1. What is the mechanism of action of propofol? Propofol enhances GABA-A
receptor activity, causing CNS depression. It increases chloride conductance,
leading to hyperpolarization of neurons.
2. What is the induction dose of propofol in adults? 1.5-2.5 mg/kg IV for
induction in healthy adults. Lower doses (0.5-1.5 mg/kg) in elderly or
compromised patients.
3. What are the cardiovascular effects of propofol? Decreases systemic
vascular resistance, myocardial contractility, and preload, resulting in decreased
blood pressure and cardiac output. No significant effect on heart rate.
4. What is the mechanism of action of etomidate? Enhances GABA-A
receptor activity. It is highly protein bound and rapidly redistributed.
5. What is the induction dose of etomidate? 0.2-0.4 mg/kg IV. It provides
hemodynamic stability with minimal cardiovascular depression.
6. What endocrine effect is associated with etomidate? Adrenocortical
suppression by inhibiting 11-beta-hydroxylase, which decreases cortisol and
aldosterone synthesis. Even a single dose can suppress adrenal function for 5-8
hours.
7. What is the mechanism of action of ketamine? NMDA receptor antagonist.
Also interacts with opioid receptors, monoaminergic receptors, and muscarinic
receptors.
8. What is the induction dose of ketamine? 1-2 mg/kg IV or 4-6 mg/kg IM.
Produces dissociative anesthesia.
9. What are the cardiovascular effects of ketamine? Increases heart rate,
blood pressure, and cardiac output through sympathetic stimulation and
catecholamine release. Direct myocardial depressant in catecholamine-depleted
patients.
,10. What is the mechanism of action of succinylcholine? Depolarizing
neuromuscular blocker. Acts as ACh agonist at nicotinic receptors, causing
sustained depolarization.
11. What is the dose of succinylcholine for intubation? 1-1.5 mg/kg IV.
Onset is 30-60 seconds with duration of 5-10 minutes.
12. What are contraindications to succinylcholine? Hyperkalemia risk
(burns, crush injuries, denervation injuries, severe infections after 24-48 hours),
malignant hyperthermia susceptibility, pseudocholinesterase deficiency, open
globe injury.
13. What is the mechanism of action of rocuronium? Non-depolarizing
neuromuscular blocker. Competitive antagonist at nicotinic ACh receptors at the
neuromuscular junction.
14. What is the intubating dose of rocuronium? 0.6-1.2 mg/kg IV. Onset is
60-90 seconds with 1.2 mg/kg dose. Duration is 30-45 minutes.
15. What reverses rocuronium? Sugammadex (Bridion) is a selective relaxant
binding agent. Dose: 2-4 mg/kg for moderate block, 16 mg/kg for immediate
reversal.
16. What is the mechanism of action of neostigmine? Acetylcholinesterase
inhibitor that increases ACh at the neuromuscular junction. Reverses non-
depolarizing neuromuscular blockade.
17. What is the dose of neostigmine? 0.04-0.07 mg/kg IV (maximum 5 mg).
Must be given with anticholinergic (glycopyrrolate or atropine).
18. What is the MAC of sevoflurane? 2.0% in adults, 2.5% in children. MAC
decreases with age.
19. What is the blood:gas partition coefficient of desflurane? 0.42 (lowest of
volatile anesthetics). Results in rapid onset and emergence.
20. Which volatile anesthetic has the highest potential for hepatotoxicity?
Halothane (rarely used now). Can cause "halothane hepatitis" - immune-
mediated hepatic necrosis.
21. What is the mechanism of action of opioids? Mu, kappa, and delta opioid
receptor agonists. G-protein coupled receptors that inhibit adenylyl cyclase,
decrease cAMP, and hyperpolarize neurons.
22. What is the potency of fentanyl compared to morphine? Fentanyl is 75-
100 times more potent than morphine.
, 23. What is the dose of fentanyl for induction? 2-10 mcg/kg IV depending on
desired effect. For cardiac anesthesia: 20-50 mcg/kg.
24. What is remifentanil's unique characteristic? Metabolized by plasma and
tissue esterases (not pseudocholinesterase). Context-sensitive half-time remains
constant regardless of infusion duration.
25. What is the dose of remifentanil? Bolus: 0.5-1 mcg/kg. Infusion: 0.05-2
mcg/kg/min. Very short duration of action (3-10 minutes).
26. What is the mechanism of action of naloxone? Competitive opioid
receptor antagonist at mu, kappa, and delta receptors.
27. What is the dose of naloxone? 0.04-0.4 mg IV every 2-3 minutes. Titrate
to effect. Duration is 30-45 minutes (shorter than most opioids).
28. What are side effects of naloxone reversal? Hypertension, tachycardia,
pulmonary edema, dysrhythmias, pain, withdrawal symptoms. Reverses
analgesia.
29. What is the mechanism of action of midazolam? Benzodiazepine that
enhances GABA-A receptor activity, increasing chloride conductance.
30. What is the premedication dose of midazolam? 0.02-0.04 mg/kg IV (1-2
mg typical adult dose) or 0.5 mg/kg PO (maximum 20 mg).
31. What reverses benzodiazepines? Flumazenil, a competitive
benzodiazepine receptor antagonist. Dose: 0.2 mg IV, repeat every minute up to
1 mg total.
32. What is the mechanism of action of dexmedetomidine? Selective alpha-2
adrenergic receptor agonist. Provides sedation, analgesia, and anxiolysis
without respiratory depression.
33. What is the loading dose of dexmedetomidine? 1 mcg/kg over 10 minutes
(often omitted to avoid bradycardia and hypotension). Maintenance: 0.2-0.7
mcg/kg/hr.
34. What are cardiovascular effects of dexmedetomidine? Biphasic: initial
hypertension and bradycardia (peripheral alpha-2B activation), followed by
hypotension (central alpha-2A activation). Decreases HR and CO.
35. What is the mechanism of action of local anesthetics? Reversibly block
voltage-gated sodium channels, preventing action potential propagation in nerve
fibers.
receptor activity, causing CNS depression. It increases chloride conductance,
leading to hyperpolarization of neurons.
2. What is the induction dose of propofol in adults? 1.5-2.5 mg/kg IV for
induction in healthy adults. Lower doses (0.5-1.5 mg/kg) in elderly or
compromised patients.
3. What are the cardiovascular effects of propofol? Decreases systemic
vascular resistance, myocardial contractility, and preload, resulting in decreased
blood pressure and cardiac output. No significant effect on heart rate.
4. What is the mechanism of action of etomidate? Enhances GABA-A
receptor activity. It is highly protein bound and rapidly redistributed.
5. What is the induction dose of etomidate? 0.2-0.4 mg/kg IV. It provides
hemodynamic stability with minimal cardiovascular depression.
6. What endocrine effect is associated with etomidate? Adrenocortical
suppression by inhibiting 11-beta-hydroxylase, which decreases cortisol and
aldosterone synthesis. Even a single dose can suppress adrenal function for 5-8
hours.
7. What is the mechanism of action of ketamine? NMDA receptor antagonist.
Also interacts with opioid receptors, monoaminergic receptors, and muscarinic
receptors.
8. What is the induction dose of ketamine? 1-2 mg/kg IV or 4-6 mg/kg IM.
Produces dissociative anesthesia.
9. What are the cardiovascular effects of ketamine? Increases heart rate,
blood pressure, and cardiac output through sympathetic stimulation and
catecholamine release. Direct myocardial depressant in catecholamine-depleted
patients.
,10. What is the mechanism of action of succinylcholine? Depolarizing
neuromuscular blocker. Acts as ACh agonist at nicotinic receptors, causing
sustained depolarization.
11. What is the dose of succinylcholine for intubation? 1-1.5 mg/kg IV.
Onset is 30-60 seconds with duration of 5-10 minutes.
12. What are contraindications to succinylcholine? Hyperkalemia risk
(burns, crush injuries, denervation injuries, severe infections after 24-48 hours),
malignant hyperthermia susceptibility, pseudocholinesterase deficiency, open
globe injury.
13. What is the mechanism of action of rocuronium? Non-depolarizing
neuromuscular blocker. Competitive antagonist at nicotinic ACh receptors at the
neuromuscular junction.
14. What is the intubating dose of rocuronium? 0.6-1.2 mg/kg IV. Onset is
60-90 seconds with 1.2 mg/kg dose. Duration is 30-45 minutes.
15. What reverses rocuronium? Sugammadex (Bridion) is a selective relaxant
binding agent. Dose: 2-4 mg/kg for moderate block, 16 mg/kg for immediate
reversal.
16. What is the mechanism of action of neostigmine? Acetylcholinesterase
inhibitor that increases ACh at the neuromuscular junction. Reverses non-
depolarizing neuromuscular blockade.
17. What is the dose of neostigmine? 0.04-0.07 mg/kg IV (maximum 5 mg).
Must be given with anticholinergic (glycopyrrolate or atropine).
18. What is the MAC of sevoflurane? 2.0% in adults, 2.5% in children. MAC
decreases with age.
19. What is the blood:gas partition coefficient of desflurane? 0.42 (lowest of
volatile anesthetics). Results in rapid onset and emergence.
20. Which volatile anesthetic has the highest potential for hepatotoxicity?
Halothane (rarely used now). Can cause "halothane hepatitis" - immune-
mediated hepatic necrosis.
21. What is the mechanism of action of opioids? Mu, kappa, and delta opioid
receptor agonists. G-protein coupled receptors that inhibit adenylyl cyclase,
decrease cAMP, and hyperpolarize neurons.
22. What is the potency of fentanyl compared to morphine? Fentanyl is 75-
100 times more potent than morphine.
, 23. What is the dose of fentanyl for induction? 2-10 mcg/kg IV depending on
desired effect. For cardiac anesthesia: 20-50 mcg/kg.
24. What is remifentanil's unique characteristic? Metabolized by plasma and
tissue esterases (not pseudocholinesterase). Context-sensitive half-time remains
constant regardless of infusion duration.
25. What is the dose of remifentanil? Bolus: 0.5-1 mcg/kg. Infusion: 0.05-2
mcg/kg/min. Very short duration of action (3-10 minutes).
26. What is the mechanism of action of naloxone? Competitive opioid
receptor antagonist at mu, kappa, and delta receptors.
27. What is the dose of naloxone? 0.04-0.4 mg IV every 2-3 minutes. Titrate
to effect. Duration is 30-45 minutes (shorter than most opioids).
28. What are side effects of naloxone reversal? Hypertension, tachycardia,
pulmonary edema, dysrhythmias, pain, withdrawal symptoms. Reverses
analgesia.
29. What is the mechanism of action of midazolam? Benzodiazepine that
enhances GABA-A receptor activity, increasing chloride conductance.
30. What is the premedication dose of midazolam? 0.02-0.04 mg/kg IV (1-2
mg typical adult dose) or 0.5 mg/kg PO (maximum 20 mg).
31. What reverses benzodiazepines? Flumazenil, a competitive
benzodiazepine receptor antagonist. Dose: 0.2 mg IV, repeat every minute up to
1 mg total.
32. What is the mechanism of action of dexmedetomidine? Selective alpha-2
adrenergic receptor agonist. Provides sedation, analgesia, and anxiolysis
without respiratory depression.
33. What is the loading dose of dexmedetomidine? 1 mcg/kg over 10 minutes
(often omitted to avoid bradycardia and hypotension). Maintenance: 0.2-0.7
mcg/kg/hr.
34. What are cardiovascular effects of dexmedetomidine? Biphasic: initial
hypertension and bradycardia (peripheral alpha-2B activation), followed by
hypotension (central alpha-2A activation). Decreases HR and CO.
35. What is the mechanism of action of local anesthetics? Reversibly block
voltage-gated sodium channels, preventing action potential propagation in nerve
fibers.
