Anesthetics Flashcards
1
Q
This anesthetic causes aplastic anemia in the unborn child
A
Nitric oxide
2
Q
This anesthetic may cause oral clefts in the fetus
A
Benzodiazepines
3
Q
This dopamine receptor antagonist is an adjunct to anesthetic with prokinetic effects (speeds up gastric emptying and increases lower esophageal sphincter tone)
A
Metoclopramide
4
Q
Metoclopramide is an antagonist to this receptor
A
Dopamine receptor
5
Q
Glycopyrrolate is an adjunct to anesthesia with this effect
A
Anticholinergic (prevents bradycardia and secretion of fluids into the respiratory tract)
6
Q
What is the 1st stage of depth of anesthesia?
A
Analgesia
7
Q
What is the 2nd stage of depth of anesthesia?
A
Disinhibition (excitement)
8
Q
What is the 3rd stage of depth of anesthesia?
A
Surgical anesthesia
9
Q
What is the 4th stage of depth of anesthesia?
A
Medullary paralysis
10
Q
During this stage of anesthesia, delirium and amnesia is present, reflexes are enhanced, and nausea and vomiting are possible
A
Stage 2: disinhibition (excitement)
11
Q
This stage of anesthesia is the ideal stage for surgery, where autonomic signs are stable
A
Stage 3: surgical anesthesia
12
Q
This stage of anesthesia is a medical emergency as death can occur from severe depression of the respiratory and vasomotor centers
A
Stage 4: medullary paralysis
13
Q
Induction of anesthesia depends on this
A
How fast the effective dose of the drug reaches the brain
14
Q
Recovery from anesthesia depends on this
A
How fast the drug leaves the brain
15
Q
Termination of anesthetic effect is by this
A
Redistribution of anesthetic from brain
(NOT by renal/hepatic/pulmonary excretion)
16
Q
What effect does general anesthesia have on system arterial BP?
A
Decreases
17
Q
How does general anesthesia decrease systemic arterial BP?
A
Direct myocardial depression
18
Q
This effect of general anesthesia is modulated by chemical stimulation, motion, and even gastric irritation
A
Nausea and vomiting
19
Q
This antiemetic can be given to prevent nausea and vomiting from general anesthesia
A
Ondansetron (Zofran)
20
Q
Ondansetron (Zofran) can be given to prevent this effect of general anesthesia
A
Nausea and vomiting
(is an antiemetic)
21
Q
MOA of general anesthesia is not understood, but may be related to these 2 actions
A
Membrane disruption
GABA-receptor enhancement
22
Q
Inhaled general anesthetics are used for what step in anesthesia?
A
Maintenance (given after administration of an IV agent)
23
Q
This is the difference between the dose margins that cause no effect, surgical anesthesia, and severe cardiac or respiratory depression
A
Therapeutic index
24
Q
Is the therapeutic index for inhaled general anesthetics large or small?
A
Small (narrow: 2-4)
25
Isoflurane, sevoflurane, N2O, desflurane are this type of anesthetic
Inhaled general anesthetics
26
This is the alveolar concentration (in percent) needed to prevent movement in 50% of experimental subjects with a standardized skin incision
It is an ED50 value but with standardized measures
Minimum alveolar concentration (MAC)
27
The higher the lipid solubility of an inhaled general anesthetic, the lower or higher the potency?
Higher
(lower MAC)
28
Which inhaled general anesthetic is the most soluble (and thus most potent)?
Isoflurane
29
Which inhaled general anesthetic is the least soluble (and thus least potent)?
Desflurane
30
This inhaled general anesthetic has a MAC value of 105%, and is not used for surgical anesthesia
Nitrous oxide
31
What correlation is there between cardiac output and induction time for inhaled anesthetics?
Inverse correlation
32
With this inhaled general anesthetic, concentration in the blood is so high that when anesthesia is ended, it rushes out of the blood into the lungs displacing O2, leading to diffusion hypoxia
Nitrous oxide
33
This inhaled general anesthetic can cause diffusion hypoxia
Nitrous oxide
34
How can diffusion hypoxia be prevented with use of nitrous oxide for anesthesia?
100% O2 used at the end of N2O anesthesia
35
Malignant hyperthermia is related to increased myoplasmic levels of this ion
Calcium
36
Malignant hyperthermia can be treated with withdrawal of the drug and cooling the patient, in addition to treatment with this drug
Dantrolene
37
Dantrolene can be used to treat this adverse effect of anesthesia that is most common with inhaled anesthetic or succinylcholine
Malignant hyperthermia
38
This adverse effect of anesthesia is related to increased myoplasmic calcium levels and increased excitation-contraction coupling
Malignant hyperthermia
39
What effect do general anesthetics have on the sensitivity of GABA receptors for its ligand?
Increase
40
What effect do general anesthetics have on the activity of inhibitory glycine receptors in the spinal motor neuron?
Increase
41
What effect do general anesthetics have on excitatory postsynaptic nicotinic currents?
Block
42
Is Isoflurane toxic to the liver and kidney?
No
(undergoes little metabolism)
43
Does Isoflurane induce cardiac arrhythmias?
No
44
This inhaled general anesthetic can produce dose-dependent hypotension due to peripheral vasodilation
Isoflurane
45
Dose-dependent hypotension as a result of Isoflurane use can be treated with phenylephrine, which has this effect
Vasoconstriction
46
With this inhaled general anesthetic, a pungent odor stimulates respiratory reflexes and is therefore not used for induction
Isoflurane
47
Is Isoflurane used for induction?
No -- due to pungent odor stimulating respiratory reflexes
48
This drug provides very rapid onset and recovery due to its lowest blood solubility of all the volatile anesthetics
Desflurane
49
This drug is a popular anesthetic for outpatient surgery
Desflurane
50
Is there toxicity with use of Desflurane?
Rare; degradation is minimal
51
High cost of this inhaled general anesthetic limits its use
Desflurane
52
This inhaled general anesthetic irritates the airway
(causing laryngospasm, coughing, excessive secretions)
Desflurane
53
This inhaled general anesthetic has low pungency, low respiratory irritation, and low solubility
Sevoflurane
54
Does Desflurane irritate the airway?
yes
55
Does Sevoflurane irritate the airway?
No; low
56
This inhaled general anesthetic allows rapid induction without irritating the airway, making it suitable for inhalation induction in pediatric patients
Sevoflurane
57
Is Sevoflurane toxic to the liver?
Low
58
Is Sevoflurane toxic to the kidney?
Yes - is nephrotoxic
59
This inhaled general anesthetic has low hepatotoxicity but is nephrotoxic
Sevoflurane
60
Is Nitrous Oxide irritating to the airways?
No
61
This inhaled general anesthetic is a nonirritating and potent analgesic but a weak general anesthetic
Nitrous oxide
62
MOA of nitrous oxide in anesthesia is unclear, but may involve activity on these 2 types of receptors
GABA-A and NMDA
63
This is the least hepatotoxic of all inhaled anesthetics
Nitrous oxide
64
Is Nitrous oxide hepatotoxic?
No - is the least hepatotoxic of all inhaled anesthetics
65
These 2 inhaled anesthetics have transient stimulation of respiratory depression
Isoflurane
Desflurane
66
This inhaled anesthetic with some dry adsorbents in scavenger system forms carbon monoxide causing carboxyhemoglobinemia
Desflurane
67
Desflurane with some dry adsorbents in scavenger system forms carbon monoxide causing this
Carboxyhemoglobinemia
68
IV anesthetics are primarily used as adjuncts to these
Inhalation general anesthetics
69
Are IV anesthetics rapid or slow acting?
Rapid in effect
(produce analgesia)
70
IV anesthetics produce analgesia, but in lower doses they may be used to produce this
Sedation
71
Recovery from anesthesia ends by this
Redistribution (of drug from brain to muscle/fat)
72
These are allosteric GABA enhancers that act mainly by enhancement of GABA-mediated hyperpolarization
Barbiturates
73
What is the duration of Methohexital sodium, Thiopental sodium, and Thiamylal sodium?
Ultra-short (minutes)
74
Methohexital sodium, Thiopental sodium, and Thiamylal sodium are this type of drug
Barbiturates
(ultra-short duration)
75
Methohexital sodium is this type of drug
Barbiturate
(ultra-short duration)
76
Thiopental sodium is this type of drug
Barbiturate
(ultra-short duration)
77
Thiamylal sodium is this type of drug
Barbiturate
(ultra-short duration)
78
What is the duration of action of Pentobarbital?
Intermediate duration (hour)
79
Pentobarbital is this type of drug
Barbiturate
(intermediate duration)
80
Phenobarbital is this type of drug
Barbiturate
(long duration)
81
What is the duration of action of phenobarbital?
Long duration (hours)
82
Do Barbiturates produce analgesia?
No
83
Do Barbiturates produce muscle relaxation?
No
84
With Barbiturates, is respiratory and CVS depression lesser or greater than CNS depression?
Greater
(major problem in elderly or infants)
85
What effect do Barbiturates have on intracranial pressure?
Reduce
86
Porphyria is an absolute contraindication of this IV anesthetic
Barbiturates
87
Hypersensitivity reactions are a major concern for this IV anesthetic
Barbiruates
88
This Barbiturate has minor effects on the CVS but may contribute to severe hypotension in patients with hypovolemia (all barbiturates)
Thiopental
89
Thiopental is this type of drug
Barbiturate
(ultra-short duration)
90
Thiopental is a Barbiturate with minor effects on the CVS, but may contribute to this
severe hypotension in patients with hypovolemia
91
Thiopental is a Barbiturate with minor effects on the CVS, but may contribute to this in patients with hypovolemia
Hypotension
92
Thiopental is a Barbiturate with minor effects on the CVS, but may contribute to severe hypotension in patients with this
Hypovolemia
93
These are used in conjunction with anesthetics for sedation, facilitate amnesia while causing sedation
Benzodiazepines
94
Midazolam is this type of drug
Benzodiazepine
95
Estazolam is this type of drug
Benzodiazepine
96
Triazolam is this type of drug
Benzodiazepine
97
Lorazepam is this type of drug
Benzodiazepine
98
Temazepam is this type of drug
Benzodiazepine
99
Flurazepam is this type of drug
Benzodiazepine
100
Quazepam is this type of drug
Benzodiazepine
101
This IV anesthetic can induce a temporary form of anterograde amnesia
Benzodiazepines
102
Benzodiazepines can induce anterograde or retrograde amnesia?
Anterograde
103
This is a water-soluble benzodiazepine with a half-life of ~1 hour
Powerful amnestic
Midazolam
104
What is the half life of Midazolam (a benzodiazepine)?
~1 hour
105
Is Midazolam (a benzodiazepine) water or lipid soluble?
Water-soluble
106
This is the antidote to benzodiazepines
Flumazenil
107
Flumazenil is the antidote to this type of drug
Benzodiazepines
(displaces from active binding site)
108
This is a dissociative anesthetic
Patient is in a trance-like state, may be aware of surroundings, appear to be awake (eyes may be open)
Patient does not feel pain and is unable to respond
Ketamine
109
Ketamine most likely acts via antagonism of this binding site on NMDA receptor
Glutamate
110
Ketamine most likely acts via antagonism of glutamate binding site on this receptor
NMDA
111
This anesthetic most likely acts via antagonism of glutamate binding site on NMDA receptor
Ketamine
112
What effect does ketamine have on muscle tone?
Increases
113
What effect does ketamine have on reflexes?
Maintains most reflexes
114
What effect does ketamine have on blood pressure?
Increases
(because it stimulates the central sympathetic outflow)
115
What effect does ketamine have on cardiac output?
Increases
(because it stimulates the central sympathetic outflow)
116
This anesthetic is beneficial in patients with hypovolemia or cardiogenic shock (e.g. trauma patients except in head or ocular trauma) and in asthmatics
Not used in hypertensives or stroke patients
Ketamine
117
Is Ketamine used in patients with hypertension?
No
(increases BP)
118
Is Ketamine used in patients with in asthmatics?
yes
119
Is Ketamine used in patients with stroke history?
No
120
Is Ketamine used in patients with cardiogenic shock?
Yes
121
Emergence from this anesthetic is characterized by excitement and hallucinations
Ketamine
122
This drug should always be given during use of Ketamine to reduce side effects such as hallucinations
Benzodiazepines
123
Benzodiazepines should always be given during use of this drug to reduce side effects such as hallucinations
Ketamine
124
Pharmacology and pharmacokinetics of administering this anesthetic by intramuscular route is similar to IV route, so is good for burn patients
Ketamine
125
This anesthetic has other indications including topical for analgesia, refractory status epilepticus, and depression
Ketamine
126
This anesthetic may depress steroid production for 24 hours
Etomidate
127
Etomidate may depress production of this for 24 hours
Steroid
128
Etomidate inhibits this enzyme, and thus may depress steroid production
11-beta-hydroxylase
129
This anesthetic inhibits 11-beta-hydroxylase
Etomidate
130
This drug is widely used in pediatric anesthesia due to low incidence of post-anesthetic nausea and vomiting
Propofol
131
Supplementation with narcotics for analgesia is required (transient pain at injection site common) for this drug
Propofol
132
This anesthetic increases GABA-mediated inhibitory tone in the CNS
Lowers BP without depressing the myocardium
Propofol
133
What effect does Propofol have on BP?
Lowers
134
Does Propofol depress the myocardium?
No
(should still be avoided in patients with cardiac or peripheral vascular disease)
135
What effect does Propofol have on intracranial pressure?
Reduces
(due to systemic vasodilation)
136
Propofol reduces intracranial pressure due to this
Systemic vasodilation
137
Opioids are used in conjunction with anesthetics for this function
Analgesia
138
Fentanyl is this type of drug
Opioid
139
Remifentanil is this type of drug
Opioid
140
Sufentanil is this type of drug
Opioid
141
These aid induction and maintenance of general anesthesia
Respiratory depression lasts longer than analgesia
Opioids
142
Naloxone can antagonist the effects of these
Opioids
143
This drug is a selective central alpha-2 agonist
Dexmedetomidine
144
Dexmedetomidine is a selective agonist of this
Central alpha-2
145
Cisatracurium besylate is this type of drug
Neuromuscular blocker
146
Rocuronium is this type of drug
Neuromuscular blocker
147
Vecuronium is this type of drug
Neuromuscular blocker
148
Neuromuscular blockers block these receptors in the neuromuscular junction, suppressing the muscle tone required for surgery
Acetylcholine nicotinic receptors
149
Neuromuscular blocking effects are reversed by this drug
Bridion
150
Bridion reverses the effects of this
Neuromuscular blocking
(e.g. Cisatracurium besylate, Rocuronium, Vecuronium, Succinylcholine Cl-)
151
Local anesthetics act by interfering with the function of these channels
Sodium
152
This is the primary mechanism of inactivation of local anesthetics
Redistribution
153
Most local anesthetics may be toxic to this at high plasma levels
Especially true for longer duration drugs
Cardiac
(Be alert to signs of vascular administration (perioral tingling, tinnitus))
154
Local anesthetics are vasodilators, except this one
Cocaine
155
Are local anesthetics vasoconstrictors or vasodilators?
Vasodilators
(except cocaine)
Leads to rapid diffusion from site and short duration of action
156
Adding a vasoconstrictor to the local anesthetic has what effect on its duration of action?
Increases
(by decreasing its rate of diffusion and absorption from the site of administration)
157
Vasoconstrictors are not routinely used with local anesthetics in these
Terminal vascular beds
158
Cocaine is this type of local anesthetic
Ester-type agent
159
Benzocaine is this type of local anesthetic
Ester-type agent
160
Procaine is this type of local anesthetic
Ester-type agent
161
Chloroprocaine is this type of local anesthetic
Ester-type agent
162
Tetracaine is this type of local anesthetic
Ester-type agent
163
Lidocaine is this type of local anesthetic
Amide-type agent
164
Mepivacaine is this type of local anesthetic
Amide-type agent
165
Ropivacaine is this type of local anesthetic
Amide-type agent
166
Bupivacaine is this type of local anesthetic
Amide-type agent
167
Ester-type local anesthetics are hydrolyzed by these
Pseudocholinesterases
(results in very short half lives)
168
What type of local anesthetics are considered safer for prengnacy?
Ester-type agents
169
Final product of ester-type local anesthetics biotransformation is this, which may be a hypersensitivity trigger
PABA
170
PABA is the final product of these
Ester-type local anesthetics
171
Is tetracaine short- or long-lasting?
Long
172
Is Ropivacaine short- or long-lasting?
Long
173
Is bupivacaine short- or long-lasting?
Long
174
Amide-type local anesthetics are biotransformed by these
Liver microsomal enzymes
175
Pseudocholinesters hydrolyze this type of local anesthetics
Ester-type agents
176
Liver microsomal agents biotransform this type of local anesthetics
Amide-type
177
Are ester-type or amide-type local anesthetics safer during pregnancy?
Ester-type
178
This amide-type local anesthetic is not recommended for obstetric anesthesia because its actions are greatly prolonged in the fetus
Mepivacaine
179
Local anesthetics stimulate this at high doses
CNS
(Anxiety, feeling restless/excited, depression, tremors, dizziness/drowsiness, blurred vision, ringing in ears)
180
Local anesthetics may cause this, which may produce lethal respiratory depression
Medullary depression from brainstem
181
This toxicity may occur with local anesthetic depression of conduction at systemic levels
Cardiac toxicity
182
Skin irritations and allergic reactions occur especially with this type of local anesthetic
Ester-type agents
183
Circumoral tingling or tinnitus is an adverse effect of this type of anesthetic
Local anesthetic
184
This is a major sign of vascular administration of local anesthetics
Circumoral tingling or tinnitus
