Volatile Anesthetics
Which volatile anesthetic is a respiratory irritant?
Desflurane
Which drug can cause cardiac failure, rhabdomyolysis, metabolic acidosis, and kidney failure with high dose infusion (> 4 mg/kg/hr) if infused for more than 48 hours?
Propofol
Which drug causes irreversible inhibition of acetylcholinesterase and prolongs Succinylcholine blockade?
Organophosphates - pesticide, Echothiophate used in the treatment of glaucoma
Which volatile anesthetic can potentially cause vinyl halide nephrotoxicity? What does the manufacturer recommend?
Sevoflurane
Manufacturer recommends that FGF should be equal to or greater than 2 L/min when administering Sevoflurane.
Which drug can reverse benzodiazepine? At what dose should it be administered and titrated?
Romazicon (Flumazenil)
Start with 0.1 - 0.2 mg IV. See CNS reversal effects in 2 minutes. If more drug is needed, give 0.1 mg every minute to a total of 1 mg.
What is the reversal agent for opioid overdose? What dose should you start with?
Naloxone (Narcan)
Start with 40 mcg IV
What can Desflurane be degraded into if the carbon dioxide absorbent is desiccated?
Carbon monoxide
Which sedative hypnotic can cause emergence delirium (dreaming, hallucination, confusion) and increased oral secretions? What can you give to decrease these side effects?
Ketamine
Give Versed and Glycopyrrolate.
Name at least 3 conditions where MAC requirement is increased.
1. Natural red heads
2. Young - MAC is greatest in patients < 1 years of age
3. Temperature > 42 degrees Celsius
4. Chronic alcohol abuse
5. Hypernatremia
6. Acute use of Amphetamine (sympathomimetic)
7. Cocaine (sympathomimetic)
8. Ephedrine (sympathomimetic)
What is 1 MAC % of N2O, Desflurane, Sevoflurane, and Isoflurane?
N2O = 104 - 105%
Desflurane = 6 - 6.6%
Sevoflurane = 1.8 - 2%
Isoflurane = 1.2%
What are 2 contraindications to using Etomidate?
Porphyria
Adrenal suppression (sepsis)
Fill in the blank.
____ is a potent monoamine oxidase inhibitor and can cause ____ if given with Demerol or selective serotonin reuptake inhibitors (SSRI). Name at least 2 SSRI drugs.
Methylene blue
Serotonin syndrome
SSRI drugs - Fluoxetine, Sertraline, Paroxetine, Citalopram, Escitalopram, Dapoxetine, Seproxetine, Mesembrine, Zimelidine
Name at least 2 pros and 2 cons of nitrous oxide.
Pros: Low cost; not pungent; low blood:gas partition coefficient (0.42); stable from cardiovascular standpoint, does NOT trigger malignant hyperthermia
Cons: Not potent (1 MAC = 104 - 105%, can't rely on it alone); expand air-filled cavity; increases PONV; implicated in depletion of ozone layer
Name at least 2 cardiovascular and 2 CNS effects of Ketamine.
Cardiovascular: Increase BP, increase HR, increase cardiac output
CNS: Increase CBF, increase ICP, increase CMRO2
Which drug is contraindicated in patients on monoamine oxidase inhibitors? What does the interaction cause? Name at least 2 symptoms of this syndrome. Name at least 2 monoamine oxidase inhibitor drugs or substance.
Meperidine (Demerol)
Serotonin syndrome - excess serotonin in CNS leading to confusion, fever, shivering, diaphoresis, ataxia, myoclonus, diarrhea
MAOI drugs - Selegiline (Emsam, Eldepryl, Carbex, Zelapar), Rasagiline (Azilect), Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxacid (Marplan), Methylene blue