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Neuro Exam 3 > Anesthetics - Dr. Tomas > Flashcards

Anesthetics - Dr. Tomas Flashcards

1
Q

Anesthetics have ____ therapeutic index.

A

narrow

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2
Q

Anesthesia decreases arterial BP by:
A. Vasodilation
B. Myocardial depression
C. Blunted baroreceptor control so the body can’t determine what the appropriate BP should be
D. General decrease in sympathetic control
E. All of the above

A

E. All of the above

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3
Q

True or False: Anesthesia requires airway maintenance because it reduces or eliminates both ventilatory drive and respiratory reflexes designed to maintain the airway.

A

True

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4
Q

True or False: If there is a blockage/obstruction of the airway under anesthesia, your body can gag/cough it up like normal to get rid of the blockage.

A

False! Normal respiratory reflexes like that are reduced/eliminated while under anesthesia.

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5
Q

Which of the following respiratory effects of anesthesia can cause you to regurgitate and may lead to aspiration?
A. Reduction/elimination of ventilatory drive
B. Reduction/elimination of respiratory reflexes
C. Lower esophageal sphincter tone reduction
D. A and B

A

C. Lower esophageal sphincter tone reduction

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6
Q

Hypothermia is a physiological effect of anesthesia. It is defined as a body temperature less than ___°C.

A

< 36°C

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7
Q

List the 4 main physiological effects to consider with general anesthesia.

A
  1. Hemodynamic effects
  2. Respiratory effects
  3. Hypothermia
  4. Nausea & vomiting
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8
Q

General anesthetics act on the Chemoreceptor Trigger Zone (CTZ) and _____ (the “vomiting center” in brainstem).

A

Area Postrema

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9
Q

The use of ____ to induce anesthesia may help to overcome the N/V aspect of anesthetics.

A

Propofol

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10
Q

______ is the global but reversible depression of CNS functioning resulting in the loss of response to, and perception of all external stimuli.

A

General anesthesia

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11
Q

What are the 5 components of anesthesia that are absolutely necessary for them to work well.

A

1) Amnesia
2) Immobility
3) Attenuation of autonomic responses
4) Analgesia
5) Unconsciousness

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12
Q

The ____ is measured by determining [drug] that prevents movement in response to surgical stimulation.

A

Anesthetic potency

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13
Q

The anesthetic potency of inhaled anesthetics is measured in MAC units
(Minimum Alveolar Concentration), which is the percentage of inhaled gas that is anesthetic. Which of the following is true?
A. High MAC means high potency
B. High MAC means low potency
C. Low MAC means low potency
D. MAC is not related to potency

A

B. High MAC means low potency (and low MAC means high potency)

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14
Q

Though the mechanism of action of general aesthetics is widely unknown, the immobilization element of inhaled anesthetics occurs by acting at the _________.

A

Spinal cord

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15
Q

True or False: Inhaled and IV anesthetics depress excitability of thalamic neurons, which plays a role in the sedative effects of these agents.

A

False! Only Inhaled works on the thalamus.

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16
Q

True or False: Inhaled and IV anesthetics depress hippocampal neurotransmission, which plays a role in the amnesic effects of general anesthetics.

A

True

17
Q

_____ anesthetics hyperpolarize neurons, which decreases likelihood of neuron depolarization.
A. IV
B. Inhalational
C. IV and inhalational

A

B. Inhalational

18
Q

At anesthetizing concentrations, _______ anesthetics have substantial effects on synaptic transmission and smaller effects on action potential generation and propagation.
A. IV
B. Inhalational
C. IV and inhalational

A

C. IV and inhalational

19
Q

______ anesthetics inhibit excitatory synapses and enhance inhibitor synapses via effects on pre- and post-synaptic sites.
A. IV
B. Inhalational
C. IV and inhalational

A

B. Inhalational

20
Q

_____ anesthetics have a more narrow range of effects, usually work at synapse and primarily on post-synaptic sites, and most predominantly act by enhancing inhibitory neurotransmission (by enhancing GABAergic neurotransmission.
A. IV
B. Inhalational
C. IV and inhalational

A

A. IV

21
Q

Ketamine is an IV anesthetic but works differently than other IV anesthetics in terms of their cellular mechanism. How does ketamine work?

A

Predominantly inhibit excitatory neurotransmission at glutamatergic synapses rather than working like other IV anesthetics by enhancing GABAergic neurotransmission.

22
Q

The only general anesthetics that do not have significant effects on GABA-A or glycine receptors, but DO have effect on NMDA receptors of glutamate, are _______.

A

Ketamine and nitrous oxide

23
Q

We know that inhalational anesthetics enhance glycine’s ability to activate glycine receptors (glycine is inhibitory). Which IV anesthetics do so as well?

A

Barbiturates and propofol

24
Q

Agents that work on GABA-A to promote chloride conductance include most inhalationals as well as _____.

A

Propofol and etomidate

25
Q

Two-pore Domain Channels are K+ channels that set resting membrane potential in neurons. Anesthetics that act here are ____.

A

halogenated anesthetics

26
Q

A vesicular protein called synaptobrevin will interact with specific proteins on the nerve terminal, called _____ and SNAP-25), so that these vesicles can fuse with the presynaptic membrane and release their contents once calcium comes in.

A

Syntaxin-1

27
Q

Partition coefficients = ratio of concentrations in two tissues. Common partition coefficients for gases (inhalational anesthetics) are blood:gas, brain:blood, fat:blood. A higher Blood:Gas ratio means (more OR less) soluble in blood than air.

A

More soluble in blood than air

28
Q

Low tissue solubility means a (more rapid OR slower) recovery from anesthetics.

A

More rapid

29
Q

High tissue solubility means a (more rapid OR slower) recovery from anesthetics.

A

slower

30
Q

Local anesthetics bind to (activated OR inactivated) sodium channels.

A

Inactivated (because we want them to stay inactivated for a while to inhibit generation of action potential).

31
Q

True or False: Selectivity of effects of local anesthetics on Na+ channels is concentration dependent.

A

True

32
Q

In terms of local anesthetic action, small diameter axons are (more OR less) susceptible than larger diameter axons.

A

More

33
Q

In terms of local anesthetic action, myelinated axons are (more OR less) susceptible than unmyelinated axons.

A

More

34
Q

In local anesthetics, duration of action is (directly OR inversely) related to regional blood flow.

A

Inversely (So greater blood flow = greater dissipation of the anesthetic from the area of effect)

35
Q

_______ can be included with the local anesthetic when administering to the patient to slow the absorption rate.

A

Epinephrine (bc it vasoconstricts)

36
Q

Which local anesthetic has unique vasoconstricting effects within itself, so it doesn’t have to be administered with epinephrine?

A

Cocaine

37
Q

In terms of local anesthetic action, potency and duration of action are (directly OR inversely) proportional to hydrophobicity.

A

Directly proportional (moderate is best)

38
Q

Which of the following factors influence local anesthetic absorption and distribution?
A. Dosage
B. Epinephrine present
C. Injection site
D. Chemical properties (whether it’s hydrophobic or not)
E. All of the above

A

E. All of the above

39
Q

Which of the following is not a desired characteristic of anesthesia?
A. Rapid and pleasant induction of surgical anesthesia
B. Absence of secondary effects
C. Low therapeutic index
D. Sufficient skeletal muscle relaxation

A

C. Low therapeutic index

Neuro Exam 3 (7 decks)

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