149 Questions
Which term refers to a drug that induces a state of calm or sleep?
Sedative
What is the chemical composition of propofol?
Isopropylphenol
Which class of pharmacologic agents is central to the practice of anesthesiology?
Intravenous sedatives and hypnotics
What is the dose of propofol for rapid IV injection?
75 μg/kg/minute
Which drug is commonly used to attenuate the frequency of myoclonic-like movements during the induction period?
Opioid
After a single IV dose, which drug has a similar awakening time to etomidate?
Propofol
Which drug has a slower full recovery of psychomotor function compared to etomidate?
Propofol
Which drug is commonly used to blunt the hemodynamic responses evoked by direct laryngoscopy and tracheal intubation?
Opioid
Which of the following is a potential adverse effect of propofol sedation in children in the ICU?
Bradycardia
What is the recommended course of action if unexpected tachycardia occurs during propofol anesthesia?
Evaluate for metabolic acidosis
What is the potential mechanism for propofol-induced metabolic acidosis?
Impaired oxidation of long chain fatty acids
What is the recommended timeframe for discarding an opened ampule of propofol if it is not used?
6 hours
Which of the following is a property of propofol that contributes to its neuroprotective effect?
All of the above
What is the most commonly reported adverse event associated with propofol administration to awake patients?
Pain on injection
What is the effect of subhypnotic concentrations of propofol, isoflurane, and sevoflurane on pharyngeal contraction force?
Decrease pharyngeal contraction force
What is the original formulation of etomidate and what was it changed to?
Fat emulsion; propylene glycol
Which of the following statements about the effects of etomidate on myocardial contractility is most accurate?
Etomidate has minimal depressive effects on myocardial contractility at concentrations needed for anesthesia.
Which of the following statements about the effects of etomidate on ventilation is most accurate?
Etomidate has less depressant effects on ventilation compared to barbiturates and propofol.
Which of the following statements about the effects of etomidate on pain on injection is most accurate?
Pain on injection and venous irritation is eliminated with the use of etomidate in a lipid emulsion vehicle.
Which of the following statements about the effects of etomidate on myoclonus is most accurate?
Etomidate can cause myoclonus in a high percentage of patients receiving the drug.
Which of the following statements is true about the mechanism of etomidate-induced myoclonus?
Etomidate inhibits subcortical structures that suppress extrapyramidal motor activity.
When does excitatory movements typically occur in relation to the EEG during etomidate-induced myoclonus?
During the early slow phase of the EEG.
Which enzyme does etomidate inhibit to cause adrenocortical suppression?
11-β-hydroxylase
How long does the inhibition of the enzyme by etomidate last after an induction dose?
4 to 8 hours
In what situation could suppression of adrenocortical function be considered desirable?
"Stress-free" anesthesia
Was there a difference in the plasma concentrations of cortisol, corticosterone, or adrenocorticotrophic hormone in patients receiving a single dose of etomidate?
It was not possible to demonstrate a difference.
Etomidate is unique among injected and inhaled anesthetics in being administered as a single isomer. The anesthetic effect of etomidate resides predominantly in the R(+) isomer, which is approximately 5 times as potent as the S(−) isomer. Which of the following statements is true about the isomers of etomidate?
The R(+) isomer is approximately 5 times as potent as the S(−) isomer.
Which of the following is true about the distribution of etomidate in the body?
Etomidate is mainly distributed in the plasma.
What is the main reason for the prompt awakening after a single dose of etomidate?
Distribution of the drug from brain to inactive tissue sites.
What is responsible for the hydrolysis of etomidate in the body?
Hepatic microsomal enzymes and plasma esterases.
Which drug is chemically distinct from all other drugs that act as IV sedative-hypnotics?
Propofol
What is the recommended dose of propofol for rapid IV injection?
1.5 to 2.5 mg/kg IV
Which term refers to a drug that induces hypnosis or sleep?
Hypnotic
Which class of pharmacologic agents is central to the practice of anesthesiology?
IV sedatives and hypnotics
Which of the following is a potential adverse effect of propofol sedation in children in the ICU?
Severe bradycardia
Which of the following is a potential mechanism for propofol-induced metabolic acidosis?
Impaired oxidation of long chain fatty acids
Which of the following is true about the growth of bacteria in propofol?
Propofol supports the growth of Escherichia coli and Pseudomonas aeruginosa
What is the recommended timeframe for discarding an opened ampule of propofol if it is not used?
6 hours
Which of the following is true about the pharmacokinetics of etomidate?
Etomidate reaches peak levels in the brain within 1 minute after IV injection
What is the mechanism of action of etomidate on GABAA receptors?
Etomidate binds directly to a specific site on GABAA receptors
Which of the following is true about the metabolism of etomidate?
Less than 3% of an administered dose of etomidate is recovered unchanged in urine
In what situation could etomidate be considered as an alternative to propofol or barbiturates for the IV induction of anesthesia?
In patients with hepatic dysfunction
Which of the following statements about the effects of etomidate on cerebral blood flow (CBF) is most accurate?
Etomidate decreases CBF by 35% to 45%
Which of the following statements about the effects of etomidate on heart rate and blood pressure is most accurate?
Etomidate causes minimal changes in heart rate and stroke volume
Which of the following statements about the effects of etomidate on adrenocortical function is most accurate?
Etomidate transiently depresses adrenocortical function
Which of the following statements about the effects of etomidate on postoperative nausea and vomiting (PONV) is most accurate?
There is a decreased incidence of PONV in patients receiving etomidate
Which of the following is a potential mechanism for etomidate-induced myoclonus?
Disinhibition of subcortical structures
What is the main reason for the prompt awakening after a single dose of etomidate?
Inhibition of the conversion of cholesterol to cortisol
Which enzyme does etomidate inhibit to cause adrenocortical suppression?
11-β-hydroxylase
When does excitatory movements typically occur in relation to the EEG during etomidate-induced myoclonus?
Coincident with the early slow phase of the EEG
What is the effect of subhypnotic concentrations of propofol, isoflurane, and sevoflurane on pharyngeal contraction force?
Decrease
What is the recommended timeframe for discarding an opened ampule of propofol if it is not used?
6 hours
Which of the following statements about etomidate-induced negative inotropic effects is most accurate?
Etomidate-induced negative inotropic effects are minimal at clinical use concentrations.
Which of the following statements about the effects of etomidate on ventilation is most accurate?
Etomidate may stimulate ventilation independently of the medullary centers that normally respond to carbon dioxide.
Which of the following statements about pain on injection of etomidate is most accurate?
The incidence and intensity of pain on injection of etomidate can be reduced by pretreatment with small doses of etomidate.
Which of the following statements about myoclonus associated with etomidate administration is most accurate?
Other commonly administered IV anesthetics have a higher incidence of myoclonus compared to etomidate.
Which of the following statements about the antioxidant properties of propofol is most accurate?
Propofol has potent antioxidant properties that resemble those of the endogenous antioxidant vitamin E.
What is the most commonly reported adverse event associated with propofol administration to awake patients?
Pain on injection
Which of the following statements about the effects of etomidate on pain on injection is most accurate?
Etomidate does not cause pain on injection.
Which of the following statements about the effects of propofol on lipid peroxidation during coronary artery bypass graft surgery is most accurate?
Propofol strongly attenuates lipid peroxidation.
Propofol is a γ-Aminobutyric Acid Agonist.
True
Propofol is administered orally.
False
Propofol can be used to induce general anesthesia.
True
Propofol is chemically similar to other drugs that act as IV sedative-hypnotics.
False
Propofol sedation can cause severe and fatal bradycardia in children in the ICU.
True
Short-term infusions of propofol for surgical anesthesia have been associated with the development of metabolic acidosis.
True
Propofol-induced metabolic acidosis can be reversed with discontinuation of propofol administration.
True
Propofol administration can lead to the growth of Escherichia coli and Pseudomonas aeruginosa.
True
True or false: Propofol has antioxidant properties similar to vitamin E.
True
True or false: Propofol can suppress phagocytosis due to its peroxynitrite-scavenging activity.
True
True or false: Propofol can cause pain on injection in awake patients.
True
True or false: Etomidate is water-soluble at an acidic pH and lipid-soluble at physiologic pH.
True
True or false: Involuntary myoclonic movements are a common side effect of etomidate during the induction period.
True
True or false: Etomidate has analgesic properties.
False
True or false: Etomidate can be used as an alternative to drugs that decrease the duration of seizures in patients undergoing electroconvulsive therapy.
True
True or false: Etomidate has minimal effects on the duration of electrically induced seizures.
True
Etomidate causes dose-dependent decreases in myocardial contractility.
True
Etomidate has minimal negative inotropic effects at concentrations used for anesthesia.
True
Etomidate-induced decreases in tidal volume are offset by compensatory increases in breathing frequency.
True
Etomidate may stimulate ventilation independently of the medullary centers that respond to carbon dioxide.
True
True or false: Etomidate is administered as a single isomer, with the R(+) isomer being more potent than the S(-) isomer.
True
True or false: Etomidate exerts its effects on GABAA receptors by binding directly to a specific site or sites on the protein and enhancing the affinity of the inhibitory neurotransmitter (GABA) for these receptors.
True
True or false: Etomidate is known to modulate other ligand-gated ion channels in the brain at clinically relevant concentrations.
False
True or false: Etomidate is rapidly metabolized by hydrolysis of the ethyl ester side chain to its carboxylic acid ester, resulting in a water-soluble, pharmacologically inactive compound.
True
True or false: Etomidate-induced myoclonus is caused by disinhibition of subcortical structures that normally suppress extrapyramidal motor activity.
True
True or false: Excitatory movements during etomidate-induced myoclonus are often observed during the early slow phase of the EEG, which corresponds to the beginning of deep anesthesia.
True
True or false: Etomidate-induced myoclonus can occur upon awakening if the extrapyramidal system emerges more quickly than the cortex that inhibits it.
True
True or false: Seizure-like activity on the EEG has been documented in association with etomidate-induced myoclonus.
False
True or false: Etomidate causes adrenocortical suppression by inhibiting the conversion of cholesterol to cortisol through the enzyme 11-β-hydroxylase.
True
True or false: Adrenocortical suppression caused by etomidate lasts for 4 to 8 hours after an induction dose.
True
Which of the following is a potential adverse effect of propofol sedation in children in the ICU?
Respiratory depression
What is the recommended timeframe for discarding an opened ampule of propofol if it is not used?
72 hours
True or false: Etomidate has analgesic properties.
False
Which of the following statements about the effects of etomidate on heart rate and blood pressure is most accurate?
Etomidate has no effect on heart rate and blood pressure.
Which of the following statements about the duration of action of etomidate is most accurate?
Increasing the dose of etomidate prolongs its duration of action.
True or false: Etomidate provides analgesia.
False
Which of the following statements about the effects of etomidate on cerebral blood flow is most accurate?
Etomidate decreases cerebral blood flow by 35% to 45%.
Which of the following statements about the cardiovascular effects of etomidate is most accurate?
Etomidate causes minimal changes in heart rate.
Which of the following is a potential adverse effect of propofol sedation in children in the ICU?
Respiratory depression
What is the recommended course of action if unexpected tachycardia occurs during propofol anesthesia?
Evaluate for metabolic acidosis
True or false: Propofol has antioxidant properties similar to vitamin E.
False
Which drug is commonly used to blunt the hemodynamic responses evoked by direct laryngoscopy and tracheal intubation?
Etomidate
Which term refers to a drug that induces a state of calm or sleep?
Sedative
What is the chemical composition of propofol?
2,6-diisopropylphenol
Which drug can be used to allay anxiety with minimal sedation or produce varying degrees of sedation?
Etomidate
What is the recommended dose of propofol for rapid IV injection?
1.5 to 2.5 mg/kg IV
Which of the following statements about the effects of etomidate on myocardial contractility is most accurate?
Etomidate has minimal negative inotropic effects at concentrations used for anesthesia.
Which of the following statements about the effects of etomidate on ventilation is most accurate?
Etomidate may stimulate ventilation independently of the medullary centers that normally respond to carbon dioxide.
Which of the following statements about pain on injection of etomidate is most accurate?
Pain on injection of etomidate is virtually eliminated by using a lipid emulsion vehicle.
Which of the following statements about etomidate-induced myoclonus is most accurate?
Etomidate-induced myoclonus is dose-related and suppressed by pretreatment with small doses of etomidate.
What is the main reason for the prompt awakening after a single dose of etomidate?
Distribution to inactive tissue sites
Which of the following statements about the effects of etomidate on myoclonus is most accurate?
Etomidate-induced myoclonus is more likely to occur with higher doses of the drug.
Which of the following statements about the effects of etomidate on pain on injection is most accurate?
Pain on injection of etomidate can be minimized by administering the drug slowly.
Which of the following best describes the mechanism of etomidate-induced myoclonus?
It is caused by the inhibition of subcortical structures that normally suppress motor activity.
What is the main reason for the prompt awakening after a single dose of etomidate?
Etomidate has a short duration of action.
What is the specific enzyme inhibited by etomidate that causes adrenocortical suppression?
11-β-hydroxylase
How long does adrenocortical suppression caused by etomidate last after an induction dose?
4 to 8 hours
Which of the following statements about the effects of etomidate on cerebral blood flow (CBF) is most accurate?
Etomidate does not significantly affect cerebral blood flow.
Which of the following statements about the effects of propofol on lipid peroxidation during coronary artery bypass graft surgery is most accurate?
Propofol reduces lipid peroxidation during coronary artery bypass graft surgery.
Which of the following terms refers to a drug that induces a state of calm or sleep?
Sedative
What is the chemical composition of propofol?
2,6-diisopropylphenol
What is the recommended dose of propofol for rapid IV injection?
1.5 to 2.5 mg/kg IV
Which of the following is a potential adverse effect of propofol sedation in children in the ICU?
Hypotension
Which of the following is a potential mechanism for propofol-induced metabolic acidosis?
Impaired oxidation of long chain fatty acids
What is the effect of subhypnotic concentrations of propofol, isoflurane, and sevoflurane on pharyngeal contraction force?
Decrease
Which drug is commonly used to attenuate the frequency of myoclonic-like movements during the induction period?
Etomidate
What is the dose of propofol for rapid IV injection?
5-10 mg/kg
Which of the following statements about the effects of etomidate on cerebral blood flow is most accurate?
Etomidate decreases cerebral blood flow by 35% to 45%.
What is the recommended dose of propofol for rapid IV injection?
0.75 to 1.5 mg/kg
Which drug is commonly used to blunt the hemodynamic responses evoked by direct laryngoscopy and tracheal intubation?
Opioids
After a single IV dose, which drug has a similar awakening time to etomidate?
Propofol
Which of the following statements about the effects of etomidate on myocardial contractility is most accurate?
Etomidate causes dose-dependent decreases in developed tension in isolated cardiac muscle.
Which of the following statements about the effects of etomidate on ventilation is most accurate?
Etomidate causes compensatory increases in the frequency of breathing.
Which of the following statements about the effects of etomidate on pain on injection is most accurate?
Etomidate eliminates pain on injection.
Which of the following statements about the effects of etomidate on myoclonus is most accurate?
Etomidate-induced myoclonus is dose-related.
Which of the following statements about etomidate is most accurate?
Etomidate is a modulator of GABAA receptors.
What is the effect of hepatic blood flow changes during cardiopulmonary bypass on etomidate metabolism?
Decreased hepatic blood flow decreases etomidate metabolism.
Which of the following statements about the pharmacokinetics of etomidate is most accurate?
Etomidate has a larger volume of distribution compared to propofol.
What is the main reason for the prompt awakening after a single dose of etomidate?
Redistribution of the drug from brain to inactive tissue sites.
Which of the following is the most likely mechanism for etomidate-induced myoclonus?
Disinhibition of subcortical structures
What is the potential disadvantage of administering etomidate to patients experiencing sepsis or hemorrhage?
Suppression of adrenocortical function
How long does the inhibition of adrenocortical function last after an induction dose of etomidate?
4 to 8 hours
What is the specific enzyme inhibited by etomidate that causes adrenocortical suppression?
11-β-hydroxylase
What is the potential advantage of adrenocortical suppression caused by etomidate?
Stress-free anesthesia
What has not been documented on the EEG in association with etomidate-induced myoclonus?
Seizure-like activity
Which of the following statements about the antioxidant properties of propofol is most accurate?
All of the above statements about the antioxidant properties of propofol are accurate.
Which of the following statements about pain on injection of propofol is most accurate?
Changing the composition of the carrier fat emulsion for propofol decreases the incidence of pain on injection.
Which of the following statements about the effects of propofol on airway protection is most accurate?
Propofol alters pharyngeal function and impairs upper airway protection.
Which of the following statements about the effects of etomidate on pain on injection is most accurate?
Etomidate is now formulated with a fat emulsion, which has virtually abolished pain on injection.
Study Notes
Pharmacology of Propofol: Key Facts and Considerations
- Intravenous (IV) sedatives and hypnotics are crucial in anesthesiology for anxiety reduction, sedation, and general anesthesia.
- Sedative-hypnotics are drugs that depress the central nervous system (CNS) and induce calmness or sleep.
- Propofol is an IV sedative-hypnotic that is chemically distinct from other drugs in its class.
- Propofol is administered as a 1% solution in an aqueous solution of soybean oil, glycerol, and egg phosphatide.
- Prolonged use of propofol sedation can lead to severe bradycardia in children and metabolic acidosis in surgical patients.
- Propofol-induced metabolic acidosis may be reversible by discontinuing the drug, but can lead to cardiogenic shock in rare cases.
- Propofol does not produce seizure activity in patients with epilepsy and is safe for use in patients with known seizures.
- Propofol has addictive potential and has been associated with intense dreaming, hallucinations, and amorous behavior.
- Propofol supports the growth of certain bacteria, leading to postoperative surgical infections if not handled aseptically.
- Propofol has potent antioxidant properties, which contribute to its neuroprotective effects and ability to suppress phagocytosis.
- Pain on injection is a common adverse event with propofol, but can be reduced by using lidocaine or a short-acting opioid beforehand.
- Propofol does not trigger malignant hyperthermia and can be used safely in patients with hereditary coproporphyria.
Test your knowledge on the effects of etomidate on myocardial contractility and its implications for anesthesia induction in patients with limited cardiac reserve. Explore the challenges of documenting anesthetic-induced negative inotropic effects in vivo.
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