IV Induction Agents
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| Barbiturates are what type of solution? | show 🗑
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| What property do barbituric solutions have? | show 🗑
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| show | A chemical that inhibits bacterial growth.
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| show | Acids
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| What can happen to barbiturates if they are mixed with acidic compounds? | show 🗑
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| show | The formation of a solid from a solution.
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| What are three examples of acidic compounds that cause precipitation with barbiturates? | show 🗑
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| show | Glutamate/Adenosine/Neuronal Nicotinic AcH receptors
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| Barbiturates have greater CNS access if they are (ionized/non-ionized)? | show 🗑
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| The non-ionized form of barbiturates are favored by high or low pH? Describe what that environment would be called. | show 🗑
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| show | High pH/Alkalosis Environment
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| show | San Fernando Valley
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| Barbiturates depress which neurological network? Ultimately, what receptors are potentiated by this? | show 🗑
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| show | Low
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| show | High
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| Which waves are replaced with EEG burst suppression of barbiturates? Which waves are formed? | show 🗑
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| What do Delta & Theta waves lead to on an EEG reading? | show 🗑
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| show | Thiopental 3-5 mg/kg IV
Methohexital 1-1.5 mg/kg IV
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| show | Pentothal
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| What is the other name for Methohexital? | show 🗑
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| Which barbiturates is used for ECT and why? | show 🗑
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| How long after giving a barbiturate will unconsciousness occur? | show 🗑
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| Which NMBA is given with barbiturates for RSI? | show 🗑
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| What is important to remember with giving barbiturates and NMBAs? | show 🗑
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| How are barbiturates metabolized? | show 🗑
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| show | Bile/Urine
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| show | Inactive
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| show | False - Phenobarbital is the only one unchanged in urine.
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| show | True
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| What enzyme is promoted in barbiturate oxidative metabolism? What does this enzyme form? | show 🗑
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| show | Heme Synthesis
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| What patients should avoid barbiturates? | show 🗑
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| How is ventilation effected by barbiturates? | show 🗑
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| How is the CV system effected by barbiturates and by what physiological system? | show 🗑
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| BONUS: What food can Meghan not eat? | show 🗑
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| What is the emulsion of Propofol made? | show 🗑
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| T/F: Egg lecithin is made from the whites of an egg? | show 🗑
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| How many hours after opening Propofol? should the unused portion be discarded? IV line changed after how many hours? | show 🗑
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| show | False
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| What is the dose of Propofol and how long will it take to accomplish unconsciousness? | show 🗑
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| show | To inhibit pain caused from proposal infusion.
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| T/F: Propofol and Lidocaine can be safely administered together in one syringe? | show 🗑
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| show | GABA
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| Describe the relationship between Propofol and the effects of amnesia/analgesia/anticonvulsant properties. | show 🗑
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| How does Propofol effect CBF/ICP/CMRO2? | show 🗑
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| What other pressure does Propofol decrease? | show 🗑
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| show | Excitatory / Twitching
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| show | True
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| BONUS: What is Drew Smith's favorite food chain in Philadelphia? | show 🗑
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| show | Patients with asthma/wheezing. It produces bronchodilation.
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| show | Occulocardiac
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| show | Negative Inotropic effect.
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| show | Triglycerides
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| What two behaviors occur with Propofol? | show 🗑
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| What is Etomidate classified as? | show 🗑
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| show | Dextro Isomer
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| Which neurotransmitter is enhanced with Etomidate? | show 🗑
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| show | Large
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| What percent is Etomidate bound to albumin? | show 🗑
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| What condition causes a high elevation of active Etomidate in a patient? | show 🗑
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| What metabolizes Etomidate? What percent and where are the metabolites excreted? | show 🗑
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| show | 30-60 seconds / 0.2-0.4 mg/kg
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| T/F: Etomidate is cardiovascular stable? | show 🗑
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| show | PONV.
Adrenocortical Suppression.
Pain with injection.
Can cause seizures in those with focal epilepsy.
Myoclonus
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| T/F: Etomidate can not be used to treat status epilepticus due to its pro-focal epileptic effects. | show 🗑
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| show | Decreases CBF 35% / Decrease ICP / Decrease CMRO2 45%
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| show | 11 Beta Hydroxylase / Last 4-8 hours
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| What bar will Gary Gentner never go to again in Philadelphia? | show 🗑
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| show | Anxiolytic Properties
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| T/F: Benzodiazepines bind to a different part of the GABA receptor to produce their effects? | show 🗑
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| What subunit causes sedation with Benzodiazepines? | show 🗑
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| What subunit causes anxiolytic property with Benzodiazepines? | show 🗑
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| What do Benzodiazepines decrease degradation of? | show 🗑
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| show | Decrease HR / Decrease 02 demand / Dilate Coronary Vessels / Increase Oxygen Delivery
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| What system allows the levels of Adenosine to be increased? | show 🗑
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| show | Myocardial Ischemic patients
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| show | Midazolam (Versed)
Lorazepam (Ativan)
Diazepam (Valium)
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| show | High / High
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| What percent of benzos are bound to plasma proteins? | show 🗑
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| show | Midazolam - all others have slower onsets / much longer durations
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| show | Oral - 0.5 mg/kg - 20 mg/kg / 30 minutes before.
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| T/F: Midazolam undergoes 1st pass hepatic effect? | show 🗑
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| show | 50%
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| T/F: Midazolam is a potent anti-convulsant that is unable to produce an isoelectric EEG? | show 🗑
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| What is the most significant effect of Midazolam? | show 🗑
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| show | Flumazenil
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| What type of drug is Romazicon? | show 🗑
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| show | 0.2 mg - 1 mg
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| show | Appox. 2 minutes
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| What is the duration of action for Flumazenil? | show 🗑
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| A patient with a history of seizures comes into the ER for recreational overdoes of benzodiazepine. Would this patient benefit from Flumazenil (Romazicon) antidote? | show 🗑
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| What class of anesthetic is Ketalar? | show 🗑
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| show | Phencyclidine derivative
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| What type pf mixture is Ketamine? | show 🗑
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| What is unique about Propofol as it enters our body? | show 🗑
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| Ketamine decreases release of a (pre/post) synaptic neurotransmitter? What is that neurotransmiter? | show 🗑
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| show | NMDA
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| show | N-Methyl-D-Aspartate
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| What is the major excitatory neurotransmitter in the CNS? | show 🗑
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| show | GABA
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| What does GABA stand for? | show 🗑
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| show | 10, 50, 100 mg/ml
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| What other receptor sites can Ketamine bind to? | show 🗑
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| What recreational drug does Ketamine mimic? | show 🗑
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| show | Inhibits uptake of catecholamines back into the post-ganglionic nerve ending.
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| show | Ketamine is a potent cerebral vasodilator and increases all. However, it only increases CBF in the latest research. (YOU decide which concept to take to the test!)
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| T/F: Ketamine may cause myoclonus, but does not alter the seizure threshold? | show 🗑
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| T/F: Ketamine can cause burst suppression? | show 🗑
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| Which EEG lead waves are presence when Ketamine causes unconsciousness? | show 🗑
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| Dexmedetomidine is what type of anesthetic? | show 🗑
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| show | Selective alpha 2 agonist in the locus ceruleus?
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| show | Part of the Pons in the brain responsible for panic and stress.
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| show | False, decreases HR, SVR, and BP?
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| show | HR - severe bradycardia, heart block, and asystole have been observed.
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| The CO2 response to ventilation is unchanged with which induction agent? | show 🗑
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| Yohimbine (agonizes/antagonizes) alpha 2 receptors? What type of drug is Yohimbine and what induction agent does it effect? | show 🗑
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| How does Precedex effect CBF? | show 🗑
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| What is Precedex's bolus dose? | show 🗑
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| show | 0.2-0.7 mcg/kg/hr
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| What 3 medications are used as adjuncts for certain procedures? | show 🗑
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| show | Chest wall rigidity
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| How do you treat Chest Wall Rigidity? | show 🗑
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| What two drugs are know as brain "scrambling" agents? What situation are they given in? | show 🗑
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| Which division of opioid derivatives has opioids activity? | show 🗑
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| show | Morphine, codeine, and Thebane
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| show | Morphine - Codeine / Heroin
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| Name the Synthetic opioids. | show 🗑
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| T/F: Opioids act as agonist at pre and post synaptic opioid receptors. | show 🗑
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| show | Stereo-specific (lock and key).
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| Where are opioid receptors located? | show 🗑
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| Opioids mimic what endogenous peptide ligands? | show 🗑
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| show | AcH, dopamine, norepinephrine, substance P
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| What electrolyte is increased with opioid effects causing the cell to be (hypopolarized/hyperpolarized)? | show 🗑
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| show | Mu1 / Mu2 / Kappa / Delta
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| show | Couple guanine or (G) proteins and inhibit adenyl cyclase, decrease the conductance of voltage gated calcium channels, or open inward flowing potassium channels - with net result in decrease of neuronal activity.
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| What is the most notable feature of clinical use of opioids? | show 🗑
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| show | Morphine
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| show | 15-30 minutes
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| show | Rapid conjugation
Poor lipid solubility
Highly Ionized
<0.1 at peak plasma concentration
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| What will enhance morphine's CNS penetration? | show 🗑
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| What is the percent of morphine's protein binding? | show 🗑
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| When a patient is acidotic with high CO2 levels, cerebral blood vessels (constrict/dilate) allowing more blood flow to the brain (increasing/decreasing) morphine concentration, making the aspect of ionization not as important for morphine's effects. | show 🗑
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| T/F: Morphine undergoes ester hydrolysis? | show 🗑
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| What are two metabolites of morphine? | show 🗑
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| Which morphine metabolite is active? | show 🗑
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| What physiological response occurs with the active morphine metabolite? | show 🗑
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| What patient population should excellent CRNAs be cautious in giving morphine? | show 🗑
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| What class of drugs potentiates morphine? | show 🗑
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| Morphine exhibits greater analgesic recovery in (men/women)? | show 🗑
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| Morphine exhibits slower speed of offset in (men/women)? | show 🗑
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| show | > 5mg
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| show | Fentanyl / Sufentanyl
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| show | Opioids and Benzos - myocardial depression / decrease in CO / decrease in SVR.
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| show | Mu2
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| show | Shifts curve to right.
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| show | A patient will require a higher PaCO2 to initiate breathing.
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| show | Codeine and Dextromethorphan
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| Which opioid is is most prevalent with chest wall rigidity? | show 🗑
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| T/F: Opioids cause increased ICP? | show 🗑
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| How does opioids effect ICP? | show 🗑
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| Opioids cause pupil (constriction/dilation)? | show 🗑
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| show | Pupil constriction
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| What nerve is responsible for pupil changes with opioids? | show 🗑
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| Opioids can effect the biliary smooth muscle in which way? What two medications can be used to treat this opioid response? | show 🗑
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| show | Chemoreceptor trigger zone in the 4th Ventricle
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| show | 1/10 potent as morphine (10mg morphine = 100mg Demerol)
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| What is another name for Meperidine? | show 🗑
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| show | 2 hours
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| show | Active / nor-meperidine
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| show | Seizures
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| T/F: Meperidine does not release histamine? | show 🗑
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| show | Kappa Receptors
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| show | MAOIs
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| How does Meperidine effect the heart? | show 🗑
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| show | 75-125 times more potent
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| T/F: Fentanyl has a (small/large) Vd that causes more rapid onset and shorter duration in relation to its increase lipid solubility? | show 🗑
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| show | 79%-87%
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| What dose of fentanyl will provide analgesia? | show 🗑
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| show | 50-150 mcg/kg
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| T/F: Fentanyl can be injected intrathecally? | show 🗑
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| What are two unique ways that fentanyl can be given and what are the respective doses? | show 🗑
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| What two unique problems can make fentanyl have a secondary peak in our bodies? | show 🗑
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| T/F: Opioids can cause myoclonus? | show 🗑
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| show | HR
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| Fentanyl causes what compensatory mechanism in neonates? At what does of fentanyl will this be inhibited? | show 🗑
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| T/F: Opioids can produce detectable changes in SEPS monitoring? | show 🗑
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| What is the potency of Sufentanil compared to fentanyl? | show 🗑
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| How is sufentanil related to the lungs? | show 🗑
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| How does low protein concentrations in infants increase sufentanil's effects? | show 🗑
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| show | Desmethyl sufentanil 10% active
N-Dealkylation inactive
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| T/F: Sufentanil can cause chest wall rigidity, similar to fentanyl? | show 🗑
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| show | 1/5-1/10 potent.
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| What precent does Alfentanil exist in the non-ionized formed at physiologic pH? Does it cross the BBB? | show 🗑
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| What CYP enzyme is responsible for Alfentanil's clearance? | show 🗑
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| show | 100-300 mg/kg ?? - 45 minutes (I looked up doses and all were written in 'mcg' so I think it is 100-300 mcg).
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| Alfentanil has a (lower/higher) Vd then fentanyl? | show 🗑
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| show | Less
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| What opioid has equianalgesic potency to fentanyl? | show 🗑
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| What type of metabolism does Remifentanyl undergo? Are the metabolites active or inactive? | show 🗑
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| T/F: Remifentanyl needs to be dosed based on real body weight due to the pharmokinetics of this drug in lean and obese patients. | show 🗑
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| show | True
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| What is the metabolite of Remifentanyl? How much less potent is it to the Mu receptors? | show 🗑
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| show | Remifentanyl, Fast wake up.
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| What substance is Remifentanyl packaged in? What cases would be effected by this? | show 🗑
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| show | N/V, ventalitory depression, mild decreases in BP/HR
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| show | 5 times more potent
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| What drugs are have partial agonist/partial antagonist effects? | show 🗑
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| show | Mu
Kappa
Delta
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| What features make opioid agonist/partial antagonist desirable? | show 🗑
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| show | Stadol, 2-3mg IM
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| What drug can counteract the lingering post-op ventilatory depression effects? | show 🗑
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| show | Naloxone (IV)
Naltrexone (oral)
Nalmefene (IV)
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| show | N-alkyl derivative of oxymorphone
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| What is the dose of Naloxone? Duration of action? | show 🗑
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| show | Sympathetic
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| show | True - leads to acute withdrawal in neonates
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| TIVA is indicated for what type of patients? | show 🗑
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| How does inhaled anesthetics influence latency and amplitude of SSEPS? | show 🗑
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| show | Enough proposal
2 (250ml) NSS bags for narcotic mixture
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| What is the concentration and infusion rate of Remifentanyl for TIVA cases? | show 🗑
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| show | 250 mcg in 250ml
0.1-0.3 mcg/kg/hour
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| What pressor would be best for hypotensive patients for TIVA cases? | show 🗑
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| show | 10mg in 50ml
0.25 mcg/kg/min
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| show | 105
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| Blood:Gas solubility coefficient of Nitrous Oxide? | show 🗑
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| Molecular weight of Nitrous Oxide? | show 🗑
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| show | Nitrous Oxide
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| What emergent condition can be worsened by Nitrous Oxide? What percent N2O and how quick? | show 🗑
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| What response of infection can N2O inhibit? | show 🗑
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| What two enzymes can be inhibited by N2O and what are these enzyme responsible for? | show 🗑
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| What key comment in our body does N2O inhibit? | show 🗑
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| show | Neuromuscular Symptoms - Neuropathies.
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| What can occur by turning off Nitrous Oxide and allowing patients to breath in Room Air? | show 🗑
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| How can we prevent Diffusion Hypoxia cause by N2O? | show 🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
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