General And Local Anesthetics CIS Flashcards
List inhaled anesthetics
Desflurane Enflurane Halothane Isoflurane Nitrous oxide Sevoflurane
List intravenous anesthetics
Dexmedetomidine Diazepam (valium) Etomidate Fentanyl Fospropofol Ketamine Lorazepam (Ativan) Methohexital Midazolam (Versed) Propofol (Diprivan) Thiopental
List local anesthetics
Articaine Benzocaine Bupivacaine Chloroprocaine Cocaine Dibucaine Levobupivacaine Lidocaine Mepivacaine Procaine (Novocain( Proparacaine Ropivacaine Tetracaine
Chemical with which blood:gas partition coefficient will reach highest concentration in brain the fastest? (Assume brain:blood partition coefficients are equal) A. 0.42 B. 0.47 C. 0.69 D. 1.4 E. 1.8
*A. 0.42* - desflurane B. 0.47 - nitrous oxide C. 0.69 - sevoflurane D. 1.4 - isoflurane E. 1.8 0 enflurane
Two inhaled general anesthetics (X and Y) have following MAC values:
X: MAC - 2%
Y: MAC - 100%
Based on this, which statement is true?
A. Drug X has a longer duration of action than drug Y
B. Drug X is more soluble in blood than drug Y
C. Drug Y causes greater general analgesia and skeletal muscle relaxation than drug X
D. Concentration of drug in inspired air that is needed to cause adequate anesthesia is higher for drug Y than for drug X
E. Time to onset of adequate anesthesia is 50 times longer for drug Y than for drug X
D. Concentration of drug in inspired air that is needed to cause adequate anesthesia is higher for drug Y than for drug X
68 y/o hospitalized female develops general malaise, fever (38.2 C, 100.7 F), nausea, vomiting, jaundice, and a skin rash 4 days after undergoing surgery to remove a uterine myoma. Emergency lab exams show:
Aspartate aminotransferase: 240 U/L (Females: 8-40 U/L)
Alkaline phosphatase: 380 U/L (25-100 U/L)
The patient’s condition rapidly deteriorates and coma ensues. which of the following drugs most likely caused her syndrome?
A. Fentanyl B. Halothane C. Isoflurane D. Nitrous Oxide E. Thiopental
B. Halothane
Common side effects include nausea and vomiting
Halothane may cause hepatitis (halothane hepatitis:
1. May occur with or without prior halothane exposure (more rare)
2. Symptoms develop 2 days to 3 weeks after exposure (nausea, myalgias, rash, eosinophilia, jaundice, elevated liver enzymes)
3. Other inhaled anesthetics are less hepatotoxic
Agents metabolized to products including fluoride ions may cause renal toxicity (enflurane and sevoflurane)
19 y/o female is admitted to ambulatory surgery center for strabismus surgery to correct misalignment of her extraocular muscles. She is otherwise healthy, and all laboratory values are within normal limits. Which intravenous induction agent may be used that is rapid in both onset and recovery and has antiemetic actions? A. Halothane B. Nitrous oxide C. Procaine D. Propofol E. Sevoflurane
D. Propofol - rapid onset and rapid recovery. Used in induction and for maintenance, can cause hypotension, has useful antiemetic action
A patient on trauma-burn unit received a drug to ease pain of debridement and dressing changes for several severe burns. He experiences good, prompt analgesia, but despite near absence of pain, his heart rate and blood pressure rises considerably, consistent with sympathetic nervous system activation. As effects of the drug develops, his skeletal muscle tone progressively increases. He appears awake at times because his eyes periodically open. As drug effects wear off, he hallucinates and behaves in a very agitated fashion. Hallucinations, bad dreams, and periods of delirium recur over several days after receiving the drug. What drug was most likely given? A. Fentany B. Ketamine C. Midazolam D. Succinylcholine E. Thiopental
B. Ketamine - moderately rapid onset and recovery. CV stimulation, increased cerebral blood flow, and emergence reactions that impair recovery
27 y/o female undergoes a minor suture procedure for a skin cut on her R leg. A local anesthetic is injected around wound to provide regional anesthesia. Blockade of which ion channels most likely mediates pharmacological effects of drug?
A. Activated, ligand-gated Ca2+ channel
B. Activated, voltage-gated Ca2+ channel
C. Inactivated, ligand-gated K+ channel
D. Inactivated, voltage-gated Na+ channel
E. Resting, ligand-gated Na+ channel
F. Resting, voltage-gated K+ channel
D. Inactivated, voltage-gated Na+ channel
Blockade of Na+ channels is both voltage and time dependent:
Channels in rested state, which predominate at more negative membrane potentials, have lower affinity for local anesthetics than activated (open state) and inactivated channels, which predominate at more positive membrane potentials
42 y/o male presents to ED following a MVA. He undergoes a minor arm repair procedure requiring a standard dose of lidocaine administered near brachial plexus for peripheral nerve block. 15 minutes later, anesthesia is still incomplete, and another dose of lidocaine is administered. Which adverse effect is most likely? A. Abdominal colic B. Convulsions C. Drowsiness D. Hypertensive crisis E. Ventricular tachycardia
C. Drowsiness
Undesired effects of local anesthetics (CNS):
Lower concentrations have ability to produce sleepiness, light-headedness, visual and auditory disturbances, and restlessness
High concentrations may result in nystagmus (unintentional jittery movement of eyes), muscular twitching, and convulsions
B. Convulsions - AE of local anesthetics at high doses (high dose administered IV)
D. Hypertensive crisis - cocaine
E. Ventricular tachycardia - Class Ib antiarrhythmic
2 y/o female presents to ED after cutting herself with a kitchen knife. The fingers are bleeding. Examination reveals two clean wounds on the middle and ring fingers of right hand. Lidocaine without epinephrine is administered prior to suturing wounds closed. Epinephrine was avoided to prevent what possible complication? A. Delayed wound repair B. Excessive bleeding C. Ischemic gangrene D. Systemic toxicity E. Wound infection
C. Ischemic gangrene
Epinephrine-containing solutions should not be injected into organs supplied by end arteries (fingers, toes, ears, nose, penis)
B. Excessive bleeding - benefit of coadministration with epinephrine
D. System toxicity - benefit of coadminsitration with epiniephrine
60 y/o male is scheduled for a lithotripsy to shatter a bladder stone. Lumbar epidural anesthesia is selected for procedure. Anticipated duration of procedure is about 20 minutes. Which local anesthetic would be most appropriate? A. Benzocaine B. Bupivacaine C. Cocaine D. Lidocaine E. Tetracaine
D. Lidocaine
Medium duration of action
A. Benzocaine - surface use only
B. Bupivacaine - long duration of action
C. Cocaine - not for epidural
E. Tetracaine - long duration of action
