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A-CNS Pharma > Genral&Local anastheisa > Flashcards

Genral&Local anastheisa Flashcards

1
Q

بسم الله الرحمن الرحيم وبه نستعين
____________________
Mention aim of general anastheisa

A

RAASI
Reversible loss of consciusness
Amensia
Analgesia
Skeletal muscle relaxation
Inhibtion of Visceral reflexes

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2
Q

Blanced anasthsia is done by ?

A

Preanstehtic medication:- HOBA
H1,2blockers Opioides BZs Atropine
for amenisa anxiety and visceral reflexes and anathsies
____________________
IV anasthic for induction
Inhalation ansthetic for maintaence
_____________
Skeletal Muscle relaxant Succinylchlone or NMBs

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3
Q

GA works by?

A

Inhibtion of midbrain reticular formation
by?
Facilitaion of GABA :
BZs+ Barbit. + halogenated agents Propfol + etomidate
OR
Inhibtion of glutamate NMDA receptor by?
Ketamine+Nitrous oxide

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4
Q

MAC?

A

Minumun alvolar concentartion
اقل تركيز للغاز المخدر في الحويصلات الهوائية عشان العيان ميترحكش لما يتعرض لمؤثر الم زي فتح جراحي
measuring potency +ED50

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5
Q

MAC is decreased by and inc by?

A

MAC dec by?
Anathetics BZs + Opioids
A2 blockers clondine
Elderly
Inc potency decreasing ED50
___________________
MAC decreased by?
Drugs increasing Cataechols
Alchol abuse
Increasing ED50 decreasing Potency

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6
Q

High blood gas solubility
or parition cofficient means

A

slow induction
slow recovery
and vice versa

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7
Q

Halogenated agent
used mainly for Maintaince bu may bu used for indcution

A

Halotahane
Non irritant smooth pleasnt odor

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8
Q

why halothan + N2o ?

A

for powerful analgesia
as halothane weak anglesic storong anasthetic
and the N2o is the opposite

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9
Q

Halogenated agent with mdeium rate of Induction and recovery

A

Halothane

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10
Q

mention adverse effects of halothane

A

4H+BSCU
Hypotension
HR decreased
Hepatotoxic
Hyperthermia Malignant
_________________-
Uterine relaxation increasing bleeding
Increased ICP due to cerberal VD
Bronchodilator
skeletal muscle relax

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11
Q

Newer Halogenated agents are discovered why?

A

To Overcome the Hepatoxic effect of halothane
but still
Resp and CVS depression with Maligant Hyperthermia
________________________-
Isoflurane
Desfulrane
SevoFlurane

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12
Q

Halogenated agent casuses Ischemia ?

A

ISOflurane

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13
Q

Halognated agent whichc is respiarotry irritant with purgant odor casing larynospam + Cough?
and may cause (ISCHEMIA)
OR with high PC

A

ISO flurane
Contraindicated in
Induction
Asthma

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14
Q

Describe PC of ISOFLURANE

A

It is of high paritotion cofficient so? slow induction slow recovery not for short procedure

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15
Q

Halognated agent whichc is respiarotry irritant with purgant odor casing larynospam + Cough?
WITH low PC

A

Desflurane
fastest onset and recovery so used in Short procedures

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16
Q

Halogenated that is used for induction of Anastheisa
Halogenated that has no respiratory irritaion
Halogenated that has nephrotoxic effect?

A

Sevoflurane
___________
Interacting with soda lime forming substance A that is nephrotoxic

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17
Q

Anathetic with Rapid onset and recovery PC=0.47
With Low potency High MAC
Used with other analgesics to minimize thier side effects and increasing analgesic effect
Used in analgesia
in dental clinic -Obsteric analgesia

A

Nitrous Oxide
N2O

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18
Q

N2O is the safest inhalation agent give reason
__________________
N2O is perferd to Halothane
why?

A

Less CVS and resp depression
Less Hepatotoxica
Less uterine relaxation
No malignant hyperthermia
Less Effect in ICP
& Skeletal muscle relaxation

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19
Q

List adverse effects of N2O

A

EHA3b
1-Expand gases in closed spaces increasing pressure in closed spaces
So contraindicated in Bowel obsteruction and Pnemothorax
2-Hypoxia on Recovery
on prolonged use
3-Abuse euphoria
4-Anemia Megaloblastic + Abortion

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20
Q

Mention
Wiedly used IV anasthetic for induction
_________________
Or alone in anastheisa for short procedure

A

Thiopental

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21
Q

Thiopental redistributed to ?

A

Skeletal muscles then fatty tissue so ? when readminstered may lead to toxicity due to accumulated amount in fatty tissue

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22
Q

Mention adverse effects of thiopental

A

Barbituate! ?
Narrow TI with no antidote:
CVS and resp Depression
Acute prophyria
Vasospam+Gangrene

23
Q

IV anastheic that can cause Vasospam+Gangrene?

A

Thiopental

24
Q

IV anasthetic that is used for induction with rapid onset rapid recovery may be used also in IV infusion maintainance
And Has Antiemetic advantage !

A

Propofol

25
Q

IV anathetic used in Conscious and deep sedation in ICU ?”

A

Propofol

26
Q

Disadvantages of Propofol mention ?

A

CVS and resp depression +
Pain at site of injection

27
Q

Dissociative anasteheisa by ?

A

Ketamine

28
Q

Mention Advanatages of Ketamine

A

Bornchodilator so ? prefered in athmatics
Increasing HR and ABP As CVS stimulant
Analgesic: used for minooor procedure

29
Q

Mention adverse effect of ketamine

A

-Increasing ICP so CI in head injuires
-Hallucinations and disorientaion on Recovery so proceeded by Diazpam

30
Q

Benzodiazepine lkie
,,,,,,and,,,,and,,,,,
used in anastheisa especially ,,,,,, due to its ,,,, and ,,,,,and,,,,,,
________________
indications :
1-
2-
3-
____________________
Advantage?

A

Midazolam
Lorazepam
Diazpema
_____________
Midozolam
Short onset and duration and less irritant
___________________
Conscious sedation
preanasthetic
Balanced anastheisa
___________________
Flumzenil as antidote

31
Q

gopioids and propfol may be combined in …. anastheisA

A

IV

32
Q

What is the mechanism of Local anastheisa

A

ان الجزء المحب للدهون للمخدر الموضعي يعدي غشاء الخلية العصبية ويقفل من جوا بوابات الصوديوم ويمنع جهدالحركة انه بتولد وبالتالي يمنع انتقال النبضات العصبية في مسارات الألم

33
Q

اذكر العوامل المؤثرة علي حساسية العصب للمخدر الموضعي

A

1-LA is more effective in rapid firing nerves
2-More effective on small nerves of Pain &temperature

34
Q

chemical structure of LA ?

A

(Aromatic + ( Ester-Amide ) + Amine )

35
Q

Compare between Esters &Amide LA MDLE
Metabolism
duration
liable to
expanison of duration
________________
Esters like Procaine - benzocaine -Cocaine
Amides lkie Lidocaine bupivacaine

A

Esters hydolysed by pseudocholin esterases
but Amide by Liver metabolism
_________________
Esters shorter duration due to palsma esterases but amide longer duration due to liver
________________
Esters liable to allergy (analgue with PABA)
But Amide liable to Systemic Toxicity
_____________________
Esters duration increased in genetic defect on enzyme but Amide duration increased in liver diseases

36
Q

Examples to LA

A

Procaine from esters short acting may extends to one hour
Lidocaine intemediate 2 hours
Bupivacane Long 3 hours

37
Q

Mnetion Factos affecting Activity of Lcoal anasthetics

A

p2L

-Plasma protein binding
Bubivacne > lidocaine so longer acting
-Lipid Solubility Bubivance 7 times more potent than lidocaine
-PKa of drug as the less basic the more non ionized extracellular the more rapid tha action is as Bupivacne >lidocaine

38
Q

LAs are weak,,,,,,, Pka from ,,,,,to ,,,,,,,
Only,,,,,,, form can cross the nerve membrane to the site of action
ECF PH= ?
IC = ?

A

bASES (7,7-9
Non ionized
______________
7,35
6-7,4

39
Q

What happens in increased ECF acidity for LAs?
What happens in infection in relation to LAs?

What Happes in Repeated lidocaine ?

A

increasing ECF acidity
________________________
Incrasing IOINZED
Decreasing Non ionized
so few inoized intracellular so less action

40
Q

how to improve local anasthetsia?

A

By adding NaHCO3 to alkalnization of the media of ECF
Increasing NON ionized form of the LA so increased Ionized Intracellulaet potenitating the blockade

41
Q

GR for using vasoconstrictors with LAs?

A

LAs except cocaine cause VD of blood vessels increasing absorption of LAs in blood causing systemic toxicity
_________________
Vasoconstirtors prevents absorption of LAs preventing Systemic toxicity
as Epinphernie CI in finger toes nose gangrene
Felypressin perefered to EP in cardiac patients

42
Q

LA in surface anasthesia ?

A

applied to skin and muscous membrane

43
Q

LA in infiltartion anasthesia ?

A

Submucosal
subcutanuous
dentist

44
Q

LAs nerve block ?

A

in denistiry and surgery
Inject clost to trunk blocking all branches

45
Q

used in surgery of abdomen , pelvis and legs when general anasthesia in contraindicated

A

spinal and epidural anastheisa

46
Q

Injection in subarachanoid space below L2 Acting on spinal cord and spinal roots with immediate onset?\
Mention side effects

A

Spinal anasthesia
side effcets:HSI
Headache (CSF Leakage and traction)
Hypotension due to sympathatic block
Spinal root injury
Infection

47
Q

Injection outside dura blckong spinal roots onset 10 minutes delay

A

Epidural anasthesia\in
painless labot

48
Q

Injection outside dura blckong spinal roots onset 10 minutes delay

A

Epidural anasthesia\in
painless labor

49
Q

Mention adverse effect of Local anasthertics

A

1-CNS :
Numbness -restlessness
tremors - consulsions coma death
2-Neurotoxicity: spinal cord or trunks as paraplegia or parathesia in spinal and eipdural anathesia
3-CVS decrasing HR and ABP
Bbpivacin is extermely cardiotoxic in high doses
4-VCs increasing BP may peripitate arryhtmia
5-allergy: Esters analogue to PABA

50
Q

Lidocaine is CI with ?

A

Propranolol
as propranolol reuces the hepatic blood flow decrasing clearance of lidocaine casuing toxicity

51
Q

Lidocain/EP CI with Propranolo ?

A

As propranolo blockinb2 so alpha is not opposed casuing sever VC and severe hypertension

52
Q

MAOI &TCAs are CI with Lidocaine/EP ? WHY

A

MAOI and TCAs increasing CA + EP = hypertensice crisis

53
Q

الله نزل أحسن الحديث كتابا متشابها مثاني تقشعر منه جلود الذين يخشون ربهم ثم تلين جلودهم وقلوبهم إلي ذكر الله ذلك هدي الله يهدي به من يشاء

A

A-CNS Pharma (11 decks)

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