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Pharma > L3 GA, LA > Flashcards

L3 GA, LA Flashcards

1
Q

General anesthesia definition

A

loss of response to and perception of external stimuli.

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2
Q

General anesthetic drugs should ideally produce ?

A

• Unconsciousness
• Analgesia
• Amnesia
• & muscles relaxation.
• Suppression of undesirable reflexes

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3
Q

Drug Groups used for Optimal anesthesia?

A

Pre-anesthetic medications
Skeletal muscle relaxants
IV anesthetic agents
Potent general anesthetics

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4
Q

IV anesthetic agents: Used for?

A

induction

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5
Q

Potent general anesthetics via inhalation Used for ?

A

maintenance of anesthesia

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6
Q

Ideal anesthetic should ?

A

• Induce anesthesia smoothly, rapidly & for enough time
• Allow quick recovery & be safe (no adverse effects)
• It should be non-inflamable

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7
Q

• For sedation in GA we use?

A

barbiturates ( thiopental)

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8
Q

• For vomiting in GA we use ?

A

anti- emetic Domperidone

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9
Q

• For analgesia in GA we use ?

A

opiads (fentanyl)

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10
Q

• To prevent bradycardia in GA we use ?

A

atropine

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11
Q

• For muscles relaxation in GA we use ?

A

muscle relaxant (succinylcholine)

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12
Q

• produce tachycardia?

A

Adrenaline

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13
Q

surgery is done in which stage of GA ?

A

III- Stage of surgical anesthesia:

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14
Q

Stages of anesthesia

A

1-Induction of anesthesia (anesthetics, muscles relaxants & analgesics)
2-Maintenance
3-Recovery

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15
Q

Pre- anesthetic medication ?

A

drugs given before anesthesia to produce balance anesthesia
& to reduce the side effects of G.anesthetics.

They calm the patient, relieve pain,& protect against undesirable effects of the subsequently administered anesthetics or surgical procedure.

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16
Q

Used to induce anesthesia rapidly & pass endotracheal tube?

A

thiopental (For sedation)

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17
Q

Mechanism of action Of general anaesthetic ?

A

-facilitate GABA-A receptor, increase Cl- channels & inhibit synaptic transmission.
-open K-channels

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18
Q

-antagonizes excitatory effect of glutamic acid on NMDA receptors?

A

Ketamine

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19
Q

measures relative potency of anesthetic agents ?

A

MAC
Nitrous oxide is less potent( largeMAC)

Halothane is more potent ( LessMAC)

( Lower the MAC, more potent the anesthetic agent)

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20
Q

-A drug which is less soluble in blood, will have…………………… e.g. Nitrous oxide.

-A drug which is more soluble in blood, will have ……………………. e.g. Halothane.

A

-rapid induction & rapid recovery

-slow induction &slow recovery

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21
Q

It is a potent analgesic but a weak anesthetic?

A

Nitrous oxide

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22
Q

safest anesthetic provided if administered with at least 20 % oxygen?

A

Nitrous oxide

لانه ممكن يسبب hypoxia
لازم O2 معه

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23
Q

-It is a potent anesthetic & weak analgesic
-It is used more in obstetrics because (relaxes uterine & skeletal muscles)
-It is suitable in children having pleasant odor.
-It is hepatotoxic but not hepatotoxic in children??

A

Halothane

(but due to side effects not much used nowadays)

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24
Q

side effects of Halothane?

A

Cardiac arrhythmia
& malignant hyperthermia.

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25
Q

-given for treatment of malignant hyperthermia?

A

Dantroline

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26
Q

nephrotoxic drug and It is more muscles relaxant due to curare like action?

A

Enflurane

27
Q

side effects of Enflurane?

A

CNS excitation, so should not be used in seizure like disorders.

28
Q

((good for ischemic heart disease patient))
Because
-It dilate coronary vasculature
-increase coronary blood flow
-increase myocardial O2 consumption

A

Isoflurane

29
Q

Drug Cause hypotension Does not increase intracranial pressure?

A

Isoflurane
اغلبهم الانهيليشنز يقللون BP وهذا من ضمنهم

30
Q

………….. can cause transient sympathetic stimulation, thus may ↑ heart rate & BP ( inhaled GA )

A

Desflurane
الوحيد اللي يزود ضغط الدم،بس بالنسبه لICP كلهم ممكن يزودونه
اكسبت isuflurane

31
Q

Inhaled anesthetics except………………depress respiration & ↑ PaCO2

A

N 2 O

32
Q

• Inhaled anesthetics ↑ cerebral blood flow & ↑ ICP
•………….. causes lesser ↑ in ICP but ……………. does not cause it.

A

N2O
Isoflurane

33
Q

Malignant hyperthermia Consists of:

A

tachycardia ,
hypertension,
hyperthermia,
muscle rigidity,
hyperkalemia & acidosis
الصراحه مدري شلون acidosis مع hyperkalemia بس الشكوى لله
(Dantrolene is specific antidote) يعالج الموضوع الذيب

34
Q

metabolized to fluoride ?

A

Enflurane \ Methoxyflu- rane

nephrotoxic وكلهم

35
Q

Recovery from intravenous anesthetics is due to ………. from CNS to muscle & fat.

A

redistribution

36
Q

rapid injection Intravenous Anesthetics may cause ?

A

respiratory & cardiovascular depression.

37
Q

Intravenous Anesthetics

A

• Barbiturates: Thiopental
• Benzodiazepines: Medazolam, Diazepam, Lorazepam
• Opioids: Fentanyl, Sufentanil , Remifentanil
• Others: Propofol, Ketamine.

38
Q

-Short acting barbiturates It is a potent anesthetic but a weak analgesic Commonly used IV for induction of anesthesia ?

A

Thiopental
تم استبداله

39
Q

Adverse effects of Thiopental

A

• Can cause cardiovascular & respiratory depression
• ↑ acute intermittent porphyria & (((bronchospasm)))
ممنوع للي عندهم asthma

40
Q

Used as pre-anesthetic medication for sedative & amnesic effects & given before induction of anesthesia ?

A

Diazepam
Medazolam افضل

41
Q

(specific antagonist) is used to enhance recrvery from over sedation with benzodiazepines?

A

Flumazenil

42
Q

Adverse effects of Opioids ( Fentanyl ) ?

A

• Chest wall rigidity & respiratory impairment

43
Q

(specific antagonist) of opioids ( fentanyl)
can be used to ↑ recovery?

A

Naloxone

44
Q

Ketamine properties :

A

-Short acting nonbarbiturate G. anaesthetic.
-antagonizes excitatory effect of glutamic acid on
-Produce dissociative anesthesia ( patient seems awake)
-Useful anesthetic for cardiogenic , septic shock patients , patients with asthma & good for children also young adults.

45
Q

Ketamine Adverse effects:

A

not be used in hypertensive & stroke patients

لانه يزود الضغط

46
Q

It decreases B.P without depressing myocardium
It decreases intracranial pressure. It is widely used & has replaced thiopental as a 1 st choice for induction of anesthesia & sedation?

A

Propofol

47
Q

Adverse effects of Propofol ?

A

Muscles twitching, hiccups.

48
Q

Local anesthetics definition ?

A

These are agents generally applied locally.
They block nerve conduction of sensory impulses from periphery in a limited area to CNS without producing unconsciousness. affect touch, pressure and thermal sensations

49
Q

-was the first agent used for Local anesthetics in (1884)

A

Cocaine

50
Q

Esters LA?

A

Cocaine ( 2 - medium )
Procaine ( 1 - short )
Tetracaine ( 16 - long )
RBT. Long

(Short - long acting مهمين بس)

51
Q

Amides LA?

A

Lidocaine ( 4- medium )
Mepivacaine( 2- medium )
Bupivacaine (16 - long )
Prilocaine ( medium )
Ropivacaine ( 16 - long )

52
Q

Pharmacokinetics of LA?

A

In infected tissues, PH will be low and penetration will be less

53
Q

LA combination with local V.C ( Epinephrine, nor E) effects?

A

} To prolong the action of LA
} To increase the depth of LA
} To reduce the systemic toxicity of LA
} To obtain hemostatic effect
Don’t produce unconsciousness

54
Q

Rotes of administration of LA

A
  1. Topical application (Nasal mucosa, wound margin, eye surgery )
  2. Infiltration (LA will be Injected in the vicinity of peripheral nerve Endings)
  3. Regionalanaesthesia
    ( large part of the body will be anaesthetised; it is divided into:
    -central technique “ neuroaxial blocks ” And
    -peripheral technique “plexus block or nerve block”.

Neuroaxial blocks include ( epidural/spinal anaesthesia )

55
Q

For Prophylaxis in LA We give ?

A

IV benzodiazapines

56
Q

Adverse effects of LA in CVS?

A

(cause vasodilatation and ↓BP ) الاهم

-All LA block Na+ channels, so depress abnormal cardiac pacemaker activity
-Also, depress the strength of cardiac contraction
-Long-acting agents may produce ventricular arrhythmias

57
Q

-Long-acting agents of LA may produce ventricular arrhythmias except?

A

Cocaine; blocks NE reuptake and accordingly,
cause vasoconstriction and ↑BP

Cocaine dilate pupil

58
Q

Spinal Anaesthesia Advantages / Disadvantages

A

Advantages:
1- Less cost
2- Rapid recovery with no post- operative nausea and vomiting
3- No depression of respiration and airway are patent
4- Less post-operatively deep venous thrombosis “DVT” and pulmonary embolism

Disadvantages:
1- Difficult technique
2- Doesn’t suit any patient/surgeon
3- Uncomfortable if long procedure (>2hr)
4- Infection

59
Q

LA preferred For obstetric procedures ?

A

Bupivacaine and Ropivacaine

60
Q

Complications of neuraxial anaesthesia?

A
  1. Post dural puncture headache; occipital,
    ((worse on standing and relieved by lying down, more in young females))
  2. Spinal hematoma/Epidural abscess
    - Facial paralysis
    - Needle –stick injury & needle fracture
61
Q

Uses of LA in dentistry

A

-((Reduce bleeding: Due to addition of vasoconstrictor)) اهم
-Differentiate between pain from upper or lower tooth
(pulpitis makes difficult to differentiate)

Reduction of arrhythmias during general anesthesia
Reduce depth of general anesthesia (less dose needed)

62
Q

Compilation of local A?

A

-Failure to achieve LA; related tp hot pulp or apical abscess
(pus decreases action of LA)
-Hematoma
-Trismus

63
Q

Mechanism of action of cocaine?

A

It inhibits reuptake of norepinephrine Also cause anesthesia.

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