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JT - Basics > Week 7 Handout > Flashcards

Week 7 Handout Flashcards

1
Q

What is Dexmedetomidine?

A

S-enantiomer of medetomidine, an alpha agonist

Dexmedetomidine is used for sedation, analgesia, and anxiolysis.

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2
Q

What is the pH of Dexmedetomidine?

A

7.4

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3
Q

What is the mechanism of action for Dexmedetomidine?

A

CNS alpha receptor agonist and systemic vasodilation

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4
Q

What are the cardiovascular effects of Dexmedetomidine?

A

Hypotension and bradycardia

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5
Q

What is the loading dose of Dexmedetomidine?

A

1 mcg/kg over 10 min

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6
Q

What is the duration of action for Dexmedetomidine after stopping the infusion?

A

10-30 min

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7
Q

Does Dexmedetomidine cause respiratory depression?

A

No, it does not cause respiratory depression

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8
Q

What is Etomidate?

A

Carboxylated imidazole derivative

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9
Q

What is the mechanism of action for Etomidate?

A

GABA modulator

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10
Q

What is the emergence time for Etomidate after bolus administration?

A

5-15 min

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11
Q

What are the adverse effects of Etomidate?

A
  • Pain on injection
  • Thrombophlebitis
  • Nausea and vomiting
  • Myoclonia
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12
Q

What is the primary use of Ketamine?

A

Induction of anesthesia

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13
Q

What type of anesthesia does Ketamine provide?

A

Dissociative anesthesia

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14
Q

What is the pKa of Ketamine?

A

7.5

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15
Q

What is the induction dose of Ketamine when administered IV?

A

2-4 mg/kg

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16
Q

What are the cardiovascular effects of Ketamine?

A

Circulatory stimulant, indirect sympathomimetic

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17
Q

What is the primary mechanism of action for Propofol?

A

GABA agonist

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18
Q

What is the standard induction dose of Propofol?

A

1-2 mg/kg

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19
Q

What are the concerns regarding Propofol’s use?

A
  • Susceptible to bacterial contamination
  • PRIS (Propofol Infusion Syndrome)
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20
Q

What is the half-life of Midazolam?

A

Short half-life

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21
Q

What is the primary effect of opioids?

A

Analgesia

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22
Q

What is the active metabolite of Morphine?

A

M6G (active metabolite) and M3G (inactive metabolite)

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23
Q

What is the onset time for Morphine when given IV?

A

20 min

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24
Q

What is Fentanyl primarily used for?

A

Profound dose-dependent analgesia

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25
Does Fentanyl have an active metabolite?
No, it does not have an active metabolite
26
What is the primary disadvantage of Meperidine?
Accumulation of normeperidine can lead to CNS excitation and seizures
27
What is the pH of Etomidate?
8.1
28
What effect does Propofol have on cerebral blood flow?
Decreases CBF and CMRO2
29
What is the mechanism of action for opioids?
Inhibit ascending transmission of nociception and activate descending pain control pathways
30
What effect does the active metabolite of the drug have on seizure threshold?
Lowers seizure threshold and induces CNS excitability ## Footnote The active metabolite is normeperidine, which has an analgesic effect but can cause CNS issues.
31
What is the elimination half-life of normeperidine compared to its parent drug?
Significantly longer ## Footnote This can lead to accumulation and CNS excitation.
32
What are the effects of kappa receptor stimulation in relation to this drug?
Shivering reduction in general and epidural anesthesia ## Footnote This is an important consideration in anesthesia management.
33
Which patient populations should exercise caution with normeperidine?
* Patients with renal failure * Elderly patients * Chronic use in cancer patients ## Footnote High doses may be required in chronic pain management.
34
What are the characteristics of remifentanil?
* Piperidine-derived opioid with ester link * No active metabolite * Water soluble * Rapid onset and ultrashort duration ## Footnote These properties allow for rapid recovery after infusion.
35
What is the elimination half-life of remifentanil?
8-20 minutes ## Footnote This facilitates quick recovery after anesthesia.
36
Why is bolus dosing of remifentanil not recommended in the preop and postop phases?
Potential for respiratory depression and muscle rigidity ## Footnote Alternative analgesic therapy is advised in these phases.
37
What is buprenorphine classified as?
Potent partial agonist opioid ## Footnote It primarily binds to mu receptors and has a unique pharmacological profile.
38
What is the duration of action for buprenorphine?
8 hours ## Footnote It shows slow dissociation from the receptor.
39
What is a key characteristic of butorphanol?
Highly lipophilic opioid ## Footnote It acts as a kappa agonist and mu antagonist, producing analgesia with a ceiling effect.
40
What are the uses of nalbuphine?
* Treat pain * Treat pruritus induced by epidural morphine * Treat respiratory depression from other opioids ## Footnote It has a ceiling effect for respiratory depression.
41
What is naloxone?
Pure opioid antagonist ## Footnote It reverses respiratory depression and opioid analgesia through competitive antagonism.
42
What is naltrexone used for?
Alcohol disorder treatment ## Footnote It prevents the euphoric effects of opioids and has a longer duration of action than naloxone.
43
What is the primary mechanism of action for ketorolac?
Inhibiting cyclooxygenase enzymes ## Footnote This makes it effective for mild to moderate pain.
44
What is the maximum daily dose of acetaminophen for adults?
4000 mg/day ## Footnote Exceeding this dose can lead to hepatotoxicity.
45
What is the definition of Minimum Alveolar Concentration (MAC)?
The alveolar concentration of an inhaled anesthetic that prevents movement in 50% of patients in response to a standardized stimulus ## Footnote MAC is a measure of anesthetic potency.
46
What factors influence MAC?
* Decreases by 6% per decade of age * Unaffected by species, sex, or anesthesia duration ## Footnote These factors are important for tailoring anesthetic dosage.
47
What is the Train of Four (TOF) response indicative of?
Neuromuscular blockade levels ## Footnote TOF measures the response of muscle to electrical stimulation, helping assess recovery.
48
What is a Phase II block?
Desensitization block occurring after large doses of depolarizing neuromuscular blockers ## Footnote It shows a fade in response, unlike Phase I.
49
What is the primary method of elimination for inhalation anesthetics?
Alveolar ventilation ## Footnote This is crucial for effective anesthesia management.
50
What are the contraindications for inhalation anesthetics?
* Potentiate neuromuscular blocking agents * Catecholamine-induced arrhythmias * Malignant hyperthermia ## Footnote These contraindications highlight the need for careful patient selection.
51
What are the effects of nitrous oxide on the cardiovascular system?
Stimulates sympathetic nervous system, may mask myocardial depression ## Footnote In patients with CAD or severe hypovolemia, this effect may be significant.
52
What is the primary concern with sevoflurane?
Degradation into nephrotoxic compound A ## Footnote Monitoring renal function is important during its use.
53
What is the respiratory effect of isoflurane?
Causes respiratory depression with less pronounced tachypnea ## Footnote It is an effective bronchodilator.
54
What is the mechanism of action for succinylcholine?
Depolarizes nicotinic receptors, causing transient activation followed by neuromuscular blockade ## Footnote It does not cross the blood-brain barrier.
55
What is succinylcholine composed of?
2 acetylcholine (ACh) molecules; quaternary ammonium structure; water-soluble.
56
Does succinylcholine cross the blood-brain barrier?
No, it does not cross the blood-brain barrier.
57
What is the primary action of succinylcholine?
Depolarizes nicotinic receptors, causing transient activation followed by neuromuscular blockade.
58
What is the onset time for succinylcholine?
Within 3 minutes.
59
What is the duration of action for succinylcholine?
5-10 minutes.
60
What is the plasma half-life of succinylcholine?
2-4 minutes.
61
How is succinylcholine metabolized?
By plasma cholinesterase (hydroxylation), then further into succinic acid and choline.
62
What is the intravenous dose range for succinylcholine?
0.5 - 1.5 mg/kg; ED95 ~0.30 mg/kg.
63
In which special population is succinylcholine contraindicated?
Patients with a history of malignant hyperthermia.
64
What are the side effects of succinylcholine?
* Myalgias * Hyperkalemia * Possible malignant hyperthermia trigger.
65
What can cause prolonged effects of succinylcholine?
Pseudocolinesterase deficiency.
66
What is rocuronium bromide?
A monoquaternary aminosteroid neuromuscular blocker.
67
What are the onset and duration of action for rocuronium?
Onset: rapid (45-90 sec); Duration: intermediate (30-60 min).
68
What is the elimination half-life of rocuronium?
60-120 minutes.
69
What is the intravenous dose range for rocuronium?
0.6 – 1.2 mg/kg.
70
What is vecuronium bromide?
A monoquaternary aminosteroid neuromuscular blocker developed from pancuronium.
71
What is the onset time for vecuronium?
2-4 minutes.
72
What is the elimination half-life of vecuronium?
51-90 minutes in healthy adults.
73
What is the induction dose for vecuronium?
0.1 mg/kg.
74
What is cisatracurium besylate?
A nondepolarizing muscle relaxant, three times more potent than atracurium.
75
What is the mechanism of action of cisatracurium?
Competes with acetylcholine for binding to nicotinic receptors at the motor endplate.
76
What is the elimination process for cisatracurium?
Hofmann elimination and non-specific esterases.
77
What is atracurium besylate?
A competitive bisquaternary neuromuscular blocker.
78
What is the onset time for atracurium?
1.2 to 2.8 minutes.
79
What are the adverse effects of atracurium?
* Histamine release * Hypotension * Bradycardia.
80
What is neostigmine?
An anticholinesterase agent.
81
What is the dose range for neostigmine?
25-75 mcg/kg.
82
What is the onset time for neostigmine?
5-15 minutes.
83
What NMBA cannot be reversed by neostigmine?
Succinylcholine.
84
What is sugammadex?
A drug that reverses neuromuscular blockade but is not an anticholinesterase.
85
What is the onset time for sugammadex?
1-2 minutes.
86
What are the common side effects of sugammadex?
* Nausea * Vomiting * Allergy * Hypertension * Headache.
87
What is the role of anticholinergics in the context of NMBA reversal?
To prevent parasympathetic side effects of anticholinesterase drugs.
88
What is the dose range for atropine?
7-15 mcg/kg.
89
What is glycopyrrolate?
A quaternary ammonium compound used to prevent excessive parasympathetic effects.
90
What is the onset time for glycopyrrolate?
1-2 minutes IV.
91
What are common side effects of anticholinesterase drugs?
* Bradycardia * Arrhythmias * Hypotension * Bronchoconstriction * Hypersalivation.
92
What is the onset time for Glycopyrrolate when administered IV?
1-2 min ## Footnote Glycopyrrolate has a duration of action of 2-4 hours.
93
What is the primary route of excretion for Glycopyrrolate?
Feces, urine (85% in urine after 48 hrs) ## Footnote Glycopyrrolate is excreted mostly as unchanged.
94
What is the dose for Scopolamine when applied for preoperative sedation?
1.5 mg applied behind ear ## Footnote Scopolamine has a duration of action of 3 days.
95
What is the mechanism of action for Ephedrine?
Stimulates both alpha and beta receptors directly and indirectly ## Footnote Causes the release of endogenous catecholamines.
96
What is the drug of choice for maternal hypotension after regional anesthesia?
Phenylephrine ## Footnote Ephedrine was previously used but phenylephrine is now preferred.
97
What is the onset time for Phenylephrine?
Immediate ## Footnote Phenylephrine has a duration of action of 5-20 min.
98
What is the primary use of Esmolol?
Beta 1 selective Beta blocker ## Footnote Used to decrease heart rate and blood pressure perioperatively.
99
What is the standard IV dose for Metoprolol?
5 mg every 5 min, max 15 mg ## Footnote Metoprolol is used to manage arrhythmias and decrease heart rate.
100
What is the ratio of alpha to beta blocking effects in Labetalol?
7:1 ## Footnote Labetalol is used to treat hypertension without affecting uterine blood flow.
101
What is the standard adult dose of Cefazolin for surgical prophylaxis?
2g IV (3g if patient weight >120kg) ## Footnote Administer within 60 minutes before incision.
102
What type of bacteria does Cefazolin target?
Staphylococcus aureus and enteric gram-negative bacilli ## Footnote Commonly used for surgical prophylaxis.
103
What is the mechanism of action for Dexamethasone?
Inhibition of the nucleus tractus solitarius, serotonin reduction, and prostaglandin synthesis ## Footnote Used to manage PONV.
104
What is the duration of action for Ondansetron?
4-6 hrs ## Footnote Most effective for vomiting rather than nausea.
105
What is the long half-life of Palonosetron?
44 hrs ## Footnote Preferable for PDNV.
106
What type of receptor does Aprepitant block?
Neurokinin 1 Receptor ## Footnote FDA-approved for PONV.
107
What are the side effects of Droperidol?
Extrapyramidal side effects ## Footnote Contraindicated in Parkinson’s disease.
108
What is the primary action of Midazolam in the context of nausea?
Reduces dopamine’s emetic effects ## Footnote Used as a sedative near the end of surgery.
109
What caution should be noted with Metoclopramide?
Can cause dyskinesia and extrapyramidal effects ## Footnote Contraindicated in Parkinson’s disease and bowel obstructions.

JT - Basics (36 decks)

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