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*Pharmacology > Prodigy- IV anesthetics > Flashcards

Prodigy- IV anesthetics Flashcards

1
Q

Formula to calculate drug clearance

A

Q x E

Q= blood flow
E = extration ratio

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2
Q

Clearance is directly proportional to ________ and inversely related to ________

Half live vs drug dose administered

A

drug dose administered
(increased dose = increased cleared)

inversely to half life
(increased half life, decreased clearance)

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3
Q

what is defined as the volume of plasma cleared of a drug per unit of time?

A

Clearance

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4
Q

What induction agent has the shortest elimination half-time

A

Propofol

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5
Q

T/F: despite the extensive hepatic metabolism of propofol, it does not exhibit signs of impaired elimination in patients with hepatic or renal failure

A

True

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6
Q

What population is at increased risk of propofol infusion syndrome and why?

A

Children with mitochondrial disease

-it’s believed to the the result of impaired mitochondrial function and subsequent uncoupling of oxidative phosphorylation

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7
Q

T/F - propofol has antioxidant properties

A

True

-similar to vitamin E, it has a phenolic hydroxyl group that scavenges free radicals and inhibits lipid peroxidation

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8
Q

Protein binding of Etomidate

A

75%

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9
Q

How does etomidate produce decreased CBF, ICP and CMRO2?

A

by cerebral vasoconstriction

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10
Q

What has the least effect on bronchomotor tone among ketamine, etomidate, prop, and midaz?

A

etomidate

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11
Q

What formulation of etomidate can produce pain and burning upon injection?

A

formulations containing propylene glycol

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12
Q

Protein binding of midazolam

A

96%- apex
98%- prodigy

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13
Q

Elimination half life of midazolam

A

2 hours

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14
Q

T/F midazolam depresses ventilation by suppressing the hypoxic drive

A

True

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15
Q

Concentration of oral midazolam syrup for kids

A

2mg/mL

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16
Q

Pediatric dose of intranasal midazolam

A

0.1-0.2mg/kg

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17
Q

What is added do diazepam and lorazepam that causes burning on injection?

A

Propylene glycol (solvent)

diaz > loraz

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18
Q

T/F: Diazepam shifts the CO2 response curve to the right

A

false

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19
Q

Dosing of diazepam in the treatment of status epilepticus

A

01.mg/kg IV every 10 mins until seizure controlled or max dose of 30mg has been reached

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20
Q

Which of the benzos has the most potent amnestic and sedative effects?

A

Lorazepam

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21
Q

Which benzo is less affected by hepatic disease

A

Lorazepam

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22
Q

What is the commercially-available pharmacologically-active metabolite of diazepam

A

Oxazepam

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23
Q

Which benzo inhibits adrenocorticotropic hormone and the secretion of cortisol to a greater extent than the others?

A

Alprazolam

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24
Q

Hypotension related to dexmedetomidine results from stimulation of which receptor?

A

Imidazoline

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25
Q

How does diazepam affect the CO2 response curve?

A. It decreases the slope of the curve
B. It shifts the curve to the left
C. It increases the slope of the curve
D. It shifts the curve to the right

A

A. It decreases the slope of the curve

26
Q

The pharmacokinetics of which agent are least affected by chronic kidney disease?
A. Midazolam
B. Dexmedetomidine
C. Propofol
D. Lorazepam

A

C. Propofol

27
Q

Induction doses of midazolam
A. are 0.5-0.6 mg/kg
B. typically decrease the heart rate substantially
C. can decrease the systemic blood pressure significantly
D. produce bronchospasm in most patients

A

C. can decrease the systemic blood pressure significantly

28
Q

The anesthetic state produced by ketamine is caused in part by
A. stimulation of the medullary cortex
B. stimulation of the thalamocortical pathways
C. stimulation of the limbic system
D. stimulation of the cerebellar region

A

C. stimulation of the limbic system

29
Q

Which of the following characteristics is true of midazolam?
A. It prevents increases in ICP due to laryngoscopy
B. It decreases CMRO2
C. It stimulates the hypoxic ventilatory drive
D. It increases cerebral blood flow

A

B. It decreases CMRO2

30
Q

Which of the following will decrease cerebrospinal fluid production?
A. Etomidate
B. Isoflurane
C. Fentanyl
D. Meperidine

A

(It’s not B - need to find answer)- A i think

31
Q

Lorazepam’s usefulness as an induction agent in anesthesia is primarily limited by its
A. low protein binding
B. short duration
C. slow onset
D. unpredictable pharmacologic effects

A

C. slow onset

32
Q

A pediatric patient with which condition is more likely to develop propofol infusion syndrome?
A. Polycythemia
B. Gastroschisis
C. Mitochondrial disease
D. Sickle cell disease

A

C. Mitochondrial disease

33
Q

Approximately how much of a drug will be remaining in the bloodstream after four elimination half-lives have passed for a drug that undergoes first-order kinetics?
A. 0.5%
B. 5%
C. 25%
D. 50%

A

B. 5%

34
Q

Which of the following would be an appropriate dose of intranasal midazolam in a 20 kg pediatric patient?
A. 10 mg
B. 7.5 mg
C. 15 mg
D. 2 mg

A

D. 2mg

(0.1mg/kg)

35
Q

You administer midazolam rapidly via the IV route to a pediatric patient. The patient begins to exhibit seizure-like activity. What is the most likely cause of this?
A. The patient has undiagnosed seizure disorder precipitated by midazolam
B. Allergic reaction
C. The patient has undiagnosed porphyria
D. Myoclonic reaction

A

D. Myoclonic reaction

36
Q

What chemical characteristic of midazolam allows it to be supplied as an aqueous solution that becomes lipid soluble when it contacts the bloodstream?
A. a pKa of 7.4
B. a benzene ring
C. a propylene glycol based preservative
D. an imidazole ring

A

D. an imidazole ring

37
Q

The clearance of a drug is inversely proportional to
A. body weight
B. the dose administered
C. renal blood flow
D. its half-life

A

D. Half life

(increased half-life = decreased clearance)

38
Q

The elimination half-time of midazolam is approximately
A. 2 hours
B. 48 hours
C. 18 hours
D. 6 hours

A

A. 2 Hours

39
Q

Midazolam can depress ventilation primarily by
A. increasing the response to CO2
B. suppressing the hypoxic drive
C. dilating the pulmonary vasculature
D. weakening respiratory muscles

A

B

40
Q

During intravenous induction with etomidate, the patient complains of burning in the arm with the IV. You know that this is due to
A. the propylene glycol preservative
B. the high lipid solubility of etomidate
C. the lack of protein binding the drug exhibits
D. the low pH of etomidate

A

A. the propylene glycol preservative

41
Q

What specific receptor binding sites are on the GABA receptor (4)

A

Benzos
Barbituates
Ethanol
GABA

42
Q

How do benzodiazepines affect CMRO2 and cerebral blood flow?

A

decrease both

43
Q

How are benzodiazepines metabolized?

A

Liver

-Hepatic oxidation and glucuronide conjugation

44
Q

How does diazepam affect minute ventilation?

A

*Decreases minute ventilation

(Nagelhout)

45
Q

*What is the elimination half-life of flumazenil and what is the significance of this?

A

It has a half-life of about 1 hour, so it is possible that re-sedation can occur with benzodiazepines that half a longer half-life than this.

(Nagelhout)

46
Q

Despite having a lower blood:gas solubility coefficient, the rate of rise of the FA/Fi ratio is higher for nitrous oxide than for desflurane. This is due primarily to the
A. concentration effect
B. oil:gas partitioning effect
C. second-gas effect
D. concentrating effect

A

A. concentration effect

47
Q

resistance will _____.
A. increase, increase
B. decrease, decrease
C. decrease, increase
D. increase, decrease

A

A. increase, increase

48
Q

You are inducing a patient undergoing surgery for an intracranial mass. What intervention would most help keep the intracranial pressure from increasing?
A. Administer sevoflurane at 1.5-2.0 MAC
B. Encourage the patient to cough forcefully on emergence
C. Maintain the PaCO2 at 45-50 mmHg
D. Administer desflurane at 0.8 MAC or less

A

D

49
Q

Modern inhaled anesthetics
A. produce no clinically significant levels of fluoride
B. can reduce the fluoride content in teeth
C. can produce vasopressin-resistant fluoride toxicity
D. contain no fluoride

A

A. produce no clinically significant levels of fluoride

50
Q

All of the volatile anesthetics below have been noted to increase right atrial pressure except for
A. desflurane
B. isoflurane
C. sevoflurane
D. nitrous oxide

A

Idk but it aint A

maybe Iso since they use it in the heart room- idk?

51
Q

Which inhalational agent has a vapor pressure of about 160 mmHg?
A. desflurane
B. sevoflurane
C. nitrous oxide
D. isoflurane

A

B. sevoflurane

52
Q

Approximately what percent of the cardiac output goes to the adipose tissue group?
A. 6%
B. 56%
C. 26%
D. 16%

A

A. 6%

53
Q

You are anesthetizing a patient with a congenital heart disease and a right-to-left shunt. The use of nitrous oxide could
A. increase the shunt due to a decrease in PVR
B. decrease the shunt due to a decrease in PVR
C. decrease the shunt due to an increase in PVR
D. increase the shunt due to an increase in PVR

A

D. increase the shunt due to an increase in PVR

54
Q

A patient with a right-to-left shunt is about to undergo induction of general anesthesia. You expect that the speed of induction will be _____ and this effect would be greatest with _____.
A. slower, desflurane
B. faster, desflurane
C. faster, isoflurane
D. slower, isoflurane

A

A. slower, desflurane

55
Q

Which of the following laws explains how nitrous oxide can expand an existing pneumothorax?
A. Fick’s law
B. The law of Brownian motion
C. Graham’s law
D. Henry’s law

A

A. Fick’s law

56
Q

Which agent has the lowest blood:gas partition coefficient?
A. Desflurane
B. Nitrous oxide
C. Isoflurane
D. Xenon

A

D. Xenon

57
Q

Which of the following is an expected respiratory effect of an inhaled anesthetic?
A. A decrease in tidal volume
B. A decrease in respiratory rate
C. An increase in the response to hypoxia
D. An increase in the response to hypercarbia

A

A. A decrease in tidal volume

58
Q

You are using the nitrous oxide tank connected to your anesthesia machine. Your flowmeters are set to administer 1 liter per minute of oxygen and 2 liters per minute of nitrous oxide. The nitrous oxide tank just dropped below a pressure of 745 psig. About how many more minutes of nitrous oxide do you have left?
A. 60 minutes
B. 400 minutes
C. 200 minutes
D. 120 minutes

A

C

-n20 below 745psi is ~400L left
400/2lpm = 200 min

59
Q

Which of the following is more likely to produce the pumping effect in an anesthetic vaporizer?
A. Using low respiratory rates
B. Having a full vaporizer fill chamber
C. Using high vaporizer dial settings
D. Using the oxygen flush valve

A

Idk- not C (guessed)> D

60
Q

When a volatile anesthetic is administered to a patient undergoing EEG monitoring, there is an initial ______ in amplitude followed by a(n) _________ in both frequency and amplitude.
A. increase, decrease
B. decrease, increase
C. increase, greater increase
D. decrease, greater decrease

A

A. increase, decrease

*Pharmacology (25 decks)

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