Test 3 Study Guide- Induction / Opioids/ Non-opioids

Question 2

How do you dilute Narcan for standard IV use?

Answer 2

Dilute 0.4 mg/mL to 0.04 mg/mL (1 mL in 9 mL normal saline).

Question 3

How do you dilute phenylephrine for IV push use?

Answer 3

Dilute 10 mg/mL to 100 mcg/mL (1 mL in 100 mL or 0.1 mL in 10 mL NS).

Question 4

What is the chemical structure class of fentanyl?

Answer 4

Synthetic phenylpiperidine derivative.

Question 5

What is the chemical structure class of morphine?

Answer 5

Natural phenanthrene derivative.

Question 6

What is the maintenance infusion rate for remifentanil?

Answer 6

0.05–2 mcg/kg/min.

Question 7

What makes remifentanil’s pharmacokinetics unique?

Answer 7

Rapid onset/offset due to esterase metabolism, not organ-dependent.

Question 8

Rank these opioids from most to least potent: morphine, fentanyl, sufentanil, meperidine.

Answer 8

Sufentanil > Fentanyl > Morphine > Meperidine.

Question 9

Is codeine a natural, semisynthetic, or synthetic opioid?

Answer 9

Natural.

Question 10

How does opioid metabolism differ in the elderly vs. young?

Answer 10

Elderly have reduced hepatic/renal clearance → prolonged effect.

Question 11

Where specifically do opioids act in the spinal cord?

Answer 11

Substantia gelatinosa (Lamina II of dorsal horn).

Question 12

What is the active metabolite of ketamine?

Answer 12

Norketamine.

Question 13

What is the active metabolite of meperidine?

Answer 13

Normeperidine (can cause seizures).

Question 14

What is a major side effect of intrathecal morphine?

Answer 14

Pruritus (itching); treat with Benadryl and time.

Question 15

Which formulation of opioids must be used intrathecally?

Answer 15

Preservative-free only.

Question 16

Name 3 side effects of chronic opioid use.

Answer 16

• Constipation
• Endocrine suppression
• Opioid-induced hyperalgesia

Question 17

Bradycardia from opioids is mediated by which receptor?

Answer 17

Mu receptor.

Question 18

How long must you observe a patient after giving flumazenil?

Answer 18

At least 2 minutes—resedation may occur.

Question 19

What is the onset of action for pentobarbital IV?

Answer 19

30–60 seconds.

Question 20

Which property affects a drug’s protein binding?

Answer 20

High protein concentration, high pH (>8), low Vd, low body fat.

Question 21

What is the IM ketamine dose for an uncooperative patient?

Answer 21

4–10 mg/kg.

Question 22

What is a contraindication to ketamine?

Answer 22

Elevated intracranial pressure or psychiatric illness.

Question 23

What is a contraindication to etomidate?

Answer 23

Adrenal suppression (inhibits 11β-hydroxylase).

Question 24

What is the induction dose of propofol in mg/kg?

Answer 24

1.5–2.5 mg/kg.

Question 25

What is the antiemetic infusion dose of propofol?

Answer 25

10–25 mcg/kg/min.

Question 26

What is the loading and maintenance dose of dexmedetomidine (Precedex)?

Answer 26

Loading: 1 mcg/kg; Maintenance: 0.2–0.7 mcg/kg/hr.

Question 27

Which IV agent is a bronchodilator?

Answer 27

Ketamine.

Question 28

Which barbiturate is most commonly used for sedation?

Answer 28

Pentobarbital.

Question 29

Which barbiturate may cause bronchospasm?

Answer 29

Thiopental.

Question 30

What is the pH of barbiturates like thiopental?

Answer 30

~11 (highly alkaline).

Question 31

Do benzos act on GABA or NMDA receptors?

Answer 31

GABA-A receptors.

Question 32

What GABA receptor subtypes are responsible for sedation and anxiolysis?

Answer 32

* α1 = sedation * α2/α3 = anxiolysis

Question 33

What is the midazolam dose for seizure control vs anxiolysis?

Answer 33

Seizure: 0.1–0.2 mg/kg; Anxiolysis: 0.02–0.04 mg/kg.

Question 34

What is a safe IV agent for patients with AIP (acute intermittent porphyria)?

Answer 34

Propofol.

Question 35

How do you treat accidental intra-arterial injection of a barbiturate?

Answer 35

Brachial plexus block.

Question 36

Changing which groups on the barbiturate ring alters activity?

Answer 36

Groups on C2–C5 of the hexagon ring.

Question 37

What syndrome is associated with long-term propofol infusions?

Answer 37

Propofol Infusion Syndrome (PIS).

Question 38

What is the Jar value where benzos are ineffective?

Answer 38

<4.

Question 39

When is a benzo pharmacologically active in humans (pH)?

Answer 39

pH >7.

Question 40

What receptor does Propofol act on?

Answer 40

GABA-A receptor (positive allosteric modulator).

Question 41

What is the formulation base for Propofol that can cause allergic reactions?

Answer 41

Soybean oil and egg phospholipid.

Question 42

What receptor does Etomidate mimic?

Answer 42

GABA-A receptor.

Question 43

Why is Etomidate preferred in unstable patients?

Answer 43

Minimal CV and respiratory depression.

Question 44

What enzyme does Etomidate inhibit, causing adrenocortical suppression?

Answer 44

11β-hydroxylase.

Question 45

What is the IV induction dose of Etomidate?

Answer 45

0.2–0.3 mg/kg.

Question 46

What is the primary receptor target of Ketamine?

Answer 46

NMDA receptor (noncompetitive antagonist).

Question 47

Does Ketamine cause respiratory depression?

Answer 47

No, it preserves respiratory drive.

Question 48

How does Ketamine affect cardiovascular system?

Answer 48

Increases BP, HR, and CO.

Question 49

What is the major active metabolite of Ketamine?

Answer 49

Norketamine.

Question 50

Which barbiturate is associated with bronchospasm?

Answer 50

Thiopental.

Question 51

Which barbiturate is safer in terms of histamine release?

Answer 51

Methohexital.

Question 52

What substitution increases lipid solubility in barbiturates?

Answer 52

Sulfur at the C2 position.

Question 53

What is the primary mechanism of barbiturates?

Answer 53

GABA-A receptor agonism (Cl⁻ influx).

Question 54

What is the onset time for Thiopental?

Answer 54

15–30 seconds.

Question 55

What is the most common clinical use of Midazolam?

Answer 55

Preoperative sedation.

Question 56

Which benzodiazepine has an ultra-short duration of action?

Answer 56

Remimazolam.

Question 57

How does Flumazenil reverse benzodiazepines?

Answer 57

Competitive antagonist at GABA-A receptor.

Question 58

What is the major risk after flumazenil reversal?

Answer 58

Resedation—monitor for 2 hours.

Question 59

What does Dexmedetomidine primarily act on?

Answer 59

Alpha-2 adrenergic receptors.

Question 60

Does Dexmedetomidine cause respiratory depression?

Answer 60

No.

Question 61

What is the loading dose of Dexmedetomidine?

Answer 61

0.5–1 mcg/kg over 20 minutes.

Question 62

What is the maintenance infusion dose of Dexmedetomidine?

Answer 62

0.2–1 mcg/kg/hr.

Question 63

What is the effect of Dexmedetomidine on opioid requirement?

Answer 63

Reduces opioid requirement.

Question 64

Which receptor subtype is responsible for Dexmedetomidine’s analgesia?

Answer 64

Alpha-2A in dorsal horn.

Question 65

What is a side effect of rapid bolus of Dexmedetomidine?

Answer 65

Transient hypertension.

Question 66

What are common cardiovascular effects of Precedex?

Answer 66

* Bradycardia * Hypotension

Question 67

What organ clears Dexmedetomidine?

Answer 67

Liver (hepatic metabolism).

Question 68

What neurotransmitter is decreased by Precedex?

Answer 68

Norepinephrine.

Question 69

What brain area does Precedex act on to induce sedation?

Answer 69

Locus coeruleus.

Question 70

What electrolyte ion is involved in GABA receptor hyperpolarization?

Answer 70

Chloride (Cl⁻).

Question 71

Which IV agent is ideal for awake fiberoptic intubation?

Answer 71

Dexmedetomidine.

Question 72

Which IV anesthetic agent causes the most apnea?

Answer 72

Propofol.