Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Daddy Pharm > IV anesthetics > Flashcards

IV anesthetics Flashcards

(98 cards)

Start Studying
1
Q

T/F
90% of anesthesia is done with propofol

A

False
90% of anesthesia can be done with propofol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

emulsion

A

mix of water and oil into continuous form (ie: mayo)
add emulsifying agent (lipid sol end & w. sol end)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Prop emulsion vehicle

A

soybean oil and egg lecithin

used b/c prop isn’t very water soluble

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

egg lecithin is also known as

A

(an emulsifier)
phosphatidyl choline
serine

naturally occurring in cell membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prop
chemical name & structure

A

2,6-diisopropylphenol
(know how to draw it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Propofol
class
MoA

A

Unique class of anesthetics

interacts w/ GABA A receptor
decreases GABA dissociation

~ selective with few perceivable effects at other receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

EDTA

A

disodium edenate
preservative in Diprivan (brand)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Generic prop should not be used in pts with…

A

sulfite allergies
generic contains sodium metabisulfite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Your pt is allergic to wine. Which should you administer?
Diprivan
Generic propofol

A

Diprivan

generic contains sodium metabisulfite
(wines also have sulfites)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Egg lecithin is found in

A

the fatty part of the yolk

not a protein (which pts with egg allergies are most likely allergic to)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Prop induces how quickly?

A

15-30 secs
not as fast as thiopental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is prop taken up by cells?

A

(very lipid soluble; put into an emulsion)
remains as micelle in BS
outer layer begins brkdwn
oil droplets taken up via endocytosis or absorb across membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F
Push propofol fast

A

False
painful on injxn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T/F
Hand veins are ideal for propofol administration

A

False
smaller veins a/w more pain on injxn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mixing propofol w/ liodcaine

A

not recommended
1) lido cant act fast enough
2) breaks emulsion –> oil droplet –> PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Awakening time faster than with other IV induction agents

A

prop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Less occurrence of post-op hang-over, reports of elevated post-op mood

A

prop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Prop and BZDs have ____ properties

A

anticonvulsant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prop metabolism
_____ loses most of the compounds activity.
_____ removes it from the body

A

hydroxylation (now 1/3 as active)

glucuronide/sulfate conjugation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Prop
termination of actions d/t…

A

redistribution to fatty tissues and metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Prop metabolism

A

Hepatic and extrahepatic P-450 oxidative metabolism

secondary: phase II glucuronide & sulfate conjugation

High lung uptake but released ~unchanged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Prop metabolism
first [O] rxn

A

form 4 hydroxy diisopropyl phenol (hydroxylate 4th C on ring; “ring hydroxylation”)

becomes point of attachment for glucuronide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Lung metab of propofol

A

not a primary method of metab
but
becomes important for uptake of IAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Prop
DoE

A

5-10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Prop HL
2-3 hours
26
Prop OB
crosses placenta but rapidly metabolized by fetus Pregnancy Category B – no proof of direct risk, however **only recommended if benefits outweigh risk**
27
T/F Liver/renal Dz significantly affects prop elimination
False d/t extra hepatic metab (hydroxylation by tissues outside the liver)
28
T/F Prop & BARBs increase pain sensitivity
False prop does not BARBs do
29
Prop effects on BP
decreased d/t ↓CO & vascular resistance decreases more than Thiopental inhibits SNS vasoconstriction
30
Prop Increased risk of ___ death, due to ....
brady♡-related inhibition of cardiac sarcolemmal calcium release (blocks muscle activity)
31
T/F Skeletal muscle inhibition is seen with Prop.
True inhibition of cardiac sarcolemmal calcium release (blocks muscle activity)
32
Opioids increase ____ respiration & inhibits the ability to ...
Cheyne stokes (deep breathing followed by shallow breathing) sense CO2 caution when using prop with opioids
33
Prop resp fx
Depresses ventilation apnea in ~30% of patients.
34
Which accumulates in fat more? Prop BARBs
BARBs (they both accumulate in fat but prop has a shorter HL; metabolized out of fat faster)
35
Prop when continuously administered for more than 24 hours
lactic acidosis d/t high triglyceride levels
36
Why does prop cause high TGC?
lipid emulsion vehicle
37
Prop SEs
bradycardia pain (limited to injxn) hypertriglyceridemia (lipid emulsion vehicle) allergic reactions lactic acidosis (long term infusion)
38
Fospropofol (Lusedra)
propofol prodrug FDA approve 2008 cleaved to propofol on administration by endothelial alkaline phosphatases
39
Fospropofol (Lusedra) current status
Dc’d bc not making enough $, but still FDA approved Could go back into production if shortage of prop
40
Fospropofol (Lusedra) pros and cons
water soluble (~no pain on injection) more expensive half-life (to Propofol) = 8 min (slower onset) other metabolite = formaldehyde (toxicity in **large** doses)
41
Propoven
different vehicle formulation more lipids no preservative short vial life
42
Propofol Pumps
Mechanical syringe presser Motor pushes on end of plunger Adjust speed to control rate of infusion Use with BIS hold a certain rate of infusion/anesthetic depth Controversy: Japan company says pump can replace anesthesiologist and use general nursing staff (US protests prevented entry into practice)
43
BIS monitor ___% of normal brain wave activity is considered anesthetized
40
44
Etomidate (Amidate) Structure
unlike any other anesthetics (he did not say to memorize it)
45
propylene glycol toxicity
relatively low avoid very large doses
46
Why makes etomidates HL so short?
1) rapid lipid redistribution 2) Metabolized rapidly (ester) hydrolysis of side chain ester group by plasma esterases and hepatic P-450 system
47
Etomidate MoA
GABA-activity enhancement like BARBs and BZDs GABA A site but unclear location
48
Etomidate is more selective for ___ receptors than the barbiturates
GABA A
49
weak base, that's 99% unionized at physiological pH
etomidate
50
Etomidate protein binding
75%
51
Etomidate Vd
large (~300 L) (tissue distribution)
52
Etomidate time until peak brain concentration
w/in 1 min
53
Etomidate emergence time
5-10 mins
54
Etomidate elim HL
2-5 H
55
T/F Etomidate does not cause any resp depression
False Occasional apnea on rapid administration Less ventilatory depression than with barbiturates or propofol
56
Etomidate incidence of myoclonus on rapid IV induction
>80%
57
Etomidate depresses....
Depresses steroid (cortisol) synthesis in adrenals
58
T/F A single dose of etomidate can increase risk of mortality.
True
59
Depressed steroid (cortisol) synthesis in adrenals can cause...
Increased risk in sepsis and hemorrhage
60
Dexmedetomidine (Precedex)
alpha-2 agonist shuts off norepi release
61
Alpha 2 receptors in brain are mostly
pre-synaptic inhibitory on adrenergic neurons
62
advantage of PREsynaptic inhibition
reduces risk of overstimulation "fine-tuning"
63
Goal when developing Precedex
mimic the CNS depressant effects of Clonidine but with better distribution to the brain
64
Dexmedetomidine (Precedex) uses
control of stress, anxiety and pain used alone: sedates + can arouse to communicate
65
T/F Placebo can cause sedation
True
66
T/F Adjust Precedex dosing based on age.
False hepatic disease Pharmacokinetics unaltered by age
67
Precedex Vd HL protein binding
Vd ~ 118 liters t1/2 ~ 2 hrs ~95% protein bound
68
Precedex Metabolism
mainly via glucuronidation (34%) and P-450 hydroxylation
69
Why do we usually give Precedex as a drip?
short half-life (~ 2 hrs)
70
T/F Precedex is lipid insoluble & doesn't cross BBB
False some lipid solubility; gets into brain
71
Versed indxn time DoE
~60 secs ~15 mins
72
Versed + opioids
for longer durations greater pain relief than midaz alone
73
T/F BZDs tend to be highly protein bound True
True "Versed is 95% plasma protein bound (similar to other benzodiazepines)"
74
T/F Versed has minimal CV fx
True
75
Remimazolam (Byfavo)
midazolam analog with an ester linkage (rapid metab)
76
Remimazolam FDA approval
2020
77
Remimazolam (Byfavo) Primary use
induction conscious/ procedural sedation (< 30 min )
78
Remimazolam SEs
hypo/hyperTN hypoxia (due to hypoTN)
79
Remimazolam vs Versed duration
~ ¼ the duration of an equivalent dose of midazolam
80
T/F Ketamine can be used IV only
False IV and IM
81
T/F Ketamine has amnesic effects
True Good analgesic and amnesic
82
Ketamine action at opioid receptors
Blocks Mu agonist @ Kappa
83
Ketamine psych instability & hallucinations
d/t kappa antagonism/stimulation
84
Ketamine IV duration
15 mins
85
catalepsy (dissociative anesthesia)
(Ketamine) eyes wide open, look awake but don’t respond blockade of specific neural tracts (block consciousness) + stimulate RAS
86
Ketamine solubility and protein binding
Highly lipid soluble but minimal protein binding Ketamine: fat and free
87
Recovery phase characterized by CNS stimulation
Ketamine emerge in quiet & dim (avoid seizures)
88
Adjust Ketamine dosing in the presence of...
liver Dz
89
Ketamine MoA
Blocks: glutamate excitatory NMDA receptors (CNS) neuromuscular nACh receptors Mu receptors agonism: Kappa receptors
90
Ketamine metab
N-demethylated (P450) => Norketamine (25% active) hydroxylation (P450) => hydroxynorketamine (inactive) Glucuronated & excreted in urine.
90
T/F Glucuronidation of ketamine inactivates the compound
False hydroxylation (P450) => hydroxynorketamine (inactive) glucuronidation allows excretion
91
T/F A pt's tonic-clonic movements under ketamine can help estimate the depth of anesthesia.
False
92
Ketamine should be given slowly bc
limit respiratory depression and strong vasopressor effects (Possibly life threatening)
93
Ketamine emergence reaction occurence
over 10%
94
Ketamine hallucinations
can be dream-like or delirium possible long term mental health effect less often in old ppl
95
Ketamine can be given with ___ to reduce the risk of seziures
diazepam
96
PF0713
propofol analog less injxn pain slower onset and longer duration Benefits questionable – possibly better for maintenance
97
Carboetomidate
etomidate analog "no" adrenal suppression slower onset

Daddy Pharm (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions