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Pharmacology I > Lecture 02_Fall > Flashcards

Lecture 02_Fall Flashcards

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2
Q

List the 10 factors of an ideal anesthetic.

A
  1. water soluble and stable
  2. no pain on injection;no tissue damage w/extravasation
  3. low incidence of histamine release or hypersensitivity
  4. rapid smooth onset
  5. rapid metabolism to inactive metabolites
  6. steep dose response curve
  7. minimal cardiac/respiratory depression
  8. decreases ICP/CMRO2
  9. rapid smooth recovery
  10. minimal side effects: PONV, amnesia, HA, dizziness
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3
Q

Intra-arterial injection of _____ ->crystals-> thrombosis, necrosis? What is the treatment?

A

thiobarbiturates (thiopental and thioamylal)

Treat: papaverine, lidocaine, stellate ganglion block, heparin

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4
Q

Which of the following is true regarding barbiturates - indicate all that apply

A. water soluble
B. stable
C. no pain on injection
D. no pain on extravasation 
E. acidic
A 
A. water soluble - T
B. stable - F
C. no pain on injection - T
D. no pain on extravasation  - F
E. acidic - F
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5
Q

What is the mechanism of action of barbiturates?

A

depress the RAS (reticular activating system ) - consciousness center in the brain stem

Suppress excitatory neurotransmitters (Ach)

Enhance inhibitory (GABA)

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6
Q

What is the difference between Thiobarbiturates and Oxybarbiturates? Give an example of each.

A

Thiobarbs (thiopental, thioamylal)=
higher lipid solubility->greater potency, rapid onset, shorter duration

Oxybarbs (methohexital) =
lower lipid solubility->less potency, slower onset, longer duration

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7
Q

Are Barbiturates acidic or alkaline?

A

very alkaline (pH>10)

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8
Q

Are barbiturates a good choice for maintenance of anesthesia?

A

No bc the elimination half-life is 3-12hrs after multiple doses - saturate the peripheral compartments and have slower redistribution

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9
Q

What are the routes of absorption of barbiturates?

A

IV for GA; rectal/IM for premedication

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10
Q

T or F. Thiopental has high hepatic extraction, perfusion-limited metabolism, and a shorter elimination half life than Methohexital

A

False. Thiopental has low hepatic extraction, capacity-limited metabolism, and a longer elimination half life than Methohexital

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11
Q

T or F. Methohexital has high hepatic extraction, perfusion-limited metabolism, and a shorter elimination half life than thiopental

A

T

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12
Q

T or F. 2-4mg/kg/hr of Thiopental can be given for treatment of intracranial HTN or intractable seizures?

A

T

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13
Q

What is the half-life of Methohexital?

A

3.9 hrs

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14
Q

T or F. Barbiturates increase BP and decrease HR.

A

False.

Barbiturates decrease BP and increase HR (central vagolytic effect); venous pooling

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15
Q

T or F. CO is maintained with barbiturates except in hypovolemia, CHF, and beta blockade.

A

True. CO is maintained with barbiturates except in cases of hypovolemia, CHF, and beta blockade - this leads to very decreased CO and BP

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16
Q

What is the half-life of thiopental?

A

11.6 hrs

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17
Q

T or F. Bronchospasm and laryngospasm are associated with barbiturates.

A

True

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18
Q

Porphyria is associated with what class of induction agents?

A

barbiturates

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19
Q

T or F. Barbiturates are anti-epileptics.

A

True

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20
Q

T or F. Barbiturates do not blunt hypercapnic or hypoxic respiratory drive.

A

False.

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21
Q

T or F. Barbiturates decrease CBF and ICP but increase CMRO2.

A

False. They decrease all and decrease CMRO2 to burst suppression on EEG

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22
Q

Which of the following are water soluble?

A. Barbiturates
B. Propofol
C. Etomidate
D. Ketamine
E. Versed
A

Barbs, Ketamine, Versed

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23
Q

Which of the following are lipid soluble

A. Barbiturates
B. Propofol
C. Etomidate
D. Ketamine
E. Versed
A

Lipid soluble = Propofol and Etomidate

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24
Q

T or F. Barbiturates are renal protective bc they increase RBF.

Study These Flashcards
A

False. They decrease RBF due to hypotension

25
Q

Rhabdomyolysis is associated with with induction agent after prolonged high-dose infusions?

Study These Flashcards
A

Propofol - this is one symptom of Propofol Infusion Syndrome

26
Which induction agents cause burning on injection?
Propofol and etomidate
27
Which of the following are anti-epileptics? ``` A. Barbiturates B. Propofol C. Etomidate D. Ketamine E. Versed ```
A. Barbiturates B. Propofol E. Versed
28
In which of the following groups would higher plasma levels of barbiturates be seen? (choose all that apply) A. hypovolemic B. hypoalbuminemia C. acidosis D. elderly
All of the above
29
T or F. Patients allergic to eggs should not get propofol.
False. Propofol is emulsion in intralipid (soybean, glycerol, egg lecithin)Lecithin is from egg yolk and most allergies are to egg white
30
What acute condition is associated with barbiturates and is characterized by the following: abd pain, vomiting, neuropathy, weakness, seizures, hallucinations, depression, anxiety, paranoia cardiac arrhythmias, pain, constipation/diarrhea
Acute porphyria
31
T or F. Thiopental contains sulfur and therefor may evoke histamine release
TRUE
32
T or F. Propofol is renally excreted and doses should be decreased for pts with chronic renal failure.
False. It is renally excreted but is not effected by chronic renal failure
33
When placing a pt on a propofol infusion for GA, what is your target plasma concentration (in mcg/mL)?
4-6 mcg/mL
34
What are 3 ways to prevent pain caused by the burning on injection of propofol?
1. Bier Block (lido + tourniquet) 2. pre-treat with IV opioid 3. mix lido with propofol (to acidify emulsion)
35
T or F. Propofol causes hypotension because it decreases SVR, myocardial contractility, and preload.
TRUE
36
What drug has been associated with abuse and addiction due to its characteristic side effects of euphoria on emergence, intense dreaming and amorous behavior .
propofol
37
T or F. There is little evidence of tolerance developing with propofol.
True
38
T or F. One reason propofol is used in MAC cases is because it causes very little depression of upper airway reflexes.
False. causes PROFOUND depression of upper airway reflexes.
39
Where is etomidate metabolized?
liver (hepatic hydrolysis) and plasma esterases(even if you have no liver, you can metabolize etomidate, just slower)
40
T or F. Myoclonus is a side effect of etomidate.
TRUE
41
T or F. Etomidate causes minimal respiratory depression.
TRUE
42
Transient inhibition of cortisol/aldosterone synthesis can be seen after one dose of what induction agent?
etomidate
43
T or F. Etomidate is a good induction agent in hemodynamically unstable pts because it has minimal CV effects.
TRUE
44
Dissociative amnesia is associated with which induction agent?
Ketamine. It dissociates the thalamus for the limbic system = "cataleptic state"
45
Which induction agent has analgesic properties?
Ketamine
46
What is the mechanism of action of Ketamine?
Inhibition + excitation; NMDA antagonist
47
Which IV induction agent is associated with the following: bronchodilator, salivation, hallucinations, minimal respiratory depression,
Ketamine
48
What are the routes of absorption for ketamine?
IV and IM
49
T or F. Ketmaine is the drug of choice for neuro cases.
False. It increases CMRO2, CBF, and ICP
50
T or F. Versed causes respiratory depression.
TRUE
51
T or F. Versed should be avoided in neuro cases or is seizure patients.
FALSE
52
What is dependence?
onset of physical or psychological symptoms after reduction in dose
53
T or F. Patients that are on benzodiazepines may experience withdrawal symptoms that are so severe it can be fatal.
TRUE
54
What can be given for a benzodiazepine over dose and how does it work?
Flumazenil - high affinity for receptor with minimal activity
55
T or F. Flumazenil acts as a non-competitive antagonist.
False. It is a competitive antagonist
56
What are some advantages and disadvantages of Precedex?
Adv: minimal resp depression, calm sedation with rousability, anxiolysis, some analgesia Disadv: hypotension, bradycardia, expensive
57
What is dexmedetomidine?
(Precedex) Highly elective alpha-2 receptor agonist used for sedation.

Pharmacology I (3 decks)

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