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Pharmacology > Anesthetics/Analgesics > Flashcards

Anesthetics/Analgesics Flashcards

1
Q

What inhaled anesthetic has the fastest induction rate?

A

Nitrous Oxide N2O

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2
Q

What inhaled anesthetic drug has a medium rate of onset and recovery, is pungent, and is declining in use?

A

Isoflurane

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3
Q

What inhaled anesthetic is used in combination with other agents?

A

Nitrous Oxide

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4
Q

What inhaled anesthetic drug has poor induction, rapid recovery, is pungent, and is used in outpatient care?

A

Desflurane

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5
Q

What inhaled anesthetic has the highest liver metabolism?

A

Sevoflurane (2-5)

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6
Q

What inhaled anesthetic drugs should you avoid in people with bronchospams?

A

pungent agents

Isoflurane and Desflurane

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7
Q

Balanced Anesthesia is…

A

combination of inhaled and IV

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8
Q

Oral or parenteral sedatives + local sedatives ares ____ anesthesia

A

Monitored

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9
Q

Alleviation of anxiety and pain + altered levels of consciousness produced by small doses is known as…

A

Conscious sedation

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10
Q

Light state of anesthesia used in the ICU is known as…

A

Deep Sedation

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11
Q

Analgesia = lack of pain and subsequent amnesia is seen in what stage of anesthesia?

A

Stage I

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12
Q

Stage II of anesthesia is known as…

A

Excitement

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13
Q

Delirium, combative behavior, increased BP, increased RR is what stage of anesthesia?

A

Stage 2 - Excitement

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14
Q

Surgical Anesthesia is associated with…

A

Stage III = regular respiration, skeletal muscle relaxation, decreased eye reflexes and movements, fixed pupils, AND loss of motor and autonomic responses to pain

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15
Q

What is required before beginning surgery on a patient to ensure no pain is felt?

A

Reaching Stage III of anesthesia which results in loss of motor and autonomic responses to pain

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16
Q

Which stage of anesthesia is involved with depression of respiratory and vasomotor centers?

A

Stage IV = Medullary Paralysis

Can lead to death without intubation

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17
Q

What type of anesthetics end in -flurane and what is the outlier of that group?

A

General inhalational anesthetics

Nitrous Oxide

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18
Q

Increased ventalitory depth and rate cause…

A

shorter induction time

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19
Q

increased uptake from lungs…

A

increased rate of induction

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20
Q

lower solubility = higher arterial pressure which causes…

A

faster induction since less of it is dissolved in blood

Seen in blood/gas partitioning coefficients

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21
Q

Which type of tissue accumulates anesthetics the slowest?

A

adipose tissue and muscle

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22
Q

What is the Meyer & Overton Rule?

A

higher lipid solubility = more potent

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23
Q

What is MAC?

A

When 50% of patients are rendered immobile.

So EC50

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24
Q

What inhaled anesthetic has the highest MAC

A

nitrous oxide (100%) so it’s used in combination

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25
Q

What is the major route of clearance of inhaled anesthetics?

A

lungs

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26
Q

What are the 4 steps in the MOA of an anesthetic?

A
  1. DRG neurons
  2. Frontal cortex - sedation
  3. Thalamus- hypnosis/loss of consciousness
  4. Ventral horn neurons- loss of motor function/immobile
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27
Q

What is the most sensitive area of neurons that is affected by anesthetics first?

A

Dorsal root ganglia neurons

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28
Q

What does the thalamus step cause in a patient…

A

loss of consciousness

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29
Q

What are the possible MOA for inhaled anesthetics in terms of activating?

A

Activating GABA-A receptors and glycine receptors (inhibitory)

Activating K+ channels –> hyperpolarization

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30
Q

What are the possible MOA for inhaled anesthetics in terms of inhibition?

A

Inhibiting glutamatergic ionotropic receptors and neuronal nicotinic AChR

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31
Q

What is the MOA of nitrous oxide?

A

Blocks the NMDA-receptor

like ketamine

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32
Q

Is nitrous oxide a weak or strong analgesic?

A

Strong pain reliever

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33
Q

Malignant hyperthermia is caused by…

A

mutations in ryanodine receptors –> sensitization to anesthetics –> release massive amounts of Ca2+ into cytosol –> trigger massive contraction

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34
Q

What is mutated in malignant hyperthermia?

A

Ryanodine receptor mutations

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35
Q

What disorder is AD and characterized by tachycardia, hypertension, severe muscle rigidity, hyperthermia, hyperkalemia, and acidosis?

A

Malignant Hyperthermia

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36
Q

How do you treat Malignant Hyperthermia?

A

Dantrolene

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37
Q

What is the MOA of dantrolene?

A

blocks Ca2+ release from ryanodine receptor activation of Sarcoplasmic Reticulum

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38
Q

What drug can diffuse into cavities and cause (for example) pneumothorax?

A

Nitrous Oxide

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39
Q

How much liver metabolism is associated with nitrous oxide?

A

None.

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40
Q

Balanced anesthesia is a combo of inhaled and IV drugs. IV drugs include…

A

Premedication
Induction
Intubation
Maintenance

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41
Q

For balanced anesthesia, what is the premedication?

A

Midazolam (IV benzodiazepine)

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42
Q

What induction IV drugs are used in balanced anesthesia?

A

Fentanyl (opioid)
Propofol (anesthetic)
Curare-like NM blocker (pancuronium)

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43
Q

Is intubation of the trachea required in balanced anesthesia?

A

Yes.

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44
Q

What maintenance drug is used in balanced anesthesia?

A

Inhalational- sevoflurane + nitrous oxide combo

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45
Q

What is TIVA?

A

Total Intravenous Anesthesia

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46
Q

What drugs are used in TIVA?

A

Premedication- midazolam

Induction- remifentanil or propofol

Trachael intubation

Maintenance- remifentanil and propofol (instead of inhaled drugs)

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47
Q

What drugs are used as adjuncts prior to induction?

A

Premedication - benzodiazepines

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48
Q

What drug is used for sedation procedures that do not require general anesthesia?

A

Benzodiazepines

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49
Q

What class of drug is Fentanyl?

A

An opioid

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50
Q

What are 3 uses for Opioids like fentanyl?

A

induction & maintenance of TIVA

epidural anesthesia with local

ICU- conscious and deep sedation

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51
Q

What drug has chest wall laryngeal rigidity and impaired ventilation?

A

Opioids like fentanyl, sufentanil, and remifentanil

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52
Q

What drug is a lipophilic agent that rapidly enters and depresses CNS, is short-acting?

A

Barbiturate anesthetics like thiopental

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53
Q

Thiopental is…

A

a barbiturate anesthetic used in induction of anesthesia and deep sedation

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54
Q

Is the barbiturate class good analgesics?

A

No, but they decrease cerebral metabolism and flow which is good with head swelling patients

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55
Q

Propofol is..

A

the most commonly used agent for induction and maintenance

56
Q

What is the MOA of propofol?

A

Potentiates/activates the GABA-A receptors

57
Q

What drug has rapid onset and recovery which is why it’s common in day surgeries, conscious sedation, and radiology?

A

Propofol

58
Q

What drug is a PCP analog?

A

Ketamine

59
Q

What is the MOA of Ketamine?

A

blocking of NMDA receptor

60
Q

Is ketamine a good analgesic?

A

Yes.

61
Q

What drug causes dissociateive anesthesia, catatonia, amnesia, analgesia, no loss of consciousness?

A

Ketamine

62
Q

What drug is used commonly with kids and short procedures of adults?

A

Ketamine

63
Q

What is the ONLY IV drug that induces cardiovascular stimulation causes increased HR and CO?

A

Ketamine

64
Q

What drug is associated with postoperative hallucinations?

A

Ketamine

65
Q

What is the MOA of Etomidate?

A

Potentiation of GABA-A receptors

66
Q

What drug is used in patients at risk of hypotension?

A

Etomidate because it causes minimal cardiovascular depression

67
Q

What drug is used for short-term sedation of intubated and ventilated ICU patients or during regional anesthesia?

A

Dexmetomidine

68
Q

What is the MOA of Dexmetomidine?

A

a2- adrenergic receptor agonist –> analgesia and hypnosis

69
Q

Hypnosis by Dexmetomidine is caused by activation of a2-adrenergic receptors in…

A

locus coeruleus (involved in endogenous sleep states)

70
Q

What is the MOA of hypnosis by Dexmetomidine?

A

a2- adrenergic receptor activation in Locus ceruleus –> decreases NE –> release of GABA (inhibitory) from the ventrolateral preoptic nucleus (VPN) –> prevents release of histamine from tuberomamillary nucleus –> NO arousal –> sleep

71
Q

What are the good analgesics?

A

Nitrous oxide
Fentanyl
Ketamine
Dexmetomidine

72
Q

What IV drugs have less affects on respiratory function?

A

Etomidate, Ketamine, and Dexmetomidine

73
Q

What drug is an antiemetic?

A

Propofol

74
Q

What drugs have increased cerebral blood flow and intracranial pressure? And should be watched with head trauma patients.

A

Volatiles, Nitrous oxide, Fentanyl, Ketamine

75
Q

What drugs have decreased cerebral flow and intracranial pressure? Should be used in head trauma patients.

A

Thiopental, Propofol, Etomidate, and Dexmetomidine

76
Q

What drug should you watch for in liver failure patients?

A

Fentanyl

77
Q

What drug would a heroin addict not respond to?

A

Fentanyl

78
Q

What are the two classes of local anesthetics?

A

esters (one I) and amides (two Is)

79
Q

What enzymes hydrolyze esters?

A

plasma esterases

80
Q

Esters end in -caine and have ___ I’s

A

1 I

81
Q

Lipophilic esters are…

A

More potent and longer lasting

82
Q

What drugs have longer duration than esters and are metabolized in the liver?

A

Amides (two Is)

Two a’s = long lasting

83
Q

Amides also end in -caine but have __ I’s

A

2

84
Q

What is the MOA of local anesthetics?

A

OPEN channel blocks of voltage-gated SODIUM channels

They block from the inside when channels are open –> decreased AP propagation –> conduction failure

85
Q

What molecule crosses the membrane in local anesthetic MOA?

A

uncharged base

86
Q

What molecule blocks the channel from the inside?

A

The cationic BH+

87
Q

Explain the H-H application in acidic environments?

A

Lower pH –> more H+ –> push to BH+ side of equation –> less B to go across membrane –> less blocking from inside –> more pain

88
Q

What molecule can be used in combination with local anesthetics to ensure B crossing membrane?

A

Bicarbonate

89
Q

Local anesthetics work better on what types of fibers…

A

smaller nerve fibers and myelinated fibers

90
Q

Local anesthetics can selectively block pain fibers because…

A

they fire rapidly

91
Q

Fibers located where are blocked sooner by local anesthetics?

A

The periphery of thick nerve bundles because they are exposed before

92
Q

What is the order of blockade by local anesthetics?

A

pain fibers –> other sensations –> motor function

93
Q

What fibers are lease sensitive to local anesthetics?

A

aA fibers- proprioception and motor

94
Q

Why do we give an injection of epinephrine with local anesthetics?

A

Causes vasoconstriction via activation of a1-adrenergic receptors –> decreases removal of local anesthetic –> increases duration and effect

Also activates presynaptic a2-adrenergic receptors –> decrease release of pain mediators such as Substance P

Local bleed control

95
Q

What drug helps local bleed control?

A

Epinephrine

96
Q

What receptor does epinephrine block to decrease release of pan mediators such as Substance P?

A

a2-adrenergic

97
Q

What local anesthetic is used topically in cases of pruritus?

A

Dibucaine

Amide, short-lasting

98
Q

What are the adverse affects of dibucaine?

A

absorbed rapidly –> toxicity

99
Q

For wound suturing and biopsies, you use what local anesthetic?

A

Injection (infiltration) without considering cutaneous nerves or deep tissue structures

100
Q

What are adverse affects of infiltration local anesthetics?

A

Injection can cause inadvertent intravascular injection

prevent by aspirating

101
Q

IV Lidocaine can be used as…

A

an anti-arhythmic agent for ventricular arrhythmias

102
Q

Allergies are commonly associated with which local anesthetic group?

A

Esters

103
Q

What do you NOT give to patients with limited collateral circulation (toes, fingers, nose, ears, etc)

A

Epinephrine

104
Q

Cardiovascular collapse is associated with high volumes of bupivacaine. Instead use the lower affinity…

A

Levobupivacaine and ropivacaine

105
Q

Lipid emulsion acts as a “sink” for anesthetics which you can reverse by…

A

lipid resuscitation - saving the patient

106
Q

What drugs are used to reverse opioid effects? Antagonists of opioids?

A

Naloxone and Naltrexone

end in -xone

107
Q

Strong analgesics include:

A

Morphine, oxycodone, fentanyl, methadone, meperidine

108
Q

Partial analgesics include:

A

codeine and hydrocodone

109
Q

Buprenorphine is a…

A

mixed-opioid agonist-antagonist

110
Q

What opioid is also used for acute pulmonary edema?

A

Morphine

111
Q

What opioid is also used for antitiussive?

A

dextromethorphan

112
Q

What opioid is also used for anti diarrhea?

A

diphenoxylate and loperamide

113
Q

What opioid is also used for shivering?

A

meperidine

114
Q

What opioid is also used for adjuncts to anesthesia?

A

fentanyl (regionally)

115
Q

Sedative hypnotics with opioids cause what adverse effect…

A

increased respiratory depression (CNS depression)

intubation required

116
Q

Antipsychotic tranquilizers used with opioids cause…

A

increased sedation and cardiovascular affects

117
Q

Monoamine oxidase inhibitors used with opioids cause…

A

hyperpyrexic coma and hypertension

118
Q

Endorphins have the highest opioid receptor affinity to u (mu) which are located in…

A

brain, brainstem, spinal cord = CNS

119
Q

What analgesics have the highest 1st pass elimination upon oral admin?

A

morphine

120
Q

The best route of admin for oxycodone is…

A

oral

121
Q

The best route of admin for fentanyl is…

A

transdermal

122
Q

Since morphine has high 1st pass effect, you can give it…

A

parenterally (elsewhere)

Low oral:parenteral ratio

123
Q

High oral:parenteral ratio is seen in…

A

methadone

124
Q

What are the metabolites of morphine and what do they do?

A

M3G (90%) and M6G

Accumulation can lead to CNS effects

125
Q

morphine is eliminated by what…

A

kidneys

126
Q

Fentanyl is metabolized by…

A

hepatic oxidative metabolism via P450 system

CYP3A4

127
Q

Codeine also has a high oral: parenteral ratio because demethylated it is…

A

morphine

128
Q

As you take more opioids, you build no tolerance to…

A

miosis, constipation, and convulsions

129
Q

As you take more opioids, you build tolerance to…

A 
nausea and vomiting
cough suppression
respiratory depression
anti-diuresis
etc.
130
Q

Opioids can affect the heart by causing…

A

brachycardia (slow heart action)

131
Q

What opioid is best for chronic and severe pain… not sharp, intermittent pain?

A

Morphine

132
Q

What opioid is given via transdermal patch over long periods?

A

Fentanyl

133
Q

What opioid is given in the mucosa of the mouth for short, breakthrough pain?

A

Fentanyl

134
Q

What opioid is is used in maintenance in rehabilitation programs because withdrawal symptoms are less severe?

A

Methadone

135
Q

What drug has less severe respiratory depression, constipation, biliary colic, and urinary retention? In addition to strong anti-muscarinic effects and tachycardia?

A

Meperidine

136
Q

What drug combination is used with heroin addicts?

A

Buprenorphine and naloxone

Pharmacology (6 decks)

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