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PHARMA (FINALS) > GENERAL ANESTHETICS > Flashcards

GENERAL ANESTHETICS Flashcards

1
Q

A state of decreased awareness of pain, sometimes with amnesia

A

Analgesia

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2
Q

Is a state characterized by unconsciousness, analgesia, amnesia, skeletal muscle relaxation and loss of reflexes

A

General Anesthesia

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3
Q

The stages of Anesthesia

A
  1. Analgesia
  2. Excitement
  3. Surgical Anesthesia
  4. Medullary Depression
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4
Q

Depression of vasomotor and respiratory centers-coma & dealth

A

Medullary Depression

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5
Q

sleep, normal respiration and blood pressure

A

Surgical Anesthesia

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6
Q

Amnesia, hyperreactivity, irregular respiration

A

Excitement

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7
Q

Analgesia without amnesia

A

Analgesia

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8
Q

The mechanism of action of Inhalation Anesthetics

A

-Depress electrical activity of neurons
-Interaction of anesthetic with lipid cell membrane (Meyer-Overton principle) with increased fluidity and a reduction of “orderliness” of the lipid structure
-Act on specific receptors (GABAa receptor)

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9
Q

What are the uptake & distribution of INHALED ANESTHETICS

A

-Solubility
-Anesthetic concentration in the Inspired Air
-Pulmonary Ventilation
-Pulmonary blood flow
-Arteriovenous Concentration gradient

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10
Q

One of the most important factors influencing the transfer
of an anesthetic from the lungs to the arterial blood is its

A

Solubility Characteristics

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11
Q

It is a useful index of solubility and defines the relative affinity of an anesthetic for the blood compared with that of inspired gas.

A

blood:gas partition coefficient

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12
Q

The partition coefficients for desflurane and nitrous oxide are

A

relatively insoluble in blood, are extremely low

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13
Q

possesses low solubility in
blood, reaches high arterial tensions rapidly, and
in rapid equilibration with the brain and fast
onset of action.

A

Nitrous Oxide

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14
Q

A rapid onset of anesthetic action is also characterized as

A

desflurane and, to a lesser
extent, with sevoflurane.

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15
Q

The anesthetic concentration gradient between
arterial and mixed venous blood is dependent
mainly on uptake of the anesthetic by the
tissues, including nonneural tissues.

A

ArterioVenous concentration gradien

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16
Q

the tissues that exert greatest
influence on the arteriovenous
anesthetic concentration gradient are
those that are highly perfused

A

Brain, Heart, Liver, Kidney, and splanchnic bed

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17
Q

Muscle and skin constitute of

A

50%

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18
Q

These tissues accumulate more slowly than in highly perfused tissues

A

Brain

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19
Q

Are relatively insoluble in
blood and brain are eliminated at faster rates than the
more soluble anesthetics.

A

Inhaled Anesthetics

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20
Q

Is twice as soluble in brain tissue and five
times more soluble in blood than nitrous oxide and
desflurane

A

Halothane

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21
Q

The major route of elimination from the body.

A

Lungs

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22
Q

May also contribute to
the elimination of some volatile anesthetics

A

Hepatic

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23
Q

Metabolism of halothane results in the formation
of trifluoroacetic acid and release of bromide and chloride
ions

A

Oxidative metabolism

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24
Q

The least metabolized of the
fluorinated anesthetics.

A

Isoflurane and desflurane

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25
Q

is degraded by contact with the carbon dioxide
absorbent in anesthesia machines, yielding a vinyl ether called
“compound A*,” which can cause renal damage if high
concentrations are absorbed.

A

Sevoflurane

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26
Q

70% of the absorbed methoxyflurane is
metabolized by the

A

Liver

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27
Q

In terms of the extent of hepatic metabolism, rank order for the inhaled anesthetic is

A
  1. Methoxyflurane
    2.Halothane
  2. Enflurane
  3. Sevoflurane
  4. Isoflurane
  5. Desflurane
  6. Nitrous Oxide
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28
Q

Not metabolized by human
tissues.

A

Nitrous Oxide

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29
Q

General Anesthetics Effects in CNS

A

-motor and autonomic systems are inhibited
-respiratory function depressed via CNS
-cerebral blood flow increased

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30
Q

General Anesthetics Effects in Cardiovascular

A

-blood pressure may decrease (inhibition of sympathetic tone) or increase (vagal inhibition)
-adrenal medullary secretion of catecholamines (Counteract myocardial depression)

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31
Q

Decreases mean arterial pressure in direct
proportion to their alveolar concentration.

A

-Halothane
-Desflurane
-Enflurane
-Sevoflurane
-Isoflurane

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32
Q

Have a depressant
effect on arterial pressure as a result of a decrease in
systemic vascular resistance with minimal effect on cardiac
output.

A

-Isoflurane
-Desflurane
-Sevoflurane

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33
Q

Can be seen with halothane, probably because of
direct vagal stimulation

A

Bradycardia

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34
Q

Desflurane and Isoflurane increases

A

Heart Rate

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35
Q

Causes transient sympathetic activation with
elevations in catecholamine levels can lead to marked
increases in HR and BP

A

Desflurane

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36
Q

Have greater myocardial
depressant effects than isoflurane and the newer, less soluble
halogenated anesthetics.

A

Enflurane and Halothane

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37
Q

Found to depress the myocardium in a
concentration-dependent manner

A

Nitrous Oxide

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38
Q

Are less likely to produce
arrhythmias

A

Sevoflurane and Desflurane

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39
Q

General Anesthetic Effects in Salivary and bronchial secretions

A

-inhalation anesthetics irritate mucosal cells
-Results in coughing and laryngeal spasms

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40
Q

General Anesthetics Effects in Skeletal Muscles

A

-Depression of reflexes
-via effect of reflexes
- by inhibiting activity at neuromuscular junction

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41
Q

Have little effect on uterine
musculature

A

Nitrous Oxide

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42
Q

Potent uterine
muscle relaxants.

A

Halogenated anesthetics

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43
Q

This pharmacologic effect can be used to
advantage when profound uterine relaxation is
required for an intrauterine fetal manipulation or
manual extraction of a retained placenta during
delivery.

A

Effects on Uterine Smooth Muscle

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44
Q

What stages is the induction of anesthesia

A

Stages 1 and 2

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45
Q

What stages is the maintenance of anesthesia?

A

Stages 3

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46
Q

Pre-operative medication for sedation and analgesia

A

Balanced Anesthesia

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47
Q

Combination of inhales and IV anesthetics generally used

A

Balanced Anesthesia

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48
Q

What are the 3 toxicity?

A

-Hepatotoxicity (Halothane)
-Nephrotoxicity
-Malignant Hyperthermia

49
Q

The 4 chronic toxicity

A

-Mutagenicity
-Carcinogenicity
-Effects on Reproductive Organs
-Hematotoxicity

50
Q

under normal conditions, inhaled anesthetics are neither mutagens nor carcinogens in patients

A

Mutagenicity

51
Q

Increase in the cancer rate in OR personnel

A

Carcinogenicity

52
Q

Higher incidence of miscarriages, abortions

A

Effects on reproductive organs

53
Q

Prolonged exposure to nitrous oxide
decreases methionine synthase activity
and theoretically can cause megaloblastic
anemia.

A

Hematotoxicity

54
Q

commonly used for induction of
general anesthesia.

A

Intravenous agents

55
Q

is a barbiturate commonly used for induction
of anesthesia.

A

Thiopental

56
Q

is structurally almost identical to thiopental and
has the same pharmacokinetic and pharmacodynamic
profile.

A

Thiamylal

57
Q

After an IV bolus injection, thiopental rapidly crosses the

A

B-B-B

58
Q

This can cause central excitatory activity

A

Methohexital

59
Q

These benzodiazepines drugs are used for
preanesthetic medication and as adjuvants during surgical
procedures performed under local anesthesia.

A

-Diazepam
-Lorazepam
-Midazolam

60
Q

Considered to be the drugs of choice for
premedication

A

Benzodiazepines drugs

61
Q

are not water-soluble, and their
intravenous use necessitates nonaqueous vehicles, which
cause pain and local irritation

A

Diazepam and Lorazepam

62
Q

Water-soluble and is the benzodiazepine of
choice for parenteral administration.

A

Midazolam

63
Q

is frequently
administered intravenously before patients
enter the operating room

A

Midazolam

64
Q

Unpleasant sensation that is acute
or chronic and is a consequence of
complex neurochemical processes
in the peripheral and central
nervous system

A

Pain

65
Q

Produce morphine-like effects

A

Opiod Analgesics

66
Q

Types of opioid Analgesics

A

-Synthetic
-Semi-synthetic
-Natural

67
Q

Opioid Analgesics Receptors

A

-Mu
-Kappa
-Delta

68
Q

Morphine Actions of Analgesia

A

-Raise the pain threshold, alter brain perception

69
Q

Disinhibition of dopamine-containing neurons

A

Morphine Actions of Euphoria

70
Q

Therapeutic uses of Morphine

A

-Analgesia
-Treat Diarrhea
-Relief of cough
-Treat acute pulmonary edema

71
Q

Binds to Mu & Kappa receptors

A

Meperidine

72
Q

Therapeutic Uses of Meperidine

A

-Analgesic
-Not effective for diarrhea & cough

73
Q

Binds to Mu receptors, antagonist of
the N-methyl-D-aspartate (NMDA)
receptor

A

Methadone

74
Q

Therapeutic Uses of Methadone

A

-Analgesic in nociception and neurogenic pain
-Treatment by controlled withdrawal of heroin and morphine dependency

75
Q

Induce anesthesia and analgesia postoperatively

A

Epidural

76
Q

Transmucosal preparation for patients with cancer who are tolerant to other opiods

A

Fentanyl

77
Q

Are less potent, shorter acting

A

Alfentanil, Remifentanil

78
Q

Is more potent than fentanyl

A

Sufentanil

79
Q

A potent and extremely short-acting opioid has
been used to minimize residual
ventilatory depression

A

Remifentanil

80
Q

These 2 drugs are administered together to produce analgesia and amnesia and combined with
nitrous oxide provide a state referred to as
neuroleptanesthesia

A

Fentanyl and Droperidol

81
Q

Heroin

A

-Diacetylmorphine
-Crossess BBB
-Converted to Morphine in the body

82
Q

It is a treatment for moderate to severe pain and twice the analgesic effect to morphine

A

Oxycodone & Oxymorphone

83
Q

8-10x more potent than morphine

A

Hydromorphone

84
Q

Weaker than hydromorphone

A

Hydrocodone

85
Q

Only 30% analgesic activity compared to morphine and is used for cough

A

Codeine

86
Q

Agonist on the kappa receptors, relieves moderate pain and can precipitate a withdrawal syndrome for morphine abuser

A

Pentazocine

87
Q

A partial agonist, Mu receptor and Precipitate withdrawal with morphine addicts

A

Buprenorphine

88
Q

Treatment for chronic pain, mimics the symptoms of psychosis and ceiling effect of respiratory depression

A

Nalbuphine & Butorphanol

88
Q

Treatment for chronic pain, mimics the symptoms of psychosis and ceiling effect of respiratory depression

A

Nalbuphine & Butorphanol

89
Q

Binds to mu receptors, lesser respiratory depression to morphine and causes CNS excitation seizure

A

Tramadol

90
Q

Binds to mu receptors, norepinephrine reuptake blocker and for the management of moderate to severe pain, both chronic and acute

A

Tapentadol

91
Q

Reverse coma and respiratory depression in opioid overdose and a competitive antagonist at the mu, kappa and delta receptors

A

Naloxone

92
Q

Has become the most popular IV anesthetic and is used for both induction and maintenance of anesthesia as part of total IV or balanced anesthesia techniques

A

Propofol

93
Q

Agent of choice for ambulatory surgery

A

Propofol

94
Q

Is excreted in the urine as
glucoronide and sulfate conjugates.

A

Propofol

95
Q

It causes a marked decrease in blood
pressure during induction of anesthesia
through decreased peripheral arterial
resistance and venodilation.

A

Propofol

96
Q

A water-soluble prodrug of
propofol, has recently been approved

A

Fospropofol

97
Q

A carboxylated imidazole
and for induction of anesthesia in patients with limited cardiovascular reserve

A

Etomidate

98
Q

It produces a dissociative anesthetic
state characterized by catatonia,
amnesia, analgesia, with or without
loss of consciousness (hypnosis)

A

Ketamine

99
Q

The only IV anesthetic that possesses
both analgesic properties and the
ability to produce dose-related CV
stimulation.

A

Ketamine

100
Q

Is a potentially dangerous drug when
intracranial pressure is elevated.

A

Ketamine

101
Q

Adverse effect of etomidate

A

-Pain on injection, myoclonic activity, postoperative nausea and vomiting

102
Q

Adverse effect of Ketamine

A

-posoperative disorientation
-sensory and perceptual illusions
-vivid dreams

103
Q

Is the condition that results when sensory
transmission from a local area of the body to
the CNS is blocked.

A

Local Anesthesia

104
Q

In the body, they exist either as the uncharged base
or as a cation.

A

Local Anesthesia

105
Q

Systemic absorption of injected local anesthetic from the
site of administration is determined by several factors

A

-Dosage
-Site of injection
-Drug-tissue binding
-Local tissue blood flow
-Use of vasoconstrictors
-The physiochemical properties of the drug itself

106
Q

The local anesthetics are converted in the liver (amide
type) or in plasma (ester type) to more water-soluble
metabolites, which are excreted in the urine.

A

Metabolism and Excretion

107
Q

Promotes ionization of the tertiary
amine base to the more water-soluble charged form,
leading to more rapid elimination

A

Acidification of urine

108
Q

Isolated by Niemann in 1860 and introduced into
practice by Koller in 1884 as a topical ophthalmic
anesthetic

A

Cocaine

109
Q

The first local anesthetic introduced into medical
practice

A

Cocaine

110
Q

It was the only local
anesthetic drug available for 30 years

A

Cocaine

111
Q

In 1905 he synthesized procaine, which became
the dominant local anesthetic for the next 50 years.
In an attempt to improve the clinical properties
of cocaine

A

Einhorn

112
Q

was synthesized in 1943 by Löfgren

A

Lidocaine

113
Q

Repeated injection of Lidocaine can result in

A

Loss of effectiveness

114
Q

Are commonly used as
adjuvants to the combination of a tricyclic
antidepressant (eg, Amitriptyline) and an
anticonvulsant (eg, Carbamazepine) in
patients who fail to respond to the
combination of antidepressant and
anticonvulsant

A

Systemic LA drugs

115
Q

Toxcicity in CNS

A

-Sleepines
-Light-headedness or sedation
-Visual and auditory disturbances
-Circumoral & tongue numbness
-metallic taste
-restlessness
-nystagmus & muscular twitching
-tonic-clonic convulsions

116
Q

May produce severe CV
toxicity, including arrhythmias and hypotension, if
given intravenously

A

Bupivacaine

117
Q

Cocaine cardiovascular toxicity includes

A

-severe hypertension with cerebral hemorrhage
-cardiac arryhtmias
-MI

118
Q

Is metabolized to products that include
an agent capable of causing methemoglobinemia
(patient may appear cyanotic and the blood
ʺchocolate-colored

A

Prilocaine

PHARMA (FINALS) (6 decks)

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