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pharm exam 3 > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Triad of anesthesia

A

amnesia, algesia, muscle relaxant

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2
Q

what are some main conditions to consider prior undergoing anesthesia

A

cardiovascular problems and respiratory disease

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3
Q

what effect will anesthesia have besides numbing to the site?

A

decreased respiration and blood pressure

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4
Q

General anesthesia MOA

A

increase GABA-A–>CNS depression
activate K+ channels for hyperpolarization

Inhibit Glutamate NMDA receptors–>decrease excitatory NT

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5
Q

which inhalable anesthetic can be used for mask induction?

A

Sevoflurane

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6
Q

Blood:Gas partition coefficient determines what? what is the relation to the drug and onset?

A

solubility in blood

the lower coefficient–>the less soluble–> faster onset and recovery

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7
Q

what can increase potency of an anesthetic?

A

Age(elderly), **exposure to other CNS depressant, increase PaCO2, severe anemia/hypoxemia

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8
Q

What is the limitation of nitrous oxide

A

LOW potency; incomplete anesthetic; has insufficient potency for surgical anesthesia

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9
Q

what is the 2nd gas effect from nitrous oxide?

A

↓induction time for primary agent
↓Required concentration of primary agent
↓toxicity of primary agent

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10
Q

what are some disadvantages of N2O

A

lack potency
cannot be used as sole agent
lack skeletal muscle relaxation
potential airpockets in closed space to expand

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11
Q

which halogenated agents has very rapid onset and recovery, and excellent minute-to minute control?

A

Desflurane, sevoflurane

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12
Q

what are the general adverse effects for halogen agents?

A
  1. Depression of cardiovascular function
  2. Depression of respiration and response to CO2
  3. Decreased blood flow to liver and kidneys
  4. Organ toxicity—varies by agent
  5. Malignant Hyperthermia
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13
Q

which halogen drug is safest to use for people with impaired liver and kidney functions due to lower toxicity

A

Isoflurane

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14
Q

Which anesthetic agent is frequently used as IV drip anesthetic?

A

propofol

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15
Q

Dissociative Anesthesia

A

intense analgesia, catalepsy and amnesia: patient is immobilized, appears awake but no awareness or recollection after recovery

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16
Q

What anesthetic has dissociative anesthesia?

A

Ketamine

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17
Q

“Emergence phenomenon”

A

Emergence process is unpleasant: dreams, hallucination, disorientation

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18
Q

what drug causes emergence phenomenon

A

ketamine

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19
Q

Which drug can be used to substitute for thiopental/propofol in high risk patients?

A

Midazolam

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20
Q

Analgesic adjuvant drugs

A

morphine/fentanyl/sufentanyl/opioids

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21
Q

Antiemetic adjuvant drugs

A

Scopolamine

22
Q

Anticholinergic

A

Scopolamine, glycopyrrolate

23
Q

Ideal anesthetic agent includes

A 
amnesia
algesia
muscle relaxant
unconsciousness
Areflexia-eliminiate noxious reflexes
-good min to min control
smooth and rapid induction/recovery
-Wide margin of safety and few adverse effects
24
Q

what anxiolytic/hypnotic drugs are used as adjuvant drugs?

A

Midzolam and diazepam, thiopental

25
Q

what are the 4 stages of anesthesia? which stages would you want to get out as soon as you can?

A
  1. analgesia
  2. excitement
  3. surgical anesthesia
  4. Medullary suppression

2 and 4. least time in

26
Q

which agent is the “milk of amnesia”

A

propofol

27
Q

Perineural infiltration

A

injection of agent at one or more site around specific area where anesthesia is desired

disadvantage: large amt of drug in one area could lead to systemic toxicity

28
Q

what are the advantages/disadvantages of spinal block

A

advantage: affects large body area w/ small amt of drug. patient can be conscious with min disruption of respiratory and cardiovascular function
disadvantage: could reach brain via CSF

29
Q

epidural block and its advantages

A

injection into EXTRADURAL space to block nerve roots. can stilll target larget part of body w/ small amt of drug and avoids CSF, so will not get to brain

30
Q

when you have high Cm, what type of fiber, pH and potency will you have

A

larger fiber, decrease in pH, and decrease in potency

31
Q

which fibers will be blocked first? last?

A

B fibers: preganglionic, small and myelinated

A-alpha(motor, proprioception)–last

32
Q

what type of nerve fiber is most sensitive and would be blocked first

A

nociceptive (sensory) nerves, preganglionic, myelinated

33
Q

what is the effect on increasing calcium concentration?

A

increase Cm, decrease potency

34
Q

what do you NEVER do with an LA?

A

inject LA w/ vasoconstrictor into areas with end arterioles (digi,toes, nose, penis)

35
Q

which LA is more prone for systemic toxicity

A

Amides

36
Q

which LA is more prone for causing allergic rxn?

A

ester

37
Q

which anesthetic drug can be given orally or injection

A

Lidocaine

38
Q

which Local anesthetic drug has high incidence of Transient neurologic symptoms w/ spinal administration?

A

lidocaine

39
Q

which drug is frequently used for epidural infusion/ labor analgesia/post op pain

A

bupivacaine

40
Q

which LA increases risk of cardiotoxicity

A

bupivacaine

41
Q

which drug should be used that has less cardiotoxicity effect and less potent

A

levobupivicaine

42
Q

Which is the primary use for dental anesthetic

A

Articaine

43
Q

what is PABA prone for

A

allergic rxn

44
Q

what do you always have to do prior to giving a patient ester LA

A

check if patient have rxn towards PABA

45
Q

which ester LA is ONLY topical use?

A

Benzocaine

46
Q

which ester agent is used for labor anesthesia?

A

chloroprocaine

47
Q

EULA, use? and what is it composed of

A

mixture of lidocaine and prilocaine in oil-water emulsion.

topical anesthetic on intact skin

48
Q

what is a topical used for pediatrics in ER

A

tetracaine, Adrenalin, and cocaine

49
Q

what are the neurolytic agents, and what is its use?

A

ethyl alcohol and phenol;

permanent block in terminal cancer or other chronic condition

50
Q

primary goal of preanesthetic medication

A
  • Reduction in requirement for inhalation agents
  • increase rate of induction
  • decrease anxiety
  • reduction in acidity and volume of gastric contents
  • relief of preo/postop pain
  • reduction in side effects associated w/ inhalational agents

pharm exam 3 (9 decks)

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