Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Spring '20/ L. PHARM TEST 2 - opioids, anticholinergics, cholinesterase > IV SEDATIVES AND HYPNOTICS (PP+Notes) > Flashcards

IV SEDATIVES AND HYPNOTICS (PP+Notes) Flashcards

1
Q

Barbiturates

how fast?

A

rapid onset and rapid awakening

Short-acting: thiopental, methohexital, thiamylal

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

Barbituates Mechanism of action

A

Depress the Reticular Activating System (RAS)

Hypoproteinemia intensifies the response to barbiturates because the free fraction of drug is increased, causing more to diffuse from blood to brain

potentiating GABAa channel activity, functions allosterically to increase the affinity of gaba for its binding site increasing the duration of the gaba

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

Barbiturates PH? Lipid soluble?

A

High pH; drug dissolved in low pH solution should not be mixed with thiopental to avoid precipitation

Lipid soluble, 60% unionized in plasma—good entry into the brain; rapid onset

Methohexital has prominent excitatory effects—hiccups, seizures

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

Thiopental -vascular and intracranial effects? power point

good for seizures?

A

Anticonvulsant and amnestic actions

Increases cerebral vascular resistance; decreases cerebral blood flow and intracranial pressure; decreases cerebral metabolism
Drug of choice in head injury

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

Thiopental and pain control?(PP)

A

Poor analgesic; may be hyperalgesic

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

Thiopental and Histamine? (PP)

A

May cause histamine release (avoid in severe asthmatics)

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

Thiopental and contraindications (PP)

A

Contraindicated in patient with porphyria

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

Thiopental and Respiratory and cardiac system (pp)

A

Depresses respiratory system, myocardial contractility

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

Why is thiopental is mixed and stored in a solution with pH = 10-11? (PP)

A

To keep thiopental in ionized form. Ionized form is more water soluble. A precipitate will not from when thiopental is stored in a solution with a high pH

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

Thiopental (BOOK) induction dose requirements

A

vary with patient age, weight, and most importantly cardiac output.
the dose should decrease with age
dose needed for anesthesia in early pregnancy is decreased 18%
requirements are higher in children 1 year post thermal injury.

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

Methohexital (BOOK) and seizures?

A

effective in inducing seizures. useful during electroconvulsive therapy.
disadvantage is myoclonus.

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

Propofol (PP) MOA & recovery?

A

Acts on GABA and glycine receptors
Quicker, better recovery than with the barbiturates
Most important advantage—more rapid and complete awakening

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

Propofol cardiac changes

PP

A

Causes greater decrease in BP than thiopental (decrease in CO and SVR); HR often unchanged; may have sympatholytic or parasympathomimetic action

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

Propofol Respiratory (PP)

A

More profound ventilatory depressant than thiopental

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

Propofol antiemetics properties ?

pruritic?

analgesic effects?

anticonvulsant effect?

cerebral blood effects?
(PP)

A

Antiemetic properties— chemoreceptor trigger zone (CTZ) and vomiting center action

Antipruritic

No analgesic effects

Anticonvulsant

Decreases cerebral blood flow and metabolism

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

Propofol preparations considerations BOOK

A

increases triglyceride,

supports bacterial growth.

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

what is different about propofol and spinal motor neuron excitability? (book)

A

in contrast to volatile anesthetics, spinal motor neuron excitability is not altered by propofol suggesting that immobility during propofol anesthesia is not caused by drug induced spinal cord depression.

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

propofol metabolism (book)

A

metabolized by p450 and excreted by the kidneys. no evidence of delayed clearing in patients with cirrhosis.

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

propofol lungs uptake? (book)

A

pulmonary uptake of propofol is significant and influences the initial availability of propofol. most of the drug that undergoes pulmonary uptake during the first pass is released back into the circulation

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

Propofol induction children and elderly (BOOK)

A

children require higher doses elderly require lower induction dose

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

propofol conscious sedation dose?

A

25-100mcg/kg/min

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

propofol maintenance of anesthesia dose

A

100-300mcg/kg/min

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

propofol antiemetic dose?

A

10-15mg IV in pacu

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

Propofol cardiac dry old people. tell me about this.

A

exaggerated in hypovolemic patients, elderly patients and patient with compromised left ventricular function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what does propofol block the stimulation of? (think airway)
stimulation produced by direct laryngoscopy and intubation of the trachea reverses the blood pressure effects of propofol. also blunts the hypertensive response to placement of laryngeal mask airway.
26
propofol hepatic and renal function, eye pressure, coags?
green urine decreases intraocular pressure no alter of coags risk of brady cardia- give epinephrine
27
propofol lactic acidosis
propofol infusion syndrome metabolic acidosis. doses exceeding 75mcg/kg/min
28
Benzodiazepines moa (pp)
Enhance actions of GABA lead to increase entry of Cl- leads to hyperpolarization Short-acting: diazepam, lorazapam, midazolam
29
Benzodiazepines used for?(pp)
Antianxiety, amnestic, sedative, hypnotic, anticonvulsant; muscle relaxation Poor analgesics
30
benzodiazepines (pp) cardiac effects
Little effect on CV system unless patient is hypovolemic—profound hypotension
31
benzodiazepines (pp) cerebral effects
Cause cerebral vasoconstriction—lowers cerebral blood flow, metabolism and intracranial pressure
32
benzodiazepines (pp) soluability?
Diazepam is poorly water soluble; dissolved in organic solvent and pain may occur on injection
33
protein bound of diazepam %? (pp)
98-99%
34
Epidural placement considerations (in class discussion)
GIVE FLUIDS! some will not put in an epidural until they have had a liter of fluids
35
Benzodiazepines side effects BOOK name the synergistic effects with various drugs?
fatigue and drowsiness are most common side effects antacids decrease absorption impairment of cognitive function. anterograde amnesia-especially if there is concomitant ingestion of ETOH. Synergistics effects with ETOH, inhaled and injected anesthetics opioids and alpha 2 agonists.
36
Ketamine (pp)
Produces amnesia and profound analgesia by interacting with NMDA-type glutamate receptor Cerebral vasodilator— increases cerebral blood flow and metabolism and increases intracranial pressure Contraindicated in head injury Causes hypertonus and nystagmus Stimulates SNS—CV enhancement (increased HR, CO, bp) IV or IM
37
Ketamine in class discussion
Never give ketamine unless your on the way to the or Give versed as it will relax the patient. Don’t give with dementia, ptsd, if they start having flashbacks give more versed If you know the patient has ptsd or they are a young buck 18-19 year old kids- they get wild when they wake up. Move them over to the bed, put your rails up, then wake them up. Deep extubate if they don’t have any contraindications. Hypertonus- tense muscles, ridged, nystagmus- eyes are going twitchy. Im- pediatric patients. Mentally retarded, psychiatric issues- im ketamine calms them down. If someone is already wild you need to IM them Higher icp- infarct the brain. They can’t play the piano anymore Severe dreams hallucinations nausea and vomiting
38
ketamine who is a poor candidate? (pp)
Poor risk patients are candidates for ketamine Avoid in cardiac patient, glaucoma patient, patient with elevated ICP Emergence is severe; dreams, hallucinations, N/V Weak base; do not mix with alkaline solutions
39
Versed BOOK pharmacokinetics
rapid absorption from the GI tract and prompt passage across the blood brain barrier. extensively bound to plasma proteins
40
``` versed metabolism (book) what drugs will slow the metabolism of this drug ```
hepatic ally metabolized. metabolism is slowed in the presence of cimetidine, erythromycin calcium channel blockers an anti fungal drugs. that inhibit p450. really excreted and not altered by renal failure.
41
versed central nervous system (book)
potent anticonvulsant effects. produces decreases in CMRO2 and cerebral blood flow comparable to barbiturates and propofol.
42
versed ventilation (book)
dose dependent decreases in ventilation by decreasing hypoxic drive. COPD- even greater respiratory depression. transient apnea may occur after rapid injection of large doses of midazolam. decreases upper airway activity and swelling reflex
43
versed cardiovascular system (book)
induction dose create a decrease in systemic blood pressure and increase in heart rate. cardiac output not effected. decrease in bp is due to decrease in SVR.
44
versed sedation dose, onset, peak, and duration.
1-2.5mg iv onset 60 seconds peak 5 minutes duration 80 minutes.
45
versed induction of anesthesia
0.1-0.2mg/kg iv over 30-60 minutes synergistic interaction is facilitated when a small dose of opioid
46
flumazenil dose? onset? peak? duration?
0.2-1mg IV give additional doses up to 3mg in 1 hour. duration of action is 30-60 mimutes. RESEDATION MAY OCCUR!
47
flumazenil and antieliptics drugs
administration to patients being treated with anti epileptic drugs for control of seizure activity is not recommended as it could precipitate acute withdrawal seizures.
48
Scopolamine (Hyoscine) & indications
competitive ACH antagonist at muscarinic receptor. prevent and create N&V motion sickness amnesia sedation or vagolysis. greater antisialagogue and ocular effects that does atropine with lesser effects on the heart.
49
Scopolamine onset
apply one patch the evening before surgery or 1 hour before cesarean section. effects within 4 hours and last for 72 hours
50
scopolamine reversal
pyridostigmine 15-60mg/kg
51
scopolamine adverse effects
hallucinations, delirium, tachycardia drowsiness restlessness, confusion, anaphylaxis increased intraocular pressure decreased sweating.
52
scopalamine precautions
children and elderly more suspectable to adverse effects. contraindicated in acute angle glaucoma, patients unable to tolerate tachycardia.
53
scopolamine on the eye
produces mydriasis and cycloplegia
54
Etomidate dose
0.2-0.4mg/kg onset 1 minute duration 10min
55
Etomidate contraindications
adrenocortical suppression.
56
etomidate metabolism
metabolized by hydrolysis in the liver.
57
lorazepam
1-2mg max of 4mg more potent sedative and amnesic than midazolam and diazepam. obesity prolongs the sedative effects of lorazepam duration 6-24hrs.
58
ketamine
dissociative anesthesia. resembles a cataleptic state in which the eyes remain open with a slow nystagmic gaze. non communicative though wakefulness may appear present. however frequency of emergence delirium limits the clinical usefulness of ketamine as a sole agent.
59
ketamine binding site
NMDA receptor possibly muscarinic receptors??
60
ketamine induction dose
1-2mg/kg IV
61
ketamine precautions
HTN, coronary heart disease. increased intracranial pressure, history of cerebrovascular accident increased intraocular pressure and psychiatric disorder, it is contraindicated for surgery or diagnostic procedures of the pharynx. use it cautionsly in patients with convulsive disorder.
62
VERSED CONTRAINDICATION
GLAUCOMA
63
risk factors for propofol infusion syndrome
``` propofol greater than 75mcg/kg/min infusion duration greater than 48hours children greater adults inadequate oxygen delivery sepsis significant cerebral injury ```
64
clinical presentation of propofol infusion syndrome
``` metabolic acidosis rhyabdomyolysis enlarged or fatty liver renal failure hyperlipidemia lipemia (cloudy plasma or blood) ```

Spring '20/ L. PHARM TEST 2 - opioids, anticholinergics, cholinesterase (8 decks)

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