Sedation

Question 1

Propofol mechanism of action

Answer 1

low dose- potentiates Gaba
high dose- activates gaba receptors, slows dissociation of gaba from receptors
(slows the closing of calcium channels in the neuron)

Question 2

which receptor does propofol bind to

Answer 2

GABA

Question 3

Biggest contraindication of propofol

Answer 3

decreases preload, do not use for induction in pts with aortic stenosis

Question 4

Effects of propofol (5)

Answer 4

resp. depression
hypotension
hyperlipidemia
hypertriglyceridemia
propofol infusion syndrome

Question 5

4 signs of propofol infusion syndrome

Answer 5

bradycardic HF
lactic acidosis
rhabdomyolysis
acute renal failure

Question 6

Properties of propofol

Answer 6

sedation an amnesic, no analgesia

Question 7

Precedex mechanism of action

Answer 7

alpha-2 agonist

Question 8

Precedex properties

Answer 8

sedative, amnesic, mild analgesia

Question 9

Effects of precedex

Answer 9

hypotension
bradycardia

Question 10

Contraindications of precedex

Answer 10

cardiac conduction defects
caution if HF or hemodynamic instability

Question 11

How is propofol metabolized and excreted

Answer 11

hepatic metabolism
renally excreted

Question 12

How is precedex metabolized and excreted

Answer 12

hepatic metabolism
renally excreted

Question 13

Precedex half life

Answer 13

2-2.5 hours

Question 14

How are opioids metabolized and excreted

Answer 14

hepatic metabolism
renally excreted

Question 15

Fentanyl onset

Answer 15

1-2 minutes

Question 16

Fentanyl lipid solubility

Answer 16

600x morphine

Question 17

Lipid solubility meaning

Answer 17

drug must pass a lipid bilayer to enter the brain

Question 18

Fentanyl two reasons it is safe

Answer 18

No histamine release
No active metabolites- no renal dose adjustment

Question 19

Morphine onset

Answer 19

5-10 minutes

Question 20

Morphine safety (4)

Answer 20

Histamine release causes hypotension
Active metabolites- requires 50% dose reduction in renal failure
Can cause seizures
No bronchoconstriction

Question 21

Hydrocodone onset

Answer 21

5-15 mins

Question 22

Hydrocodone safety (2)

Answer 22

No histamine release
Active metabolites- no need for renal dose adjustment

Question 23

ketorolac mechanism of action

Answer 23

NSAID, inhibits prostaglandin

Question 24

3 adverse effects of ketorolac

Answer 24

gastric mucosal injury
upper GI bleed
impaired renal function

Question 25

ketorolac dose

Answer 25

30mg

Question 26

tylenol mechanism of action

Answer 26

COX2 inhibition for pain inhibits prostaglandin synthesis and release

Question 27

Max dose tylenol

Answer 27

4grams/day

Question 28

gabapentin mechanism

Answer 28

unknown

Question 29

benzodiazepines metabolism and excretion

Answer 29

metabolized in liver mostly renal excretion

Question 30

4 properties of benzos

Answer 30

amnesic anticonvulsant promotes delirium delayed awakening

Question 31

versed onset and duration

Answer 31

rapid acting 2-5 mins short duration

Question 32

versed lipid solubility

Answer 32

high

Question 33

versed continuous infusion considerations

Answer 33

limited to less than 48 hours d/t drug uptake into tissues

Question 34

versed active metabolites?

Answer 34

active metabolites prolong sedation especially in renal failure

Question 35

ativan duration

Answer 35

long acting, lasts 6 hours

Question 36

max dose ativan and why

Answer 36

10mg/hr d/t propylene glycol used as solvent can lead to toxicity

Question 37

why is propylene glycol toxic?

Answer 37

converts to lactic acid which leads to metabolic acidosis

Question 38

propylene glycol toxicity s/sx (3)

Answer 38

delirium with hallucinations hypotension multisystem organ failure

Question 39

benzo withdrawal syndrome (4)

Answer 39

agitation disorientation hallucinations seizures

Question 40

Rocuronium cisatracurium, and vecuronium mechanism of action

Answer 40

nicotinic-acetylcholine receptor antagonist at the muscle end-plate

Question 41

Rocuronium duration (2)

Answer 41

intermediate acting 30 mins

Question 42

how much of nAch needs to be blocked rocuronium

Answer 42

70% blocked

Question 43

Rocuronium twitch goal

Answer 43

2-3

Question 44

where are nAch receptors found

Answer 44

at neuromuscular junction

Question 45

Rocuronium dose

Answer 45

0.6-1.2 mg/kg

Question 46

Rocuronium metabolism

Answer 46

minimally, hepatic

Question 47

roc excretion

Answer 47

mostly by liver (feces), some by kidneys

Question 48

Dopamine use low-dose

Answer 48

improve renal blood flow (not backed by evidence)

Question 49

Dopamine moderate dose receptor sites

Answer 49

Beta 1 Beta 2

Question 50

Dopamine high dose receptor sites

Answer 50

Alpha Beta 1 Beta 2

Question 51

Alpha receptor stimulation results in

Answer 51

vasoconstriction

Question 52

Beta 1 receptor stimulation results in

Answer 52

Increased HR Increased contractility

Question 53

Beta 2 receptor stimulation results in

Answer 53

vasodilation bronchodilation

Question 54

Half life of dopamine

Answer 54

2 min

Question 55

Dopamine dose

Answer 55

2-20 mcg/kg/min

Question 56

Levo effect on MAP

Answer 56

marked increase

Question 57

Levo effect on HR

Answer 57

mild decrease

Question 58

Levo effect on CO

Answer 58

mild decrease

Question 59

Levo effect on SVR

Answer 59

marked increase

Question 60

Dobutamine effect on MAP

Answer 60

mild increase

Question 61

Dobutamine effect on HR

Answer 61

mild increase

Question 62

Dobutamine effect on CO

Answer 62

Marked increase

Question 63

Dobutamine effect arrhythmogenicity

Answer 63

mild decrease

Question 64

Dopamine metabolism and excretion

Answer 64

metabolized by kidneys, liver, plasma excreted renally

Question 65

Dopamine considerations (2)

Answer 65

correct hypovolemia before or concurrently Start with lower initial doses in elderly and decreased organ fuction

Question 66

What is dobutamine

Answer 66

synthetic catecholamine inodilator

Question 67

Dobutamine receptor activation

Answer 67

beta 1 weak beta 2

Question 68

Inotropes are contraindicated in

Answer 68

hypertrophic cardiomyopathy

Question 69

Dobutamine dose range

Answer 69

5-20 mcg/kg/min

Question 70

Adverse effects of dobutamine

Answer 70

tachycardia and increased myocardial o2 demand

Question 71

Milrinone mechanism of action

Answer 71

phosphodiesterase inhibitor

Question 72

milrinone effects on hemos

Answer 72

Increase myocardial contractility Small chronotropic effect vasodilator- decreases preload and afterload (produces more hypotension)

Question 73

mechanism of increasing contractility that milrinone and dobutamine share

Answer 73

cyclic AMP-mediated calcium influx into cardiac myocytes

Question 74

Milrinone dosing

Answer 74

0.125-0.75 mcg/kg/min

Question 75

Milrinone adverse effects

Answer 75

ventricular arrhythmias

Question 76

Milrinone metabolism and excretion

Answer 76

liver urine

Question 77

Milrinone half life

Answer 77

2.5 hours

Question 78

Dopamine half life

Answer 78

2 minutes

Question 79

Dobutamine half life

Answer 79

2 minutes

Question 80

Dobutamine metabolism

Answer 80

in tissues and liver by catechol-O-methyl tranferase

Question 81

Dobutamine excretion

Answer 81

urine

Question 82

milrinone onset

Answer 82

5-15 mins

Question 83

albumin mechanism

Answer 83

increases intravascular oncotic pressure

Question 84

hydralazine mechanism

Answer 84

unknown direct peripheral vasodilator of arterioles

Question 85

hydralazine onset

Answer 85

10-80 mins

Question 86

hydralazine half life

Answer 86

3-7 hours

Question 87

hydralazine metabolism and excretion

Answer 87

liver urine

Question 88

hydralazine dosing

Answer 88

10-20 mg

Question 89

hydralazine effects on SVR/preload

Answer 89

decreases SVR, no effect on preload

Question 90

nitro mechanism of action (5)

Answer 90

forms free nitric oxide smooth muscle relaxation produces vasodilator effect on peripheral veins and arteries Decreases preload more than afterload dilates coronary arteries

Question 91

nitroglycerin effects on hemos (4)

Answer 91

Decreases CVP, SVR, PAP, can increase CO by increasing coronary blood flow

Question 92

Nitro contraindications

Answer 92

sildenafil use shock inferior MI (preload dependent)

Question 93

Nitro dose

Answer 93

5-200 mcg/min

Question 94

How long can nitro gtt be used?

Answer 94

24-48 hours tachyphylaxis develops

Question 95

Nitro onset

Answer 95

immediate

Question 96

nitro half life

Answer 96

1-4

Question 97

nitro metabolism and excretion

Answer 97

liver, RBCs, and vasc. walls

Question 98

Roc effects on hemodynamics

Answer 98

increased MAP

Question 99

vec effects on hemodynamics

Answer 99

none

Question 100

vec onset

Answer 100

2-5 mins

Question 101

vec duration

Answer 101

45-65 mins

Question 102

vec metabolism and excretion

Answer 102

liver feces

Question 103

vec dosing for shivering

Answer 103

8-10 mg

Question 104

cis onset of action

Answer 104

3-5 mins

Question 105

cis duration

Answer 105

25-90 mins

Question 106

cis metabolism

Answer 106

degraded in plasma to laudanosine

Question 107

cis excretion

Answer 107

urine

Question 108

cis hemodynamic changes

Answer 108

none

Question 109

cis dosing

Answer 109

1-3 mcg/kg/min

Question 110

succinylcholine dosing (RSI)

Answer 110

1-1.5 mg/kg

Question 111

succinylcholine hemodynamic changes

Answer 111

bradycardia or asystole (pretreat with atropine) increases BP arrhythmias

Question 112

succinylcholine adverse effects

Answer 112

hyperkalemia MH

Question 113

Succs onset

Answer 113

Less than 60 seconds

Question 114

Duration

Answer 114

4-10 mins

Question 115

Succs metabolism

Answer 115

Plasma pseudocholinesterase

Question 116

Succs excretion

Answer 116

Urine