Pharm 11 Anesthetics

Question 1

General Anesthetic definition

Answer 1

Loss of awareness, memory, and perception, not actual loss of sensation

Question 2

Stage 1 of anesthesia

Answer 2

Analgesia

Question 3

Stage 2

Answer 3

Excitement
Irregular respiration
Vomiting

Question 4

Stage 3

Answer 4

Surgical
Regular respiration
Reflexes (eyelash) are abolished

Question 5

Stage 4

Answer 5

Medullary depression

Need full circulatory and respiratory support

Question 6

Speed of induction correlations:

1. Gas concentration
2. Pulmonary ventilation
3. Blood solubility
4. Pulmonary circulation
5. A-V concentration gradient

Answer 6

1. Direct
2. Direct
3. Inverse
4. Inverse
5. Inverse

Question 7

Blood:gas partition coefficient

Answer 7

High solubility = high coefficient = slow induction

Question 8

Redistribution

Answer 8

Gas solubility in other body tissues, important for determining elimination from the brain

Question 9

Minimum Alveolar Concentration

Answer 9

Low MAC = High Potency

-Concentration that produces absence of response in 50% of patients

Question 10

Elderly MAC

Answer 10

Lower than normal

Question 11

Halothane effect on heart

Answer 11

Sensitization to catecholamines -> arrhythmias

Question 12

Halothane effect on liver

Answer 12

Occasional severe hepatitis

Question 13

Drug causing nephrotoxic effect

Answer 13

Methoxyflurane (due to inorganic fluoride release)

Question 14

Effect on pregnancy

Answer 14

Increase in abortions, no mutations

Question 15

-Thiopental-
Speed
Elimination

Answer 15

30s onset, 10m duration

Redistribution

Question 16

-Thiopental-
Action
SE

Answer 16

Sedative (barbiturate), poor analgesia

Decrease HR (Hypotension)
Decrease Resp

Question 17

-Benzodiazepines-

Speed

Answer 17

Slower than Thiopental

Question 18

-Benzodiazepines-
Action
SE

Answer 18

Sedative, no analgesia
Anterograde amnesia

Prolong recovery

Question 19

-Narcotics-
Action
SE

Answer 19

Good analgesia, no anesthesia

Respiratory depression

Question 20

-Ketamine-
Action
MOA
SE

Answer 20

Dissociative Anesthesia
NMDA antagonist

CV stimulation
Post-op illusions

Question 21

-Propofol-
Action
Speed

Answer 21

Anestesia (most popular)
Anti-emetic
Fast

Question 22

-Propofol-

SE

Answer 22

Respiratory depression

Question 23

-Etomidate-
Action
SE

Answer 23

Rapid hypnotic
No analgesia

Nausea, Vomiting

Question 24

-Promazine-

Answer 24

Adjunct

• Anti-emetic
• Sedation

Question 25

-Promethazine-

Answer 25

Adjunct - Anti-emetic - Sedation

Question 26

Local anesthetic basic action

Answer 26

Prevent pain by interruption nerve conduction

Question 27

Local anesthetic specific action

Answer 27

Block voltage-gated sodium channels

Question 28

Local anesthetic pH effects

Answer 28

Weak base - Uncharged at body pH (for uptake) - Cationic and higher pKa (for action)

Question 29

Differential sensitivity

Answer 29

Attack fast firing channels (pain) first because Na channel needs to be open for action

Question 30

Ester metabolism

Answer 30

Rapidly hydrolyzed in blood by pseudocholinesterase

Question 31

Amide metabolism

Answer 31

Redistributed first, then hydrolyzed in liver by CYP450. Liver disease causes toxicity

Question 32

Local anesthetic problem

Answer 32

Vasodilation leads to systemic absorption. Give with epinephrine

Question 33

Lidocaine (amide) CNS effect

Answer 33

Drowsiness -> Activation -> Depression -> Respiratory failure

Question 34

Local anesthetic CV problem

Answer 34

Decrease excitability -> antiarrhythmic

Question 35

Epidural LA issues

Answer 35

Hypotension due to sympathetic blockade

Question 36

Cocaine toxicity

Answer 36

Hypertensive vasoconstriction | Arrhythmias

Question 37

LA hypersensitivity

Answer 37

Esters metabolized to PABA - some patients allergic

Question 38

LA for burn patients

Answer 38

Benzocaine - hydrophobic, stays on wound

Question 39

LA for arrhythmia

Answer 39

Lidocaine and Procainamide

Question 40

``` -Cocaine- E/A Use action SE ```

Answer 40

Ester Useful for vasoconstriction Medium Systemic toxicity

Question 41

``` -Procaine- E/A Use action SE ```

Answer 41

Ester Novicaine Short few

Question 42

``` -Tetracaine- E/A Use action SE ```

Answer 42

Ester Topical, spinal Long Toxic (lipophilic)

Question 43

``` -Benzocaine- E/A Use action SE ```

Answer 43

Ester Surface only (wounds) surface only surface only

Question 44

``` -Lidocaine- E/A Use action SE ```

Answer 44

Amide Patients with Ester Sensitivity, better than procaine Medium none

Question 45

``` -Mepivacaine- E/A Use action SE ```

Answer 45

Amide Obstetrics Medium neuro effects in baby

Question 46

``` -Bupivacaine- E/A Use action SE ```

Answer 46

``` Amide Post-op nerve blocks, obstetric epidural Long Toxic (lipophilic) better for baby ```