IV Anesthetics

Question 1

Main contributor to termination of effects of most anethstics

Answer 1

distribution

Question 2

Distribution definition

Answer 2

initial dispersion of drug into body compartments

Question 3

affects drug distribution

Answer 3

hemodynamics, disease states

Question 4

terminates the effect of thiopental

Answer 4

redistribution

Question 5

formerly most common used barbituate (no longer available)

Answer 5

thiopental

Question 6

time course of thiopental

Answer 6

ultra-short acting, but long elimination

Question 7

name the drug: rapid unconciousness, good amnesia but poor analgesia, poor muscle relaxation, pleasant induction

Answer 7

Thiopental

Question 8

MOA of thiopental

Answer 8

binds to GABAA receptor and stimulates inhibitory neuronal systems

Question 9

drug that best protects against hypoxic/ischemic injury

Answer 9

thiopental

Question 10

drug that reduces cerebral blood flow, but not perfusion pressure

Answer 10

thiopental

Question 11

CV effects of thiopental

Answer 11

hypotension in shock pts, lowers contractility. (HR increases via reflex),

Question 12

IV drug that can cause massive BP drops in pts with high sympathetic tone

Answer 12

Thiopental

Question 13

IV drug that causes hiccups

Answer 13

thiopental

Question 14

drug that depresses mucocillary reflexes

Answer 14

thiopental

Question 15

drug needed to be added to thiopental to overcome tracheal/laryngeal reflexes

Answer 15

muscle relaxants

Question 16

clinical uses of thiopental

Answer 16

general anesthetic induction, brain protection

Question 17

Best amnestic agents

Answer 17

Benzodiazapines

Question 18

benzodiazepines class examples

Answer 18

midazolam and lorazepam

Question 19

drug to give synergestic sedative effects with opiods

Answer 19

benzos

Question 20

MOA of Benzos

Answer 20

bind to GABAA receptor, fires inhibitory neurons

Question 21

receptor occupancy of benzo giving anxiolysis

Answer 21

20%

Question 22

receptor occupancy of benzo giving sedation

Answer 22

30-50%

Question 23

receptor occupancy of benzo giving hypnosis or unconciousness

Answer 23

60%

Question 24

drug that is pH 3.5 in vial and pH 6.2 in plasma

Answer 24

midazolam

Question 25

CNS effect of midazolam

Answer 25

reduction in cerebral metabolism and blood flow.

Question 26

benzo used for anticonvulsant

Answer 26

midazolam

Question 27

drug causing antegrade, but not retrograde amnesia

Answer 27

midazolam

Question 28

CV effects of midazolam

Answer 28

hypotension in hypovolemia

Question 29

Resp effects of midazolam

Answer 29

hypnotic dose - apnea. | Amnestic dose gives minimal depression

Question 30

clinical uses of benzos

Answer 30

premedication before anesthesia Conscious or heavy sedation induction of anesthesia

Question 31

drugs that are not reliable for amnesia

Answer 31

opiods

Question 32

clinical use of opiods

Answer 32

premedication, maintenance of anesthesia, postop pain control

Question 33

MOA of opiods

Answer 33

acts on G-protein linked mu receptors

Question 34

SE of opiods

Answer 34

itching, chest wall regidity, "forgetting to breathe"

Question 35

opioid only used for shivering

Answer 35

meperidine

Question 36

fentanyl class

Answer 36

opoid

Question 37

sufentanil class

Answer 37

opioid

Question 38

alfenranil class

Answer 38

opioid

Question 39

used as adjunct with inhaled agants for intraoperative analgesia

Answer 39

hydromorphone

Question 40

opioid that's termination of action is due to elimination - not redistribution

Answer 40

remifentanil

Question 41

shortest acting opioid

Answer 41

remifentanil

Question 42

drug that may result in acute tolerance to other opioids

Answer 42

remifentanil

Question 43

MOA of Ketamine

Answer 43

NMDA antagonist, inhibits stimulatory systems

Question 44

"dissociatibe anesthetic"

Answer 44

ketamine

Question 45

CNS effects of ketamine

Answer 45

bad dreams, halluciations, delirium raises ICP antidepressent effects

Question 46

treats ketamine "bad trip"

Answer 46

benzo, barbiutates, N2O

Question 47

CV effects of ketamine

Answer 47

central sympathetic stimulation (higher HR/BP, catchecolamine levels)

Question 48

direct myocardial depressent drug

Answer 48

ketamine

Question 49

respiratory effects of ketamine

Answer 49

small doses = minimal ventilory depression | bronchodilation from sympathetic effects

Question 50

causes nystagmus

Answer 50

ketamine

Question 51

increases salivary and tracheobroncial secretions

Answer 51

ketamine

Question 52

Etomidate MOA

Answer 52

activates GABAA receptors

Question 53

etomindate CNS effects

Answer 53

lowers ICP and cerebral O2 metabolic rate

Question 54

etomindate respiration effects

Answer 54

minimal vent depressant

Question 55

good choice for short procedures, due to lower risk of apnea

Answer 55

etomidate

Question 56

DOC for pts with CV factors

Answer 56

etomidate

Question 57

propofol MOA

Answer 57

some action at GABAA complex, may enhance Cl-conduction at glycine receptors

Question 58

CNS effects of propofol

Answer 58

reduces cerbral blood flow and metabolism

Question 59

CV effects of propofol

Answer 59

decreasd BP, HR, CO, vascular resistance. no change to central venous pressure

Question 60

good drug for CABG pts

Answer 60

propofol

Question 61

fast acting drug that burns on injection

Answer 61

propofol

Question 62

drug that causes euphoria

Answer 62

propofol

Question 63

MOA of dexmedetomidine

Answer 63

central a-2 agonist, results in sedation and analgesia

Question 64

excellent sedative for admin by infusion

Answer 64

dexmedetomidine

Question 65

hemodynamic effects of dexmedetomidine

Answer 65

bradycardia with hypotension to hypertension (dose dependant)

Question 66

very long t 1/2 IV drug (non opioid)

Answer 66

thiopental

Question 67

very short t 1/2 IV drug (non opiod)

Answer 67

propofol

Question 68

shortest opioid t 1/2 life

Answer 68

remifentinil

Question 69

longest opioid t 1/2

Answer 69

fentanyl/meperidine