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Pharmacology > General Anesthetics, Local Anesthetics, Muscle Relaxants > Flashcards

General Anesthetics, Local Anesthetics, Muscle Relaxants Flashcards

0
Q

Four stages of Anesthesia

A
  1. Analgesia
  2. Disinhibition
  3. Surgical anesthesia
  4. Medullary depression
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1
Q

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

A

General Anesthesia

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2
Q

Stage of anesthesia: patient is unconscious, no pain reflexes, regular respiration and maintained blood pressure

A

Surgical anesthesia

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3
Q

Stage of anesthesia: severe respiratory and cardiovascular depression that requires mechanical and pharmacologic support

A

Medullary depression

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4
Q

Stage of anesthesia: patient is delirious or excited, amnesia occurs, reflexes are enhanced and respiration is typically irregular. Retching and incontinence may occur

A

Disinhibition

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5
Q

Stage of anesthesia: decreased awareness of pain, sometimes with amnesia. Consciousness is impaired not loss

A

Analgesia

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6
Q

Best measure of potency of inhaled anesthetics

A

Minimum Alveolar Anesthetic Concentration (MAC)

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7
Q

Defined as the alveolar concentration required to eliminate the response to a standardized painful stimulus in 50% of patients

A

Minimum Alveolar Anesthetic Concentration (MAC)

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8
Q

Most inhaled anesthetics are bronchodilators except for ____ which causes Asthma

A

Desflurane

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9
Q

Effect of having increased blood gas partition coefficient on action and recovery

A

Increased BG coefficient = slower onset of action, slower recovery
Decreased BG coefficient = faster onset of action, faster recovery

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10
Q

Inhalational general anesthetic for minor surgery and dental procedures. May cause megaloblastic anemia on prolonged used

A

Nitrous oxide

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11
Q

Lowest potency and least cardiotoxicity among inhalational anesthetics

A

Nitrous oxide

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12
Q

Inhalational general anesthetic with pungent smell. May cause bronchospasm and peripheral vasodilation

A

Desflurane

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13
Q

Inhalational general anesthetic, sweet-smelling and may cause peripheral vasodilation and renal insufficiency

A

Sevoflurane - facilitate GABA-mediated inhibition, blocks brain NMDA and ACh-N receptors

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14
Q

Inhalational general anesthetic that may cause arrhythmias, peripheral vasodilation and coronary steal syndrome

A

Isoflurane

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15
Q

Inhalational general anesthetic that may cause arrhythmias, myocardial depression and postoperative hepatitis

A

Halothane - may interact with succinyl choline causing malignant hyperthermia

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16
Q

Inhalational general anesthetic with highest potency and lowest MAC

A

Methoxyflurane

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17
Q

Ultrashort acting barbiturate that can be used as intravenous general anesthetic. May cause acute intermittent porphyria with additive CNS depression with Ethanol

A

Thiopental - SIMD: Methohexital, Thiamylal

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18
Q

Short-acting benzodiazepine used for intravenous general anesthetic. May cause anterograde amnesia, postoperative respiratory depression

A

Midazolam

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19
Q

IV general anesthetics, used for dissociative anesthesia. May cause emergence delirium, hypertension and increased ICP

A

Ketamine

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20
Q

IV general anesthetic with no analgesic property, for patients with limited cardiac and respiratory reserve. Less side effects

A

Etomidate - modulates GABA rceptors containing B3 subunits

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21
Q

IV general anesthetic, non selective opioid analgesic. May cause respiratory depression in M receptor, chest wall rigidity and constipation.

A

Fentanyl

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22
Q

Antidote for Fentanyl toxicity

A

Naloxone

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23
Q

IV general anesthetic that causes bradycardia and hypotension. Called as Milk of Amnesia, with additive effect with sedative-hypnotic drugs. MAC values decreases in elderly patient

A

Propofol - potentiates GABA receptors, blocks Na channels

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24
Q

Results when sensory transmission from a local area of the body to the CNS is blocked. Can be administered locally by injection or topical application to the target area

A

Local anesthesia

25
Q

Local anesthetic that has the shortest half-life of 1-2 mins

A

Procaine

26
Q

Local anesthetic with the longest half life

A

Ropivacaine - half life of 4.2 hours

27
Q

Condition that enhances local anesthetic activity

A

Hyperkalemia

28
Q

Condition that antagonizes local anesthetic activity

A

Hypercalcemia

29
Q

All local anesthetics are vasodilators except?

A

Cocaine

30
Q

Ester Local anesthetic also for extravasation complications from venipuncture and inadvertent intraarterial injections. May cause antibody formation

A

Procaine - blockade of Na channels slows, then prevent axon potential propagation

31
Q

Ester Local anesthetic also for topical anesthesia. Use cautiously when treating sunburns or large areas of skin

A

Benzocaine

32
Q

Ester Local anesthetic, drug of abuse. May cause antibody formation, abuse liability, severe hypotension, cerebral hemorrhage, cardiac arrhythmia or MI

A

Cocaine - also has intrinsic sympathomimetic activity

33
Q

Ester Local anesthetic for spinal anesthesia, epidural anesthesia. With highest allergic potential

A

Tetracaine

34
Q

Amide Local anesthetic that has group 1B antiarrhythmic activity

A

Lidocaine

35
Q

Toxic dose of lidocaine

A

5mg/kg

36
Q

Amide Local anesthetic also for dental anesthesia. May cause methemoglobinemia

A

Prilocaine

37
Q

Amide Local anesthetic for local, epidural and intrathecal anesthesia. May cause severe cardiovascular toxicity.With caution in pregnant women.

A

Bupivacine

38
Q

Treatment for Bupivacaine induced cardiotoxicity

A

Intralipid (fat emulsion used in TPN)

39
Q

Amide Local anesthetic for local and epidural anesthesia. May cause cardiotoxicity. Can be reversed with Intralipid. Had the longest half life

A

Ropivacaine

40
Q

drugs used to produce muscle paralysis to facilitate surgery or assisted ventilation.

A

Neuromuscular blocking drugs

41
Q

Drugs used to reduce abnormally elevated tone caused by neurologic or muscle end plate disease

A

Spasmolytic drugs

42
Q

Two types of neuromuscular blockade

A

Depolarizing blockade

Non-depolarizing blockade

43
Q

Blockade: neuromuscular paralysis that results from persistent depolarization of the end plate

A

Depolarizing blockade

44
Q

Blockade: neuromuscular paralysis that results from pharmacologic antagonism at the acetylcholine receptor of the end plate.

A

Nondepolarizing or stabilizing blockade

45
Q

Nondepolarizing neuromuscular blocker with the most rapid onset time

A

Rocuronium - onset time of 60-120s

46
Q

Nondepolarizing neuromuscular blocker. May cause respiratory paralysis, histamine release and recurarization. Relatively contraindicated in MI

A

Tubocurarine

47
Q

Nondepolarizing neuromuscular blocker, short acting, metabolized by pseudocholinesterase

A

Mivacurium

48
Q

Nondepolarizing neuromuscular blocker, intermediate acting, it undergoes Hoffman elimination

A

Atracurium - SIMD: Cisatracurium

49
Q

Nondepolarizing neuromuscular blocker, intermediate acting, undergoes elimination in the bile. Muscle relaxation is potentiated with inhaled anesthetics, aminoglycosides and quinidine

A

Vecuronium

50
Q

Nondepolarizing neuromuscular blocker, intermediate acting. With ost rapid onset time

A

Rocuronium

51
Q

Novel reversal agent for Rocuronium

A

Sugammadex

52
Q

Treatment for malignant hyperthermia

A

Dantrolene and rapid cooling of the patient

54
Q

Nondepolarizing neuromuscular blocker, long acting, with moderate block on cardiac muscarinic receptors. Used for lethal injection, euthanasia, strychnine poisoning

A

Pancuronium

55
Q

Earliest sign of malignant hyperthermia?

A

Contraction of jaw muscles (trismus)

57
Q

Side effects of all Nondepolarizing neuromuscular blocker can be reversed by what?

A

Neostigmine

58
Q

Drugs used in lethal injection

A

Thiopental 5mg
Pancuronium 100 mg - resp. paralysis
Potassium chloride 100mg - stop the heart

59
Q

Phases of Depolarizing blockade

A

Phase I: Depolarization

Phase Ii: Desensitization

60
Q

Phase: membrane depolarizes with initial electric discharge, transient fasciculations followed by flaccid paralysis

A

Phase I: Depolarization

61
Q

Earliest sign of malignant hyperthermia?

A

Trismus

62
Q

Phase: membrane repolarizes but receptor is desensitized to the effects of acetylcholine

A

Phase II: Desensitization

63
Q

Depolarizing neuromuscular blocker, that may cause muscle pain, hyperkalemia, in severe cases malignant hyperthermia. Metabolized by pseudocholinesterase

A

Succinylcholine

Pharmacology (11 decks)

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