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*Pharmacology > Nagalhout Videos- IV anesthetics > Flashcards

Nagalhout Videos- IV anesthetics Flashcards

1
Q

Brevatol aka

A

Methohexitol

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2
Q

Pentothal aka

A

Thiopental

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3
Q

Why isn’t thiopental used in the USA anymore?

A

Used be to used for the death penalty

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4
Q

What’s half life

A

The time it takes for the drug level in the blood to decrease by 1/2

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5
Q

Alpha half life =

A

Distribution half life - how long is going to take the drug to distribute from the blood to the tissues

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6
Q

Once the drug stops distributing into tissues and starts being metabolized

A

Beta half life (elimination half life)
- how long the drug takes to be metabolized once it has been distributed

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7
Q

Elimination half life of thiopental is 12 hours. How long before it’s removed from the body?

A

48hours (12x4 = 48) - takes 4 half lives for drug to be removed from the body (thought it was 5. He said technically it was but not clinically idk)

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8
Q

Difference between half life and duration of action

A

Half life tells you how long it stays in the body

Duration of action tells you how long it’s at a receptor

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9
Q

Why would a 3rd trimester mom require a higher close of sux for RSI?

A

Bc she has a greater total body fluid
More total body fluid = more Vd than the normal person ( it was be diluted)

Think about 100 sux in a small bucket of water be bigger

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10
Q

If a drug is ____% protein bound, there can be significant changes in the free fraction of the drug with changes in protein levels

A

90% or more

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11
Q

If you give two very highly protein bound drugs. Will the plasma concentration/free fraction of the drug be higher or lower than if used alone

Is this clinically relevant? Why or why not?

A

Both drug free fraction will be Higher. Only occupying half of the albumin than it normally would, increased free fraction amount

Not clinically relevant bc the increased free fraction of the drug will just be metabolized and peed out

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12
Q

How long after giving a propofol bolus should you expect to see a drop in BP? Why?

A

About 1 minute bc that’s how long it takes for propofol levels to peak in the heart (VRG)

  • if it’s 15 mins after, there’s something else going on
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13
Q

What kind of receptor subtypes are found on the target tissues vs the presynaptic nerve terminal? Examples?

A

1- post synaptic
2- pre synaptic

Alpha 1 = post synaptic , found on target tissues
Alpha 2 = pre synaptic . Found on nerve terminal and inhibits it’s own release /negative feedback

Histamine 1 & 2
1 on tissue, 2 on nerve

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14
Q

Why don’t we like Valium?

A

It’s got a really long half life of 48 hours . 48 x 4 = 196hrs = 16 days.

We like quick acting drugs. In and out . Not something that’s gonna hang along for that long

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15
Q

What does it mean if something is conjugated?

A

Glucose is added to it and it’s peed out

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16
Q

Half life of versed vs duration of action

A

Half life 2hrs (2x4=8 hrs stays in the body)

Duration of action = 30min - 2hrs (how long it will exert its effect on the receptor)

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17
Q

T/F : propofol is prepared as a 1% solution

A

True: 10mg/ml

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18
Q

Why does propofol burn on injection?

A

Bc it’s a lipid emulsion

19
Q

What’s the only IV drug that’s considered an IV anesthetic

A

Ketamine

20
Q

Etomidate comes in 20mg vials (10mg/ml )
70kg pt
What how much are u giving for an induction dose? How many mls?

A

70kg x 0.3mg = 21mg
Give 2mls

21
Q

T/F - all IV anesthetics decrease CMRO2

A

True

22
Q

True/False: all IV anesthetics decrease CBF … why does this matter

A

False- ketamine does not

But decreased in CBF decreases ICP (less flow, less pressure intractanially)

23
Q

5 mechanisms by which iv induction agents cause hypotension

A

CNS depression
Direct cardiac depression
Baroreceptor depression
Vasodilation
Decrease hormone release (renin, aldosterone)

*same for inhalations

24
Q

Least cardiac depressing induction agent

A

Etomidate

25
Q

Non-cardiac depressing iv induction agent

A

Ketamine

26
Q

How does ketamine cause bronchodilation?

A

Bc ketamine releases catecholamines and when you release catecholamines (SNS response) you get bronchodilation (via beta 2)

27
Q

If you have a patient coming in for an elective surgery who is actively wheezing what are u going to put them to sleep with?

What if it’s emergent?

A

Cancel if elective

If emergent- induce with ketamine

28
Q

What kind of disorder is porphyria?

A

A blood disorder

29
Q

Difference between acute and chronic porphyria

A

Chronic means you cannot induce an attack

Acute means you can absolutely induce an attack

*regardless, your not going to give them anything that could induce an attack

30
Q

What are porphyrins?

A

Normal chemicals in the body that help make heme (hemoglobin, iron)

31
Q

What enzyme controls how much hemoglobin is produced?

A

ALA synthase (rate limiting step = monitors, increases/decreases amount of heme)

32
Q

What substrate is needed to make steroids

A

Cholesterol

33
Q

Rate limiting enzyme for steroid production

A

11-beta hydroxylase

34
Q

When does propofol peak in the brain?

A

60 seconds

35
Q

Which IV induction drugs are emetic? (2)

A

Etomidate & ketamine (E>K)
(Opioids still higher than etomidate)

36
Q

T/F : higher doses of propofol will last longer

A

Yea bc there is more drug to redistribute out of the brain

37
Q

Duration vs half life of propofol

A

Duration of action - 10 mins (how long it exerts it’s effects at its receptor before redistributing)

Half life = 1 hour- time it takes for the blood level of propofol to decrease 1/2

38
Q

Elimination half life vs duration of action of precedex

A

Elimination half life = 2 hours
DOA= 15-30 mins

39
Q

The main way antipsychotics work?

A

They block dopamine in the brain

(Droperidol, thorazine, compazine)

*drugs that block dopamine in the brain are excellent antiemetics

40
Q

What’s one of the most emesis-inducing NTs in the brain?

A

Dopamine

41
Q

Black box warning on droperidol & what is droperidol used for?

A

Qt prolongation, cardiac arrhythmias and death

*to give it you must get a 12 lead beforehand

  • used for PONV - 0.625mg / 0.25mls
    (Dose they found that rid NV but didn’t make you sleep forever so u could go home and not stay in pacu forever)
42
Q

If a drug blocks dopamine receptors in the brain, what kind of side effects can be seen?

A

Extrapyramidal side effects (extrapyramidal means motor system: Parkinsonian like features: tremors)

43
Q

Drugs that block dopamine in the brain (droperidol & reglan) are contraindicated in patients with

A

Parkinson’s

*Pharmacology (25 decks)

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