General and Local Anesthetic Pharm

Question 1

General Anesthetics Channel Examples

Inhibitory (2) Excitatory (3)

Answer 1

Inhibitory Receptors (activated)
Chloride Channels: GABAa and glycine receptors
Potassium Channels

Excitatory Receptors (inhibited)
Acetylcholine
Amino Acids: AMPA, NMDA
Serotonin: 5-HT 2/3

Question 2

Blood:Gas Partition Coefficient Description
Anesthesia Onset (1) Solubility Effects (2)

Answer 2

Inverse relationship between coefficient and rate of anesthesia onset

High blood solubility, slow onset of action
Low blood solubility, fast onset of action

Question 3

Minimum Alveolar Concentration

Definition (3) Use Explanation (2)

Answer 3

Anesthetic potency:
Minimum amount required to prevent response so surgical incisions (ED50)
Volume of air required for response

Higher MAC means less potent and less complete anesthesia
Lower MAC means more potent and more complete anesthesia

Question 4

Inhaled Anesthetics

Examples (6) with MAC Volume %

Answer 4

Nitrous oxide: >100%

Desflurane: 6-7%

Sevoflurane: 2%

Enflurane: 1.7%

Isoflurane: 1.4%

Halothane: .75%

Question 5

Inhaled Anesthetics Side Effects (4)

Answer 5

N/V
Hepatitis (Halothane)
Renal Toxicity from Flourine (-flurane drugs)
Malignant Hyperthermia (Dantrolene antidote)

Question 6

Etomidate

MOA (2) Kinetics (2) Benefit, Adverse Effect

Answer 6

GABAa agonist
GABA enhancement

Rapid onset
Moderately fast recovery

Provides CV stability

Adrenocortical suppression (11-Beta hydroxylase)

Question 7

Ketamine

MOA, Kinetics (2) Other Effects (2) Benefit, Adverse Effects (2)

Answer 7

NMDA antagonist

Moderately rapid onset
Moderately fast recovery

CV stimulation
Increased cerebral bloodflow

Profound Analgesia

Slow nystagmic gaze
Emergence reaction (dissociation)

Question 8

Propofol

MOA, Kinetics (3) Indications (2) Adverse Effects (3)

Answer 8

GABAa agonist

Rapid onset (30 seconds)
Rapid recovery
Low Context sensitive half-life

Induction and maintenance of anesthesia
Anti-emetic

Hypotension
Respiratory depression
Allergic reactions to solubility agents

Question 9

Local Anesthetics

MOA, Routes of Administration (3) Side Effects (5)

Answer 9

Block inactivated, voltage gated Sodium channels

Topical
Injection
IV Regional (Bier Block)

Hypotension (except cocaine)
Sleepiness
Nystagmus
Muscular twitching
Convulsions

Question 10

Amide Local Anesthetics

Examples (5) with Duration of Action

Answer 10

Mepivacaine (medium acting)
Articaine (medium acting)
Lidocaine (medium acting)

Bupivacaine (long acting)
Ropivacaine (long acting)

Question 11

Ester Local Anesthetics

Examples (4) Side Effects (2)

Answer 11

Benzocaine (surface use only)
Procaine (short acting)
Cocaine (medium acting)
Tetracaine (long acting)

Allergic reactions
Cocaine causes Vasoconstriction and can cause HTN Crisis

Question 12

Fentanyl

MOA, Kinetics (2) Indications (3) Adverse Effect

Answer 12

strong mu opioid agonist

Slow onset
Slow recovery

Conscious sedation
General anesthesia adjunct
Perioperative analgesia

Respiratory depression

Question 13

Midazolam

MOA, Kinetics (2) Reversal Agent, Benefits (2)

Answer 13

Increased GABAa sensitivity to GABA

Slow onset
Slow recovery

Flumazenil

CV stability
Marked amnesia

Question 14

Intravenous General Anesthetic

Examples (5)

Answer 14

Propofol
Ketamine
Etomidate
Midazolam
Fentanyl

Question 15

Local Anesthetics
Coadministered drugs (2) with Effects (3) and Contraindication (2)

Answer 15

Vasoconstrictors (Epi/NE)

Avoids systemic side effects
Decreases blood loss
Prolongs effects

Not used in areas with poor circulation (periphery)
Can cause ischemic gangrene