl without incidence of emergence reactions?
Ketamine
141
What is the metabolism of thiopental dependent on?
Thiopental has a low hepatic extraction ratio so metabolism is dependent on hepatic enzyme activity not hepatic blood flow.
142
What is the metabolism of methohexital dependent on?
CO and hepatic blood flow
143
Where is methohexital metabolized?
Liver
144
What side effect occurs with thiopental and thiamylal (1:30,000)
histamine release
145
Etomidate
Use cautiously in patients with focal seizures. Can cause hypotension if given to hypovolemic patients
Pain occuring during IV injection is frequent (80%).
146
Use with caution or avoid in patients that may require an intact cortisol response (sepsis or hemorrhage patients).
Etomidate
147
What is the side effect with overdose or large doses of barbiturates required to lower ICP?
Direct mYocardial depression
148
Disadvantage of mEthohexital
Increased incidence of excitatory phenomena such as involuntary skeletal muscle movements (myoclonus) and hiccough.
149
Between barbiturates and isofulrane which agent is preferable if profound EEG is desired?
Barbiturates
150
How are thiobarbiturates metabolized?
Break down in extra hepatic sites such as the kidneys
151
What are the risk factors of emergence delirium associated with ketamine?
Age >15, females, doses >2 mg/kg, history of personality disorders or frequent dreaming.
152
What beneficial effect does propofol have on the lungs?
Causes bronchodilation and decreases the incidence of intra-operative wheezing in patients with asthma.
153
What beneficial effect does ketamine have on the lungs?
Has bronchodilatory activity (successful in treatment of status asthmaticus).
154
May increase ICP placing patients with intracranial pathology at risk. Increases salivary secretions necessitating protection of airway.
Ketamine
155
What agent can impair neutrophil functions?
Thiopental.
156
How much of thiopental and methohexital is excreted unchanged in the urine?
Less than 1%.
157
How can venous thrombosis be prevented with barbiturate use?
By using diluted concentrations: methohexital 1%, thiopental 2.5%.
158
What agents may increase the incidence of emergence delirium?
Atropine or droperidol, and scopolamine.
159
What agents may decrease the incidence of emergence delirium?
Thiopental or inhalation agents.
160
Sufentanyl vs morphine
1000 times more potent than morphine
161
Meperidine vs morphine
0.1 times more potent than morphine
162
Remifentanyl vs morphine
100 times more potent than morphine
163
Alfentanyl vs morphine
10 times more potent than morphine
164
Hydromorphone vs morphine
8 times more potent than morphine
165
Opiods with active metabolites
Morphine
| Meperidine
166
Opioids with anticholinergic effects
Meperidine
167
Demythlation in the liver metabolism of
Meperidine
168
Can lead to SEROTONIN SYNDROME
Meperidine with MAOI
169
What is the effect equillibration of ALfentanyl
1.4 min
170
Why is the effect equilibration time so fast in ALFENTALY
Low degree of ionization
171
90 % unionized in Physiologic pH
Alfentanyl
172
For short but INTENSE periods of stimulation used
Alfentanyl
173
Dose of remi
0.1 to 1mcg/kg/min
174
Mu agonist rapid on and off
Remifentanyl
175
Context sensitive half life of remifentanyl
4 minutes
176
Is Bradycardia a side effect of Narcan
No
177
AMnesia associated with Midazolam
ANTEROGRADE
178
Clearance directly related to
blood flow to organ
| Extraction ratio
179
Steady state is achieved after
5 half lives
180
Circumstance for Ion trapping
Maternal ALKALOSIS
| Fetal ACIDOSIS
181
Constant AMOUNT per unit of time (ZA)
ZERO
182
Constant FRACTION per unit of time (FF)
FIRST order
183
Perfusion dependent HEPATIC elimination meds
Fentanyl
Lidocaine
Propofol
184
CAPACITY dependent HEPATIC elimination meds
Rocuronium
| DIAZEPAM
185
Acidic drugs
better ABSORBED in ACIDIC
186
Basic drugs
BASIC Better ABSORBED in BASIC
187
Drugs dose and plasma concentration is PHARMD or PHARK
PHARMACOKINETICS
188
Effect site and clinical effect is PHARMD or P ARK
Pharmacodynamics
189
Dose response curve x axis is (PX)
potency
190
Dose response curve y axis is
Efficacy
191
From top to bottom dose response curve
Agonist
Partial agonist
Antagonist
Inverse Agonist
192
TI formula
LD50/ ED 50
193
Chiral molecules non-superimposable
Enantiomers
194
Levorototary rotaes
counterclockwise
195
WK ACIDS ph and pKa
if ph < pka NON-IONIZED
| if ph>pka IONIZED
196
WK Bases pH and pKa
If ph PKA IONIZED
