54 Questions
Which of the following statements about diazepam is true?
Diazepam is highly protein-bound.
What is the recommended time to administer diazepam before surgery?
20 minutes
Intravenous sedation with diazepam has an onset of action of
30-60 seconds
Which of the following statements about sedatives and hypnotics is true?
Sedatives induce a state of calm or sleep.
What is the chemical structure of propofol?
2,6-diisopropyl phenol
Which of the following is a potential risk associated with fospropofol?
Pulmonary embolism
Which of the following is true about the mechanism of action of benzodiazepines?
Benzodiazepines enhance the affinity of GABA receptors.
Which of the following is a side effect of chronic administration of benzodiazepines?
Respiratory depression
Which of the following drugs exert synergistic sedative effects with benzodiazepines?
Antihistamines
Which of the following is a sign of benzodiazepine dependence?
Irritability
Which of the following is NOT a cardiovascular effect of propofol?
Increased heart rate
Which organ system does propofol NOT affect?
Hepatic system
Which adverse event is most commonly reported with propofol use?
Pain on injection
Which of the following is NOT a side effect of propofol?
Decreased intraocular pressure
Which of the following statements about propofol is correct?
Propofol is primarily metabolized by the liver
Which of the following is a clinical use of propofol?
Maintenance of anesthesia
Which of the following statements about propofol and opioids is correct?
Propofol decreases the plasma concentration of opioids
Which of the following effects does propofol have on the central nervous system?
Decreases cerebral metabolic rate for oxygen
Which of the following statements about the mechanism of action of etomidate is correct?
Etomidate is a weak base and 99% unionized at physiologic pH.
Which of the following statements about the metabolism of etomidate is correct?
Etomidate is rapidly metabolized by hepatic microsomal enzymes and plasma esterases.
Which of the following statements about the cardiopulmonary effects of etomidate is correct?
Etomidate has minimal changes in heart rate, stroke volume, and cardiac output.
Which of the following statements about the ventilation effects of etomidate is correct?
Etomidate does not affect ventilation.
Which of the following is a risk associated with mixing propofol with lidocaine?
Increased risk of pulmonary embolism
Which of the following propofol alternatives has a non-lipid formulation?
Fospropofol
Which propofol alternative has a higher risk of pain on injection?
Ampofol
Which of the following statements about the pharmacokinetics of propofol is correct?
The clearance of propofol from plasma is lower than hepatic blood flow.
Which of the following patient populations requires a lower induction dose of propofol?
Elderly
At what plasma concentration of propofol does awakening without residual CNS effects occur?
1.0 to 1.5 𝜇/mL
Which of the following is NOT a nonhypnotic therapeutic application of propofol?
Antiarrhythmic effects
Which of the following opioids show synergism when coadministered with propofol?
Fentanyl
What is the formula for calculating cerebral perfusion pressure (CPP)?
CPP = MAP - (CBP or ICP)
Which of the following is a potential side effect of propofol?
Hepatocellular injury
Which of the following is NOT a cardiovascular effect of propofol?
Increased heart rate
Which of the following is a potential effect of propofol on the lungs?
Potentiation of respiratory depression
Which of the following is a characteristic of etomidate?
Rapid awakening after a single dose
Which of the following is a potential side effect of chronic administration of benzodiazepines?
Respiratory depression
Which of the following effects do benzodiazepines have on the hypothalamic-pituitary-adrenal (HPA) axis?
Inhibition of ACTH and cortisol production
Which of the following drugs exert synergistic sedative effects with benzodiazepines?
Alpha-2 agonists
Which of the following statements about the metabolism of etomidate is correct?
Etomidate is metabolized by hepatic microsomal enzymes and plasma esterases
Which of the following statements about the cardiovascular effects of etomidate is correct?
Etomidate may cause a decrease in mean arterial pressure (MAP) due to decreases in systemic vascular resistance (SVR)
Which of the following statements about the side effects of etomidate on the central nervous system (CNS) is correct?
Etomidate is a potent direct cerebral vasoconstrictor that decreases cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2)
Which of the following statements about the pharmacologic effects of benzodiazepines is correct?
Benzodiazepines enhance the affinity of GABA receptors rather than directly activating them
Which of the following is a characteristic of diazepam metabolism?
It is metabolized by hepatic microsomal enzymes by oxidative N-demethylation.
What is the peak effect of diazepam?
3-5 minutes
Which of the following is a potential effect of long duration infusion or administration of diazepam?
Postoperative sedation
Which of the following drugs is known for its rapid metabolism and has no need for propylene glycol during injection?
Midazolam
Which enzyme is responsible for the rapid metabolism of midazolam in the liver and small intestine?
CYP3A4
Which of the following statements about midazolam's effects on the cardiovascular system is correct?
It has a minimal effect on blood pressure and heart rate.
Which of the following statements about diazepam is correct?
Diazepam is insoluble in water.
Which of the following is a potential effect of long duration infusion or administration of diazepam?
Postoperative sedation.
Which of the following is a characteristic of the metabolism of diazepam?
Diazepam is metabolized by hepatic microsomal enzymes by oxidative N-demethylation.
Which of the following is true about the pharmacokinetics of midazolam?
Midazolam undergoes extensive first-pass hepatic metabolism.
What effect does midazolam have on ventilation?
Midazolam has a dose-dependent effect on ventilation.
Which of the following statements about midazolam's clinical uses is correct?
Midazolam is primarily administered intravenously for sedation.
Study Notes
Sedatives and Hypnotics
- Recommended time to administer diazepam before surgery: 30 minutes
- Onset of action of intravenous sedation with diazepam: 1-5 minutes
- True statement about sedatives and hypnotics: they can cause respiratory depression
- Chemical structure of propofol: 2,6-diisopropylphenol
Propofol
- Potential risk associated with fospropofol: respiratory depression
- Mechanism of action of benzodiazepines: enhancing the effects of GABA
- Side effect of chronic administration of benzodiazepines: dependence
- Drugs that exert synergistic sedative effects with benzodiazepines: opioids, antihistamines, and antidepressants
- Sign of benzodiazepine dependence: withdrawal symptoms
- Cardiovascular effect of propofol: decreasing systemic vascular resistance
- Organ system not affected by propofol: skeletal muscles
- Most commonly reported adverse event with propofol use: injection pain
- Side effect of propofol: hypotension
- Correct statement about propofol: it has a rapid onset and short duration of action
- Clinical use of propofol: induction and maintenance of anesthesia
- Correct statement about propofol and opioids: they can be used together to reduce the risk of respiratory depression
- Effect of propofol on the central nervous system: decreasing cerebral metabolism
- Correct statement about the mechanism of action of etomidate: it inhibits the 11β-hydroxylase enzyme
Etomidate
- Correct statement about the metabolism of etomidate: it is rapidly metabolized by esterases
- Correct statement about the cardiopulmonary effects of etomidate: it increases cardiac output
- Correct statement about the ventilation effects of etomidate: it does not affect ventilation
- Risk associated with mixing propofol with lidocaine: increased risk of cardiac arrhythmias
- Propofol alternative with a non-lipid formulation: fospropofol
- Propofol alternative with a higher risk of pain on injection: fospropofol
Pharmacokinetics and Pharmacodynamics
- Correct statement about the pharmacokinetics of propofol: it has a high lipid solubility
- Patient population requiring a lower induction dose of propofol: elderly patients
- Plasma concentration of propofol for awakening without residual CNS effects: 1.5-2.5 μg/mL
- Nonhypnotic therapeutic application of propofol: treatment of refractory migraines
- Opioids that show synergism when coadministered with propofol: fentanyl, alfentanil, and sufentanil
- Formula for calculating cerebral perfusion pressure (CPP): CPP = MAP - ICP
Diazepam and Midazolam
- Correct statement about diazepam: it is metabolized by the liver and has a long duration of action
- Peak effect of diazepam: 15-30 minutes
- Potential effect of long duration infusion or administration of diazepam: accumulation of active metabolites
- Drug known for its rapid metabolism and no need for propylene glycol during injection: etomidate
- Enzyme responsible for the rapid metabolism of midazolam in the liver and small intestine: CYP3A4
- Correct statement about midazolam's effects on the cardiovascular system: it decreases systemic vascular resistance
- Correct statement about diazepam: it has a long duration of action and can cause dependence
- Correct statement about the metabolism of diazepam: it is metabolized by the liver into active metabolites
- True statement about the pharmacokinetics of midazolam: it has a rapid onset and short duration of action
- Effect of midazolam on ventilation: decrease in respiratory rate
- Correct statement about midazolam's clinical uses: it is used for conscious sedation and anesthesia
Test your knowledge on the commercial preparation of a medication, its formulation, mechanism of action, and delivery options. Learn about its original composition, pain on injection, and the development of a new fat emulsion. Explore the benefits of an oral formulation for transmucosal delivery and its avoidance of first-pass hepatic metabolism.
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