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4.1 > N16/17 - Anesthetics (Zhu) > Flashcards

N16/17 - Anesthetics (Zhu) Flashcards

1
Q

Types of local anesthetics (chemical property)

A

Esters

Amides

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2
Q

local anesthetic that mainly exists in neutral form (pka 3.5)

A

Benzocaine

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3
Q

hydrophobicity of most effective LAs

A

moderate

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4
Q

2 changes due to binding of LA to binding site

A

occlusion

restriction of conformational change

  • AP generation is blocked (prevented channel opening)
  • AP conduction is blocked (prolonged refractory period)
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5
Q

modulated receptor hypothesis

A

Low binding affinity at resting state

High binding affinity at:

  • intermediate closed state
  • open state
  • inactivated state: LA stabilizes channel in innactivated state, channel cannot be reopened even after repolarization
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6
Q

channel states when LAs have major effect

A

Intermediate closed - prevents opening

Inactivated - extends refractory period

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7
Q

attenuates effectiveness of LAs

A

hypocalcemia - increased Na excitability

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8
Q

Potentiates the effectivenss of local anesthetics

A

Hyperkalemia - membrane is persistently depolarized

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9
Q

General blockade order

A

First pain

Second pain

Temperature

Touch, proprioception (pressure, position, stretch)

Motor function

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10
Q

blocks pain, without significant motor block

A

Epidural bupivacaine

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11
Q

A-gamma fibers

A

muscle tone

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12
Q

A-delta fibers

A

First pain & temperature

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13
Q

C fibers

A

second pain & temperature

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14
Q

to avoid systemic absorption of LAs

A

co-administration of vasoconstrictors

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15
Q

Co-administered vasoconstrictor:

Except in which areas?

A

epinepherine

Except in: fingers, toes, ears, nose, penis

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16
Q

Pain relief

oral, nasal, laryngeal, rectal disorders, surgery

A

Topical: Mucous membrane application

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17
Q

Tx: pruritus

poison ivy, insect bites, eczema, venipuncture, chickenpox, etc

A

topical anesthesia: skin application

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18
Q

suturing wounds

removal of foreign bodies

dental procedures

A

Infiltration LA - intradermal or subq

Lidocaine, procaine, bupivacaine

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19
Q

toxicity due to

A

systemic absorption

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20
Q

systems affected by LA toxicity

A

CNS - excitement followed by depression (inhibition of inhibitory pathways, then both excite & inhib)

Cardiovascular - vasoconstriction, then vasodilation

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21
Q

Acts as antiarrhythmic at very low concentration

A

Lidocaine

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22
Q

hypersensitivity

A

Ester-type LAs

met. product = p-aminobenzoic acid (PABA)

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23
Q

cautioned use for potentiation of neuromuscular blockers

A

Myasthenia gravis

(use great caution)

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24
Q

Vasoconstriction

cardiotoxicity

CNS stimulation

Tx: opthalmic, nasal surgery (blocks bleeding), topical

A

Cocaine

(Ester-type)

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25
Q

nasal surgery

A

Cocaine

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26
Q

No topical application

A

Procaine (Novocain)

Chloroprocain (Nesacaine)

(Ester-type)

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27
Q

High hydrophobicity

Fast onset

High potency

Long acting

Spinal & topical

A

Tetracaine

(Ester-type)

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28
Q

Weak

Used in nonprescription topicals

A

Benzocaine

(Ester-type)

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29
Q

Risk for hypotension & cardiotoxicity

A

Bupivacaine

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30
Q

Similar to bupivacaine

less cardiotoxicity

A

Levobupivacaine

Ropivacaine - structural analog

Mepivacaine - structural analog

(Amide-type)

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31
Q

Amide-type drugs - name hint

A

2 I’s

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32
Q

Ester-type drugs: name hint

A

1 “I” in name

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33
Q

Topical & infiltraion anesthesia

A

Prilocaine

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34
Q

Infiltration and nerve block anesthesia

A

Etidocaine

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35
Q

Amide-type with ester group

dental procedures

A

Articaine

36
Q

Lidocaine + Prilocaine combo

Topical - Venipuncture, lumbar, dental

A

EMLA (Eutectic mixure of local anesthetic)

37
Q

Contain halogens in chemical structure

A

Inhaled anesthetics

(except nitrous oxide)

38
Q

Contain ether bond in chemical structure

A

Intravenous anesthetics

39
Q

Stage I anesthesia

A

Analgesia

40
Q

Stage II anesthesia

A

Excitement

41
Q

Stage III anesthesia

A

Surgical anesthesia

  • unconscious
  • regular respiration
  • decreased eye movement
42
Q

Stage IV anethesia

A

Medullary depression

  • respiratory arrest
  • cardiac depression & arrest
  • no eye movement

AVOID THIS STAGE - REVERSE STAGES IN RECOVERY

43
Q

Ion channel hypothesis

A

Potentiation of inhibitory channels

  • GABA(A) receptors

Glycine receptors

44
Q

No significant action on GABA(A) or glycine receptors

A

Ketamine

Nitrous oxide

45
Q

Inhibits excitatory channels - NMDA glutatmate receptors

A

ketamine

46
Q

Activates K channels

A

inhalational anesthetics

47
Q

Partial pressure

A

P = (# Mol. of gas A / # Mol. of mixture) x 760 mmHg

48
Q

coefficient correlated directly with potency

inversely correlated with minimal alveolar concentration (MAC)

A

Oil : gas partition coefficient

49
Q

Coefficient inversely related with anesthesia induction rate

No relation to potency

A

Blood : gas partition coefficient

50
Q

Meyer-Overton rule

A

Anesthetics with larger oil/gas are more potent

51
Q

Most common cause of malignant hyperthermia

A

Halothane

Tx: Dantrolene

52
Q

Driving force for equilibrium

A

alveolar partial pressure gradient

NOT blood concentration

53
Q

Speeds up induction

A

High partial pressure of anesthetic

High ventilation rate

  • agents with high blood/gas are affected most
54
Q

Smaller blood:gas partition coefficient =

A

faster induction

55
Q

Larger blood:gas partition coefficient =

A

slower induction

56
Q

Low cardiac output

A

high induction rate

57
Q

high cardiac output

A

low induction rate

58
Q

Reflects tissue uptake of drug

A

venous blood partial pressure

59
Q

Drug significantly metabolized by the liver

A

Halothane

60
Q

Inversely proportion to blood:gas

delayed w/ increased duration of anesthesia

profoundly decreased w/ long duration & high blood/gas

A

recovery rate

61
Q

malignant hyperthermia

A

halothane

62
Q

maintenence of in-patient anesthesia

pungent odor

A

isoflurane

63
Q

fluoride ions formed from metabolism may cause renal toxicity

A

enflurane

64
Q

outpatient surgery

not for induction

usually used with IV agent

A

desflurane

65
Q

outpatient surgery

anesthesia induction in children

sweet-tasting

“compound A” may be renal toxic

A

Sevoflurane

66
Q

diffusional hypoxia

A

nitrous oxide

67
Q

primarily used as adjuct

dental procedures when full anesthesia isnt needed

A

nitrous oxide

68
Q

N2O diffuses from blood to alveoli,

reduces PO2 in lung

A

diffusional hypoxia

69
Q

upon discontinuation of N2O

A

100% O2 to avoid hypoxia

70
Q

contraindications to nitrous oxide use

A

air-filled cavities (embolus, pneumothorax, etc)

Vit B12 deficiency

71
Q

Most potent inhaled anesthetic

A

halothane

72
Q

Least potent anesthetic

A

nitrous oxide

73
Q

most analgesic of inhaled anesthetics

A

nitrous oxide

74
Q

least analgesic of inhaled anesthetics

A

halothane

75
Q

barbiturate

contraindicated w/ variegate prophyria

hepatic metabolism

renal excretion

not analgesic

hypotension

A

Thiopental

76
Q

Rapid onset & recovery even w/ repeat dosing

Anti-emetic action

short day-surgery procedures

A

Propofol

77
Q

young or head-injured patients

higher-dose infusions

metabolic acidosis, hyperlipidemia, rhabdomyolysis, liver enlargement

A

propofol infusion syndrome (PRIS)

78
Q

minimal cardiovascular effects

A

etomidate

79
Q

anesthesia induction in patients with cardiovascular diseases

A

etomidate

80
Q

dissociative anesthesia - awake with profound analgesia and amnesia

A

ketamine

81
Q

cardiovascular stimulating effects

bronchodilation

A

ketamine

82
Q

benzodiazepines

A

midazolam

diazepam

lorazepam

83
Q

opioids

A

morphine

fentanyl

sufentanil

84
Q

pre-operative anti-anxiety and anterograde amnesia

A

benzodiazepines

85
Q

anestesia with a combination of several inhaled and/or IV anesthetics, and adjuvant drugs

A

balanced anesthesia

4.1 (14 decks)

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