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Pharmacology > !Neuropharm Anesthetics > Flashcards

!Neuropharm Anesthetics Flashcards

1
Q

Local anesthetic

A

Localized analgesia for minorprocedures and epidurals

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2
Q

How do local anesthetic pls work

A

Inhibit intracellular Na influx by blocking Na channels

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3
Q

Local anesthetic are state dependent.what does that mean

A

Neuronal blockade works best in rapidly firing neurons and they preferentially block activated sodium channels

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4
Q

Why are local anesthetic often combined with vasoconstrictors for minor procedures

A

Vasoconstricteres lead to increased concentration of the anesthetic agent and also decreased local bleeding

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5
Q

__ tissues decrease the action of local anesthetic and a larger amount is needed in an infected area to provide the same effects as in healthy tissue

A

Infected

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6
Q

What are the two groups of local anesthetic

A

Esters (one i in name)

Amides (two i in name)

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7
Q

Why are u given an ester or aimed

A

Depending on allergies and liver function

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8
Q

Side effects of local anesthetic

A

Arrhythmia

Cardiotoxicity

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9
Q

Indication for local anesthetic

A 
Minor procedures (stitches)
Epidurals  (needle into l2-l3 and catheter def to bathe the epidural space)
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10
Q

How do local anesthetic work

A

Prevent sodium influx by blocking sodium channels int he neuronal membrane.
This prevents action potential from arising, inhibiting signal conduction

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11
Q

State dependency of local anesthetic

A

Exhibit preferential binding to activated Na channels and their neuronal blockage works best in rapidly firing neurons

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12
Q

Why are local anesthetics given with. Vasoconstrictors

A

Increased anesthetic action and decreased bleeding

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13
Q

Why does infected tissue require a higher dose of local anesthetic

A

Infected tissue is acidic and ionized local anesthetics and decreases their ability to cross the cell membrane and reach sodium channels, decreasing the drugs overall action. This it takes a greater amount of local anesthetic to provide its effects.

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14
Q

Ester local anesthetics

A

More prone to cause allergic reaction

One i in name

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15
Q

Examples of ester local anesthetics

A

Procaine, cocaine, tetracaine

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16
Q

Ester local anesthetics are hydrolyzed by _____ in the plasma

A

Pseudocholinesterases

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17
Q

Amide local anesthetics

A

Two i

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18
Q

Examples of amide local anesthetics

A

Lidocaine, mepivacaine, bupivacaine

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19
Q

Amide local anesthetics are metabolized in the __ and should not be given to patients with __ ___

A

Liver

Liver failure

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20
Q

Cocaine, levobupivacaine, ropivacaine causes __ ___ and may give rise to ___

A

Cocaine
Levobupivacaine
Ropivacaine

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21
Q

Bupivicain is considered to be __ bc it blocks cardiac na channels and can lead to malignant arrhythmia

A

Bupivicain

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22
Q

Inhaled anesthetics are highly __ soluble

A

Lipid

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23
Q

Commonly used inhaled anesthetics

A

HEISMN

Halothane, enflurane, isoflurane, devoflurane, ,ethoxyflurance, nitrous oxide

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24
Q

Effects of inhaled anesthetics

A

Respiratory depression
Myocardial depression
Depressing the SA node
Decreasing bp

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25
Q

How do inhaled anesthetics cause respiratory depression

A

Decreasing medullary drive to breathe

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26
Q

How do inhaled anesthetics cause myocardial depression

A

Decreasing cardiac contractility

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27
Q

Inhaled anesthetics have profound CNS effects and lower ___ __ __ but increase __ __ ___ by ___ ___

A

Cerebral metabolic demand
Cerebral blood flow
Mediating vasodilation

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28
Q

Side effects inhaled anesthetics

A

Hepatotoxicity (halothane)
Nephrotoxicity (methoxyflurane)
Seizure (enflurane)
Malignant hyperthermia

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29
Q

What is malignant hyperthermia

A

Severe catabolic condition characterized by increased temperature, CO2 production, O2 production, respiration, acidosis and rhabdomyolysis

30
Q

Which inhaled anesthetic doesn’t cause malignant hyperthermia

A

Nitrous oxide

31
Q

Problem with nitrous oxide

A

Expansion of trapped gas, which becomes a problem when it affects areas which cannot expand such as sinuses and the middle ear

32
Q

Inhaled anesthetic MOA

A

Unknown

33
Q

How work with respiratory depression with inhaled anesthetics

A

Mechanical ventilation

34
Q

How do inhaled anesthetics increase cerebral blood flow

A

Vascular vasodilation

35
Q

Halothane and hepatotoxicity

A

Due to oxidative reactions in the liver”halothane hepatitis”

Rarely used! Not safe

36
Q

Nephrotoxicity and methoxyflurane

A

Broken down by liver and kidney and its metabolites lead to irreversible dose dependent nephrotoxicity. Linked to hepatotoxicity as well

Not used anymore really

37
Q

Seizure enflurane

A

Lower the seizure threshold and used should cautioned in patients with epilepsy
Can also cause nephrotoxicity

38
Q

Nitrous oxide problem

A

Trapped gas when blood containing NO equilireiates with closed air containing spaces in the body

39
Q

What tissues is nitrous oxide a problems with

A

Not a problem with Compliant tissue (gut lumen) but may cause increased pressure and trauma if the space cant expand (sinuses, middle ear)

40
Q

IV anesthetics

A

CNS drugs and cross the BBB due to their lipid solubility

41
Q

Examples of IV anesthetics

A 
Barbiturates
Benzodiazepines
Ketamine
Opioids
Proposal
42
Q

Barbiturate and thiopental

A

Ultra short action

43
Q

Benzodiazepines(midazolam)

A

Preoperatively and can be used for endoscopes or non invasive procedures

44
Q

Ketamine

A

Arylcyclohexadine IV anesthetic NMDA receptor antagonist and can cause vivid nightmare like hallucinations in adults

45
Q

Opioids

A

In combination with other CNS depressants to provide analgesia during procedures

46
Q

Propofol

A

For rapid induction and sedation in an ICU setting and works by potentiating GABA A

47
Q

Side effects benzodiazepines

A

Severe postoperative respiratory depression, amnesia and lowered bp

48
Q

__, used as amnestic with other anesthetics has a side effect of severe postoperative respiratory depression

A

Midazolam

49
Q

How treat benzodiazepine overdose

A

Flumazenil

50
Q

Ketamine

A

Arylcycloheexylamine which is a class of PCP analogs that act as dissociative anesthetics

51
Q

How does ketamine work

A

Arylcyclohexylamines are PCP analogs that act by blocking the effects of glutamic acid at NMDA receptors. This interferes with pain transmission int he spinal cord and also leads to a dissociative amnesia

52
Q

Why does ketamine cause hallucinations

A

It is a cardiovascular stimulant that increases cerebral blood flow and may result in disorientation, distortions of reality, and bad dreams ,espicially in adults

53
Q

Opoids

A

Morphine and fentanyl are given preoperatively together with inhalation and IV anesthetics to help reduce pain

54
Q

Propofol

A

For sedation in the ICU , for rapid anesthesia induction and short procedures.

55
Q

Why use propofol over thiopental

A

Less nausea

56
Q

Who shouldn’t use propofol

A

Pop stars at home

57
Q

MOA propofol

A

Potentiating GABA-A and leads to rapid anesthesia induction

58
Q

Lidocaine (xylocaine)

A

Sodium channel blocker that inhibits neuronal impulses

59
Q

Indication for lidocaine

A

Ventricular dysrhythmias and induce local anesthesia

60
Q

Side effects of lidocaine

A

Drowsiness, confusion, paresthesia, seizures, and respiratory arrest

61
Q

Lidocaine is an __-type anesthetic and it metabolized by the _

A

Amide

Liver

62
Q

MIA lidocaine

A

Stops neuronal conduction by blocking Na channels and inhibiting AP
By blocking Na channels in neurons of the skin, this drug prevents action potentials from creating pain perception.
Lidocaine also blocks na channels in heart and suppresses neuronal excitability present in ventricular dysrhythmias
Class IB antiaarhythmic

63
Q

Indications for lidocaine

A

Ventricular arrhythmia

Anesthetic

64
Q

Lidocaine and ventricular arrhythmia

A

Blocks Na channels and slows nerve conduction in ther heart

Also slows the hearts depolarization activity and accelerates depolarization duration.

65
Q

Unlike other antidysrhythmic medications, lidocaine does not cause ___ effects

A

Anticholinergic

66
Q

What kind of anesthetic is lidocaine

A

Nonselective amide local anesthetic

67
Q

How does lidocaine work as an anesthetic

A

Blocks both conduction to both sensory and motor neurons. Degree of blockage depends on volume and concentration of drug

68
Q

What is the order in which lidocaine blockers impulses

A

Autonomic, somatic sensory, somatic motor

69
Q

How is lidocaine administered

A

Topically or injection

70
Q

Side effects of lidocaine

A

Paresthesia
Seizures
Respiratory depression
Drowsiness

71
Q

Why may lidocaine cause seizure

A

Excessive amounts may cause CNS excitation

-give benzodiazepine to manage convulsions

72
Q

Why give a vasoconstrictor (epinephrine) with lidocaine

A

Extends duration of the local anesthetic
By decreasing local blood flow and delaying systemic absorption of the anesthetic, epinephrine prolongs anesthesia and decreases the risk of toxicity. Delaying systemic absorption of lidocaine allows a lower dosage to obtain the desired effect

Pharmacology (52 decks)

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