IV anesthetics PP questions
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Questions and Answers

Which of the following statements about diazepam is true?

  • Diazepam is highly protein-bound. (correct)
  • Diazepam is rapidly eliminated from the body.
  • Diazepam has a short half-life.
  • Diazepam is commonly used for pediatric dosing.

    • What is the recommended time to administer diazepam before surgery?

  • 10 minutes
  • 30 minutes
  • 20 minutes (correct)
  • 60 minutes

    • Intravenous sedation with diazepam has an onset of action of

  • 3-5 minutes
  • 1-2 minutes
  • 30-60 seconds (correct)
  • 10-20 seconds

    • Which of the following statements about sedatives and hypnotics is true?

    <p>Sedatives induce a state of calm or sleep.</p> Signup and view all the answers

    What is the chemical structure of propofol?

    <p>2,6-diisopropyl phenol</p> Signup and view all the answers

    Which of the following is a potential risk associated with fospropofol?

    <p>Pulmonary embolism</p> Signup and view all the answers

    Which of the following is true about the mechanism of action of benzodiazepines?

    <p>Benzodiazepines enhance the affinity of GABA receptors.</p> Signup and view all the answers

    Which of the following is a side effect of chronic administration of benzodiazepines?

    <p>Respiratory depression</p> Signup and view all the answers

    Which of the following drugs exert synergistic sedative effects with benzodiazepines?

    <p>Antihistamines</p> Signup and view all the answers

    Which of the following is a sign of benzodiazepine dependence?

    <p>Irritability</p> Signup and view all the answers

    Which of the following is NOT a cardiovascular effect of propofol?

    <p>Increased heart rate</p> Signup and view all the answers

    Which organ system does propofol NOT affect?

    <p>Hepatic system</p> Signup and view all the answers

    Which adverse event is most commonly reported with propofol use?

    <p>Pain on injection</p> Signup and view all the answers

    Which of the following is NOT a side effect of propofol?

    <p>Decreased intraocular pressure</p> Signup and view all the answers

    Which of the following statements about propofol is correct?

    <p>Propofol is primarily metabolized by the liver</p> Signup and view all the answers

    Which of the following is a clinical use of propofol?

    <p>Maintenance of anesthesia</p> Signup and view all the answers

    Which of the following statements about propofol and opioids is correct?

    <p>Propofol decreases the plasma concentration of opioids</p> Signup and view all the answers

    Which of the following effects does propofol have on the central nervous system?

    <p>Decreases cerebral metabolic rate for oxygen</p> Signup and view all the answers

    Which of the following statements about the mechanism of action of etomidate is correct?

    <p>Etomidate is a weak base and 99% unionized at physiologic pH.</p> Signup and view all the answers

    Which of the following statements about the metabolism of etomidate is correct?

    <p>Etomidate is rapidly metabolized by hepatic microsomal enzymes and plasma esterases.</p> Signup and view all the answers

    Which of the following statements about the cardiopulmonary effects of etomidate is correct?

    <p>Etomidate has minimal changes in heart rate, stroke volume, and cardiac output.</p> Signup and view all the answers

    Which of the following statements about the ventilation effects of etomidate is correct?

    <p>Etomidate does not affect ventilation.</p> Signup and view all the answers

    Which of the following is a risk associated with mixing propofol with lidocaine?

    <p>Increased risk of pulmonary embolism</p> Signup and view all the answers

    Which of the following propofol alternatives has a non-lipid formulation?

    <p>Fospropofol</p> Signup and view all the answers

    Which propofol alternative has a higher risk of pain on injection?

    <p>Ampofol</p> Signup and view all the answers

    Which of the following statements about the pharmacokinetics of propofol is correct?

    <p>The clearance of propofol from plasma is lower than hepatic blood flow.</p> Signup and view all the answers

    Which of the following patient populations requires a lower induction dose of propofol?

    <p>Elderly</p> Signup and view all the answers

    At what plasma concentration of propofol does awakening without residual CNS effects occur?

    <p>1.0 to 1.5 𝜇/mL</p> Signup and view all the answers

    Which of the following is NOT a nonhypnotic therapeutic application of propofol?

    <p>Antiarrhythmic effects</p> Signup and view all the answers

    Which of the following opioids show synergism when coadministered with propofol?

    <p>Fentanyl</p> Signup and view all the answers

    What is the formula for calculating cerebral perfusion pressure (CPP)?

    <p>CPP = MAP - (CBP or ICP)</p> Signup and view all the answers

    Which of the following is a potential side effect of propofol?

    <p>Hepatocellular injury</p> Signup and view all the answers

    Which of the following is NOT a cardiovascular effect of propofol?

    <p>Increased heart rate</p> Signup and view all the answers

    Which of the following is a potential effect of propofol on the lungs?

    <p>Potentiation of respiratory depression</p> Signup and view all the answers

    Which of the following is a characteristic of etomidate?

    <p>Rapid awakening after a single dose</p> Signup and view all the answers

    Which of the following is a potential side effect of chronic administration of benzodiazepines?

    <p>Respiratory depression</p> Signup and view all the answers

    Which of the following effects do benzodiazepines have on the hypothalamic-pituitary-adrenal (HPA) axis?

    <p>Inhibition of ACTH and cortisol production</p> Signup and view all the answers

    Which of the following drugs exert synergistic sedative effects with benzodiazepines?

    <p>Alpha-2 agonists</p> Signup and view all the answers

    Which of the following statements about the metabolism of etomidate is correct?

    <p>Etomidate is metabolized by hepatic microsomal enzymes and plasma esterases</p> Signup and view all the answers

    Which of the following statements about the cardiovascular effects of etomidate is correct?

    <p>Etomidate may cause a decrease in mean arterial pressure (MAP) due to decreases in systemic vascular resistance (SVR)</p> Signup and view all the answers

    Which of the following statements about the side effects of etomidate on the central nervous system (CNS) is correct?

    <p>Etomidate is a potent direct cerebral vasoconstrictor that decreases cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2)</p> Signup and view all the answers

    Which of the following statements about the pharmacologic effects of benzodiazepines is correct?

    <p>Benzodiazepines enhance the affinity of GABA receptors rather than directly activating them</p> Signup and view all the answers

    Which of the following is a characteristic of diazepam metabolism?

    <p>It is metabolized by hepatic microsomal enzymes by oxidative N-demethylation.</p> Signup and view all the answers

    What is the peak effect of diazepam?

    <p>3-5 minutes</p> Signup and view all the answers

    Which of the following is a potential effect of long duration infusion or administration of diazepam?

    <p>Postoperative sedation</p> Signup and view all the answers

    Which of the following drugs is known for its rapid metabolism and has no need for propylene glycol during injection?

    <p>Midazolam</p> Signup and view all the answers

    Which enzyme is responsible for the rapid metabolism of midazolam in the liver and small intestine?

    <p>CYP3A4</p> Signup and view all the answers

    Which of the following statements about midazolam's effects on the cardiovascular system is correct?

    <p>It has a minimal effect on blood pressure and heart rate.</p> Signup and view all the answers

    Which of the following statements about diazepam is correct?

    <p>Diazepam is insoluble in water.</p> Signup and view all the answers

    Which of the following is a potential effect of long duration infusion or administration of diazepam?

    <p>Postoperative sedation.</p> Signup and view all the answers

    Which of the following is a characteristic of the metabolism of diazepam?

    <p>Diazepam is metabolized by hepatic microsomal enzymes by oxidative N-demethylation.</p> Signup and view all the answers

    Which of the following is true about the pharmacokinetics of midazolam?

    <p>Midazolam undergoes extensive first-pass hepatic metabolism.</p> Signup and view all the answers

    What effect does midazolam have on ventilation?

    <p>Midazolam has a dose-dependent effect on ventilation.</p> Signup and view all the answers

    Which of the following statements about midazolam's clinical uses is correct?

    <p>Midazolam is primarily administered intravenously for sedation.</p> Signup and view all the answers

    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

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