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What happens to half life as the volume of distribution at steady state increases?
Half life increases
What are the characteristics of a depolarizing block?
Decreased twitch height, absence of fade, a minimal reduction in twitch height (T4:T1 > 0.7)
Phenylephrine receptor(s)
Alpha-1
Dexmedetomidine receptor(s)
Alpah-2
Isoproterenol receptor(s)
Beta-1 and Beta-2 (non-selective)
Terbutaline receptor(s)
Beta-2
When should cyanide intoxication be suspected?
When the dose of sodium nitroprusside exceeds 1 mg/kg over a 2-hour period or 0.5 mg/kg/hr over 24 hours.
Which agents can be used to decrease bowel motility during surgery?
Glycopyrrolate or atropine (The PNS is responsible for the increased activity)
Digitalis induced ventricular dysrhythmias are most appropriately treated with
Lidocaine
How is the dosing of non-depolarizing neuromuscular blocking agents changed in the burn patient?
It is increased due to the presence of extrajunctional receptors (succinylcholine sensitivity is increased); this also happens to patients with LMN injury
Which narcotic should be avoided in patients taking MAOI's
Meperidine; hyperthermia, seizures and coma may result (neuroleptic malignant syndrome)
The potency of LA's is associated with?
Lipid solubility of the agent
What are the results of acetylcholine administration?
PNS:  Relaxation of the bladder sphincter, contraction of the detrusor muscle, increased insulin secretion, miosis (from iris contraction)
What is the most important factor determining spread of a LA within the subarachnoid space?
Baricity of the LA relative to patient position
Which LA will precipitate if standard (1 mEq) amount of bicarb is added?
Bupivacaine
To what does remifentanil owe its very short half-life?
Rapid hydrolysis by tissue and plasma esterases
In patients having noncardiac surgery, beta-blockade hase been shown to reduce
Perioperative dysrhythmias and myocardial ischemia; may not provide benefit with regard to MI, length of hospitalization or mortality
How much does serum potassium increase in a normal individual after receiving succinylcholine?
0.5 mEq/L
Which patients may have an exaggerated (and possibly life threatening) increase in serum potassium after receiving succinycholine?
Patients with extensive burns, muscular dystrophy or lower motor neuron diseases
What is the oil:gas coefficient of N2O?
1.4
What is the oil:gas coefficient of desflurane?
19
What is the oil:gas coefficient of sevoflurane?
47
What is the oil:gas coefficient of isoflurane?
91
What does the oil:gas coefficient correlate with?
It correlates directly with potency and inversely with MAC, therefore the agents with the highest oil:gas coefficients have the lowest MACs.
Which antibiotics are associated with increasing the depth of neuromuscular blockade?
Aminoglycocides, polymyxins, and lincosamides (clindamycin & lincomycin)
Which anesthetic agent should be avoided in the patient receiving intravitreal sulfur hexafluoride for mechanical support of the retina?
Nitrous oxide (N2O)
How does adenosine work?
It produces a complete but transient AV node block, potentially ablating a reentry rhythm producing SVT
How does ketamine effect CMRO2?
It has been shown to increase CMRO2
How should you respond to the intraarterial injection of thiobarbiturates?
1.  Promptly administer intraarterial papaverine and lidocaine (or procaine)
2.  Regional-anesthesia induced sympathectomy (stellate ganglion block, brachial plexus block)
3.  Heparinization
Which class of drug is associated with the highest incidence of hypersensitivity?
Penicillins (although non-depolarizing NMB's are the primary cause of allergic reactions during anesthesia)
List the anticholinesterase drugs by speed of reversal (from fastest to slowest)
1.  Edrophonium
2.  Neostigmine
3.  Pyridostigmine
What is the mechanism of action of montelukast (for asthma)?
Decreases leukotrienes
What is the mechanism of action of metaproterenol (for asthma)?
Beta stimulation
What is the mechanism of action of ipratropium (for asthma)?
Anticholinergic
What is the mechanism of action of theophylline (for asthma)?
Decreases phosphodiesterase
Which agents are associated with the induction of CYP-450?
Ethanol, barbiturates, ketamine, and benzodiazepines
Which agents are known to inhibit CYP-450?
Cimetidine and chloramphenicol
What is the most effective antiemetic for a patient with Parkinson's disease being treated with L-dopa/carbidopa?
Scopolamine due to its centrally acting anticholinergic effect (excellent antiemetic and improves mobility).  Anti-dopaminergic drugs are contraindicated for this patient.
Which drugs are shown to increase both gastric pH and volume?
Non-particulate antacids
What increases gastric pH most rapidly?
0.3M sodium citrate (Bicitra)
What drugs decrease gastric volume and increase gastric pH?
H2 receptor blockers
What drugs are only effective at increasing gastric pH (but do not change volume)?
Proton pump inhibitors
What drug decreases gastric volume but has no effect on pH?
Metoclopramide
Hypotensive patients with hypertrophic cardiomyopathy should be treated with which vasopressor?
Phenylephrine 100 mcg; both preload and afterload will be increased without increasing myocardial contractility
Which inhaled anesthetic causes the greatest decrease in cardiac output?
Sevoflurane
Which inhaled anesthetics do not reduce CO?
N2O, isoflurane
What are Phase I biotransformation reactions?
Hydrolysis, oxidation, or reduction; they alter the molecular structure of a drug by modifying an existing functional group, adding a new functional group, or splitting the drug molecule
What is a Phase II biotransformation reaction?
Conjugation; coupling of compounds to polar chemical groups
How does acute intoxication affect MAC?
MAC will be decreased
Name the hyperbaric spinal solutions
Tetracaine 0.5% in 5% dextrose
Bupivacaine 0.75% in 8.25% dextrose
Lidocaine 5% in 7.5% dextrose
Procaine 10% in water
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