8. General and Local Anesthetic Drugs

Question 1

All of the following are what kind of general anesthetics?
Desflurane
Enflurane
Halothane
Isoflurane
Nitrous Oxide
Sevoflurane

Answer 1

Inhaled Anesthetics

Question 2

All of the following are what kind of general anesthetics?
Diazepam
Etomidate
Fentanyl
Ketamine
Midazolam
Propofol

Answer 2

Intravenous Anesthetics

Question 3

All of the following are what kind of general anesthetics?
Benzocaine
Bupivacaine
Cocaine
Dibucaine
Lidocaine
Procaine

Answer 3

Local Anesthetics

Question 4

general anesthetics are a class of drugs that produce a behavioral state referred to as general anesthesia = anesthetic state is a collection of component changes or perception that include unconsciousness, amnesia, analgesia, attenuation of autonomic reflexes to noxious stimulation, and what in response to noxious stimulation?

Answer 4

Immobility- SKM relaxation

NONE can acheive all 5 so usually combo inhaled and IV

Question 5

MOA of anesthetics is primarily at the synapse- presynaptic release of NT and postsynaptic frequency/amplitude of impulses exiting the synapse, inhibitory ion channels- chloride channels (GABA A/glycine) and potassium channels, and excitatory ion channels including achRs, AMPA/NMDA, and what?

Answer 5

Serotonin receptors

Question 6

Volatile and gaseous anesthetics are admin by inhalation, all but nitrous oxide (gas at room temp) are liquids at room temperature so they need a device to vaporize it, uptake via gas exchange in alveoli and distribution are key to determining PK and how quickly CNS concentration changes, driving force for uptake is alveolar concentration which is driven by inspired air concentration and?

Answer 6

alveolar ventilation

Question 7

The blood:gas parition coefficient (blood solubility) defines the relative affinity of an anesthetic for the blood compared to that of inspired gas, there is an inverse relationship between blood:gas coefficient and rate of anesthesia onset, such that agents with what, reach a high arterial pressure RAPIDLY which in turn results in rapid equilibrium with the brain and fast onset of action?

Answer 7

agents with LOW blood solubility - Nitrous oxide, desflurane

Question 8

Agents with HIGH blood solubility like halothane reach HIGH arterial pressure SLOWLY, which in turn results in slow equilibrium with the brain and a slow onset of action. The brain-blood parition coefficient defines the relative affinity of an anesthetic for the brain compared to the blood- relatively similar for all inhaled anesthetics, - more soluble in the brain. Which drug has the lowest blood:gas coefficient and brain blood coefficient, a minimal alveolar concentration of over 100% and causes incomplete anesthesia with rapid onset and recovery?

Answer 8

Nitrous Oxide

Question 9

Which drug has the highest blood gas and brain blood coefficient and has a medium rate of onset and recovery due to high blood solubility?

Answer 9

Halothane

Question 10

Minimal alveolar concentration MAC is the measurement of anesthetic potency, concentration of inhalation anesthetics that prevents movement in response to surgical stimulation of 50% of subjects= effective dose ED50 meaning 50% were alseep and 50% were not, described as a volume percent which is percentage of the atmosphere that is?

Answer 10

anesthetic at the MAC

Question 11

MACs greater than 100% indicates that if 100% of inspired air is the anesthetic, less than 50% of subjects would be anesthetized and othe agents must be supplemented to achieive full surgical anesthesia- assoc with nitrous oxide (cant ever use alone), so what should be done with NO?

Answer 11

Combo 40% NO with 70% volatile agents to yeild 110% which is sufficient for most patients

Question 12

Common side effects of inhaled anesthetics is nausea and vomiting, agents metabolized to products including fluoride ions may cause renal toxicity (and inhalled with a -flu), what drug may cause hepatitis-sx developing 2 days to 3 weeks after exposure with nausea, myalgias, rash, eosinophilia, jaundice and elevated liver enzymes?

Answer 12

Halothane (hepatitis)

Question 13

in combo with succinylcholine, inhaled anesthetics may cause malignant hyperthermia, which is rapid onset of tachycardia, hypertension, severe muscle rigidity, rhabdomyolysis, hyperthermia, hyperkalemia, and acid base imbalance with acidosis- treat with dantrolene or what alternative drug?

Answer 13

Rocuronium

Question 14

Nonopioid IV anesthetics are used to facilitate rapid induction of anesthesia and have replace inhalation as preferred method of anesthesia induction, doesnt produce all 5 desired changes in behavior/perception so need inhaled/opioids/sedative hypnotics and NMJ blockers, IV anesthetics are what and preferntially partition into highly perfused lipophilic tissues such as brain spinal cord with quick onset of action?

Answer 14

HIGHLY lipophilic

Question 15

Which IV anesthetic has rapid onset and moderately fast recovery and provides CV stability, causes decreased steroidogenesis and involvuntary muscle movements?

Answer 15

Etomidate

Question 16

Which IV anesthetic has moderately rapid onset and recovery with CV stimulation, increased cerebral blood flow and emergence reactions that impair recovery?

Answer 16

Ketamine

Question 17

Which IV anesthetic has slow* onset and recover (flumazenil reversal), used in balanced anesthesia and conscious sedation and provides CV *stability, and marked amnesia?

Answer 17

Midazolam

Question 18

Which IV anesthetic has RAPID onset and recovery and used in induction and for maintenance and can cause hypotension and is useful as an antiemetic?

Answer 18

Propofol

Question 19

Which IV anesthetic has slow onset and recovery, with naloxone as reversal, is an opioid used in balanced anesthesia and conscious sedation that produces marked analgesia?

Answer 19

Fentanyl

Question 20

Propofol averages 30s for onset of action, 3-10 min duration of action, rapid rate of onset and recovery and patients are able to ambulate quick after, allows for continuous infusions and maintenacne, MOA- likely targets GABAA as agonist, what half life does it have that describes the elimination after a continouous infusion as a function of the duration of infusion- may be up to 1-3 days after 10 day infusion which diazepam and thiopental increase dramatically?

Answer 20

Context Sensitive Half life

Question 21

Propofol is highly insoluble, made from soybean oil, glycerol and lecithin, may cause hypotension, respiratory depressant, and what at the injection site?

Answer 21

Pain

Question 22

What drug enhances the actions of GABA on GABAA receptors, produces rapid loss of consciousness with less rapid recovery rate compared to propofol, minimal CV and respiratory depression, useful in pt with impaired CV and respiratory systems***, SE: endocrine- adrenocortical suppression by inhibition of 11b hydroxylase (choles to cortisol), 4-8 hour suppression after induction limits usefullness for continuous infusion, EXTENSIVE liver and plasma biotransformation?

Answer 22

Etomidate

Question 23

What drug is an NMDA receptor antagonist similar to PCP- produces dissociated anesthetic state with catatonia, amnesia, analgesia, with or without loss of consciousness, ++Nystagmic gaze, unpleasant emergence reactions post admin such as dreams hallucinations, visuals, stimulates sympathtic NS, only IV anestetic to produce analgesia?

Answer 23

Ketamine

Question 24

Anesthesia adjuncts are used to augment specific components of anesthesia, permitting lower doses of general anesthesia with fewer side effects. Opioids with large doses of benzos have been used to acheive anesthetic state, common agent inlcuding is what, which has MOA of agonist at opiate receptor, causing resp depression and often used a premedication and adjunct to provide preop analgesia?

Answer 24

Fentanyl

Question 25

Anesthesia adjuncts are used to augment specific components of anesthesia, permitting lower doses of general anesthesia with fewer side effects. barbs have no effects on pain, benzos such as what, increases GABAA receptor sensitivity to GABA, used preop for anxiety and ability to produce anterograde amnesia, terminated by flumazenil?

Answer 25

Diazepam

Question 26

Local anesthetics have the same MOA- block voltage gated sodium channel currents and stop the spread of action potentials across nerve axons, if there are two ‘i’s’ in the name then the drug falls under what chemical class?

Answer 26

AMIDE**

lidocaine, mepivacaine, bupivacaine, ropivacaine, articaine

Question 27

Any local anesthetics without 2 ‘i’s’ is an ester, such as tetracaine which is 16:1 potent, and long duration, bupivacaine and ropivacaine are also very potent and last a long time, what is the only local anesthetic used as a topical**?

Answer 27

Benzocaine

Question 28

Local anesthetics are used as topicals, injections, IV regional anesthesia aka bier block, coadmin with vasoconstrictors* (epinephrine) decreases the rate of anesthetic absorption into the circulation, epinephrine containing solutions should not be injected into tissues supplied by?

Answer 28

end arteries

Question 29

SE: toxicity following systemic absorption and direct neurotoxicity, CNS: low conc = sleepy, light headed, visual distrubances, high conc= nystagmus, muscular twitching, convulsions, they block cardiac sodium channels and dec electrical excitability conduction rate and force of contraction causing arteriorlar dilation, leading to hypotension, except which one?

Answer 29

Cocaine

vasoconstrictor

Question 30

Allergic reactions to ester type local anesthetics are MC due to metabolism to allergy causing compounds such as hives rahs and itching with problems breathing, so what drugs have a high probability of causing problems?

Answer 30

ESTERS= ONE ‘i’ -caines

Question 31

What Local anesthetic has poor solubility in water, used only as topical agent, for dermatologic conditions, hemorrhoids, premature ejaculation, and anesthetic lubricant?

Answer 31

Benzocaine

Question 32

What Local anesthetic has a long duration of action capable of producing prolonged anesthesia, has a tendency to provide more sensory than motor block?

Answer 32

Bupivacaine

Question 33

What Local anesthetic are clinically used to block nerve impulses and local vasoconstriction actions secondary to its ability to inhibit local norepinephrine reuptake, euphoric props are due to inhibition of catecholamine reuptake (dopamine)- topical anesthetic of the upper respiratory tract?

Answer 33

Cocaine

Question 34

What Local anesthetic due to its toxicity with injections is now used only as a topic cream for use on the skin?

Answer 34

Dibucaine

Question 35

What Local anesthetic is a prototypical amide local anesthetic, alternative choice for individuals sensitive to ester type local anesthetics, produces faster, more intense longer lasting and more extensive anesthesia than an equal dose of procaine- used an antiarrhythmic agent?

Answer 35

Lidocaine

Question 36

What Local anesthetic has a lower potency, slower onset, and shorter duration of action, only used for infiltration anesthesia (local anesthesia produced via injection of solution directly into area of terminal nerve endings), metabolized to a paraaminobenzoic acid which inhibits action of sulfonamide antibiotics***?

Answer 36

procaine