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Pharmacology > Drugs In Anesthesiology > Flashcards

Drugs In Anesthesiology Flashcards

1
Q

Drugs that end in -flurane are ____

A

inhalation anesthetics

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2
Q

What are three anesthetic adjuncts?

A

Benzos
Analgesics (Opioids/NSAID’s)
Alpha 2 agonist

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3
Q

Drugs that end in -caine belong to what drug class?

A

Local anesthetics

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4
Q

Drugs that end with -curium or curonim belong to what class?

A

NM Blocking Agents

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5
Q

Dexmedetomidine belongs to what drug class?

A

alpha 2 adrenergic agonists

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6
Q

What type of sedaation produces alleviation of anxiety and pain. However, in this state, patient retains ability to maintain patent airway and is responsive to verbal commands?

A

Conscious Sedation

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7
Q

What are the five primary effects of general anesthesia?

A

1) Unconsciousness
2) Amnesia
3) Analgesia
4) Inhibition of autonomic reflexes
5) Skeletal muscle relaxation

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8
Q

True or False: Hippocampus and Amygdala are important for amnesia

A

True

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9
Q

True or False: Thalamus and brain stem are important for ANS control

A

True

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10
Q

Guedel’s Stages of Anesthesia?

A

stage 1: analgesia - pain free, without amnesia

stage 2: excitement - delirium, may vocalize. There is amnesia. RR, HR, and BP are rapid and increase.

stage 3: surgical anesthesia - slow of HR and RR; cessation of spontaneous breathing

stage 4: medullary depression - severe CNS depression (vasomotor center in medulla and respiratory center in brainstem)

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11
Q

At what Guedel stage do most surgical operations occur in?

A

Stage 3

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12
Q

True or False: Eyes become more dilated in stage 3 (surgical anesthesia)

A

True

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13
Q

Hemodynamic effects of general anesthesia?

A
  • decrease arterial BP
  • blunt baroreceptor control
  • decrease sympathetic tone
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14
Q

True or False: General anesthesia can reduce/eliminate ventilatory drive - endotrach intubation helps with this

A

True

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15
Q

Consequences of general anesthesia causing hypothermia?

A

Reduced metabolic rate and altered themoregulation

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16
Q

General anesthesia targets ___ and ___, which can lead to vomiting and nausea

A

chemoreceptor trigger zone and brainstem vomiting center

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17
Q

____: refers to use of multiple classes of drugs to achieve desired depth of anesthesia

A

Balanced anesthesia

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18
Q

What is the principal molecular target of anesthetic action?

A

Neuronal ion channels
(mediates impulse conduction in the CNS)

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19
Q

Which two channels are the primary INHIBITORY ion channels considered to be legitimate candidates of anesthetic action?

A

1) Chloride channels - GABA/Glycine-R
2) Potassium channels

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20
Q

Excitatory ion channel targets include those activated by:

A
  • Ach (nicotinic/muscarinic receptors)
  • Glutamate (AMPA)
  • Serotonin
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21
Q

What is the key factor governing the pharmacokinetics of parentral anesthetics?

A

Hydrophobicity

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22
Q

True or False: Anesthetic potency is closely correlated to lipid solubility

A

True

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23
Q

What general anesthetics have interaction sites at GABA-a receptor?

A

Etomidate
Propofol
Diazepam

  • GABA binds at b-a subunit interface in extracellular domain
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24
Q

Ketamine binds to ____ site of NMDA-R while Glycine binds to ___ site and NMDA binds to ___ site

A

Ketamine - PCP Site
Glycine - Glycine Site
NMDA - Glutamate Site

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25
Q

Which receptors requires binding of both glycine and glutamate?

A

NMDA Receptor

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26
Q

___ is redistributed after IV bolus administration. How are the kinetics described?

A

Thiopental

  • Kinetics: Three compartment model (blood/brain/skeletal muscle)
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27
Q

True or False: Thiopental is terminated by redistribution for a single IV dose

A

True

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28
Q

Do Thiopental and Diazepam have a short or long infusion duration?

A

Longer

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29
Q

_____ of a drug describes the elimination half-time after discontinuation of a continuous infusion as a function of duration of infusion

A

Context sensitive half time

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30
Q

After prolonged infusions, duration of action are dependent on interaction between….

A

1) rate of drug distribution
2) amount of drug accumulated in fat
3) drug’s metabolic rate

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31
Q

What are the three parenteral anesthetics?

A

1) Propofol
2) Etodimate
3) Ketamine

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32
Q

_____ potentiates GABA receptor and blocks Na channel and is used for INDUCING anesthesia

A

Propofol

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33
Q

What do all the parenteral anesthetics have in common?

A

-Rapid onset
-Short duration
-Often used in procedures for rapid return to pre-op mental status

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34
Q

How does the propofol dosage vary in kids vs. elderly?

A

Lower dose in elderly, higher in kids (rapid clearance)

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35
Q

_____: Rare complication associated with prolonged and high dose propofol infusion in young or head injured patients

note: associated with increased intercranial pressure

A

Propofol Infusion Syndrome

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36
Q

True or False: Ketamine stimulates GABA receptors

A

False - Etodimate and Methohexital stimulate GABA receptors

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37
Q

Which parenteral anesthetics is preferred for people with risk of hypotension or MI?

A

Etodimate

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38
Q

Which parenteral anesthetic can elevate EEG activity and is associated with SEIZURE activity?

A

Etodimate

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39
Q

If there is an asthmatic, pediatric patient at risk of hypotension, what is the best parenteral anesthetic choice for them?

A

Ketamine

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40
Q

A patient is experiencing hallucinations after receiving a parenteral anesthetic. After taking vitals, it is revealed that patient has elevated HR, BP, CO, CBF, and ICP. What parenteral was likely used?

A

Ketamine

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41
Q

True or False: Emergence delirium is seen in patients after taking Ketamine

A

True

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42
Q

Thiopental and Methohexital belong to what drug class?

A

Barbituates

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43
Q

____ is an NMDA antagonist/parenteral anesthetic while ____, a barbituate, stimulates GABA receptors

A

Ketamine = NMDA antagonist
Methohexital = GABA

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44
Q

True or False: Both Methohexital (barbituate) and Propofol (parentral) can be used for anesthetic induction

A

True

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45
Q

Why is methohexital safer for epileptic patients?

A

Respiratory and EEG depressant

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46
Q

Effect of intra-arterial injection of thiobarbituates?

A

Severe inflammation and possible necrosis

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47
Q

NO is a ___ inhalation anesthetic

A

gaseous

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48
Q

Features of volatile anesthetics?

A

-Low vapor pressures
-High BP
-Lipids at room temperature

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49
Q

Induction of anesthesia is SLOWER under what condition?

A

More soluble anesthetic gases

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50
Q

Which is more soluble (and therefore causes slower induction of anesthesia?): halothane or NO?

A

Halothane

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51
Q

True or False: NO typically has to be used with another drug

A

True

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52
Q

Induction of anesthesia is much ___ with halothane, compared to NO

A

slower

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53
Q

What three anesthetics have LOW blood solubility? HIGH blood solubility?

A

Low =NO, Desflurane, Sevoflurane
High = Halothane and Isoflurane

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54
Q

For anesthetics with ___ blood solubility, equilibrium is quickly established and the blood concentration rises rapidly

A

LOW

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55
Q

For ___ and ___, which are anesthetics that have greater solubility, more molecules dissolve in blood before partial pressure changes significantly and arterial concentration of gas increases less rapidly

A

Halothane and Isoflurane

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56
Q

How can an anesthesiologist accelerate induction?

A

Increase the inspired anesthetic partial pressure to create steeper gradient between 1) inspired and 2) alveolar partial pressure

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57
Q

How can the doctor deliver LARGER amounts of anesthetic agent FASTER?

A

Increase tidal volume and RR

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58
Q

A fourfold increase in ventilation rate nearly doubles the FA/FI ratio for ___ during first 10 minutes, but there is only a 15% increase in ratio for ___

A

halothane ; NO

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59
Q

___: the concentration of inhaled anesthetic needed to eliminate movement in 50% of patients (ED50)

A

Minimum Alveolar Concentration (MAC)

60
Q

The inverse of MAC is an index of the ____ of anesthetic

A

potency

61
Q

Numerically, MAC is __ for potent anesthetics and ___ for less potent anesthetics

A

small mac = potent (halothane)
large mac = less potent (NO)

62
Q

True or False: NO alone cannot produce anesthesia

A

True

63
Q

Are less soluble anesthetics (such as NO or Desflurane) eliminated faster or more slowly compared to soluble ones?

A

Faster

64
Q

Insoluble anesthetics that prefer the __ phase over blood and will rapidly diffuse into alveolus and be removed from body via: lung ventilation

What is one of the most important factors governing the rate of recovery?

A

gas

  • Blood: gas partition coefficient
65
Q

Since the concentration of anesthetic in the inspired as cannot be reduced below zero, ___ is the only way to speed recovery

A

hyperventilation

Note: metabolism does NOT play a significant role

66
Q

Four types of ACUTE toxicity that result from anesthetic agents?

A

1) Nephrotox
2) Hematotox
3) Malignant Hyperthermia (genetic disorder of skeletal muscle that occurs in certain people exposed to VOLATILE anesthetics_
4) Hepatotox (halothane hepatitis) - most potent volatile anesthetic

67
Q

Isoflurane, Enflurane, Sevoflurane, and Desflurane belong to what drug class?

A

Inhalation Anesthetics

68
Q

What is the most commonly used inhalation anesthetic? What does it do?

A

Isoflurane
- maintains anesthesia

69
Q

True or False: Isoflurane is a positive modulator of GABA-A

A

False - Enflurane is !

70
Q

Which inhalation anesthetic increases GABA release and glutamate re-uptake potentiate glycine receptor activity (decreases motor function)?

A

Isoflurane

71
Q

Which inhalation anesthetic decreases baroreceptor function?

A

Isoflurane

72
Q

Which inhalation anesthetic can increase intracranial pressure and cause seizures?

A

Enflurane

73
Q

Clinical application of both Isoflurane and Enflurane?

A

Maintain anesthesia

74
Q

True or False: Both Sevoflurane and Desflurane can be used for outpatient surgeries (rapid onset, rapid recovery)

A

True

75
Q

Which inhalation anesthetic would you select for a patient with myocardial ischemia?

A

Sevoflurane

76
Q

___, an inhalation anesthetic, is an airway irritant

A

Desflurane

77
Q

___ is a weak inhalation anesthetic agent used for weak analgesic effects (dental) - it is also used as ADJUNCT to other anesthetics

A

NO

78
Q

What patient populations should not have NO?

A
  • Ear or bowel obstructions
  • Intraocular and intracranial air bubbles
79
Q

When discontinuing ____, administer 100% oxygen to avoid diffusional hypoxia. This drug can also increase CBF and ICP.

A

NO

80
Q

A nondepolarizing blocker prevents the opening of the _____ channel upon binding by blocking __ from binding

A depolarizing blocker will both ___ the receptor and block the ____ channel

A

sodium; Ach

note: If ach can’t bind, channel does not open

occupy; sodium channel

81
Q

What type of NM Blocking agent is Succinylcholine? Clinical use?

A

Depolarizing blocker

  • Clinical use: Place endotracheal tube
82
Q

True or False: Surgical relaxation is just one use of NM Blocking Drugs

A

True
(particularly for: intra-abdominal and intra-thoracic procedures)

  • Blocks skeletal muscle activation
83
Q

Uses of NM Blocking Agents?

A

1) Surgical Relaxation
2) Endotracheal Intubation
3) Control of ventilation
4) Treating convulsions
- Used to attenuate peripheral (motor) manifestations of convulsions

84
Q

True or False: NM Blocking Agents cross BBB

A

False - they do NOT

85
Q

______ is a depolarizing NM blocker that allows for persistent depolarization at the NMJ. It is commonly used to place endotracheal tube.

A

Succinylcholine

86
Q

Succinylcholine is rapidly metabolized by ___

A

cholinesterase

87
Q

Toxicities associated with succinylcholine?

A

Arrythmia
Hyperkal
Increased intraocular pressure
Increased intraabdominal pressure
Post-op pain

88
Q

What drug class do atracurim, vecuronium, rocuronium, pipercuronium, etc. belong to?

A

Non-depolarizing NM Blocking Agents
(competitive antagonists at nAch-R, esp NM Junction)

89
Q

Clinical use of Non-depolarizing NM Blocking Agents?

A

Prolonged relaxation for surgical procedures

90
Q

How do you reverse the actions of Rocuronium and Vecuronium?

A

Sugammadex

91
Q

True or False: An AchE Inhibitor (neostigmine) + muscarinic receptor antagonist can be used to reverse actions of non-depolarizing NM Blocking Agent

A

True

92
Q

Sugammadex encapsulates and prevents ___ molecules from binding to ___ receptors

Encapsulated ___ is inactivated and cleared

A

NMBA; Ach

93
Q

Sugammadex encapsulates ___ or _____ in plasma at 1:1

A

rocuronuium or vercuronium

94
Q

True or False: Sugammadex is a competitive inhibitor of rocuronuium and vercuronium

A

False - non-competitive

95
Q

Role of Sugammadex?

A

Reversal of NM Blockade

96
Q

Bradycardia, hypersensitivity, and recurrence of NM blockade are side effects of which NMBA inhibitor?

A

Sugammadex

97
Q

What three benzodiazepines are used as anesthetic adjuncts?

A

1) Midazolam
2) Diazepam
3) Lorazepam

98
Q

How do benzodiazepines work?

A

Enhance GABA

99
Q

Most commonly used anesthetic adjunct/benzo

A

Midazolam

100
Q

Uses of benzos, an anesthetic adjuncts?

A

1) Amnesia
2) Anxiety
3) Pre-anesthesia sedation
4) Sedation in procedures where general anesthesia is not needed

101
Q

_____ is an alpha-2 adrenergic agonist that is used as an anesthetic adjunct

A

Dexmedetomidine

102
Q

Uses of dexmedetomidine (alpha-2 adrenergic agonist)?

A

1) Short term sedation in critically ill adults
2) Sedation prior to surgery

103
Q

Why can dexmedetomidine cause hypotension and bradycardia?

A

Decreased catecholamine release in CNS

104
Q

True or False: Both opioids and NSAID’s are analgesics

A

True

105
Q

What are three opioids commonly used in surgery?

A

1) Fentanyl
2) Merperidine
3) Morphine

  • All bind to opioid receptor agonist
106
Q

Clinical application of opioids in surgery?

A
  • Reduce anesthetic requirement
  • Minimize hemodynamic changes to painful stimuli
107
Q

____ are the primary analgesic during peri-operative period

A

Opioids

108
Q

Opioids are often administered ___ and ___ for managing acute and chronic pain

A

intrathecally ; epidurally

109
Q

___ is a cox inhibitor that is used for minor surgical procedures to control post-op pain

A

Acetaminophen

110
Q

Role of oxygen as a therapeutic gas?

A

-Reverse or prevent hypoxia

111
Q

How can excessive O2 affect ventilation, HR, and CO?

A

Decrease it

112
Q

True or False: If you are administering O2 for more than 1 hr to a patient, it should be humidified

A

True

113
Q

Clinical uses of CO2?

A

1) Insufflation during endoscopic procedures
2) Flooding surgical field during cardiac surgery
3) Adjusting pH during cardiopulm bypass

114
Q

Net effect of CO2 on CO, HR, and BP?

A

Increase all

115
Q

What are the three structural regions that make up local anesthetics?

A

1) Hydrophobic/Aromatic ring
2) Linker Region - less sensitive to breakdown
3) Substituted Amine - hydrophillic (keep in solution)

116
Q

Local anesthetics bind inside of the ____ channel and block ___ entrance. This prevents neuronal depolarization and AP formation, thus blocking pain signal transmission

A

ion channels; sodium

117
Q

True or False: Local anesthetics work by causing neuronal depolarization and action potential formation, thereby BLOCKING transmission of pain signals

A

False - Local anesthetics work by PREVENTING neuronal depolarization and action potential formation, thereby BLOCKING transmission of pain signals

118
Q

True or False: The un-protonated form of LA crosses into intracellular membrane via lipid membrane, become protonated, then blocks receptor intracellularly

A

True

119
Q

Where are local anesthetics most likely to be absorbed?

A

Intercostal region

120
Q

Anesthetics that are more lipid soluble are generally more ___, have ____ duration of action, and take ___ to achieve clinical effect

A

potent; longer ; longer

121
Q

When used for major conduction blocks, local anesthetics will mostly be absorbed ____, and will not be absorbed much in ____/____ region

A

intercostal (highest serum level); femoral/sciatic

122
Q

Local Anesthetic blockage is ___ and ___ dependent

A

voltage; time

123
Q

How does the repetitive activity, as seen in local anesthetic, affect sodium channel block?

A

Pulses rapidly decrease, leading to a block

124
Q

When local anesthetics are injected extradurally, it is referred to as a ___ block

A

epidural block

125
Q

A ____ is a specific type of epidural block in which a needle is inserted into caudal canal via sacral hiatus

A

Caudal Block

126
Q

Injections around peripheral nerves is known as ___ blocks

A

perineural blocks

127
Q

Injection into CSF in the subarachnoid space is referred to as ____ block

A

spinal block

128
Q

What two systemic effects that are associated with local anesthetics?

A

1) CNS Toxicity - sedation, light-headed, disturbances, restless
2) Cardiotoxicity (effect on NE/Epi)

129
Q

What types of neurotoxicity can result from use of LA?

A

1) Neural Injury
2) Transient neurological symptoms

130
Q

Transient pain/dysesthesia has been linked to use of ___ for spinal anesthesia

A

lidocaine

131
Q

Lidocaines, Prilocaines, etc. (-caines) block ___ channels

A

sodium

132
Q

The alveolar anesthetic concentration (Fa) approaches the inspired anesthetic concentration (FI) fastest for the ____ soluble agents

A

LEAST

133
Q

How does Isoflurane affect ventilation, RBF?

CBF, BP, and coronary blood flow?

A

Isoflurane will:
- Decrease ventilation and RBF
- Increase CBF
- Can induce HYPOTENSION
- Increase coronary blood flow (and therefore, decrease myocardial O2 consumption)

note: it’s excreted by lungs unchanged

134
Q

What is the preferred agent for anesthetic induction?

A

Sevoflurane

135
Q

What three drug classes are adjuncts?

A

1) Benzos (lams/pams)
2) alpha 2 adrenergic agonists
3) Analgesics (opioids and NSAIDs)

136
Q

What three drugs make up the SHORT-DURATION amides? How do they work?

A

1) Lidocaine
2) Prilocaine
3) Mepivacaine

Block Na channels
- can last longer w epi

Toxicity: CNS excitation w high volume blocks; local neurotoxicity

137
Q

Which TWO short acting amides are associates with the risk of methemoglobinemia?

A

1) Prilocaine
2) Mepvicaine

138
Q

What are the three longer-acting amide drugs?

A

Bupivacaine
Rapivacaine
Levobupvicaine

Not often used topically or intravenously (short acting ones, by contrast, are)

139
Q

AE associated with long acting amides?

A

CNS excitation and cardiovascular collapse with high volume blocks

140
Q

____ is a amide that is commonly used as a dental anesthetic

A

Articaine

141
Q

True or False: Chloroprocaine has the same toxicities associated with lidocaine

A

True

142
Q

True or False: Procaine is used epidurally

A

False

143
Q

True or False: All the ester and amide drugs block Na channels

A

True

144
Q

Which ester is primarily used for spinal anesthesia?

A

Tetracaine

145
Q

True or False: Both Chloroprocaine and Procaine are use topically or intravenously

A

False - they are NOT

146
Q

True or False: Benzocaine is exclusively used for topical anesthesia

A

True

Pharmacology (53 decks)

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