General and Local Anesthetics

Question 1

General Anesthesia

Answer 1

reversible response of depression of CNS function resulting in loss of function and perception of external stimuli

Question 2

Local anesthetics

Answer 2

lidocaine, bupivicaine, ropivacaine, cocaine, benzocaine

Question 3

General anesthetics

Answer 3

halothane, enflurane, isoflurane, desflurane, sevoflurane, NO

Question 4

IV anesthetics

Answer 4

barbiturates, etomidate, ketamine, propofol

Question 5

Several anesthesia considerations

Answer 5

Amnesia, immobilty, attenuation of response to noxious stimuli, analgesia, unconsciousness

Question 6

Local Anest.

Answer 6

hydrophilic and lipophilic lipophilicity increases potency and duration of action (amides have two i’s in the name, esters do not)

Question 7

Local Anest.

Answer 7

hydrophilic and lipophilic lipophilicity increases potency and duration of action (amides have two i’s in the name, esters do not)

Question 8

Local Anesthesia MOA

Answer 8

decrease conduction at cell membrane, reduce or prevent Na permeability, leads to loss of sensation in the area supplied by nerve

Question 9

Local anesthesia MOA cont’d

Answer 9

anesthesia molecule gains access when the channel is open, stabilizes the inactive state, more blockage produced in highly stimulated nerves

Question 10

Routes

Answer 10

Surface: Topical, Infiltration: injected under surface, Conduction: deep injection (drug bathes nerve itself), Spinal

Question 11

Amides

Answer 11

biotransformed by liver enzymes, longer acting

Question 12

Duration of action of Local anest.

Answer 12

dependent upon- blood flow, temp. affects blood vessel size, protein binding (the stronger the bond between drug and protein on Na channel the longer the duration

Question 13

Local anest. and use with vasoconstrictor

Answer 13

ie. epinephrine, vasoconstriction, decr. systemic absorption, localized action, incr. duration of action (all local anest. are vasodilators except cocaine)

Question 14

Buffered lidocaine

Answer 14

NaHCO3 decreases pain at injection site, shortens onset, decreased stability, ph to 7.2-7.4

Question 15

Bupivicaine

Answer 15

more potent and longer acting than lidocaine, preferred for longer procedures

Question 16

ADE

Answer 16

dose related toxicity, Excitation- tachycardia/tremors, Depression-circulatory shock, respiratory depression

Question 17

General Anesthesia

Answer 17

generalized loss of felling or sensation accompanied by loss of consciousness during which surgery can be performed (no loss of consciousness with local anesthesia)

Question 18

Progression of Anesthesia

Answer 18

Induction, Maintenance, Emergence

Question 19

Mechanism of general Anesthesia

Answer 19

hyperpolarization of neurons, reduce synaptic transmission (pre-synaptic or post-synaptic)

Question 20

Molecular Targets of General Anest.

Answer 20

increase sensitivity of receptor to GABA, Inhibition of glutamate receptors (ketamine/NO)

Question 21

Inhaled Anest.

Answer 21

for maintenance of anesthesia, low TI in and out of lungs

Question 22

NO

Answer 22

weak anesthetic, gas, increased post-op NV

Question 23

Fluorinated Hydrocarbons

Answer 23

use via vaporizer, combined with NO, Very strong, increased stability, decreased toxicity, ADE-respiratory depression and malignant hyperthermia

Question 24

Isoflurane

Answer 24

most potent of the volatile anesthetics, high solubility, odorous

Question 25

Desflurane

Answer 25

rapid onset, not for induction of anesthesia

Question 26

Sevoflurane

Answer 26

for induction and maintenance, rapid onset and recovery

Question 27

IV anesthesia

Answer 27

move to lipophilic areas of CNS and spinal cord, termination of anesthesia is due to redistribution NOT metabolism

Question 28

IV anesthesia Properties

Answer 28

faster acting than inhalation, for short procedures, preferred for induction

Question 29

Brevital

Answer 29

methohexital, Barbiturate, works on GABA

Question 30

Diprivan

Answer 30

propofol, GABAa, most common for induction, hypnotic, decr. BP, respirator depression, PRIS

Question 31

Etomidate

Answer 31

GABAa, hypnotic, quick on and off, little CV effects, causes acute adrenal suppression

Question 32

Ketalar

Answer 32

ketamine, inhibits NMDA, good analgesia, amnesia, may have open eyes, increase BP and HR

Question 33

Local anesthetics

Answer 33

work by acting on Na Channels, activity is prolonged with use of vasoconstrictors like Epi

Question 34

General anesthetics

Answer 34

can be given via inhalation or IV and work primarily by acting on GABAa or NMDA receptors