535 Pharm Test 2 - Jessica
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75 terms
Terms | Definitions |
|---|---|
 What drugs to not create coronary steal? | Iso & Des |
| What drugs increase ocular pressure? | Ketamine and succinylcholine |
| What causes the greatest increase in ocular pressure? | Intubation |
| When temperature is decreased, what happens to the MAC? | Needs are decreased as well. |
| Do children require more or less MAC? | More |
| What happens to CBF when MAC is >1? | Increased CBF |
| When a higher MAC and a muscle relaxant are given together what is that effect called? | Additive effect |
| Myoclonia occurs with which drugs? | Brevital (methohexital) and Etomidate (Amidate) |
| What does flumazenil do? | It is an antagonist and is the reversal agent for Benzos. |
| What is the half life of flumazenil? | 41-79min. |
| How is flumazenil metabolized? | Hepatic system |
| Dosing of flumazenil? | 0.2mg IV Max. 1mg |
| What patient population would you be cautious of giving flumazenil to? | Patients with seizure disorders. |
| Thiobarbiturate contain what molecule? List the names of the thiobarbiturates. | Sulfur molecule. Thiopental (Pentothal) |
| Oxybarbiturate contain what molecule? List the names of the Oxybarbiturate. | Oxygen molecule. Phenobarbital (Luminal), Pentobarbital (Nembutal), Secobarbital (Seconal) |
| N-Methyl Barbiturates contain what molecule? List the names of the N-Methyl Barbiturates. | Methyl group. Methohexital (Brevital) |
| Which drugs are highly protein bound? | Diazepam, Lorazepam, Midazolam, Propofol |
| Which three drugs have the longest half-life? | Diazepam, lorazepam, and thiopental |
| What drug has the shortest half-life? | Propofol |
| Explain redistribution. | Drug is first distributed to vital organs in about 15 seconds, but drug will enter circulation and distribute throughout the rest of the body. |
| When you double the dose of a drug you increase the half-life by what? | 1 half-life |
| What two proteins do drugs usually bind to? | Albumin (most common) (acidic drugs) Alpha 2 Acid (basic drugs) |
| What 4 things alter protein binding? | Malnutrition, liver disease, kidney disease, and last trimester of pregnancy |
| Flumazenil binds to what site? | Benzodiazepine receptor site. |
| What ion is associated with GABA that causes hyperpolerization? | Chlorine |
| What do GABA and benzos do to the cell? | The cell is hyperpolarized, creating a more negative charge. Thereby reducing the firing potential of the cell. |
| Which drugs are GABA mimetic? | Barbiturates, Benzodiazepines, Propofol, Etomidate |
| What is Ketamines mechanism of action? | NMDA receptor antagonist. (Blocks the exititory response) |
| Inhalation agents work by stimulating what? | GABA receptors |
| Inhalation agents increase or decrease CMRO2? | Decrease, cerebral metabolism is decreased. |
| Inhalation agents increase or decrease ICP? | Increase, from cerebral vasodilation, can be counteracted by modest hyperventilation. pCO2 30-35 |
| What do higher MAC doses do to CBF? | Increase, Brain loses autoregulation |
| What are the five mechanisms for decreased BP? | 1.CNS depression 2.Direct cardiac depression 3. Decreased SVR 4. Baro-receptor depression 5. Hormonal changes(rennin, vasopressin) |
| All anesthetics exhibit the 5 mechanisms to ↓BP except what? | Nitrous Oxide |
| What is the safe dose of epi? | No more than 10ml in 10min period (0.1mg) Or 30ml per hour (0.3mg) |
| Which anesthetic produces tachycardia? | Desflurane |
| All gas anesthetics bronchodilate except? | Nitrous Oxide |
| Which gas anesthetics cause RR depression? | All, relax bronchial tone |
| What is the metabolism of Sevo? | 5-8% |
| What is the metabolism of other gas anesthetics? | Trace. Des is the smallest |
| Which gas anesthetic is teratogenic? | Nitrous oxide |
| Which gas anesthetic can produce free fluoride ions? What population would you avoid giving? | Sevo, avoid with renal disease |
| Compound A is produced how? | Sevo reacts with CO2 canister |
| Which gas anesthetic does not produce a dose dependent drop in BP? | Nitrous Oxide |
| Which gas anesthetic does not produce a dose dependent decrease in SVR? | Nitrous Oxide |
| Which gas anesthetic produces the greatest drop in SVR? | Isoflurane |
| Which gas anesthetics cause a dose dependent drop in RR? | All anesthetics, except Nitrous Oxide |
| Which enzyme and vitamin is inhibited by prolonged N2O administration? | Methionine Synthase and B-12 |
| What IV anesthetic has a long half life causing a hangover effect? | Thiopental (Pentothal) |
| What IV anesthetic has the shortest half life? | Propofol |
| Why do patients wake so quickly despite half life? | Redistribution. |
| What amino acid is associated with NMDA receptors? | Glutamate |
| If someone is allergic to sulfites avoid what IV anesthetic? | Generic Propofol |
| Egg and peanut allergies avoid what? | All propofol products |
| What is the most to least cardiac depressing IV anesthetics? | Propofol, thiopental, etomidate |
| Which IV anesthetic is not a cardiac depressant? | Ketamine |
| Which induction drugs decrease CBF, ICP, CMRO2? | All induction drugs except Ketamine |
| What does Ketamine do to CBF, ICP, and CMRO2, BP, HR, intraocular pressure? | Increase |
| What induction drug do you give for someone who is actively wheezing? | Ketamine |
| What induction drug is a bronchodilator? | Ketamine, all the rest are neutral |
| Porphyria is caused by what induction drug? | Barbiturates and etomidate |
| What drugs have we talked about thus far that produce Analgesia? | Ketamine, Nitrous oxide, Precedex |
| Ketamine is a derivative of what? | Phencyclidine (LSD) |
| What drug produces dissociative anesthesia? | Ketamine |
| Which induction drug is a potent bronchodilator? | Ketamine |
| Increased salivation, RR secretions, and muscle tone is cause by what? | Ketamine |
| What drug has emergent delirium/hallucinations and what can you give to decrease delirium? | Ketamine, give Versed to decrease hallucinations |
| Dexmedetomidine is a... | Nonselective a2 agonist |
| What does Precedex do? | Produces sedation, analgesia, amnesia, min RR depression, hypotension, bradycardia, dry mouth, decreased secretions. |
| What is droperidol and what does it do? | It is a butyrophenone and is a potent antiemetic |
| Why is droperidol controversial? | Prolonged QT interval and arrhythmias |
| Who is droperidol contraindicated? | Parkinson patients, Blocks dopamine in brain, causing extra pyramidal effects. |
| N2O Contraindications | Pneumothorax, Bowel obstruction, Inner ear surgery, Neuro surgery with air injections, Air embolism, Ocular eye surgery, Laparoscopy, Known b-12, deficiency Emphysema, Increased ICP, Pulm HTN First trimester of pregnancy, High risk PONV, Prolonged anesthesia >6hrs, Gas filled space |
| Epi Doses | No stronger than 1:100,000 (0.01mg/ml) No more than 10ml/10min (0.1mg) No more than 30ml/hr (0.3mg) 1:1000 = 1mg/ml (should be diluted in 1ml NS for code) 1:10,000 = 0.1mg/ml (10ml = cardiac arrest dose) 1:100,000 = 0.01mg/ml (used in surgery) 1:200,000 = 0.005mg/ml |
| Anesthetic Gases Table: MAC, B/G, O/G | Anesthetic ----- Mac -- Blood/Gas -- Oil/Gas Sevoflurane ---- 2 ----- 0.6 -------- 50 Isoflurane ----- 1.15 --- 1.4 -------- 99 Nitrous Oxide -- 105 --- 0.47 ------- 1.4 Desoflurane ---- 5.8 --- 0.42 ------- 18.7 |
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