Pharmacology Anesthetics
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- What stage of anesthesia can be described by delirium, violent behavior, increased blood pressure, and increased respiratory rate
- State II (excitement)
- What stage of anesthesia can be described by depression of vasomotor center, depression of respiratory center, and death may occur
- Stage IV (medullary depression)
- What stage of anesthesia can be described by eye movements cease, fixed pupils, regular respiration, and relaxation of skeletal muscles
- Stage III (surgical anesthesia)
- What stage of anesthesia can be described by loss of pain sensation, and patient is conscious
- Stage I (analgesia)
- With regard to inhaled anesthetics, what does MAC stand for
- Minimum alveolar concentration
- What is MAC
- The concentration of inhaled anesthetic required to stop movement in 50% of patients given a standardized skin incision; a measure of potency for inhaled anesthetics
- For potent inhaled anesthetics, is the MAC small or large
- Small (inverse of the MAC is used as an index of potency for inhaled anesthetics)
- Which inhaled anesthetic has the largest MAC
- Nitrous oxide
- Which inhaled anesthetic has the smallest MAC
- Halothane
- The more lipid soluble an inhaled anesthetic is, the concentration of anesthetic needed to produce anesthesia is lower or higher
- Lower
- What is the blood/gas partition coefficient
- Ratio of the total amount of gas in the blood relative to the gas equilibrium phase; refers to an inhaled anesthetic’s solubility in the blood
- If an inhaled anesthetic has a high blood/gas partition coefficient, will times of induction and recovery be increased or decreased
- Increased (time to increase arterial tension is longer)
- Give two examples of inhaled anesthetics with low blood/gas partition coefficients (low blood solubility)
-
Nitrous oxide (0.5)
Desflurane (0.4) - Give two examples of inhaled anesthetics with high blood/gas partition coefficients (high blood solubility)
-
Halothane (2.3)
Enflurane (1.9) - Which inhaled anesthetic, halothane or nitrous oxide, will take longer to change the depth of anesthesia when the concentration of drug has been changed
- Halothane
- Are MAC values additive
- Yes
- Are MAC valued higher or lower in elderly patients
- Lower
- Are MAC values higher or lower when opioid analgesics and/or sedative hypnotics are used concomitantly
- Lower
- What is another name for nitrous oxide
- Laughing gas
- Do inhaled anesthetics increase or decrease the response to PCO2 levels
- Decrease
- Do inhaled anesthetics increase or decrease cerebral vascular flow
- Increase
- Do inhaled anesthetics increase or decrease intracranial pressure
- Increase
- Do inhaled anesthetics relax or strengthen uterine smooth muscle contractions
- Relax (except methoxyflurane when briefly inhaled, therefore, can be used during childbirth)
- Give examples of inhaled anesthetics
-
Sevoflurane
Halothane
Isoflurane
Nitrous oxide
Enflurane
Methoxyflurane
Desflurane
*SHINE MD - Which inhaled anesthetic is not a halogenated hydrocarbon
- Nitrous oxide
- Which inhaled anesthetic is associated with malignant hyperthermia
- Halothane
- What characterizes malignant hyperthermia
-
Hyperthermia
Muscle rigidity
Acidosis
Hypertension
Hyperkalemia - Should a patient with a family history positive for malignant hyperthermia be concerned
- Yes (genetic defect may be inherited)
- What drug is given to treat malignant hyperthermia
- Dantrolene
- Which inhaled anesthetic is associated with increased bronchial secretions
- Isoflurane
- Which inhaled anesthetic is associated with muscle spasms
- Enflurane
- Which inhaled anesthetic is associated with hepatitis
- Halothane
- Which inhaled anesthetic is associated with increased bronchial spasms
- Isoflurane
- Which inhaled anesthetic is associated with cardiac arrhythmias
- Halothane
- Which inhaled anesthetics increase heart rate (via reflex secondary to vasodilation)
-
Isoflurane
Desflurane - Which inhaled anesthetics (3) decrease heart rate
-
Sevoflurane
Halothane
Enflurane - Halothane is not hepatotoxic in what patient population
- Pediatric patients
- Which inhaled anesthetic is contraindicated in patients with renal failure
- Enflurane
- Which inhaled anesthetic significantly sensitizes the heart to catecholamine
- Halothane
- Which inhaled anesthetic does not sensitize the heart to catecholamines
- Isoflurane
- An iatrogenic pneumothorax has been associated with which inhaled anesthetic
- Nitrous oxide (low blood/gas partition coefficient, therefore, accumulates rapidly and increases volume and pressure in closed compartments)
- Which inhaled anesthetic is the least hepatotoxic
- Nitrous oxide
- Are the inhaled halogenated hydrocarbon anesthetics volatile or nonvolatile gases
- Volatile gases
- Which inhaled anesthetic must be used with other anesthetics for surgical anesthesia
- Nitrous oxide (potent analgesic properties with weak anesthetic properties)
- Which inhaled anesthetic decreases renal and hepatic blood flow
- Halothane
- Which inhaled anesthetic relaxes bronchial smooth muscle
- Halothane
- Give examples of IV anesthetics
-
Thiopental
Etomidate
Midazolam
Propofol
Fentanyl
Ketamine
*TEMPerature in Farenheit or Kelvins - What IV anesthetic is a barbiturate
- Thiopental
- What IV anesthetic is a benzodiazepine
- Midazolam
- What IV anesthetic is an opioid
- Fentanyl
- Is thiopental used for induction, maintenance, or both
- Induction
- Pharmacodynamically, how does recovery occur with the rapid-acting barbiturates
- Rapid redistribution from the CNS to peripheral tissues
- Does thiopental increase, decrease, or not change cerebral blood flow
- No change
- Does thiopental increase, decrease, or not change respiratory function
- Decreases
- Does thiopental increase, decrease, or not change blood pressure
- Decreases
- Why should caution be taken when administering thiopental to asthmatic patients
- May cause laryngospasm
- Barbiturates are contraindicated in patients with which disease
- Acute intermittent porphyria (barbiturates increase heme synthesis)
- Midazolam offers which type of amnesia making it useful for conscious sedation
- Anterograde amnesia
- What is the antidote for midazolam-induced respiratory depression
- Flumazenil
- Fentanyl combined with which medication causes neuroleptic analgesia
- Droperidol
- Fentanyl combined with which two medications causes neuroleptic anesthesia
- Droperidol + NO
- What adverse drug reaction may be caused by fentanyl when given intravenously
- Chest wall rigidity
- Does propofol have good analgesic properties
- No
- What color is propofol and why
- White; contains lipids (must consider when calculating lipid concentrations in total parenteral nutrition)
- Does propofol increase or decrease blood pressure
- Decrease
- Does propofol increase or decrease intracranial pressure
- Decrease
- Is propofol used for induction, maintenance, or both
- Both
- Which IV anesthetic causes dissociative anesthesia
- Ketamine
- What is dissociative anesthesia
- Patient is unconscious and feels no pain yet appears awake (patient is sedated, immobile, and amnestic)
- Which anesthetic has antiemetic properties
- Propofol
- Which IV anesthetic is a cardiovascular stimulant (increases blood pressure and cardiac output)
- Ketamine
- Which IV anesthetic causes vivid dreams and hallucinations
- Ketamine
- Does ketamine increase or decrease cerebral blood flow
- Increase
- Which IV anesthetic is an ultra-short-acting benzylimidazole used for induction of anesthesia and has minimal cardiovascular effects
- Etomidate
- Are local anesthetics weak acids or weak bases
- Weak bases
- Give examples of local amide anesthetics
-
Prilocaine
Lidocaine
Articaine
Mepivacaine
Bupivacaine
All have >1 “i†in their name - Give examples of ester local anesthetics
-
Procaine
Benzocaine
Cocaine
All have 1 “i†in their name - Which medication, when used in combination, reduces systemic toxicity and increases the duration of action of local anesthetics
- Epinephrine
- Epinephrine should not be combined with local anesthetics when injecting near which anatomic sites
-
Nose
Ears
Digits
Penis - Which type of enzymes metabolize amide local anesthetics and where are they located
- Amidases located in the liver
- Which type of enzymes metabolize ester local anesthetics and where are they located
- Esterases located in tissues and blood
- What is the mechanism of action of local anesthetics
- Inhibition of sodium channels in axonal membranes via binding to the channels in their inactivated state and preventing a structural change to the resting state
- Do local anesthetics need to be in the ionized or nonionized form to bind to the sodium channel
- Ionized form
- Do local anesthetics need to be in the ionized or nonionized form to gain access to the sodium channel, which is located on the inner side of the axonal membrane
- Nonionized form (must be able to cross lipophilic axonal membrane)
- All local anesthetics cause vasodilation with the exception of which drug
- Cocaine (causes vasoconstriction)
- Nerve fibers most sensitive to blockade are of smaller or larger diameter
- Smaller diameter
- Nerve fibers most sensitive to blockade have low or high firing rates
- High firing rates
- Which nerve fibers are most sensitive to local anesthetics
- Type B and C fibers
- Which nerve fibers are least sensitive to local anesthetics
- Type A α fibers
- What are the adverse effects of local anesthetics
-
Hypotension (except cocaine)
Nystagmus
Seizures
Dizziness
Allergic reactions - Allergic reactions are most associated with ester or amide local anesthetics
- Esters (via para-aminobenzoic acid [PABA] formation)