Anesthetics and Skeletal muscle blockers

Question 1

All inhaled anesthetics are bronchodilators except:

Answer 1

Desflurane

Used as GA

Question 2

Desflurane not used in people with?

Answer 2

Asthma

Act as pulmonary irritant, will worsen bronchospasm

Question 3

All local anesthetics vasoDILATE except:

Answer 3

Cocaine

Question 4

Laughing gas used in minor surgeries and dental procedures?

Answer 4

Nitrous (joyOUS) oxide - rapid onset
High MAC, low potency
Low PC, rapid onset, least cardiotoxic

Question 5

Type of anemia caused by Nitrous oxide?

Answer 5

Megaloblastic

Question 6

Most hepatotoxic inhalational anesthesia? Other AE?

Answer 6

Halothane

Cause malignant hyperthermia with succinylcholine

Question 7

Antidote for malignant hyperthermia? (massive SR release of Ca due to defective RYR, trismus of the jaw)

Answer 7

Dantrolene

To decrease body temp rapidly

Question 8

Inhalational GA with the LOWEST MAC and HIGHEST potency?

Answer 8

Methoxyflurane
stays in blood longer, very SLOW recovery
Cause renal insufficiency

Question 9

Ultrashort acting barbiturate used as IV GA for anesthesia induction and increased ICP?

Answer 9

Thiopental

TAYO AGAD

Question 10

Short acting BZD also used as IV GA is? Antidote for toxicity?

Answer 10

Midazolam

Antidote: Flumazenil

Question 11

Dissociative anesthesia (no loss of consciousness but with analgesia) preferred in trauma patients with unstable vital signs?

Answer 11

Ketamine
CV stimulation (inc BP and HR)

Question 12

Ketamine AE? Therefore need pretreatment with?

Answer 12

Emergence delirium

Give BZDs first

Question 13

IV GA with no analgesic properties, used if with limited cardiac reserve or respi reserve?

Answer 13

Etomidate

“Eto may date, pareserve na tayo”

Question 14

How is neuroleptanesthesia achieved? Used in endoscopic, bronchoscopic and ophthalmic procedures

Answer 14

“Friend drop the ox”
Fentanyl
Droperidol
Nitrous oxide

Question 15

Antidote for opioid (fentanyl) overdose?

Answer 15

Naloxone

Question 16

IV GA also known as “Milk of Amnesia”?

Answer 16

Propofol - for OPD sedation

Question 17

Common AE of propofol?

Answer 17

Dec BP, dec HR

Priapism

Question 18

Local anesthetic with shortest half life?

Longest half life?

Answer 18

PRO finishes fast - Procaine - Ester

end of the ROPE - Ropivacaine - Amide

Question 19

Hyper K or Ca enhances local anesthesia effect?

Answer 19

Hyper K enhances

Hyper Ca antagonizes

Question 20

Local topical anesthesia used with care in patients with sunburn?

Answer 20

Benzocaine

Burn the Benz

Question 21

Toxic dose of Lidocaine?

Answer 21

5mg/kg (1% in 10mL solution)

Group 1B antiarrhythmic used for ventricular arrhythmias POST-MI

Question 22

Amide local anesthetic used in dental procedures that cause methemoglobinemia?

Answer 22

Prilocaine “Pri dental checkup!”

Antidote: Methylene blue
METhemoglobinemia = METhylene blue

Question 23

Give two cardiotoxic local anesthetics

Answer 23

Bupivacaine
Ropivacaine

“HeartBuRoken”

Question 24

Treatment of anesthesia induced cardiotoxicity?

Answer 24

Intralipid

Fat emulsion used in TPN

Question 25

Nondepolarizing NMB prevent action of ACh at the end plate. These effects can be reversed by?

Answer 25

Neostigmine | Cholinesterase inhibitor

Question 26

Nondepolarizing NMB with most rapid onset? | Reversed by what novel drug?

Answer 26

Rocuronium (60-120 seconds only) | Reversed by Sugammadex

Question 27

Long acting NMB that cause RECURARIZATION (drug eliminated but still with active metabolites) and is contraindicated in patients with MI?

Answer 27

Tubocurarine | AE: Resp paralysis, ganglion block

Question 28

Intermediate acting ND NMB used during intubation and GA that cause seizures, bronchospasm, histamine release?

Answer 28

Atracurium

Question 29

Atracurium undergoes what type of elimination?

Answer 29

``` Hoffman elimination (Rapid spontaneous breakdown to form laudanosine) ```

Question 30

Intermediate acting ND NMB that is eliminated in bile?

Answer 30

Vecuronium | VILE = Vecuronium

Question 31

Long acting ND NMB used in euthanasia and lethal injection?

Answer 31

Pancuronium

Question 32

Drugs used in lethal injection?

Answer 32

ToPaK! 1. Thiopental 2. Pancuronium 3. KCl

Question 33

The only DEPOLARIZING NMB?

Answer 33

Succinylcholine

Question 34

NMB metabolized by PSEUDOcholinesterase? Eliminated in bile? Excreted renally?

Answer 34

PseudoCholi - Mivacurium and Succinylcholine Bile - Vecuronium Renal - Pancuronium, tubocurarine