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Year 2 neuro exam 2 > Pharm Anesthetics, Kinder II > Flashcards

Pharm Anesthetics, Kinder II Flashcards

1
Q

what barbituates are used for IV anesthetic

A

thiopental and methohexital

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2
Q

MOA thiopental and methohexital

A

GABAa R increase channel opening duration

inhibit excitatory too

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3
Q

which barbituate has shorter elimination

A

methohexital

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4
Q

CNS effects thiopental and methohexital

A

dose dependent CNS depression

no analgesia

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5
Q

which barbituate anesthetic cannot be used for anticonvulsant

A

methohexital

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6
Q

respiratory effects thiopental and methohexital

A

depressors

transient apnea

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7
Q

use of thiopental and methohexital

A

induction anesthesia

propofol used more

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8
Q

what benzos are used perioperatively

A

midazolam
lorazepam
diazepam

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9
Q

MOA benzos

A

GABAa increase sensitibity to GABA and enhance inhibitory NT

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10
Q

benzos can be terminated by administration of what

A

flumazenil

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11
Q

what benzo is suitable for coninuous infusion

A

midolazam

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12
Q

CNS effects benzos

A

anticonvulsants- status epilepticus, alcohol withdrawal, local anesthetic induced seizure

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13
Q

resp effects benzos

A

severe resp depression if given with opioid

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14
Q

therapeutic use benzos

A

produce anxiolysis and anterograde amnesia

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15
Q

MOA etomidate

A

GABA like effects thorugh GABAa and Cl channels

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16
Q

metabolism etomidate

A

urine excretion and bile

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17
Q

CNS effects etomidate

A

cerebral vasoconstrictor

dec blood flow and ICP

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18
Q

CV effects etomidate

A

minimal hemodynamic effects! good for those with compromised cardiac contractility prior to anesthesia

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19
Q

endo effects etomidate

A

adrenocortical suppression

inhibits 11bhydroxylase for cholesterol –>cortisol

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20
Q

use of etomidate

A

alternative to propofol or barbituates for those with conmprmised cardiac contractility

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21
Q

MOA ketamine

A

inhibition of NMDA R

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22
Q

CNS ketamine

A

cerebral dilator and inc blood flow
can have emergence reactions :vivid color dreams hallucinations etc
“dissociative anesthesia” eyes open with slow nystagmic gaze

23
Q

CV ketamine

A

can increase BP HR and CO

direct myocardial depressant( mainly critically ill patients)

24
Q

therapeutic use ketamine

A

profound analgesia, SAN stimulation
bronchodilation
minimal respiratory depression

25
Q

side effect ketamine

A

lacrimation and salivation increased

so give anticholindergic before administration

26
Q

MOA dexmedetomidine

A

selective a2 agonist

27
Q

CNS dexmedetomidine

A

hypnosis from activation a2 in locus ceruleus

analgesia at level spinal cord

28
Q

CV effects dexmedetomidine

A

mod dec HR and systemic vascular R

bradycardia

29
Q

therapeutic use of dexmedetomidine

A

short term sedation of intubated and ventilated patients in ICU setting

30
Q

which IV anesthesia does not affect respirattion

A

dexemedetomidine

31
Q

local anesthesia

A

loss of sensation in limited region of body

32
Q

role of systemic circulation in local anesthesia

A

diminish or terminate its effect

33
Q

structure most local anesthetics

A

lipophilic ring and ionizable group

aromatic ring and tertiary amine

34
Q

what are the amide local anesthetics

A

bupivacaine
lidocaine
ropivacaine

35
Q

what are the ester local anesthetics

A

benzocaine
cocaine
procaine
tetracaine

36
Q

what are the long acting local anesthetics

A

bupivacaine
ropivacaine
tetracaine
(more lipophilic)

37
Q

how are local anesthetics excreted

A

converted to water soluble by liver (amide) or plasma (ester) and excreted in urine

38
Q

careful using amide type local anesthetics in what patients

A

those with hepatic disease since need hepatic metabolism

39
Q

excretion uncharged local anesthetic

A

diffuse readily across lipid membrane so no excretion of neutral form occurs

40
Q

how do local anesthetics work

A

block vNaCh

41
Q

Potency local anesthetics

A

lipid solubility

so tetracaine, bupivacaine and ropivacaine are more potent

42
Q

what are the intrinsic factors of susceptibility of nerve fibers

A

fiber diameter
firing frequency
anatomic arrangement

43
Q

which nerve fibers are blocked first

A

smallest diameter

myelinated before unmyelinated

44
Q

how does firing frequency affect nerve blocks

A

higher freq= more block

so sensory nn>motor nn

45
Q

which pain fibers affected quickly by nerve block

A

A delta and C fibers because have high freq pain transmission

46
Q

usual route of administration for local anesthetics

A

topical- nasal mucosa, wound, margins

injection

47
Q

evolution of nerve block

A

sympathetic then temp then pain then light touch then motor

48
Q

how do we prolong local anesthesia

A

add vasoconstrictor

49
Q

processes of local anesthetic toxicity

A

systemic effects from intravasc injection by accident or absorption from site
neurotoxicity from local effects with direct contact with neural elements

50
Q

CNS toxicity local anesthetic

A

sedation, light headedness, visiaul and auditory disturbances
restlessness
nystagmus, musc twitching, tonic-clonic convulsions

51
Q

what do we give to prevent CNS toxicity local anesthetic

A

give benzo before

52
Q

CV effects local anesthetics

A

arrhythmia and cardiac arrest

block Na Ch on heart so dec electrical excitability, conduction rate force and arteriolar dilation causing hypotension

53
Q

cocaine CV effects

A

inhibits NE reuptake and results in vasoconstriction leading to ischemia, also have HTN and cardiac arrhythmias

Year 2 neuro exam 2 (23 decks)

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