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Pharm > anesthetics > Flashcards

anesthetics Flashcards

1
Q

eliminate pain and other sensations in patients who undergo surgical manipulations

A

anesthesia

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2
Q

define general anaesthesia

A

Reversible state of CNS depression

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3
Q

What effects occur with general anaesthesia? (5)

A
  • loss of consciousness: hypnosis
  • loss of sensitivity: analgesia, anaesthesia
  • loss of reflex activity: autonomic protection
  • loss of motility: muscle relaxation.
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4
Q

Define local anesthesia

A

intervention is limited to a small area or limb

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5
Q

How does local anaesthesia work? (4)

A
  • Reversibly nerve block
  • ANS blocked (hypotension and vascular tone loss)
  • block nociceptive receptors (sensory)
  • no loss of consciousness
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6
Q

Which anaesthesia makes you lose consciousness?

A

general

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7
Q

Which anaesthesia doesnt make you lose consciousness?

A

local

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8
Q

The smaller the diameter of nerve fibers (C fibers) the _____ sensitive they are to anaesthetics.

A

more

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9
Q

How do we achieve differential blocking with local anesthesia? (2)

A

adjusting concentration and volume

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10
Q

Order the nerve fibers from largest to smallest: (3)

A
  • A
  • B
  • C (smallest)
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11
Q

Order the nerve fibers from fastest to slowest conduction: (3)

A
  • A
  • B
  • C (slowest)
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12
Q

Aα nerve fiber function

A

Motor function and proprioception

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13
Q

Aβ nerve fiber function

A

Touch-pressure

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14
Q

Aγ nerve fiber function

A

Muscle tone

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15
Q

Aδ nerve fiber function

A

Pain-temperature

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16
Q

B nerve fiber function

A

Vasoconstriction

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17
Q

C nerve fiber function

A

Pain-temperature

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18
Q

Blocking order of nerve fibres: (6)

A
  1. B
  2. C & Aδ
  3. Aβ
  4. Aγ
  5. Aα
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19
Q

Which nerve fibres are for pain-temperature?

A

C & Aδ

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20
Q

Sequence of nerve blocking effect wise? (5)

A

analgesia:

  • sympathetic block (vasodilation)
  • pain block
  • thermal and pain fibers

Anaesthesia:

  • touch and pressure sensitivity
  • motor and proprioceptive
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21
Q

Anaesthesia mechanism of action (6)

A

decreased membrane permeability to sodium:

  • inhibits Na+ voltage gated channels
  • decreases action pot. porpagation
  • incr. excitability threshold
  • decr. conduction
  • full conduction bloackade
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22
Q

Physico-chemical characteristics of Local Anaesthetics:

A
  • Aromatic benzene ring: lipid solubility (potency)
  • Amine portion: hydrophilic (pharmacological action)
  • Ester or amide linkage: rate of metabolism and toxicity
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23
Q

if anaesthetics have high lipid solubility…

A

more potent

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24
Q

if anaesthetics have high protein binding…

A

high duration of action

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25
Q

if anaesthetics are less ionized… (2)

A
  • faster entry

- lower latency period

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26
Q

all local anesthetics are _______ with a pKA of ______

A
  • weak bases

- 7.5-9

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27
Q

At physiological pH, local anethesia is….

A

ionized in high proportion

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28
Q

What causes a low pKa LATENCY PERIOD? what does it mean?

A

low = if pKa and pH are closer, there is more non-ionized drug and it passes through the membrane faster

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29
Q

How does the non ionized fraction of local anesthetics work? (3)

A

passes through lipophilic nerve sheath

  • then goes to the axon membrane
  • then finally the neuronal membrane
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30
Q

How does the ionized fraction of local anesthetics work? (2)

A
  • interacts with the channel to produce pharmacological action
  • can only access the binding site from inside the cell, through the channel when it is open
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31
Q

The ionized fraction of local anesthetics is….

A

a charged cation

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32
Q

The ionized fraction of local anesthetics is….

A

a charged cation

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33
Q

What happens to the pKa latency period with local anaesthesia when there is a local infection?

A

acidosis retards diffusion by increasing the ionized fraction

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34
Q

CLASSIFICATION OF LOCAL ANAESTHETICS According to the linkage: (2)

A
  • ester

- amide

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35
Q

What are the ester local anaesthetics? (4)

A
  • COCAINE
  • PROCAINE
  • TETRACAINE
  • BENZOCAINE
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36
Q

What are the amide local anaesthetics? (7)

A 
ß LIDOCAINE
ß MEPIVACAINE
ß PRILOCAINE
ß BUPIVACAINE
ß LEVOBUPIVACAINE 
ß ROPIVACAINE
ß ARTICAINE
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37
Q

What is the SHORT ACTION AND LOW POTENCY local anesthetics?

A

procaine

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38
Q

What are the INTERMEDIATE ACTION AND INTERMEDIATE POTENCY local anesthetics? How long is the action? (4)

A
  • LIDOCAINE
  • MEPIVACAINE
  • PRILOCAINE

*150 min

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39
Q

What are the

LONG ACTION AND HIGH POTENCY local anesthetics? (4) how long?

A
  • tetracaine
  • bupivacaine
  • L-bupivacaine
  • ropivacaine

*6-8 hours

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40
Q

local anesthetic elimination?

A

renal

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41
Q

Which class of local anesthetics have less toxicity?

A

ester

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42
Q

Which class of local anesthetics are allergenic and have cross reactivity?

A

ester

43
Q

Which class of local anesthetics have a very short half life?

A

ester

44
Q

Which class of local anesthetics have an average half life?

A

amide

45
Q

For general anesthesia what drugs cause analgesia?

A

opiates

46
Q

For general anesthesia what drugs cause loss of relfexes?

A

neuroleptics

47
Q

For general anesthesia what drugs cause muscle relaxation?

A

muscular blockers

48
Q

For general anesthesia what drugs cause amnesia and loss of conciousness

A

anaesthetics

49
Q

To get the effects of general anaesthesia various drugs are going to be administered _____ & ______

A

simultaneously and sequentially

50
Q

What are the 3 phases of general anaesthesia?

A
  • (preanaesthesia)
  • induction
  • maintenance
  • awakening
51
Q

What drug do we use for general preanaesthesia?

A

anxyolitics - benzo

52
Q

What drug do we use for induction of general anesthesia? (4)

A
  • anticholinergic: atropine
  • IV anaesthetic: (Thiopental-Barbiturate, Propofol, Etomidate, ketamine)
  • muscle relaxant: succinylcholine
  • opiate: fentanyl, remifentanyl, morphine
53
Q

What drug do we use for maintenance of general anesthesia? (2)

A
  • inhaled anaesthetic: enflurance

- muscle relaxant: Atracuronium, Venocuronium

54
Q

What drug do we use for awakening after general anesthesia? (3)

A
  • anti-achetylcholinesterase: neostigmine
  • anti-opiates: naloxone
  • anti-benzo: flumazenil
55
Q

what IV opiates do we use for general anaesthesia? (3)

A

fentanyl
remifentanyl
morphine

56
Q

what IV barbiturate do we use for general anaesthesia?

A

thiopental

57
Q

what IV neuroleptic do we use for general anaesthesia?

A

droperidol

58
Q

what IV anticholinergic do we use for general anaesthesia?

A

atropine

59
Q

what IV benzos do we use for general anaesthesia? (2)

A

midazolam

diazepam

60
Q

what IV anesthesia do we use for general anaesthesia? (3)

A
  • ketamine
  • propofol
  • etomidate
61
Q

What are the inhaled anesthetic classes and names? (4)

A

Volatile liquids:

  • enuflurane
  • halothane
  • sio/sevoflurane

Gas:
-nitrous oxide

62
Q

Mechanism of action for general anaesthesia? (4)

A
  • alters synaptic transmission
  • hyperpolarization of neuron membrane
  • decreased ability of neuron to respond
  • acts on ion channels
63
Q

opioid bradycardia with general anesthesia can be controlled with this drug….

A

atropine

64
Q

Which opioid do we prefer for general anesthesia?why?

A

fentanyl

-rapid onset and short duration

65
Q

How long is the effect of ketamine?

A

short action

66
Q

ketamine indications?

A
  • children

- minor painful procedures

67
Q

What effects do ketamine have? what effect does it not have (3)

A
  • sedation
  • analgesia
  • NO respiratory depression
68
Q

What are ketamines cardiovascular effects?

A

increased:

  • sympathetic activity
  • blood pressure
  • HR
  • intracranial pressure
69
Q

Ketamine contraindications (3)

A

-hypertension
heart disease
stroke

70
Q

Ketamine lipid solubility?

A

high

71
Q

etomidate indication in anesthesia?

A

induction

72
Q

etomidate effects?

A

hypnotic

73
Q

etomidate theraputic index? side effects?

A

high

respiratory depression

74
Q

does etomidate cross the BBB?

A

yes

75
Q

etomidate cross the BBB?

A

yes

76
Q

length of etomidate action? why?

A

short because of rapid redistribution

77
Q

etomidate recovery time?

A

very fast

78
Q

propofol pharmacological effects? (2)

A
  • sedation vs anaesthesia

- hypnotic

79
Q

propofol physiological effects? (3)

A
  • hypotension
  • bradycardia
  • respiratory depression
80
Q

propofol pharmacokinetic effects? (2)

A

Short duration of action, fast recovery

81
Q

What drug has less laryngospasm than fluranes in children?

A

halothane

82
Q

halothane indications? (2)

A
  • maintence general anaesthesia

- children

83
Q

halothane pharmacological actions? adverse effects? (4)

A

sensitizes myocardium to catecholamines:

  • high risk of arrhythmias
  • respiratory depression
  • hepatotoxicity esp. after repeated exposure
84
Q

nitrous oxide adverse reactions?

A
  • megaloblastic anaemia

- leukopenia

85
Q

to avoid hypoxia we use _____% of nitrous oxide

A

less than 70%

86
Q

Effect and adverse effects of nitrous oxide?

A
  • analgesic
  • loss of consciousness
  • myocardial depression
87
Q

What concentration produces loss of consciousness with nitrous oxide?

A

-80%

88
Q

What concentration of nitrous oxide do we use for analgesia?

A
  • with 50% oxygen
89
Q

What concentration of nitrous oxide do we use for sedation?

A

with 25% oxygen

-75%

90
Q

What affect do vasoconstrictions have on local anaesthetics? how? (3)

A

increased duration of action

  • slower absoprtion = prolonged effect
  • reduces risk of systemic toxicity
91
Q

vasoconstrictors used with local anaesthetics cannot be applied _______. why? (2)

A

in distal areas

risk of necrosis

92
Q

What are the vasoconstrictors used with local anaesthetics ? (2)

A
  • Epinephrine = adrenaline (the most used)

- Phenylephrine

93
Q

Which anesthetics produce intense vasodilation?

A
  • procaine
  • bupivacaine
  • lidocaine
94
Q

systemic side effects due to local anaesthesia?

A
  • CNS: b/c lipid solubility
  • cardiovascular: tachycardia
  • allergic reactions (mainly esters)
  • vasovagal rxns
  • vasoconstriction adverse reactions
95
Q

cardiovascular adverse effects with local anaesthesia?

A
  • therapeutic doses: tachycardia

- high doses: hypotension, bradycardia, decreased contractility

96
Q

What does vasovagal mean?

A

droqp in blood pressure

97
Q

Pregnancy and local anaesthesia?

A

caution when in first and third trimester

98
Q

Risk of toxicity for local anesthesia is high for the… (2)

A

children and elderly

99
Q

local anesthesia can cause _______ and _____ failure

A

renal

hepatic

100
Q

in what type of drug addicts can vasoconstrictors for local anaesethia not be used?

A

cocaine addicts

101
Q

Drug interactions with local anesthetics?

A
  1. ANTIARRHYTHMICS class I: Quinidine
  2. CNS depressants: increased toxicity
    Mainly: antihistamines H1, antidepressants, sedative drugs
  3. Beta blockers and cimetidine: decrease the hepatic metabolism of amide local anaesthetics
  4. Sulphonamides: local anaesthetics interfere with their antibacterial effects.
102
Q

contradictions for local anaesthesia? (3)

A
  • skin infection at injection site
  • swollen/eroded areas
  • large areas
103
Q

topical local anaesthesia in dentistry? (2)

A
  • LIDOCAINE: cream, aerosol, gel

- prilocaine

104
Q

infiltrated local anaesthesia in dentistry? (5)

A

LIDOCAINE 2%
LIDOCAINE 2% (every ml - 0,0125mg adrenaline) MEPIVACAINE 3%
ARTICAINE 4% (every ml - 0,01mg adrenaline) BUPIVACAINE 0,5% (every ml 0,005mg adrenaline)

Pharm (14 decks)

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