[PHARM] General and Local Anesthetic Drugs [Kruse]

Question 1

Suffix for inhaled anesthetics?

Answer 1

-flurane

Question 2

Suffix for local anesthetics?

Answer 2

-caine

Question 3

What is the one inhaled anesthetic that does NOT end in “-flurane”?

Answer 3

Nitrous oxide

Question 4

What are the inhibitory ion channel types that general anesthetics work on?

Answer 4

Chloride channels

Potassium channels

Question 5

What are the excitatory ion channel types that general anesthetics work on?

Answer 5

Acetylcholine

Excitatory amino acids

Serotonin

Question 6

Of the inhaled anesthetics; what are most of them at room temperature?

Answer 6

MOST inhaled anesthetics (halothane, enflurane, isoflurane, desflurane, sevoflurane)

are liquids at room temperature

Question 7

Nitrous oxide is a _____ at room temperature

Answer 7

GAS

Question 8

What does the blood:gas partition coefficient define?

Answer 8

The relative affinity of an anesthetic for the blood compared with that of inspired gas

(i.e. blood solubility)

Question 9

Agents with low blood solubility have a

____________ onset of action

Answer 9

Agents with low blood solubility have a

RAPID onset of action

Question 10

Name an example of an inhaled anesthetic that has a low blood solubility

Answer 10

Nitrous oxide

Desflurane

Question 11

Agents with high blood solubility have a

____________ onset of action

Answer 11

Agents with high blood solubility have a

SLOW onset of action

Question 12

What does the minimal alveolar concentration (MAC) measure?

Answer 12

Anesthetic potency

–> The concentration that prevents movement in reponse to surgical stimulation in 50% of subjects

Question 13

What is the major toxicity of halothane?

Answer 13

Hepatitis

“H”

Question 14

What are the toxicities of enflurane and sevoflurane?

Answer 14

Renal toxicity

*They are both florinated

Question 15

When inhaled anesthetics are combined with ___________, your patient can get malignant hyperthermia

Answer 15

Succinylcholine

Question 16

What is the antidote for malignant hyperthermia?

Answer 16

Dantrolene

Question 17

What IV anesthetics provide cardiovascular stability?

Answer 17

Etomidate

Midazolam

Question 18

Propofol

MOA

Pharmacokinetic

Answer 18

GABA(A) agonist

30 seconds for onset of action, 3-10 min duration of action; rapid rate of onset, rapid recovery

Question 19

Toxicities of propofol?

Answer 19

Hypotension

Respiratory depression

Question 20

Etomidate

MOA

Downside vs propofol

Useful in what patients

Answer 20

GABA(A) agonist

Less rapid recovery rate compared to propofol

Useful in patients with impaired CV or respiratory sysetms

Question 21

Ketamine

MOA

Toxicities

Special

Answer 21

NMDA antagonist

Emergence reactions (vivid colorful dreams, hallucinations etc)

Only IV anesthetic to produce profound analgesia

Question 22

Dexmedetomidine

MOA

Clinical application

Answer 22

Alpha2 adrenergic agonist

Short term sedation of intubated and ventilated patients in an ICU setting

Question 23

What are (3) classes of drugs used as anesthesia adjuncts?

Answer 23

Opioids

Barbiturates

Banzodiazepines

Question 24

What is the MOA of local anesthetics?

Answer 24

Block voltage gated sodium channels

Question 25

What is the “number of I’s rule”?

Answer 25

If the drug name has 2 I’s in the name = AMIDE

If the drug name has 1 I in the name = ESTER

Question 26

What is the ONLY local anesthetic drug with surface use only indication?

Answer 26

Benzocaine

Question 27

What should you consider coadministering with a local anesthetic?

Answer 27

Vasoconstrictor

Question 28

Why do we care about ester vs amide?

Answer 28

Ester-type local anesthetics are more likely to have allergies!!!

Remember ester-type only have one “i” in their name