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Neuro DRx > 04c: Anesthetics > Flashcards

04c: Anesthetics Flashcards

1
Q

The unimportance of the anesthetic’s (X) suggests that there (are/aren’t) distinctive receptors involved.

A

X = molecular shape (lack of chemical specificity);

Aren’t

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2
Q

Generally, the longer the (X)

chain of the anesthetic, the higher the lipid solubility and the (lower/higher) the anesthetic potency.

A

X = hydrocarbon

Higher

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3
Q

Which key observation argues against the lipid theory of anesthetic effect?

A

Beyond a certain point of hydrocarbon chain length, potency suddenly drops even though lipid solubility continues to increase

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4
Q

Protein theory of anesthesia: Increasing evidence suggests that anesthetics exert their
effects by binding to the protein phase of membranes and acting as (X) (agonists/antagonists).

A

X = GABA(A)

Agonists

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5
Q

The (X) locations in the nervous system may be the most important sites of anesthetic action

A

X = reticular formation and the

hippocampus

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6
Q

T/F: with anesthesia, transmission along

peripheral nerves is not significantly affected.

A

True

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7
Q

List the stages of anesthesia.

A
  1. Analgesia
  2. Excitement
  3. Surgical anesthesia
  4. Medullary paralysis
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8
Q

In (X) stage of anesthesia, patient loses consciousness and responds only to (Y).

A 
X = II (excitement stage)
Y = painful stimuli (reflex)
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9
Q

In (X) stage of anesthesia, spontaneous movement ceases. Respiration becomes regular/shallow.

A

X = III (surgical anesthesia)

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10
Q

In (X) stage of anesthesia, respiration ceases, along with (Y).

A

X = IV (medullary paralysis)
Y = vasomotor control
(CV collapse, death in minutes!)

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11
Q

T/F: Inhalation anesthetics both enter and leave the body via the lungs.

A

True

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12
Q

Metabolic degradation of anesthetics may be important in determining their (duration of action/toxicity).

A

Toxicity

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13
Q 
The more soluble the anesthetic agent is in blood, the (shorter/longer) it takes
for its (X) to increase in blood and the (shorter/longer) it takes for the concentration to increase in brain.
A

Longer;
X = partial pressure
Longer

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14
Q

High Blood:gas partition coefficient means (low/high) (X) solubility. Thus, (shorter/longer) time to reach a given degree of anesthetic effect, and (shorter/longer) the recovery time.

A

High;
X = blood
Longer; longer

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15
Q

Rise in pulmonary ventilation has greatest effect on anesthetics with (X) characteristic.

A

X = high blood:gas solubility coefficient

due to greater pulmonary blood flow

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16
Q

Equilibration of the anesthetic from blood to tissue occurs most rapidly with vessel (rich/poor) group of tissues, such as:

A

Rich;

brain, heart, liver, kidney

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17
Q

The MAC (minimum alveolar concentration) is a key concept in anesthesia. What does it represent?

A

Amount (% atm P) of anesthetic that prevents movement in 50% of subjects in response to a standard surgical incision

A measure of potency

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18
Q

In the operating room, anesthetic concentrations of (X) MAC are frequently used. This is because drugs such as (Y) decrease the anesthetic requirements.

A 
X = 1 or less
Y = morphine, thiopental, diazepam
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19
Q

(Hypo/hyper)-natremia, (hypo/hyper)-thermia, and (hypoxia/hypocapnia) decrease MAC/anesthetic requirements.

A

Hypo; hypo; hypoxia

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20
Q

Cocaine, amphetamines and (acute/chronic) EtOH use (increase/decrease) MAC.

A

chronic; increase

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21
Q

MAO inhibitors (increase/decrease) MAC

A

Increase

22
Q

Perhaps the most widely used inhaled anesthetic agent in the U.S.A today

A

Isoflurane

23
Q

T/F: Therapeutic index is relatively wide for inhaled anesthetics.

A

False - very narrow (dangerous drugs)

24
Q

Resp effects of anesthetics:

A
  1. Resp depression; fast, shallow, regular breathing
  2. Increase oxygen gradient
  3. Inhibit pulmonary hypoxic vasoconstriction
25
Q

Isoflurane is in (X) class of (local/inhaled) anesthetics.

A

X = Halogenated hydrocarbons

Inhaled

26
Q

Nitrous oxide is in (X) class of (local/inhaled) anesthetics.

A

X = inorganic agents

Inhaled

27
Q

Local anesthetics are agents that prevent/relieve (X) sensation by which mechanism?

A

X = pain

Interrupting nerve conduction in peripheral nervous tissue (bind R within the
pore of Na+ channels in nerves and block ion movement through)

28
Q

T/F: When local anesthetics applied to nerve tissue, they cause both sensory and motor paralysis

A

True

29
Q

List the amide-type Local Anesthetics. Star the long-acting one.

A
  1. Lidocaine
  2. Bupivacaine*

*note: amide, lido, bupivac all have letter “i”

30
Q

List the ester-type Local Anesthetics. Star the long-acting one.

A
  1. Procaine

2. Tetracaine*

31
Q

Local anesthetics have hydrophilic property conferred by (X) part of structure and lipophilic property conferred by (Y) part of structure.

A 
X = tertiary amino group (pKa 8-9)
Y = aromatic ring
32
Q

(X) is the major difference

between Ester and Amide Local Anesthetics. What are the enzymes that work on each class?

A

X = biotransformation

Amides: CYP450
Ester: Pseudocholinesterase (plasma and tissues)

33
Q

Which mechanism contributes to the toxicity of local anesthetics?

A

nonselective block of the Na+

channel (as well as other voltage-gated and ligand-gated ion channels)

34
Q

Local anesthetics are (strong/weak) (acids/bases) with pKa range of (X). They’re formulated as (Y) for increased (aqueous/lipid) solubility/stability.

A

Weak bases;
X = 7.5-9
Y = salts
aqueous

35
Q

Local anesthetics are predominantly in the (charged/uncharged), form at physiologic pH. Which form crosses the membrane? Which form binds the active site on Na channel?

A

Charged (cationic form)

Uncharged form crosses, charged form in cytoplasm binds active site

36
Q

T/F: Increased lipophilicity of local anesthetics increases distribution into nerve fiber and increases potency.

A

True

37
Q

T/F: Increased lipophilicity of local anesthetics increases duration of action.

A

True

38
Q

High pKa of local anesthetics (increases/decreases) (X).

A

decreases

X = onset time (slower distribution into nerve fiber)

39
Q

Inflammation, causing (rise/drop) in pH, has which effect on local anesthetics?

A

Drop (so more H ions and protonated drug);

decreases onset time

40
Q

T/F: Different types of neurons
have different sensitivities
to Local Anesthetics agents

A

True - based on size and myelination

41
Q

What’s the order of nerve blockade by local anesthetics from greatest to least blockade (based on myelination and size of n fiber)?

A
  1. Small, myelinated
  2. Small, unmyelinated
  3. Large, myelinated
  4. Large, unmyelinated
42
Q

List the order of loss of function (sensation, muscle, etc.) conferred by local anesthetics.

A

remember, depends on which fiber type affected most by blockade

  1. Pain
  2. T
  3. Touch
  4. Proprioception
  5. Muscle tone
43
Q

Frequently firing pain fibers have (lower/higher) sensitivity to local anesthetics compared to resting fibers.

A

Higher;

greater access to active site if Na channel is open/inactivated

44
Q

T/F: Local anesthetic blocks circumferential fibers before those in core.

A

True

45
Q

In large mixed nerve bundle in
extremities, block with local anesthetics (sensory analgesia) begins (proximally/distally) and spreads (proximally/distally). Why?

A

Proximally; distally

proximal sensory fibers more
circumferential in bundle; distal more at core

46
Q

Potential CNS adverse effects of local anesthetics.

A

Tremor, Restlessness, Convulsions

47
Q

Potential CV adverse effects of local anesthetics.

A

Decreased automaticity, Myocardial depression, arteriolar relaxation

48
Q

Antidote for local anesthetic toxicity.

A

20% IV lipid emulsion (pulls anesthetics out, like a lipid sink)

49
Q

Hypersensitivity reaction is risk with (amide/ester) local anesthetics and is attributed to (X) metabolite.

A

Ester

X = PABA (para-aminobenzoic acid metabolite)

50
Q

Effects of Vasoconstrictor use with local anesthetics.

A
  1. Increases duration of effect (increase neuronal uptake, decrease absorption in blood)
  2. Decreases risk of local side effects in brain and CV
51
Q

Local anesthetics: spinal block (in CSF/subarachnoid space) can cause (increase/decrease) BP because..

A

Decrease;

block of the preganglionic sympathetic fibers, causing
vasodilation

52
Q

Epidural nerve block differs from spinal nerve block in that:

A

Injection into epidural space outside dura (as opposed to subarachnoid space in spinal block)

Neuro DRx (10 decks)

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