General Anesthetics

Question 1

Nitrous Oxide

Answer 1

Inorganic gas; NMDA receptor antagonist - for mask induction in children, adjuvant to volatile anesthetics and opioids. no muscle relaxation

Question 2

Isoflurane

Answer 2

Volatile anesthetic, most potent; inhibits NMDA receptors => both increases and decreases GABA release - gold standard for maintenance of anesthesia

Question 3

Desflurane

Answer 3

Volatile anesthetic, least soluble, least potent (allows for rapid emergence from anesthesia) - for maintenance of anesthesia. less potent means in lungs longer => quicker acting. most pungent (airway irritation)

Question 4

Sevoflurane

Answer 4

Volatile anesthetic, less soluble, less potent (but not irritating - less pungent) - for mask induction in children and adults, maintenance of anesthesia

Question 5

MAC

Answer 5

Minimum alveolar concentration. the lower the MAC, the more potent the drug and the less you need to give

Question 6

Methohexital

Answer 6

Barbiturate; GABAa receptor agonists, antagonist of NMDA glutamate receptor - produces hypnosis & sedation but is also anti-analgesic - to induce general anesthesia

Question 7

Propofol

Answer 7

Alkylphenol; a GABAa agonist, antagonist of NMDA receptor, and some alpha2 receptor activity; rapid onset and offset - for anti-emetic at low doses, induction and maintenance of general anesthesia, sedation in ICU, and procedural sedation. Need to monitor. “Milk of amnesia”, most common IV anesthetic

Question 8

Etomidate

Answer 8

GABAa receptor agonist - for hypnosis but no analgesic activity (used for induction). drug of choice for elderly who cannot tolerate drug or high BP - minimal cardioresperatory depression

Question 9

Ketamine

Answer 9

Phencyclidine; NMDA receptor antagonist, kappa opiate agonist; leads to dose-dependent unconsciousness, amnesia, analgesia - used to reduce opioid use and for pain. also a quick antidepressant. emergence delirium (bad dreams). increases cardiac work

Question 10

Dexmedetomidine

Answer 10

alpha2 adrenergic agonist in locus coeruleus and spinal cord to produce sefation, sympatholysis, and analgesia - for awake intubation and awake craniotomies. GABA isn’t effected, so light sedation (similar to REM sleep)

Question 11

Succinylcholine

Answer 11

Depolarizing NMJ blocker (mimics ACh); overstimulates ACh receptors => paralysis - for intubation. only NMJ blocker with rapid onset and ultra-short duration

Question 12

Pancuronium

Answer 12

Non-depolarizing NMJ blocker; competitive blockade of ACh - skeletal muscle relaxant. Long acting. avoid in patients with renal insufficiency. reverse with AChE inhibitor

Question 13

Vecuronium

Answer 13

Non-depolarizing NMJ blocker; competitive blockade of ACh - skeletal muscle relaxant. Intermediate acting. Reverse with AChE inhibitor

Question 14

Rocuronium

Answer 14

Non-depolarizing NMJ blocker; competitive blockade of ACh - skeletal muscle relaxant (can substitute for succinylcholine in rapid intubation). Intermediate acting. Reverse with AChE inhibitor. Surammadex competes with rocuronium rendering it inactive (no effect on AChE), but not FDA approved yet

Question 15

Atracurium

Answer 15

Non-depolarizing NMJ blocker; competitive blockade of ACh - skeletal muscle relaxant, use in pt;s with liver or renal dysfunction. Reverse with AChE. has histamine release => hypotension and tachycardia

Question 16

Cis-atracurium

Answer 16

Non-depolarizing NMJ blocker; competitive blockade of ACh - skeletal muscle relaxant, use in pt;s with liver or renal dysfunction. Reverse with AChE. has NO histamine release

Question 17

Edrophonium

Answer 17

AChE inhibitor, fastest onset - reversal of NMJ blockers

Question 18

Neostigmine

Answer 18

AChE inhibitor, more complete, most commonly used - reversal of NMJ blockers

Question 19

Pyridostigmine

Answer 19

AChE inhibitor, long duration - reversal of NMJ blockers

Question 20

Glycopyrrolate or Atropine

Answer 20

Anti-muscarinic - used with AChE inhibitors