24 Pharmacology: Local and General Anesthetics

Question 1

General Anesthesia

• What are the 4 steps in using this?
  
  • Which step is unwanted?

Answer 1

Question 2

IV General Anesthetics

• What are the indications for this?
• Why are they used with inhaled anesthetics?

Answer 2

Question 3

Amide-Linked Local Anesthetics

• How do these drugs come to ester-linked ones in terms of half-life and duration of action?
• How are they solubilized in the liver?
• How are they eliminated?
• What happens when a patient has impaired hepatic blood flow?

Answer 3

Question 4

Adjunct Agents: Benzo’s

• Midazolam
  
  • What is this drug used for?
  • Can it produce surgical anesthesia?
  • What does it do to GABA_A activity?
  • What ADRs does this drug have?
  • How do you reverse the effects of this drug?

Answer 4

Question 5

Keeping doses low

• Why would one use a vasoconstrictor with a local anesthetic?
  
  • What vasoconstrictor is preferred?
• Why would local toxicity occur from using a vasoconstrictor?

Answer 5

Question 6

Adjunct Agents: Opioids

• When are these drugs used?
• What receptors do they act on as an agonist? What does this inhibit?
• What ARS do they have?
• What is their reversal agent?

Answer 6

Question 7

Factors that determine fiber susceptibility: Firing Frequency

• Anesthetic drugs have a higher affinity for a binding site when a channel has a _______ conformation.
• How do rapid firing neurons differ from slow-firing neurons in terms of suseptibliting to blockades?

Answer 7

Question 8

IV General Anesthetics

• What organs do these drugs favor?
• 4 compartment model
  
  • What group is associated with IV General Anesthetics?
  • How is recovery from these drugs mediated?
  • What role does metabolism play for IV General Anesthetics?

Answer 8

Question 9

ADRs Local Anesthetics

• What serum concentrations are associated with CNS adverse side effects of lidocaine?
• What type of motor neurons are directly blocked by local anesthetics?
• What happens to the urinary bladder of patients?

Answer 9

Question 10

Keeping doses low

• What can be administered to lower the pH of a target tissue?
• What effect does this have on the membrane of the target of cells in the target tissue?

Answer 10

Question 11

Local Anesthetics

• What channel must be open in order for local anesthetics to access desired binding sites?

Answer 11

Question 12

IV General Anesthetics

• What are the 4 drug types to remember for this?

Answer 12

Question 13

Local Anesthetics

• List the 3 main indications for Local Anesthetics
• List the 5 general adverse side effects for Local Anesthetics

Answer 13

Question 14

ADRS of local anesthetics

• What can these drugs do the cardiac function in terms of
  
  • chronotropic
  • entropy
• What dysrhythmias can occur?
• What drugs are actually cardioprotective at low doses?
• What drug is very lipophilic and has a high affinity for cardiac tissue?
• How can cardiotoxicity be revered?

Answer 14

Question 15

Factors that determine fiber susceptibility: Diameter

• What kind of neurons rely the most on passive propagation of action potentials?
• What does this mean in terms of “skipping” a blocked node?
• What are the notable fibers that are among the smallest and desired fibers to be blocked in a clinical setting?

Answer 15

Question 16

ADRS of Local Anesthetics

• What can toxic levels of these drugs do to the vasculature?
• What drug is known to cause cardiovascular collapse?
• What drug will actually cause vasoconstriction?

Answer 16

Question 17

Propofol

• Why does propofol have a more rapid recovery than other drugs like barbiturates?
• Does it have cause analgesia?
• What are the 3 know mechanism of this drug?

Answer 17

Question 18

Etomidate

• What is this drug used for?
• Does it have analgesia
• What is the mechanism of action and receptor type it binds to?
• Unique features
  
  • What is notable about the body systems it DOES not affect?
• ADRS
  
  • What are the 4 main ADRs for this drug?

Answer 18

Question 19

Barbituates: Propofol

• Whare is a unique feature of this drug?
• What is the prodrug for it?
  
  • How is it converted into propofol?
• What are the ADRs for this drug?

Answer 19

Question 20

Factors that determine fiber susceptibility

• What are the 4 factors that affect this?
• What fibers are unmyelinated?
• Which have the highest sensitivity to being blocked? Which have the lowest?

Answer 20

Question 21

Barbiturates

• What are the 2 drugs that were used for induction and maintenance, but have been replaced propofol?
  
  • Do they have analgesic effects?
• What receptors do they act on?
• What are the ADRs for these drugs?

Answer 21

Question 22

ADRS of Local Anesthetics

• Why do systemic effects occur?
• What dose can toxic effects occur at?
• What are 3 ways to minimize the ADRs of these drugs?

Answer 22

Question 23

Factors that determine fiber susceptibility: Fiber Position

• What fibers in a nerve bundle are exposed to higher drug concentrations?
• Relative to the spinal cord, the effects of administration of a local anesthetics depends on what?
  
  • Where does an epidural go?
  • Where does a spinal block go?
  • Where does a caudal block go?

Answer 23

Question 24

Ester-Linked Local Anesthetics

• Are these fast or short-acting?
• How fast are they eliminated?
• What are they broken down by?
• How are they excreted?

Answer 24

Question 25

Factors that determine fiber susceptibility: Myelination

• If controlling for diameter, what is notable about myelinated fibers and node blocks?
  
  • What kind of channels are concentrated at the noted of these fibers?
  • What does this mean in terms of the number of channels needed to be blocked in order to achieve full blocking effect?

Answer 25

Question 26

ADRS of Local Anesthetics

• What can happen to the blood of patients who take lidocaine or procaine?
• Why do patients become allergic to procaine or benzocaine?
• What drug is associated to cardiac arrest in pregnant women?

Answer 26

Question 27

Ketamine

• What is this drug used for?
• What is the mechanism of action and receptor it acts on?
• Unique Features
  
  • What are the 4 unique features of this drug?
• ADRS
  
  • What weird ADRs does this drug have?

Answer 27

Question 28

Adjunct Agents: Dexmedetomidine

• What receptor does this drug act on?
  
  • What are the results of this?
• Does it minimally depress the cardiac or respiratory systems?
• What ADRs does it have?

Answer 28