chapter 11 and 16- local and general anesthetic pharmacology

Question 1

what inhaled general anesthetic can be used to treat malignant hyperthermia caused by inhaled general anesthetics

Answer 1

dantrolene

Question 2

what is a contraindication for enflurane use

Answer 2

seizures and epilepsy

Question 3

what additional adverse effect can halothane cause (in addition to those of isoflurane and enflurane)

Answer 3

hepatitis and fatal hepatic necrosis

Question 4

what are some adverse effects seen with nitrous oxide use

Answer 4

expansion of air cavities (pneumothorax, obstructed middle ear, obstructed loop of bowel, intracranial air)

Question 5

what type of spasms can desflurane cause

Answer 5

laryngeal

Question 6

what intravenous general anesthetic can be used for sedation of mechanically ventilated patients

Answer 6

propofol

Question 7

what are some adverse effects seen with propofol

Answer 7

cardiovascular and respiratory depression; injection-site reaction

Question 8

what are some clinical uses for thiopental besides induction of anesthesia

Answer 8

narcoanalysis, elevated intracranial pressure, seizure

Question 9

what intravenous general anesthetic can have adverse effect of laryngeal spasm, hemolytic anemia, and radial neuropathy

Answer 9

thiopental

Question 10

what are some contraindications for thiopental use

Answer 10

acute intermitted porphyria or variegate porphyria

Question 11

what is an ultra-short acting barbiturate capable of inducing surgical anesthesia within seconds

Answer 11

thiopental

Question 12

what IV anesthetic can be used for rapid sequence intubation

Answer 12

etomidate

Question 13

what IV anesthetic can cause myoclonus

Answer 13

etomidate

Question 14

what does etomidate bind to

Answer 14

interface between the alpha and beta subunits of the GABAa receptor

Question 15

what IV anesthetic can cause minimal cardiopulmonary depression

Answer 15

etomidate

Question 16

what IV anesthetic may cause the patient to be awake but is not actually awake, and what is the term to describe this

Answer 16

ketamine: term to describe this is dissociative anesthesia/analgesia

Question 17

what IV anesthetic can cause increased intracranial pressure, hallucinations, vivid dreams, psychiatric symptoms

Answer 17

ketamine

Question 18

what is a contraindication for ketamine use

Answer 18

severe hypertension

Question 19

what does ketamine antagonize

Answer 19

NMDA receptor

Question 20

how does ketamine increase cardiac output

Answer 20

by increasing sympathetic outflow

Question 21

what IV anesthetic can be particularly useful in emergency trauma situations

Answer 21

ketamine

Question 22

what medication can reverse benzodiazepine effects

Answer 22

flumazenil

Question 23

what medication reverses the action of opioids

Answer 23

naltrexone

Question 24

what solubility determines onset/offset

Answer 24

solubility of gas for blood

Question 25

what solubility of gas determine potency

Answer 25

solubility of gas for lipids

Question 26

what local anesthetics are amides

Answer 26

lidocaine, mepivacaine, bupivacaine

Question 27

what amide local anesthetic is most cardiotoxic

Answer 27

Bupivacaine

Question 28

what local anesthetics are esters

Answer 28

procaine, cocaine, benzocaine, tetracaine

Question 29

how do you treat methemoglobinemia caused by local anesthetics

Answer 29

methylene blue

Question 30

describe the onset and recovery with propofol

Answer 30

rapid onset and rapid recovery

Question 31

what side effect can propofol particularly cause in children

Answer 31

acidosis

Question 32

describe the onset and recovery with etomidate

Answer 32

rapid onset and moderately fast recovery

Question 33

describe the onset and recovery with ketamine

Answer 33

moderately rapid onset and recovery

Question 34

describe the onset and recovery of fentanyl, remifentanil, aifentanil

Answer 34

slow onset and recovery

Question 35

describe the onset and recovery with thiopental

Answer 35

rapid onset and recovery

Question 36

describe the onset and recovery with midazolam, lorazepam

Answer 36

slow onset and recovery

Question 37

describe the onset and recovery with sevoflurane

Answer 37

rapid onset and recovery

Question 38

describe the rate of onset and recovery with osoflurane

Answer 38

medium rate of onset and recovery

Question 39

what inhaled anesthetic is most likely to cause hepatotoxicity

Answer 39

halothane

Question 40

what inhaled anesthetic is most likely to cause nephrotoxicity

Answer 40

methoxyflurane

Question 41

what type of procedures is thiopental best for

Answer 41

short surgical procedures

Question 42

what is midazolam used most for

Answer 42

endoscopy; used adjectively with gaseous anesthetics and narcotics

Question 43

what is the order of loss with local anesthetics

Answer 43

pain, temperature, touch, pressure (in order from first to last)

Question 44

what local anesthetic is most likely to adversely cause severe cardiovascular toxicity

Answer 44

bupivacaine

Question 45

what local anesthetic is most likely to adversely cause methemoglobinemia

Answer 45

benzocaine

Question 46

what local anesthetic is most likely to adverse cause arrhythmias

Answer 46

cocaine

Question 47

What is the mechanism of action of ester-linked local anesthetic

Answer 47

Inhibit voltage-gated sodium channels in excitable cell membranes

Question 48

What ester linked local anesthetic is given epidurally before delivery (pregnancy delivery)

Answer 48

2-chloroprocaine

Question 49

What ester linked local anesthetic can cause contact dermatitis

Answer 49

Procaine, 2-chloroprocaine

Question 50

What ester linked local anesthetic can cause drug-induced keratoconjunctivitis

Answer 50

Tetracaine

Question 51

Who should you avoid large doses of tetracaine in

Answer 51

Patients with heart block

Question 52

What ester linked local anesthetic can be used for diagnosis of horners syndrome pupil

Answer 52

Cocaine

Question 53

What local anesthetic is also a class 1 antiarrhythmic medication

Answer 53

Lidocaine

Question 54

What may need to be co-administered with lidocaine in order to prolong duration of action

Answer 54

Epinephrine

Question 55

What local anesthetic is most commonly used for dental infiltration anesthesia

Answer 55

Prilocaine

Question 56

What local anesthetic is used for infiltration, regional, epidural, and spinal anesthesia as well as sympathetic nerve block

Answer 56

Bupivacaine

Question 57

What is the primary use for articaine

Answer 57

Dentristry

Question 58

What are some adverse effects of articaine

Answer 58

Infection at site of injection (especially lumbar puncture sites); shock

Question 59

What general anesthetic is often used in pediatrics due to its non-irritating smell

Answer 59

Halothane