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Maddy - NMSP Exam III > Pharm - General and Local Anesthetics > Flashcards

Pharm - General and Local Anesthetics Flashcards

1
Q

-ane suffix indicates _____

A

inhaled anesthetic

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2
Q

what is the one inhaled anesthetic that is gas at room temperature

A

nitrous oxide

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3
Q

compare vapor pressures and boiling points between the volatile and gaseous inhaled anesthetics

A

volatile: low vapor pressure and high boiling points
gaseous: high vapor pressure and low boiling points

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4
Q

describe the relationship between the blood:gas partition coefficient and the rate of anesthesia onset

A

inverse relationship

the higher the blood: gas partition coefficient, the slower the onset of action

the lower the coefficient, the faster the onset of action

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5
Q

what inhaled anesthetics have a low blood solubility and thus a fast onset (low blood:gas partition coefficient)

A

nitrous oxide (0.47)

desflurane (0.42)

sevoflurane (0.69)

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6
Q

what inhaled anesthetics have a high blood solubility and thus a slow onset (high blood:gas partition coefficient)

A

halothane (2.3)

enflurane (1.8)

isoflurane (1.4)

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7
Q

rank the inhaled anesthetics in order of highest blood:gas partition coefficient to lowest

A

halothurane –> enflurane –> isoflurane –> sevoflurane –> nitrous oxide –> desflurane

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8
Q

what is used to measure the potency of inhaled anesthetics

A

minimal alveolar concentration (MAC)

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9
Q

what tissues in the body have a higher immediate concentration of anesthetic due to their high perfusion

A

brain, heart, liver, kidneys, splanchnic bed

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10
Q

which inhaled anesthetics are eliminated at faster rates

what is the major route of elimination from the body

A

those that are relatively insoluble in the blood (ex: nitrous oxide)

clearance via the lungs is the major route

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11
Q

rank the inhaled anesthetics from least to greatest in terms of potency

A

LEAST

nitrous oxide –> desflurane –> sevoflurane –> enflurane –> isoflurane –> halothane

GREATEST

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12
Q

what are the effects of inhaled anesthetics on the cardiovascular system

A

volatile liquid anesthetics decrease the mean arterial pressure in direct proportion to their alveolar concentration

ALL inhaled anesthetics increase right atrial pressure

halothane –> bradycardia

desflurance and isoflurane –> tachycardia

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13
Q

what are the general side effects of inhaled anesthetics

A

nausea and vomiting

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14
Q

what are the specific side effects for halothane

A

hepatitis

anorexia, nausea, myalgias, arthralgias, rash, eosinophilia, hepatomegaly, jaundice

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15
Q

what are the specific side effects for enflurane and sevoflurane

A

renal toxicity

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16
Q

when combining inhaled anesthetics with succinylcholine, what side effects can occur

A

malignant hyperthermia

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17
Q

MOA propofol

A

agonist at GABA-A receptors and potentiates chloride current

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18
Q

describe the pharmacokinetics of propofol, including rate of onset and recovery

A

rapid rate of onset (15-30 seconds) and rapid recovery

rapidly metabolized in liver w/ extensive extrahepatic metabolism

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19
Q

indications propofol

A
  • sedation in ICU (continuous infusion)
  • conscious sedation
  • short-duration general anesthesia in locations outside the OR
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20
Q

effects of propofol on CNS

A

general suppression of CNS activity

no analgesic properties

decreased cerebral blood flow and cerebral metabolic rate for oxygen –> decreases intracranial pressure and intraocular pressure

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21
Q

effects of propofol on CV system

A

pronounced decreased in sympathetic blood pressure due to profound vasodilation in both arterial and venous circulation

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22
Q

describe the metabolism of fospropofol

A

water soluble pro-drug of propofol

rapidly metabolized by alk phosphatase –> produces propofol, phosphate, and formaldehyde

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23
Q

compare onset and recovery between propofol and fospropofol

A

fospropofol has prolonged onset and recovery because the pro-drug has to be converted in an active form

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24
Q

side effects of fospropofol

A

paresthesias and pruritus

25
Q

MOA etomidate

A

enhances actions of GABA on GABA-A receptors

26
Q

describe rate of onset and recovery for etomidate

A

rapid loss of consciousness but less rapid recovery compared to propofol

27
Q

effects of etomidate on CNS

A

potent cerebral vasoconstrictor

decreases cerebral blood flow and intracranial pressure

28
Q

effects of etomidate on CV system

A

minimal change in heart rate and cardiac output

29
Q

effects of etomidate on endocrine system

A

adrenocortical suppression by inhibiting 11B-hydroxylase (converts cholesterol to cortisol)

30
Q

MOA ketamine

A

NMDA receptor antagonist

31
Q

what effects does etomidate produce

A

hypnotic but not analgesic effects

32
Q

what effects does ketamine produce

A

dissociative anesthetic state with catatonia, amnesia, and analgesia w/ or w/o LOC

33
Q

effects of ketamine on CNS

A

increased cerebral blood flow

34
Q

what is the main limiting factor for use of ketamine

A

unpleasant emergence reactions:

vivid colorful dreams, hallucinations, out of body experiences, increased and distorted visual, tactile, and auditory sensitivity

35
Q

effects of ketamine on CV system

A

can increase systemic BP, HR, cardiac output

36
Q

what is the only IV anesthetic to produce profound analgesia, stimulation of the sympathetic nervous system, bronchodilation, and minimal respiratory depression

A

ketamine

37
Q

MOA dexmedetomidine

A

alpha-2 agonist

38
Q

what effects does dexmedetomidine produce

A

sedative effect more resembles a physiologic sleep state through activation of endogenous sleep pathways

39
Q

effects of dexmedetomidine on CV system

A

decreased HR and systemic vascular resistance and BP

40
Q

indications dexmedetomidine

A

short-term sedation of intubated and ventilated patients in an ICU setting

41
Q

what are the three classes of drugs used in adjunct to anesthetics

A

opioid analgesics

barbiturates

benzodiazepines

42
Q

what opioids are used in adjunct to anesthetics

A

fentanyl, sufentanil, remifentanil, morphine

43
Q

what barbiturates are used in adjunct to anesthetics

A

thiopental and methohexital

44
Q

what benzos are used in adjunct to anesthetics

when are they used

A

diazepam, lorazepam, midazolam

perioperative period because of anxiolytic properties and ability to produce anterograde amnesia

45
Q

which benzo is used most frequently in adjunct to anesthetics and why

A

midazolam

rapid onset, shorter elimination half life, and steeper dose-response curve

46
Q

-caine suffix indicates what

A

local anesthetic

47
Q

-caine suffix with two i’s in the name indicates what

A

local anesthetic in the amide class

48
Q

MOA local anesthetics

A

blocks voltage gated sodium channel currents and stops the spread of axon potentials down the nerve

49
Q

what is the only “surface only” local anesthetic

A

benzocaine

50
Q

what are local anesthetics often paired with and why

A

vasoconstrictors

  • stop bleeding for trauma injuries
  • keeps the anesthetic local (decreases absorption into the circulation)
51
Q

what are the CNS effects of local anesthetics at low doses and at high doses

A

low doses –> sleepiness, light-headedness, visual/auditory disturbances

high doses –> nystagmus, muscular twitching, convulsions

52
Q

what are the CV effects of local anesthetics

A

decrease electrical excitability, conduction rate, force of contraction, and cause arteriolar dilation –> systemic hypotension

53
Q

what side effect is specific to ester-type local anesthetics

A

allergic reactions are more common

54
Q

indications bupivacaine

A

prolonged anesthesia

55
Q

indications cocaine

A

topical anesthetic of upper respiratory tract

56
Q

indications dibucaine

A

topical cream for use on the skin

used to be used for injections tho, but stopped because of toxicity

57
Q

indications lidocaine

A

anti-arrhythmic agent

58
Q

indications procaine

A

infiltration anesthesia

local anesthesia produced by injection of procaine directly into area of terminal nerve endings

Maddy - NMSP Exam III (16 decks)

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