IV Anesthetics

Question 1

Propofol drug class

Answer 1

Alkylphenol

Question 2

Ketamine drug class

Answer 2

Arylcyclohexylamine

Question 3

Etomidate drug class

Answer 3

Imidazole

Question 4

Thiopental drug class

Answer 4

Barbiturate

Question 5

Propofol chemical name

Answer 5

2,6-diisopropylphenol

Question 6

Ketamine chemical name

Answer 6

2-(o-Chlorophenyl)-2 (methylamino) cyclohexanone hydrochloride

Question 7

Etomidate chemical name

Answer 7

R-1-ethyl-1-(a-methylbenzyl) imidazole-5-carboxylate

Question 8

Thiopental chemical name

Answer 8

5-ethyl-5-(1-methylbutyl)-2-thiobarbituric acid

Question 9

Anesthetic agents most likely to cause pain on injection:

Answer 9

• Diazepam +++
• Etomidate +++
• Propofol ++
• Lorazepam +

Question 10

Propylene glycol is a solvent for:

Answer 10

• Etomidate
• Diazepam
• Lorazepam

Question 11

Which induction has bronchodilating properties?

Answer 11

Ketamine

Question 12

Which “generic” formulation is likely to precipitate bronchospasm in asthmatic patients?

Answer 12

Propofol

- Diprivan (brand) contains EDTA which doesn’t cause bronchial irritation; generic has different preservatives

Question 13

Lecithin is found in:

Answer 13

• egg yolks
• peanuts
• soy products

Question 14

Propofol may safely be administered to people with:

Answer 14

• egg, peanut, and soy allergies

Question 15

Risk factors for propofol infusion syndrome:

Answer 15

• Propofol dose > 4 mg/kg/hr
• Propofol infusion > 48 hrs
• Sepsis (inadequate oxygen delivery)
• Continuous catecholamine infusions
• High-dose steroids
• Significant cerebral injury

Question 16

Clinical presentation of propofol infusion syndrome:

Answer 16

Acute refractory bradycardia leading to asystole and at least one of the following:
- Metabolic acidosis (base deficit > 10 mmol/L)
- Rhabdomyolysis
- Hyperlipidemia
- Enlarged or fatty liver
- Renal failure
Lipemia may be an early sign

Question 17

Treatment for propofol infusion syndrome:

Answer 17

Supportive.

D/C propofol, maximizing gas exchange, cardiac pacing, PDE inhibitors, glucagon, ECMO, and renal replacement therapy

Question 18

Which induction agent is most likely to cause PONV?

Answer 18

Etomidate (30-40% incidence)

Question 19

What is the primary pathway of etomidate metabolism?

Answer 19

Hydrolysis

Question 20

Etomidate causes adrenocortical suppression by inhibiting:

Answer 20

11 beta-hydroxylase

Question 21

Two best treatments for treating an episode of acute intermittent porphyria:

Answer 21

• Heme arginate

- Glucose

Question 22

Which anesthetic agent is is least affected by alterations in plasma protein binding?

Answer 22

Ketamine

Question 23

At the N-methyl-D-aspartate receptor, ketamine is the antagonist of:

Answer 23

Glutamate

Question 24

Ketamine administration does not cause:

Answer 24

xerostomia

Question 25

Cardiovascular side effects of Ketamine administration:

Answer 25

SNS stimulation | Direct myocardial depression

Question 26

Respiratory side effects of Ketamine administration:

Answer 26

Bronchodilation Intact pharyngeal/laryngeal reflexes Spontaneous respirations usually preserved Increased salivation

Question 27

CNS side effects of Ketamine administration:

Answer 27

``` Dissociative anesthesia Analgesia Emergence delirium (treated with BZPs) Increased cerebral blood flow Neuroapoptosis in the developing brain ```

Question 28

Eye side effects of Ketamine administration:

Answer 28

Nystagmus Increased intraocular pressure (only with high doses) Increased ocular muscle tone

Question 29

Which anesthetic agent is most likely to increase oxygen consumption in the brain?

Answer 29

Ketamine

Question 30

What is the initial dose of Flumazenil?

Answer 30

0.2 mg IV

Question 31

What are repeat doses of Fluamazenil?

Answer 31

0.1 mg IV in q1min increments

Question 32

What kind of drug is Flumazenil?

Answer 32

Competitive GABA-A receptor antagonist Very high affinity but short DOA (30-60 min) Thus, may need repeat doses to prevent resedation

Question 33

Which anesthetic agents produce an active metabolite?

Answer 33

Ketamine | Midazolam