Test 1

Question 1

This can be given to treat muscle rigidity from opioids

Answer 1

NDMRs

Question 2

What should you do if you see a localized reaction at the site of morphine injection?

Answer 2

DON’T PANIC

Morphine causes histamine release, so this is a common reaction

Question 3

These meds can be used to relieve sphincter of oddi spasm

Answer 3

Glucagon, nubain, and NTG

Question 4

Opioids are weak (acids/bases)

Answer 4

Bases

Question 5

Vd is related to

Answer 5

Lipid solubility and protein binding

Question 6

A large Vd will equate to a long or short DOA?

Answer 6

Long

Question 7

Do opioids produce amnesia?

Answer 7

NO

Question 8

How do opioids produce bradycardia?

Answer 8

Vagal stimulation and inhibition of the SA node

Question 9

The bradycardia and ventilatory depression caused by opioids are

Answer 9

dose dependent

Question 10

Where do agonists/antogonists work?

Answer 10

They are Mu antagonists and full or partial kappa agonists

Question 11

Do benzos provide enough muscle relaxation for surgery?

Answer 11

NO. Give the normal amount of muscle relaxant you would normally give.

Question 12

Should you decrease the amount of muscle relaxant you give for a case if you have given a benzo?

Answer 12

NO

Question 13

Do benzos or barbiturates induce enzymes?

Answer 13

Only barbiturates

Question 14

Benzos have a (large/small) margin of error

Answer 14

Large

Question 15

Which do we typically give for pre-medication and MAC sedation? Benzos vs. barbs

Answer 15

Benzos. These have essentially replaced barbs for these purposes.

Question 16

How do benzos act at the GABA receptor?

Answer 16

They FACILITATE the actions of GABA at the receptor (increases it’s affinity and potency)

Question 17

Where are GABAa receptors found?

Answer 17

On POST-synaptic neurons in the CNS

There are barely any GABA receptors outside the CNS

Question 18

Why is there a ceiling effect with benzos?

Answer 18

Because all it can do is assist GABA to open the Cl- channels. After that, it can’t do anything else to achieve any effects.

Question 19

If given in subtherapeutic doses, this type of medication can cause a person to enter Stage 2 (excitatory) Anesthesia, and result in bronchospasm or laryngospasm

Answer 19

Barbiturates

Question 20

What does it mean if a drug has a short effect site equilibration time?

Answer 20

It means that the effects on the brain occur promptly after IV administration

Question 21

The reversal for dexmedetomidine is

Answer 21

Atipamezole

Question 22

The two preservatives used in propofol are

Answer 22

EDTA and sodium metabisulfite

Question 23

How is the pharmacologic activity of barbiturates terminated?

Answer 23

Side chain oxidation at carbon 5, converting it to carboxylic acid

Question 24

These medications are prepared as racemic mixtures

Answer 24

1) Ketamine (R and S, the S has more analgesic potency, undergoes faster metabolism, and has less incidence of emergence delirium)
2) Barbiturates (L and D, the L enantiomer has 2x the potency of D)

Question 25

Effect of barbiturates on pain

Answer 25

Small doses can lower the pain threshold

Question 26

If your patient's seizure disorder has been treated with a barbiturate, such as phenobarbital, you can expect that they will metabolize your drugs about ___x as rapidly

Answer 26

2 (this is especially evident in muscle relaxants)

Question 27

Do patients develop tolerance to barbs?

Answer 27

Yes, they induce their own metabolism and cause tolerance!

Question 28

How is diazepam prepared?

Answer 28

In benzyl alcohol and propylene glycol. pH of 6.6-6.9.

Question 29

Flumazenil is a _______ derivative

Answer 29

Imidazobenzodiazepine derivative

Question 30

What's unique about NMDA receptors?

Answer 30

They are both ligand and voltage-gated

Question 31

The clearance of this medication is dependent of hepatic blood flow

Answer 31

Ketamine

Question 32

How common are emergence reactions with ketamine?

Answer 32

10-30%

Question 33

Why should ketamine be avoided with MAOIs and TCAs?

Answer 33

Because ketamine prevents the re-uptake of NE

Question 34

MOA of propofol

Answer 34

Binds to the B1 subunit of GABA and inhibits NMDA

Question 35

What converts fospropofol into propofol?

Answer 35

Endothelial cell alkaline phosphatases

Question 36

What effect does sulfuration of barbituric acid have?

Answer 36

Makes it more lipid soluble

Question 37

What is the structure of benzodiazepines?

Answer 37

A benzene ring fused with a seven-membered diazepine ring

Question 38

The effects of benzos binding with GABA-A is thought to cause these effects

Answer 38

Sedation, anxiolysis, anticonvusant, and muscle relaxant. (everything but amnesia)

Question 39

Where can GABA-A receptors be found?

Answer 39

Almost exclusively on post-synaptic membranes in the CNS

Question 40

Which medication class causes a flattening of the CO2 response curve?

Answer 40

Benzodiazepines

Question 41

Effect of midazolam on the CV system.

Answer 41

None at small doses. At induction doses, there is a drop in SVR and BP, but CO is unchanged.

Question 42

Effect of diazepam on the CV system

Answer 42

Decrease in SVR, BP, and CO by 20%

Question 43

Ativan has this as a solvent

Answer 43

Propylene glycol

Question 44

How does flumazenil work?

Answer 44

It's a competative benzodiazepine antagonist

Question 45

Benefits of flumazenil

Answer 45

Reverses the sedation and respiratory depression. Also, it's post-op use is not associated with any anxiety provoking or neuroendocrine response (increased BP, HR, , etc), as opposed to narcan.

Question 46

A suboptimal dose of this medication can cause a patient to enter Stage 2 Anesthesia

Answer 46

TPL

Question 47

Effect of TPL on pain

Answer 47

Small doses can decrease the pain threshold. It can act as an "anti-analgesic"

Question 48

(TPL/Methohexital) can cause myoclonus and hiccups

Answer 48

Methohexital (the methyl radical causes convulsant activity)

Question 49

Allergy to TPL

Answer 49

Rare (1:30,000), but if it happens, it causes SEVERE anaphylaxis.

Question 50

If hepatic enzymes are induced, you can expect these medications to be metabolized faster

Answer 50

Oral anticoagulants, vitamine K, corticosteroids, TCAs, and phenytoin.

Question 51

TPL should not be mixed with these meds

Answer 51

Overall, avoid mixing with opioids, catecholamines, and NDMBs, because these are all acidic in solution Vecuronium Atracurium Pancuronium Sufentanil LR Alfentanil Midazolam

Question 52

IBW calculation

Answer 52

Men: 105 + 6lbs for every inch over 5 feet Women 100 + 5lbs for every inch over 5 feet

Question 53

Relationship of pKa of the opioids and their ionization

Answer 53

Lower the pKa, the more non-ionized. Alfentanil has the lowest pKa of the bunch, 6.5, and has the highest % non-ionized (90%), and thus the fastest rate of onset.

Question 54

This pain medication is contraindicated if

Answer 54

Meperidine (Demerol)

Question 55

Unlike most opioids, this one can cause tachycardia and myocardial depression

Answer 55

Meperidine (Demerol). This is because structurally, it resembles atropine.

Question 56

Effects of accumulation of normeperidine

Answer 56

Confusions, hallucinations, myoclonus, seizures

Question 57

How does meperidine act to reduce post-op shivering?

Answer 57

Works on kappa and alpha-2 receptors

Question 58

Compared with morphine, fentanyl has a (longer/shorter) onset and DOA

Answer 58

Shorter

Question 59

Why is does ketamine has sympathomimetic effects

Answer 59

1) NMDA activity in the nucleus tractus solitarius******* 2) Antagonist at muscarinic receptors 3) Inhibits the reuptake of NE

Question 60

This medication is cerebroprotective and resembles vitamin E in structure

Answer 60

Propofol

Question 61

This is a common premed we give that can inhibit the CYP450 system

Answer 61

Cimetidine

Question 62

These medications are myocardial depressants

Answer 62

* Ketamine * Propofol * Meperidine

Question 63

These medications have propylene glycol as a solvent

Answer 63

Diazepam, lorazepam, and etomidate.

Question 64

These medications flatten the CO2 response curve

Answer 64

Benos Barbs Etomidate Propofol

Question 65

These medications shift the CO2 response curve down/to the right

Answer 65

Opioids

Question 66

These medications are water soluble

Answer 66

* Midazolam * Dexmedetomidine * Fospropofol * Ketamine (both water and fat soluble)