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SUMPHARM > Anesthetics > Flashcards

Anesthetics Flashcards

1
Q

What was The first local anesthesia- abolition of sensation: leading to need for 1. Unconscious 2. Analgesia 3. muscle relaxation?

A

Cocaine.

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2
Q

What is the abolition of pain?

A

Analgesia

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3
Q

This value is the concentration that results in immobility in 50% of patients when exposed to noxious stimuli?

A

Min. alveolar anesthetic concentration. Higher the MAC= lower potency

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4
Q

What is only anesthetic agent that is inorganic, odorless, tasteless, no burn, never metabolized?

A

Nitrous oxide. MAC 105% LOW POTENT. Weak ANESTHETIC POWERFUL ANALGESIC

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5
Q

What are the systemic effects of NO?

A

Low blood solubility- Recovery faster

Min HR, BP, RR, and safe

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6
Q

What is concern of NO with sick pts?

A
  1. Myocardial depression.
  2. Manufacture impurities.
  3. BEg of case- INC in partial pressures.
  4. End of case O2 and CO2 blood diluted by this gas. DEC in Partial pressure=HYPOXIA
  5. Inhibits B12 metabolism
  6. Inhibits methione synthase-DNA precursor
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7
Q

What has the most significant reduction in systemic vascular resistance?

A

ISOflurane- MAC 1.30% HIGH POTENT. effect inc coronary steal syndrome, INC ICP, muscle relaxant

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8
Q

What receptors do Isoflurane work on?

A

*baroecptors. Depress RR and ventilatory response.

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9
Q

Avoid this drug if HF, arrhythmia, and asthma?

A

Isoflurane

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10
Q

What is a potent inhalant with MAC 7.2%

A

Desflurane- low solubility in blood, faster recovery. MILD respiratory and cardiac suppression

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11
Q

Which inhalant is ideal for kids and Why?

A

Sevoflurane- Faster recovery, less RR and CV effects. Masks, pleasant smelling

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12
Q

What are ADE of Sevoflurane?

A
  1. More respiratory depression
  2. Eliminated by lungs
  3. Excitement during recovery
  4. **NO p/o analgesia
  5. Reacts with KOH to create a chemical that cause RENAL damage
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13
Q

Which inhalant needs close monitor of HR and BP, O2 SAT?

A

Desflurane-

ADE: 1. Cough w/ strong vapors 2. AVoid lyme soda

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14
Q

What IV anesthetic is similar to AZOLES, CNS depressant and GABA agonist?

A

ETOMIDATE: Works how: dose dependent, DEC cerebral metabolism
ADE; **N/V, myoclonic activity, Cortisol suppression, inj pain,

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15
Q

What IV anesthetic causes dissociative anesthesia via stimulation of SNS?

A

KETAMINE: Works; maintains laryngeal and tone, similar to PCP, SNS ADE; hallucinatin dreams

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16
Q

What IV anesheic is painful bc not water soluble, lipid soluble-rapid onset, short duration?

A

PROPOFOL- Works: Myocaridal depression and peripheal vasodialstion. Normal Baroreflex

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17
Q

Which RX produce sedation and amnesia via GABA receptors?

A

Benzo- azepam Works; pre anesthic, relax b4 surgery, NOT water soluble most

18
Q

What BENZO is used premeditation and seizure activity?

A

Diazepam (Valium) Works- mim systemic effects.

ADE- liver metabolized, AVOID narcotics

19
Q

Which BENZO is an adjunct for anxiolytic and sedative properties?

A

LORAZEPAM- Works; slower, not for induction

20
Q

Which BENZO used for drowsiness preop with slow induction, MOST potent?

A

MIDAZOLAM;

ADE- prolonged recovery via metabolite, Min cardiac effects.

21
Q

What are some ADE of Opioids of anil/yl that are potent analgesic?

A
  1. Bradycardia
  2. NO Myocardial depression
  3. peripheral vasodilator and histamine -HYPOTENSION
  4. Chest wall rigidity
22
Q

Does inhaled and IV muscle relaxants work?

A

NO, not good for muscle tone. WORK- block ACH receptor. PK- plasma ACHe, Hepatic or Renal. USE- muscle relax in surgery, 2. intubatin 3. control ventilation

23
Q

What short acting muscle relaxant is used for intubation and last only 5-10min?

A

1.Succinylcholine; WORKS- DEPOLARIZING nicotinic receptor

ADE: myalgia day later** Malignant hyperthermia-fever, rhabdo

24
Q

What are the duration and Elimination of neuromuscular blockers?

A

SA- succinylcholine, Mivacurium- Plasma ACHe eliminated 5-20min.

IA- ATRA, VE, RO- curonium- 20-35min - HEPATIC and RENAL.

LA- Pancuriium, tubocuraine, metocurine- 60min Renal

25
Q

What are the concerns with muscle relaxants?

A
  1. Dont work
  2. INC by inhaled isoflurane
  3. INC by ahminoglycosides CCB
  4. HIGH doses, ANS ganglia blocked
  5. Respiratory paralysis
26
Q

How do non-depolarizing muscle relaxants work?

A

Competitively inhibit end plate nicotinic cholinergic receptor;
ROcuronium, Cisatracurium, vecuronium, mivacruim, Pancurium, tubcruien, metocurine

27
Q

How are muscle relaxants reversed?

A

Anticholinesterase: neostigmine, pryidostigmine, edrophonium- muscarinic stimulation

28
Q

What RX block NA channels to prevent depolarization thus excitation?

A

Local anesthetics; -caines
Esters- plasma AchE –caine
Amides- CYP450 isoenymes i-caine

29
Q

How does ionization affect crossing membrane?

A

Ionizable- lipohillic and hydrophilic end.

Ionized= low ph CANNOT cross membrane

30
Q

What can be used to help cross membrane for less pain?

A

Sodium Bicarb- Higher PH not ionized cross membrane

31
Q

What are the progression steps to local anesthetic toxicity?

A

Initial- Numbness of tongue, dizzy, tinnitus, vision
Later- drowsy, slurred speech, convulsions.
Final - Respiratory depression

32
Q

How do you prevent local anesthesia toxicity?

A

Causes IV inj or excessive dose.

  1. Aspirate often slow IV
  2. Ask about CNS toxicity ADE
  3. Monitor
  4. Be prepared to Ventilate w/ O2
  5. Seizure- TX Diazepam
  6. Hypotension- trendelenburg-head down legs up, IV bolus, vasopressor
  7. ACLS for arrhythmia- But NO MORE Lidocaine
33
Q

How was cocaine used in the day and today?

A

Euphoria, reduce hunger strikes, INC work tolerance. 2. Vasoconstrictor

34
Q

What is MOA of Cocaine?

A

Blocks Na channel, prevents uptake of Epi and NorEPi

35
Q

What are used for epidural analgesia?

A

Bupivacaine

Ropivacaine- CV risk, less motor impairment

36
Q

What are used for conditions such as Cerebral Palsy, MS, spinal cord damage, muscle inflamed?

A

Spasmolytics: Diazepam, Baclofen, Tizanidine, Cyclobensaprine, Dantrolene. Goal- reduce spasticy and pain, but retain function

37
Q

What spasmolytic activated K+, inhibitory, less sedation?

A

Baclofen-

ADE- WD, confusion, rhabdo

38
Q

What a2 adrenergic receptor agonist cause presynaptic inhibition of motor neurons?

A

Tizanidine- less lowering effect ADE- drowsy, hypotension, dry mouth

39
Q

What spasmolytic is a strong antimuscarinic sedative acting at the brain steM?

A

Cyclobenzaprin Flexeril- rarely works muscle relaxant. NOT for CNS d/o. Maybe relief of acute muscle injury OTHERS: Chlorzoxaone (paraflex), orphneadrine (norflex)

40
Q

What is a better muscle/spasmolytic but risk of physical dependence?

A

Coarisoprodoal (SOMA) metabolite potent

41
Q

Which spasmolytic IV administered can reverse malignant hyperthermia?

A

Dantrolene Sodium-
MOA- PO-interferes with excitation coupling and CA release of SR. Blocks contraction.
ADE- **HEPATITIS, MKS weakness, sedation. USE- CP, MS.

SUMPHARM (26 decks)

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