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Pharmacology (Dale Turley) > Anesthetics > Flashcards

Anesthetics Flashcards

1
Q

Lidocaine MOA ?

A

Inhibits Na ion channels, stabilizing neuronal cell membranes and inhibiting nerve impulse initiation and conduction (amide local anesthetic)

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2
Q

Lidocaine BBW ?

A

dose-related toxicity

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3
Q

Lidocaine contraindications ?

A

Infection at injection site

Obstetrical paracervical block

Obstetrical anesthesia (0.75% INJ form)

IV regional anesthesia
Intra-articular continuous infusion

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4
Q

Lidocaine Major Adverse reactions ?

A

CNS toxicity

myocardial depression

seizures

unconsciousness
respiratory arrest

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5
Q

Lidocaine common adverse reactions ?

A

hypotension

nausea/vomiting

paresthesia

pain, non-specific
bradycardia

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6
Q

Lidocaine Indications ?

A

Local

Regional

Spinal

anesthesia

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7
Q

Most lidocaines for SC anesthetics offer with ?

A

epinephrine

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8
Q

The addition of EPI creates ? and is great for ?

A

Creates local vasoconstriction (decreases bleeding)

Great for scalp, face (except nose)

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9
Q

Avoid epinephrine if what is involved ?

A

Fingers

Nose

Penis

Toes

Low blood flow areas

** topical nitro on top of the finger if you accidentally give epi in finger

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10
Q

Inhalational anesthetics inhalation examples ?

A

Sevoflurane

Isoflurane

**sedation, pain control and paralysis ( they meet all the criteria) no other class do all three, only the inhalations do all three

lower the # the more potent it is
**

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11
Q

Sevoflurane MOA ?

A

alters neuronal ion channels such as GABA, glutamate, and glycine receptors, resulting in decreased tissue excitability

**Benzos also hit GABA

glutamate - stimulating NT , paralysis **

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12
Q

Sevoflurane BBW ?

A

NONE

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13
Q

Sevoflurane contraindications ?

A

Malignant hyperthermia hx.

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14
Q

Sevoflurane pregnancy category ?

A

B

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15
Q

Lidocaine pregnancy category ?

A

C

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16
Q

Sevoflurane major adverse reactions ?

A

malignant hyperthermia

apnea

hyperkalemia

arrhythmias

seizures
hepatotoxicity
ICP incr.

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17
Q

Sevoflurane major DRUG reactions ?

A

thioridazine - antipsychotic

dronedarone

cisapride
saquinavir
toremifene

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18
Q

Sevoflurane common adverse reactions ?

A

agitation

cough

hypotension

laryngospasm

breath holding
nausea/vomiting

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19
Q

Sevoflurane indications ?

A

general anesthesia induction

general anesthesia maintenance

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20
Q

Sevoflurane monitoring ?

A

ECG

end-tidal CO2

end-tidal sevoflurane
concentration

oxygen saturation

vital signs continuously

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21
Q

Propofol aka ?

A

Diprivan

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22
Q

Propofol MOA ?

A

induces hypnosis

**meaning sedation, does not help with pain and it does not paralyses folks **

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23
Q

Propofol BBW ?

A

none

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24
Q

Propofol pregnancy category ?

A

B

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25
Q

Propofol Contraindications ?

A

Labor and delivery

avoid abrupt W/D

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26
Q

Propofol major adverse reactions ?

A

Propofol infusion syndrome

Bradycardia

Asystole

Hypotension

Cardiac arrest
seizures

**if they unstable then this is not a good choice

but anxious and about to have shoulder reduction then prob a good choice **

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27
Q

Propofol drug interactions ?

A

Sodium oxybate

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28
Q

Propofol common reactions ?

A

resp. acidosis during weaning

injection site rxn

hypotension

involuntary muscle movements
Hyperlipidemia

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29
Q

Propofol indications ?

A

General anesthesia induction

General anesthesia maintenance

Monitored anesthesia care induction

Monitored anesthesia care maintenance

ICU sedation

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30
Q

Propofol monitoring ?

A

ECG

oxygen saturation

vital signs continuously

Renal function - cause
acidosis

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31
Q

Propofol patient educations ?

A

Propofol can cause severe drowsiness or dizziness, which may last for several hours. You will need someone to drive you home after your surgery or procedure.

Do not drive yourself or do anything that requires you to be awake and alert for at least 24 hours after you have been treated with propofol.

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32
Q

Ketamine aka ?

A

Ketalar

**beneficial for Kids and is good in cases where there is pulmonary issues cause it cause bronchial dilation but it can increase ICP ( so if trauma or brain damage it can make it worse ) **

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33
Q

Ketamine MOA ?

A

Acts on cortex and limbic receptors, producing dissociative analgesia and sedation

**kinda like PCP **

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34
Q

Ketamine BBW ?

A

incidence 12%; psychologic manifestations vary in severity from pleasant dream-like states, to vivid imagery, hallucinations, or emergence delirium; may be assoc. w/ confusion, excitement, and irrational behavior; duration usually a few hours, recurrences up to 24h post-op in few cases; no residual psychological effects;

decr. incidence in <15 yo and >65 yo

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35
Q

Ketamine pregnancy ?

A

B

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36
Q

Ketamine Contraindications ?

A

HTN

Stroke

Head trauma

Intracranial mass or
hemorrhage

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37
Q

Ketamine major adverse reactions ?

A

Respiratory depression

Laryngospasm

ICP increased

IOP increased

Hypertension

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38
Q

Ketamine drug interactions ?

A

Carbinoxamine

Cocaine topical

Doxylamine

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39
Q

Ketamine common rxns ?

A

sialorrhea - profuse saliva

BP elevated

HR elevated

anorexia
nausea/vomiting

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40
Q

Ketamine Indications ?

A

General anesthesia induction

General anesthesia maintenance

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41
Q

Ketamine patient education ?

A

This medicine may impair your thinking or reactions. You will probably not be allowed to drive yourself home after your surgery or medical procedure. Avoid driving or operating machinery for at least 24 hours after you have received ketamine.

May cause hallucinations

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42
Q

Ketamine monitoring ?

A

ECG

vital signs continuously

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43
Q

Ketofol - ketamine plus profolol, with both = less incidence of ?

A

hypoTN or HTN ?

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44
Q

Etomidate aka ?

A

Amidate

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45
Q

Etomidate MC use ?

A

MC used for intubation plus a paralytic ( succinylcholine)

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46
Q

Etomidate MOA ?

A

May have GABA-like effects, depresses brain stem reticular formation activity and produces hypnosis

like a benzo

47
Q

Etomidate BBW ?

48
Q

Etomidate pregnancy ?

49
Q

Etomidate contraindications ?

50
Q

Etomidate major reactions ?

51
Q

Etomidate drug interactions ?

A

Carbinoxamine

Doxylamine

52
Q

Etomidate common reactions ?

A

Myoclonic movements, transient

Tonic movements, transient

Injection site pain

Averting movements
Nausea
Vomiting
Apnea

53
Q

Etomidate indications ?

A

General anesthesia induction

54
Q

Etomidate monitoring ?

A

ECG

vital signs continuously

55
Q

Depolarizing Neuromuscular blocker ?

A

Succinylcholine

56
Q

Non-Depolarizing Neuromuscular blocker ?

A

Rocuronium

Vecuronium
Pancuronium
Atracurium

57
Q

Succinylcholine aka ?

58
Q

Succinylcholine purpose ?

A

Neuromuscular paralytic

**stops muscle movement, flaccidity **

59
Q

Succinylcholine MOA ?

A

Stimulates motor endplate acetylcholine receptors (depolarizing neuromuscular blocker

**stimulates the muscles but it may catch it when it is in depolarization and then a separate depolarization and it sticks to the receptor so when Acetly choline hit the receptors, it just gets taken away from the enzyme cause the SUCCINYLCHONIE is blocking the receptor **

60
Q

Succinylcholine BBW ?

A

Cardiac Arrest Risk (peds pts)

61
Q

Succinylcholine pregnancy category ?

62
Q

Succinylcholine Contrindications ?

A

Malignant hyperthermia hx

Myopathy

Major trauma or burns, acute

Glaucoma, angle-closure

Penetrating eye injury
Extensive muscular denervation, acute
Upper motor neuron injury, acute

63
Q

Succinylcholine major reactions ?

A

Malignant hyperthermia

Prolonged paralysis

Respiratory depression

Apnea
Arrhythmias

64
Q

Succinylcholine common reactions ?

A

Myalgia, postop

Muscle fasciculation

Jaw rigidity

IOP elevated

HTN

Hypotension
Bradycardia
Tachycardia
Sialorrhea
Rash
65
Q

Succinylcholine indications ?

A

Neuromuscular blockade induction

Neuromuscular blockade maintenance

*Rapid sequence intubation = off-label

** induction first then paralysis !**

66
Q

Succinylcholine monitoring ?

A

ECG

peripheral nerve stimulation

vital signs continuously

serum electrolytes

67
Q

Rocuronium aka ?

68
Q

Rocuronium purpose ?

A

Intubation

Paralytic

**purely blockade **

69
Q

Rocuronium MOA ?

A

antagonizes motor endplate acetylcholine receptors (non-depolarizing neuromuscular blocker)

stops depolarization where the other one stimulated first ……

70
Q

Rocuronium BBW ?

71
Q

Rocuronium pregnancy ?

72
Q

Rocuronium Contraindications ?

73
Q

Rocuronium major reactions ?

A

bronchospasm

respiratory depression

apnea arrhythmias

prolonged paralysis (long-term use)

myopathy (long-term use)

74
Q

Rocuronium drug interactions ?

A

Aminoglycosides

quinidine (antiarrhythmic)

75
Q

Rocuronium common reactions ?

A

hypotension, transient

HTN

tachycardia

76
Q

Rocuronium Indications ?

A

endotracheal intubation

rapid sequence intubation

neuromuscular blockade induction

neuromuscular blockade maintenance

77
Q

Rocuronium monitoring ?

A

peripheral nerve stimulation

vital signs continuously

serum electrolytes

78
Q

Malignant hyperthermia inherited ?

A

Genetically

**runs in families **

79
Q

Malignant hyperthermia induced by ?

A

anesthetics

80
Q

Malignant hyperthermia results from ?

A

uncontrolled release of calcium from the sarcoplasmic reticulum and massive increase of intracellular calcium in skeletal muscle due to the inability of the calcium to be reabsorbed

81
Q

Malignant hyperthermia tx. ?

A

Dantrolene– multiple vials are available to mix

Most operating rooms have treatment protocols

82
Q

Dantrolene aka ?

83
Q

Dantrolene purpose ?

A

Malignant hyperthermia reversal

84
Q

Dantrolene MOA ?

A

dissociates excitation-contraction coupling in skeletal muscle by decreasing intracellular calcium, inducing skeletal muscle relaxation

**causes relaxation **

85
Q

Dantrolene BBW ?

A

Hepatotoxicity

86
Q

Dantrolene pregnancy category ?

87
Q

Dantrolene Contraindications ?

A

hepatic disease

active spasticity-dependent posture, balance, or function

avoid breastfeeding during tx and x2 days after D/C

88
Q

Dantrolene major reactions ?

A

hepatotoxicity

pleural effusion

pericarditis

heart failure
aplastic anemia
leukopenia

89
Q

Dantrolene drug interactions ?

A

Calcium channel blockers

Carbinoxamine
Doxylamine
sodium oxybate

**additive if taking a CCB **

90
Q

Dantrolene common reactions ?

A

Drowsiness

Dizziness

Weakness
Malaise
Fatigue
Diarrhea
Photosensitivity
Nausea
tachycardia
91
Q

Dantrolene Indications ?

A

*Malignant hyperthermia
off label

spasticity, chronic

92
Q

Dantrolene Patient Education ?

A

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Drinking alcohol can increase certain side effects of dantrolene.

Avoid exposure to sunlight or tanning beds. Dantrolene can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

93
Q

Dantrolene Monitoring ?

A

LFTs at baseline, then periodically (if long term)

cause risk of hepatotoxicity

94
Q

Potent gases, such as, Sevoflurane have all three effects ?

A

Unconscious (amnesia) (anxiolytics)

Analgesia

Muscle relaxation (paralysis)

95
Q

IV drugs for unconscious (amnesia) ?

A

Benzos

Barbituates

Etomidate

Ketamine

96
Q

IV drugs for analgesia ?

A

Opioids (Fentanyl, Morphine, Hydromorphone)

Nonopioid (ketamine)

97
Q

Ketamine does both ?

A

amnesia (Unconscious) and analgesia

98
Q

IV drugs for muscle relaxation (paralysis) Depolarizer ?

A

Succinylcholine

99
Q

IV drugs for muscle relaxation (paralysis) Non-depolarizer ?

A

Roncuronium

100
Q

Nitrous Oxide is a weak gas for ?

A

Unconscious (amnesia) and Analgesia

like ketamine

101
Q

_________________ provide all three characteristics of general anesthesia: unconsciousness, analgesia, and muscle relaxation.

A

inhalational agents

102
Q

Ketamine advantages ?

A

Airway reflexes maintained

No respiratory depression

kids

103
Q

Etomidate advantages ?

A

Rapid onset

short duration

Minimal CV effects

Cerebral protective

104
Q

Propofol advantages ?

A

Rapid onset

Short duration

Antiemetic

Cerebral protective

105
Q

Nitrous Oxide advantages ?

A

Rapid onset

Short duration

Minimal CV effects

106
Q

Ketamine best for ?

107
Q

Etomidate best for ?

A

Elderly

Critically ill

108
Q

Rapid sequence intubation paralytic choice ?

A

Succinylcholine

Rocuronium if succinylcholine contraindicated
-malignant hyperthermia

109
Q

Rapid sequence intubation, Induction choice by condition

- Status asthmaticus ?

A

Lidocaine

Ketamine

110
Q

Rapid sequence intubation, Induction choice by condition - increased ICP ?

A

Lidocaine

Etomidate

111
Q

which of the following local anesthetics have the longest duration of action ?

A

Bupivvacaine

112
Q

which of the following anesthetics is inhalation ?

A

Sevoflurane

113
Q

which of the following meds is most likely to cause malignant hyperthermia ?

A

succinylcholine

114
Q

which of the following anesthetics would be best for status asmaticus ?

Pharmacology (Dale Turley) (31 decks)

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