Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesia Pharmacology > Cumulative Final (Exam 4) > Flashcards

Cumulative Final (Exam 4) Flashcards

1
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Max dose for neostigmine and edrophonium?

A

Neostigmine: 50 mcg/kg or 5 mg
Edrophonium: 1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the dosage of edrophonium?

A

1 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the formula for glycopyrrolate to be used with a NMB reversal drug?

A

0.2 mg of glycopyrrolate / mg of neostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What drugs would be coupled with NMBD reversal agents to prevent adverse side effects from these drugs?

A

Anti-cholinergic / Anti-muscarinics

  • Atropine for edrophonium
  • Glycopyrrolate for neostigmine and pyridostigmine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the dose of atropine for use with edrophonium?

A

10 mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the max dose for glycopyrrolate?

A

1 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is sugammadex contraindicated?

A

Renal impairment on dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the Sugammadex dose for a moderate block?

A

2 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the Sugammadex dose for a deep block?

A

4 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dose Dependent Effects of Lidocaine if plasma lidocaine concentration is 1-5 mcg/ml.

A

Analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dose Dependent Effects of Lidocaine if plasma lidocaine concentration is 5-10 mcg/ml.

A
  • Circum-oral numbness
  • Tinnitus
  • Skeletal muscle twitching
  • Systemic hypotension
  • Myocardial depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dose Dependent Effects of Lidocaine if plasma lidocaine concentration is 10-15 mcg/ml.

A
  • Seizures
  • Unconsciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dose Dependent Effects of Lidocaine if plasma lidocaine concentration is 15-25 mcg/ml.

A
  • Apnea
  • Coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dose Dependent Effects of Lidocaine if plasma lidocaine concentration is >25 mcg/ml.

A
  • Cardiovascular Depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which 3 LA will have the highest protein binding?

A

Levobupivacaine (>97%)
Bupivacaine (95%)
Ropivacaine (94%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lipid solubility correlates to _______ of the drug.

Which LA has the highest lipid solubility?

A

potency

Tetracaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MOA of Local Anesthetics

A
  • Binds to voltage-gated Na+ channels (must be inactivated and closed)
  • Block/inhibit Na+ passage in nerve membranes

LA must be non-ionized and lipid-soluble to go through the cell membrane and block the Na+ gated channel from within the cell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which nerve fibers are blocked most rapidly?

A

Pre-ganglionic B fibers (SNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which patient population will have increased sensitivity and require a smaller dose?

A

Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List the uptake of Local Anesthetics Based on Regional Anesthesia Technique from highest blood concentration to lowest blood conc.

A

“I Tried Coffee Plus Espresso, But Shaky Start!”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which LA will metabolize the fastest?

A

Chloroprocaine d/t the 0% of protein binding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Metabolism of Amides.
Location of Metabolism:
Most rapidly metabolized drug:
Intermediate:
Slow:

A

Location of Metabolism: Microsomal enzyme (Liver)
Most rapidly metabolized drug: Prilocaine
Intermediate: Lidocaine, Mepivacaine
Slow: Levobupivicaine, Bupivacaine, Ropivacaine

Metabolism is dependent on protein binding! Less protein bound → higher plasma conentration → more metabolized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Metabolism of Esters?
Exception?

A

Hydrolyzed by cholinesterases in plasma, except cocaine which is metabolized by the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the metabolite of esters?

What is the significance of this metabolite?

A

ParaAminoBenzoic acid (PABA)
Allergic reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is Lidocaine max infiltration dose (plain and w/ epi)?

A

Maximum infiltration dose:
300 mg plain
500 mg with EPI (Rate of distribution is slower with epinephrine, so we can give more lidocaine.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Prilocaine metabolite.

What is the issue with this metabolite?

A

Metabolite: Ortho-toluidine

The metabolite oxidizes Hemoglobin to Methemoglobin, resulting in Methemoglobinemia (doses > 600 mg can cause symptoms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Treatment of Prilocaine induced methemoglobinemia?

A

Methylene Blue
1 to 2 mg/kg IV over 5 mins (initial dose) - dont exceed 7-8mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Procaine Metabolite:

A

Procaine Metabolite: PABA (ester anesthetics), excreted unchanged in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What makes Benzocaine unique?

A

Weak acid instead of a weak base, like most LA.
pKa = 3.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Ester or amide determination is based upon which portion of the molecular structure?

A

Intermediate chain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the ester and amide local anesthetics?

A

Amides (have 2 i’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What adjuvant medications prolong the duration of local anesthetics?

A
  • Dexmedetomidine
  • Magnesium
  • Clonidine
  • Ketamine
  • Dexamethasone
34
Q

Compute 1:10,000 Epi to mcg/mL

A

1,000,000/ 10,000 = 100

100 mcg/mL

35
Q

Compute 1:1000 Epi to mcg/mL

A

1,000,000/ 1000 = 1000

1000 mcg/mL

This is the epinephrine that we find in our crash carts.

36
Q

0.25% concentration is how many mg/mL

37
Q

1% concentration is how many mg/mL?

38
Q

2% concentration is how many mg/mL?

A

20 mg/mL

2% lidocaine is the most common concentration used in the OR

39
Q

Lidocaine Recommended Max Single Dose:

Lidocaine Recommended Max Single Dose with/Epi

Lidocaine Recommended Max Single Dose for Spinal

A

300 mg

500 mg w/ Epi

100 mg

40
Q

Bupivacaine Recommended Max Single Dose

Bupivacaine Recommended Max Single Dose with/Epi

Bupivacaine Recommended Max Single Dose for Spinal

A

175 mg

225 mg w/ Epi

20 mg

41
Q

Which anesthetic is great with surface anesthesia?

A

Lidocaine (2-4%)

42
Q

What is an LTA?

A
  • Lidocaine tracheal anesthesia
  • Localized tracheal anesthesia
43
Q

Order of blockade during Peripheral Nerve Block?

A

The proximal area (site of LA administration) is affected first and then distal.

44
Q

When the peripheral nerve block is wearing off, what comes back first? Proximal or Distal?

A

Proximal comes back first & then distal.

45
Q

What is a Region Bier Block?

A

Bier Block IV injection of LA into an extremity isolated from the rest of the systemic circulation with a tourniquet.

Sensation and muscle tone dependent on tourniquet

46
Q

What is the sequence of blockades for a segmental block in Neuraxial Anesthesia? What nerves are involved?

A
  1. SNS (Myelinated preganglionic B fibers)
  2. Sensory (Myelinated A, B fibers, unmyelinated C fibers)
  3. Motor (Myelinated A-δ and unmyelinated C fibers)
47
Q

For SAB, the _______ effect is 2 spinal segments cephalad of the sensory block.

For SAB, the _______ effect is 2 spinal segments below the sensory block.

48
Q

What dermatomes correspond with our cardiac accelerator?

49
Q

SAB Dose:
5 ft = ____ mL of 0.75% Bupivacaine
Add ____ mL for every inch above 5 ft

A

1 mL
0.1 mL

For someone who is 5’5”, you will give 1.5 mL of bupivacaine for a SAB.

50
Q

What is the difference between SAB and epidural blocks?

A

No differential zone of SNS, sensory, and motor blockade.

51
Q

What makes up the tumescent solution?

A
  • Diluted Lidocaine (0.05% to 0.1%)
  • Epinephrine 1:100,000
52
Q

Highly diluted Lidocaine with Epi Tumescent dose (mg/kg).

A

35 to 55 mg/kg

53
Q

What is the theory with the Tissue Buffering System?

A

1 gram of SQ tissue can absorb up to 1 mg of Lidocaine

54
Q

Which class of local anesthetic is more prone to an allergic reaction?

A

Esters d/t to the PABA metabolite

55
Q

What two factors predispose our OB population to LA toxicity?

A. ↓ Plasma Esterase
B. ↓ Plasma Proteins
C. ↑ Plasma Esterase
D. ↑ Plasma Proteins

56
Q

What is the MOA of Intralipids?

A

Creates lipid compartment, provides for fat for myocardial metabolism, and encapsulates LA

57
Q

Intralipid
Bolus Dose:
Infusion Dose:
1st 30 minutes:

A

Intralipid
Bolus Dose: 1.5 mL/kg of 20% lipid emulsion
Infusion Dose: 0.25/mL/kg/min for at least 10 mins
1st 30 minutes: 10 mL/kg MAX

58
Q

What is Methemoglobinemia?

Methemoglobinemia can be caused by what LA?

A

Potentially life-threatening complication d/t ↓ O2 carry capacity (metHb > 15%)

Can be caused by Prilocaine and Benzocaine

59
Q

What is the treatment for Methemoglobinemia?

How fast can this reversal take place?

A

Methylene Blue: 1 mg/kg over 5 mins (max 7 to 8 mg/kg)

Fe3+ (Ferric) can be reduced to Fe2+ (Ferrous) within 20 to 60 minutes.

60
Q

Cocaine-Associated Chest Pain Flow Chart.

Another one to memorize.

61
Q

Addition of epinephrine can do what to the systemic absorption of LA?

A

Decrease systemic absorption by 1/3

62
Q

How will β blockers affect the cardiac foci action potential?
What does this lead to?

A
  • Prolong Phase 4
  • ↓ dysrhythmias during ischemia and reperfusion (less excitable during the refractory period)
63
Q

What is SCIP?
Describe the protocol and its goals.

A
  • Surgical Care Improvement Protocol
  • β-blockers must be given within 24 hrs of surgery for patients at risk for cardiac ischemia and ones already on β-blocker therapy.
64
Q

What were the three β1 selective agents discussed in lecture?

A
  • Atenolol
  • Metoprolol
  • Esmolol
65
Q

What non-selective β-blocker has active metabolites and is generally shitty for anesthesia?

A

Propanolol

Propanolol is the prototypical BB

66
Q

Differentiate the clearance mechanisms of metoprolol, atenolol, and esmolol.

A
  • Metoprolol = Hepatic
  • Atenolol = Renal
  • Esmolol = Plasma cholinesterases
67
Q

What drug is the most selective β1 antagonist?

68
Q

What two scenarios were given in class for a β1 indication over a non-selective β blocker?

A
  • DM: β2 can cause hypoglycemia by insulin potentiation
  • Airway: β2 potentiates bronchospasm
69
Q

Is phenylephrine primarily a venoconstrictor or an arterioconstrictor?

A

Venous constriction > arterial constriction

70
Q

What is the ratio of β to α blockade for Labetalol?

71
Q

Which drug is an indirect acting sympathomimetic?
MOA?

A

Ephedrine

Causes release of NE from postganglionic SNS nerves

72
Q

Which SNS agonist can be given IM?
Why would this be done?

A
  • Ephedrine IM 50mg
  • Long lasting increase in BP for OB patients who are recieving a spinal anesthetic (C section)
73
Q

What is the preferred sympathomimetic for parturient patients?
Why?

A

Ephedrine (It doesn’t effect uterine blood flow)

74
Q

What drug would be utilized for catecholamine-resistant hypotension?

A

Vasopressin

75
Q

What drug would be used for ACE-Inhibitor induced resistant hypotension?

A

Vasopressin

Can occur with both ACEi and ARBs.

76
Q

What does nitroprusside vasodilate?

A

Arterial and venous vasculature

77
Q

What vasodilator absolutely requires arterial line monitoring?

A

Nitroprusside, due to the immediate onset and transient duration

78
Q

Where does nitroglycerin work?

A
  • Large coronary arteries
  • Venous capacitance vessels
79
Q

What is the firstline treatment for sphincter of Oddi spasm?
What is second?

A
  • Glucagon
  • Nitroglycerin
80
Q

Which CCB has the greatest coronary artery dilation and least myocardial depression?

A

Nicardipine

81
Q

Side effects of vasopressin?

A
  • Coronary artery vasoconstriction
  • Stimulates GI smooth muscle
  • Decreased PLT counts (not clinically significant)
82
Q

Your end stage COPD patient needs emergent BP control. Which medication could worsen his PaO2?
NTG
Nitroprusside
Hydralazine
Labetalol

A

Nitroprusside - release of CN causes O2 dissociation from Hb

Anesthesia Pharmacology (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions