59 Questions
Which induction agent is known for its distinct antiemetic properties?
Propofol
What is the significant disadvantage of using etomidate, particularly as an infusion?
Adrenal suppression
Which drug provides unequaled cardiovascular stability as an induction agent?
Etomidate
What are the five principal effects of benzodiazepines mentioned in the text?
Anxiolysis, sedation, anticonvulsant activity, skeletal muscle relaxation, and amnesia
What is the primary action of barbiturates at the GABA A receptor?
Enhancing its affinity for GABA and directly activating the receptor at high doses
Which setting is etomidate unlikely to be used in?
A patient in status epilepticus
What effect does etomidate have on cerebral blood flow?
Maintained or improved cerebral perfusion pressure
What is a potential side effect of etomidate induction?
Myoclonus
Which etomidate derivative may not inhibit steroidogenesis?
Methoxycarbonyletomidate (MOC)
What is the unique structure of midazolam among benzodiazepines?
Substituted imidazole ring
How do benzodiazepines act on the GABAA receptor?
Enhance the affinity of the GABAA receptors for GABA
What is true regarding the metabolism of lorazepam?
Undergoes hepatic glucuronidation
Which statement is true regarding age and midazolam requirement?
Decrease in requirement with age
In what setting is etomidate NOT a useful induction agent?
Patients with a history of PONV
What is the primary effect of benzodiazepine bound by GABAA receptor?
Increased opening of chloride channels
What is a potential side effect of etomidate induction?
Myocardial infarction
Which patient population requires a 25-50% reduction in dose of propofol?
Elderly patients
What is the recommended dosing range of propofol for maintenance of anesthesia?
100-300 μg/kg/min
Which clinical use of propofol is valued due to its rapid effect-site equilibration and short context-sensitive half-time?
Sedation
What is the bolus dose of propofol for postoperative nausea and vomiting?
10-15 mg
What organ system effect does propofol have on intracranial pressure?
~30% decrease in ICP
What is the effect of propofol on evoked potentials in the auditory system?
No effect
Which cardiovascular effect is associated with propofol administration?
Vasodilation
In which patient population is propofol-induced hypotension more common?
Elderly patients
What is the mechanism of neuroprotection associated with propofol?
Antioxidant activity and free radical scavenging
What is the risk of bradycardic death associated with propofol?
~ 1%
What is the mechanism of action of barbiturates at low concentrations?
Enhance the effect of GABA
Which barbiturate became the preferred intravenous barbiturate due to its rapid onset and short duration?
Thiopental
What is the main form of hepatic metabolism for barbiturates?
Oxidation
In pharmacokinetics, what results in the termination of action of a bolus dose of barbiturates?
Redistribution of drug into the central circulation
Which receptors do barbiturates also act at, in addition to GABAA and glutamate receptors?
Adenosine receptors
Which barbiturate may lead to accumulation of the active metabolite pentobarbital at high doses?
Thiopental
What is the main basis for recommending that barbiturates be avoided in porphyria?
Influence on hepatic microsomes
What is the primary metabolite of midazolam?
1-hydroxymidazolam glucuronide
Which drug inhibits the hepatic clearance of midazolam?
Cimetidine
Which benzodiazepine has a metabolism that is relatively unaffected by inhibition of cytochrome P-450 or changes in hepatic function?
Lorazepam
Which benzodiazepine has a lower lipid solubility resulting in a delayed onset of effect in the central nervous system (CNS)?
Lorazepam
In children, what is the recommended dosage range for oral premedication with midazolam?
0.25-1 mg/kg
Which benzodiazepine is known for its reliable amnesia and slower onset compared to thiopental or propofol?
Midazolam
What effect do benzodiazepines have on cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2)?
They decrease both CBF and CMRO2
How does flumazenil work?
It prevents or reverses all effects of other benzodiazepines as a competitive antagonist
What is a known use for flumazenil?
Reversal of residual benzodiazepine-induced sedation
Which of the following is a potential cardiovascular effect of propofol?
Increased incidence of the oculocardiac reflex
What is a potential respiratory effect of propofol?
Dose-dependent depression of ventilation
Which of the following is a potential side effect of propofol?
Hallucinations
What is a distinguishing feature of Fospropofol (AQUAVAN) compared to propofol?
Lipid emulsion preparation
What is a potential disadvantage associated with Fospropofol (AQUAVAN) administration?
Difficult titration
What is a characteristic of etomidate's mechanism of action?
Enhances the affinity of the GABAA receptor for GABA
Which statement accurately describes etomidate's pharmacokinetics?
Rapid clearance in the liver by ester hydrolysis
What is an advantage of etomidate's preparation in a lipid emulsion?
No pain on injection
What best describes the mechanism of action of etomidate?
Enhances the affinity of the GABAA receptor for GABA
What is the dominant cardiovascular effect of ketamine in a patient with an intact autonomic nervous system and adequate catecholamine stores?
Hypertension and tachycardia
Which anesthetic agent, as an adjunct to general anesthesia, markedly reduces MAC but is associated with a high incidence of bradycardia?
Dexmedetomidine
Which of the following anesthetic agents is a GABA Agonist Sedative-Hypnotic?
Propofol
What is the preparation of propofol that requires the presence of a preservative to prevent bacterial growth?
Emulsion of 1% propofol, 10% soybean oil, 2.25% glycerol, and 1.2% purified egg phosphatide
Which anesthetic agent has minimal hysteresis, rapid termination of action due to redistribution, and high clearance relative to other induction agents?
Propofol
What is the expected elimination half-life of propofol?
0.5-1.5 hours
What is the primary clinical use for propofol?
Induction of anesthesia
What is the recommended dosing for healthy adults for propofol induction of anesthesia?
1.5-2.5 mg/kg
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