General And Local Anesthetics Dr. Kruse

Question 1

Inhaled anesthetics ending and 6 of them

Answer 1

Desflurane
Enflurane
Halothane
Isoflurane
Sevoflurane 
Nitrous Oxide

Question 2

IV Anesthetics 6

Answer 2

1. Diazepam
2. Etomidate
3. Fentanyl
4. Ketamine
5. Midazolam
6. Propofol

Question 3

Local Anesthetics 6 and ending

Answer 3

Benzocaine 
Bupivacaine 
Cocaine 
Dibucaine 
Lidocaine
Procaine

Question 4

5 desired effects from an anesthetic

Answer 4

1. unconsciousness
2. Amnesia
3. Analgesia
4. Attenuation of autonomic reflex to noxious stimulation
5. immobility in response to noxious stimulation (skeletal muscle relaxer)

= need more the 1 to achieve all 5

Question 5

inhibitory channels of anesthetics

exictatory channels of anesthetics

Answer 5

1. GABA (Cl- channels) , K+ channels

2. NMDA, AchR, 5HT, AMPA

Question 6

key to how quickly an inhaled anesthetic gets into CNS and causes changes

Answer 6

the SLOWER the rate of absorption into BLOOD + concentration making it into the alveoli

Question 7

blood:gas partition

Answer 7

a drugs affinity for blood over inspired gas (higher the higher blood solubility and the lower concentration makes it to cns)

Question 8

SMALL blood:gas

what happens and 2 drugs

Answer 8

gas reaches a HIGH arterial P in alveoli Fast
= Fast acting and Fast leaving 
= A lot makes it to brain 
1. NO
2. Desflurane

Question 9

BIG blood:gas

what happens and 1 drug

Answer 9

high arterial P in alveoli is reached slowly
= Slow to get to CNS and slow to leave
1. Halothane

Question 10

MAC (Minilam Alveolar Concentration)

Answer 10

amount that a drug is needed to be inhaled that works in 50% of subjects during surgery
(most are over 100% = you need to combine more then 1 drug for good surgery anesthesia)

Question 11

Toxicity of inhaled anesthesia

1. common
2. Halothane
3. in combination with succinylcholine , and how to fix
4. drugs giving F ions

Answer 11

1. N, V
2. Hepatitis, (2days to 3 weeks later)
3. Malignant Hyperthermia (htn, tachy, muscle rigid + rhabdo, acidosis, hyperthermia) = TREAT WITH DANTROLENE
4. kidney problems

Question 12

how to reverse malignant hyperthermia

Answer 12

DANTROLENE

Question 13

IV anesthetics are different how 3 things (biochema and R is likes)

Answer 13

PREFERRED MOST
lipophilic = QUICK ONSET

(most act on GABA)

Question 14

Midazolam effects can be reversed with

Answer 14

Flumazenil

(slow onset slow recovery)

Question 15

Fentanyl effects can be reversed with

Answer 15

Naloxone

slow onset slow recovery

Question 16

Propofol

Answer 16

GABA
FAST onset + SHORT acting (3-10min)
(continuous infusion can last more hours = in ICU or operating room)

Question 17

Propofol side effects

Answer 17

hypotension

respiratory depressant

Question 18

Fospropofol

Answer 18

water soluble so similar to propofol only LONGER recovery and SLOWER onset (less pain when administrating it)

Question 19

Etomidate

Answer 19

GABA
FAST and longer then propofol recovery (continuous infusion only works before 4-8hours)
= minimal cardiovascular and respiratory depression so good for CV or Pulmonary PATIENTS**

Question 20

Etomidate adverse effects

Answer 20

inhibits cholesterol –> cortisol (11B-hydroxylase)

Question 21

Ketamine

Answer 21

NMDA agonist (PCP structure)
can cause upleasant emergence reactions (vivid colorful dreams, hallucinations, out-of-body experiences)

Question 22

Dexmedetomidine

Answer 22

A2 adrenergic agonist = hypnosis (SLEEP LIKE STATE) by binding to A2 R at locus ceruleus
(SHORT time for ICU intubated or ventilated patients, or added to adjunct)

Question 23

2 anesthesia ADJUNCTS

Answer 23

1. Opioids : Fentanyl, Sufentanil, Remifentanil, Morphine
2. Barbiturates : increase GABA, Thiopental, Methohexital
3. Benzodiazepines : increase GABA, Diazepam, Lorazepam, Midazolam

Question 24

how to reverse Benzodiazepines overdose

Answer 24

Flumazenil

Question 25

Local Anesthetics 2 classes

Answer 25

AMIDE : have 2 i's in the name (Lidocine) | ESTER : only have 1 i in the name (cocaine)

Question 26

ESTER vs AMIDE

Answer 26

ESTER Groups have higher risk of allergy causing compounds in them (hives, rash, itching, breathing difficulty)

Question 27

how to administer local anesthetics

Answer 27

injections , IV

Question 28

local anesthetics are usually given how and where

Answer 28

``` with Vasoconstrictor (unless cocaine) = give Epinephrine usually to vasoconstrict (DONT inject into end arteries like fingrs, toes, ear, nose....)**** ```

Question 29

local anesthetics adverse effects

Answer 29

high dose : nystagmus, muscular twitching, convulsions lower CV output , hypotension (except cocaine) ALLERGY (esp ESTERS)

Question 30

USE of 1. Lidocaine 2. Cocaine 3. Benzocaine 4. Dibucaine 5. Procaine

Answer 30

1. antirrhythmic agent 2. upper respiratory tract topical agent 3. only topical agent 4. skin cream due to toxic when injected 5. inject to nerve ending directly (infiltration ansesthetic)

Question 31

examples of organophosphates

Answer 31

echothiophate, parathion, malathion, sarin, soman

Question 32

Organophosphates interact with what

Answer 32

AcheE (depleted) = replenish with PRALIDOXIME

Question 33

reverse AchE inhibition

Answer 33

PRALIDOXIME

Question 34

when to use a drug that stimulates AChR

Answer 34

1. Glaucoma | 2. NMJ (Myasthenia Gravis)

Question 35

drugs used for Myasthenia Gravis 3

Answer 35

1. Pyridostigmine 2. Neostigmine 3. Ambenonium (AchE inhibitors)****

Question 36

testing if someone has Myasthenia Gravis

Answer 36

Edrophonium Test, ice pack test, Ig testing

Question 37

how to reverse NM blocking drug induced paralysis

Answer 37

1. AchE (paralytic ilieus) | 2. Neostigmine*

Question 38

TX toxicity to AchE inhibitors intoxication and SX

Answer 38

SX : miosis, salvation, sweating, bronchial constriction, V, D TX : Atropine

Question 39

2 drugs used for Spasmolytics and side effects

Answer 39

1. Carisoprodol (dizzy and drowsy)= anxiety | 2. Cyclobenzaprine (sedation, confusion, hallucination, drowsy, dizzy, xerostomia) = antidepressant like TCA

Question 40

5 other drugs for Spasmolytics besides cyclobenzapine and carisoprodol

Answer 40

1. Baclofen 2. Diazepam 3. Tizanidine 4. Dantrolene (non Central acting) 5. Botulinum toxin (non central acting)

Question 41

drugs for MS 4

Answer 41

1. Glucocorticoids 2. Glatiramer Acetate 3. Interferons (INF-B1a, INF-B1b) 4. Mitoxantrone

Question 42

when to use NMBDs

Answer 42

1. tracheal intubation 2. surgery 3. ventilation control 4. convulsion tx

Question 43

BEST NMBD

Answer 43

Succinylcholine BLOCKS DEPOLARIZATION*(Sochuronium, Vecuronium) = intubation and quick things

Question 44

NMBD used for used as adjunct to general anesthesia for longer time

Answer 44

Pancuronium (Atracurium, Cisatracurium)