APEX IV anesthetic Domain Exam

Rebound sedation is LEAST likely to occur when flumazenil is administered to reverse which agent?

A. Diazepam

B. Lorazepam

C. Midazolam

D. Ethanol

C. Midazolam

Versed has the most rapid clearance of the commonly used benzos.

t1/2 versed= 1.8-2.6 hrs

t1/2 lorazepam= 11-22 hrs

t1/2 diazepam= 20-50 hrs

flumazenil peaks at 1-3 min and t1/2 of 1 hr

Which opioid MOST often leads to opioid induced hyperalgesia postop?

A. Sufentanil

B. Fentanyl

C. Alfentanil

D. Remifentanil

D. Remifentanil

Opioid induced hyperalgesia results in an increase in pain sensitivity and decreases the analgesic effects of additional opioid dosages.

Pts who get remifentanil infusions introp have a higher incidence of OIH req higher dosages of morphine for post op pain; this may be d/t the rapid offset of analgesia with this rapid acting agent

high dose fentanyl (10 mcg/kg vs 1 mcg/kg) also assoc with OIH

What is an advantage for methohexital for ECT?

A. Decreased seiz threshold

B. Increased excitatory activity

C. Anticonvulsant

D. Inhibition of excitatory movements

A. Decreased seiz threshold

Disadv of it is increased incidence of excitatory activity (coughing, hiccups, myoclonus) pre tx with opioids can decreases the excitatory s/e

sedative-hypnotic effects in the CNS are elicited by agonism at which receptor types (select 2)

A. N-methyl-D-aspartate

B. Alpha-2 adrenergic

C. Alpha-2 Acetylcholine

D. Gamma-Aminobutyric-acid

B. Alpha-2 adrenergic

D. Gamma-Aminobutyric-acid

Propofol, barbs, benzos and etomidate all AGONIZE GABA-A receptors

Precedex agonizes alpha-2 adrenergic

Ketamine ANTAGONIZES NMDA receptor

Which opioid has the LONGEST context sensitive half time?

A. Sufentanil

B. Alfentanil

C. Fentanyl

D. Remifentanil

C. Fentanyl

after 1 hr of infusion the context sensitive half time is 6x longer than alfentanil or sufentanil

remifentanils is 4 min

Which opioids produce active metabolites (Select 3)

A. Remifentanil

B. Meperidine

C. Hydromorphone

D. Tramadol

E. Morphine

F. Fentanyl

B. Meperidine

D. Tramadol

E. Morphine

Meperidine (normeperidine), morphine (morphine-6-glucuronide) and tramadol (O-desmethyl tramadol) all form active metabolites that contribute to their analgesic effects

morphine also metab to morphine-3-glucuronide which is devoid of analgesic properties but with accumulation may produce agitation, delerium and hyperalgesia

codeine is a prodrug that must be converted to its active metabolite, morphine, to provide analgesia

Remimazolam is metabolized by?

A. cytochrome P450

B. N-demethylation

C. non specific esterases

D. conjugation with glucuronic acid

C. non specific esterases

• cytochrome P450 = versed

• N-demethylation = diazepam

• conjugation with glucuronic acid= lorazepam

What are the beneficial features of opioid agonist-antagonist (select 2)

A. minimal risk of provoking withdrawal symptoms

B. ceiling effect for resp depression

C. decreases MAC more effectively than pure agonist

D. lower potential for physical dependence

B. ceiling effect for resp depression

D. lower potential for physical dependence

Opioid agonist-antagonist have ceiling effects for resp dep, sedation and euphoria.