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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
MOA etomidate
enhances actions of GABA on GABA-A receptors
26
describe rate of onset and recovery for etomidate
rapid loss of consciousness but less rapid recovery compared to propofol
27
effects of etomidate on CNS
potent cerebral vasoconstrictor decreases cerebral blood flow and intracranial pressure
28
effects of etomidate on CV system
minimal change in heart rate and cardiac output
29
effects of etomidate on endocrine system
adrenocortical suppression by inhibiting 11B-hydroxylase (converts cholesterol to cortisol)
30
MOA ketamine
NMDA receptor antagonist
31
what effects does etomidate produce
hypnotic but not analgesic effects
32
what effects does ketamine produce
dissociative anesthetic state with catatonia, amnesia, and analgesia w/ or w/o LOC
33
effects of ketamine on CNS
increased cerebral blood flow
34
what is the main limiting factor for use of ketamine
unpleasant emergence reactions: vivid colorful dreams, hallucinations, out of body experiences, increased and distorted visual, tactile, and auditory sensitivity
35
effects of ketamine on CV system
can increase systemic BP, HR, cardiac output
36
what is the only IV anesthetic to produce profound analgesia, stimulation of the sympathetic nervous system, bronchodilation, and minimal respiratory depression
ketamine
37
MOA dexmedetomidine
alpha-2 agonist
38
what effects does dexmedetomidine produce
sedative effect more resembles a physiologic sleep state through activation of endogenous sleep pathways
39
effects of dexmedetomidine on CV system
decreased HR and systemic vascular resistance and BP
40
indications dexmedetomidine
short-term sedation of intubated and ventilated patients in an ICU setting
41
what are the three classes of drugs used in adjunct to anesthetics
opioid analgesics barbiturates benzodiazepines
42
what opioids are used in adjunct to anesthetics
fentanyl, sufentanil, remifentanil, morphine
43
what barbiturates are used in adjunct to anesthetics
thiopental and methohexital
44
what benzos are used in adjunct to anesthetics when are they used
diazepam, lorazepam, midazolam perioperative period because of anxiolytic properties and ability to produce anterograde amnesia
45
which benzo is used most frequently in adjunct to anesthetics and why
midazolam rapid onset, shorter elimination half life, and steeper dose-response curve
46
-caine suffix indicates what
local anesthetic
47
-caine suffix with two i's in the name indicates what
local anesthetic in the amide class
48
MOA local anesthetics
blocks voltage gated sodium channel currents and stops the spread of axon potentials down the nerve
49
what is the only "surface only" local anesthetic
benzocaine
50
what are local anesthetics often paired with and why
vasoconstrictors - stop bleeding for trauma injuries - keeps the anesthetic local (decreases absorption into the circulation)
51
what are the CNS effects of local anesthetics at low doses and at high doses
low doses --> sleepiness, light-headedness, visual/auditory disturbances high doses --> nystagmus, muscular twitching, convulsions
52
what are the CV effects of local anesthetics
decrease electrical excitability, conduction rate, force of contraction, and cause arteriolar dilation --> systemic hypotension
53
what side effect is specific to ester-type local anesthetics
allergic reactions are more common
54
indications bupivacaine
prolonged anesthesia
55
indications cocaine
topical anesthetic of upper respiratory tract
56
indications dibucaine
topical cream for use on the skin | used to be used for injections tho, but stopped because of toxicity
57
indications lidocaine
anti-arrhythmic agent
58
indications procaine
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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