Pharm- general anesthetics

Question 1

anesthetic potency is due to

Answer 1

lipid solubility

Question 2

anesthesia potency expressed as ?

Answer 2

minimal alveolar concentration or MAC

Question 3

MAC required to abolish the response to surgical incision in

Answer 3

50% of subjects

Question 4

concentration in the tissues after equilibration (fast in well perfused organs such as brain and heart)

Answer 4

inhaled concentration (MAC)

Question 5

ligand gated RECEPTOR Cl- channels made of two alpha, two beta, and one gamma subunit

Answer 5

GABA A

Question 6

GABA- alpha subunit mutation inhibits_____

Answer 6

volatile but not intravenous anesthetics

Question 7

GABA- beta subunit mutation inhibits_____

Answer 7

inhibits both (volatile and intravenous anesthetics)

Question 8

volatile binds to _____ intravenous binds to ___ subunits

Answer 8

volatile- alpha and beta

intravenous just beta

Question 9

TREK, TASK, or TRESK subunits

Answer 9

two pore domain K+ channels

Question 10

low concentrations of volatile and gaseous anesthetics reducing membrane excitability

Answer 10

two pore domain K+ channels

not affected by intravenous

Question 11

glutamate (major excitatory neurotransmitter)

Important side of action for nitrous oxide, xenon and ketamine

Answer 11

NDMA receptors

Question 12

inhibit sympathetic –> decreased arterial and venous tone = decreased arterial and venous pressure

Answer 12

isoflurane and other halogenated

Question 13

increase sympathetic and plasma noradrenaline –> increase HR and maintain BP

Answer 13

nitrous oxide and ketamine

Question 14

ventricular extra systoles –> increase sensitization to adrenaline

no harm except if catecholamine secretion is excessive increased risk of VF

Answer 14

halothane (and others)

Question 15

fast, unconscousness in 20 s as soon as drug reaches brain

Answer 15

intravenous anesthetic agents

Question 16

Best intravenous anesthetic drug/ fast recovery so it can be used as a continuous infusion (rapidly metabolized)
causes pain at injection site

Answer 16

propofol

Question 17

Drug in which time is sufficient so it can be administered as a single bolus for short operations

Answer 17

ketamine

Question 18

most used intravenous anesthetics act within 20-30 seconds

Answer 18

propofol, thiopental, and etomidate

Question 19

Propofol - IV
Speed of induction and recovery?
Main unwanted effects?

Answer 19

fast onset, very fast recovery

cardiovascular and respiratory depression

Question 20

thiopental - IV
Speed of induction and recovery?
Main unwanted effects?

Answer 20

fast (accumulation occurs, giving slow recovery) HANGOVER lasts 5-10 minutes on single dose

cardiovascular end resp. depression

Question 21

(IV) largely replaced by propofol causes pain at injection site
risk of precipitating porphyria in susceptible patients

Answer 21

thiopental

Question 22

Etomidate- IV
Speed of induction and recovery?
Main unwanted effects?

Answer 22

fast onset, fairly fast recovery

excitatory effects during induction and recovery adrenocortical suppression

Question 23

(IV) less cardiovascular and respiratory depression than with thiopental/ pain at injection site

Answer 23

etomidate

Question 24

Ketamine- IV
Speed of induction and recovery?
Main unwanted effects?

Answer 24

slow onset, after effects common during recovery

psychomimetic effects following recovery postoperative nausea, vomiting and salivation

raised intracranial pressure

Question 25

(IV) produces good analgesia and amnesia with little respiratory depression

Answer 25

ketamine

Question 26

(IV) slower than other agents /little respiratory or cardiovascular depression

Answer 26

midazolam

Question 27

less painful on injection and rapidly converted by alkaline phosphates to propofol in the body

Answer 27

fospropofol

Question 28

prolonged use of drug + critical care patients = severe acidosis, skeletal muscle necrosis, hyperkalemia, renal failure cardiovascular collapse, hepatomegaly

Answer 28

propofol infusion syndrome (1 in 300 patients)

Question 29

only remaining barbiturate

Answer 29

thiopental

Question 30

crosses BBB without delay, blood concentration declines rapidly 80% within 1-2 min

Answer 30

thiopental

Question 31

used to terminate epilepsy and lower intracranial pressure

Answer 31

thiopental

Question 32

if accidentally injected around rather than in vein; pain local tissue necrosis, ulceration or sever arterial spasms and gangrene

Answer 32

thiopental

Question 33

Less hangover than thiopental , less hypotension, suppress production of adrenal steroids: increase in mortality in severely ill patients

Answer 33

etomidate

Question 34

avoid in patients with adrenal insufficiency (sepsis)

Answer 34

etomidate

Question 35

good option in patients with risk of circulatory failure

Answer 35

etomidate

Question 36

has recreational use

Answer 36

ketamine

Question 37

blocks NDMA receptor, low doses treat depression,

Answer 37

ketamine

Question 38

dissociative anesthesia - sensory loss, analgesia and amnesia, without complete loss of cons.

Answer 38

ketamine

Question 39

Increased BP and HR no effect on respiration/ increase intracranial pressure

Answer 39

ketamine

Question 40

important use in pediatrics

Answer 40

ketamine

Question 41

sometimes hallucinations, delirium and irrational behavior during recovery

Answer 41

ketamine

Question 42

small, lipid soluble molecules that cross alveolar membranes

Answer 42

inhalation anesthetics

Question 43

main factor of inhalation anesthetics that determines the rate of induction and recovery

Answer 43

Blood: gas partition coefficient | solubility in blood

Question 44

Low blood: gas partition coefficient means

Answer 44

fast induction and recovery

Question 45

main factor of inhalation anesthetics that determines the potency of the drug

Answer 45

oil: gas partition coefficient High lipid solubility delays recovery influences distribution in body

Question 46

(INHALATION) fast induction recovery, few adverse effects, risk of anemia, accumulation in gas cavities

Answer 46

Nitrous oxide

Question 47

(INHALATION) good analgesic effect, low potency, usually combined with other inhalation agent

Answer 47

nitrous oxide

Question 48

(INHALATION) medium induction and recovery few adverse effects, possible risk of coronary ischemia in susceptible patients

Answer 48

isoflurane

Question 49

widely used replaced halothane

Answer 49

isoflurane

Question 50

(INHALATION) fast induction recovery,respiratory tract irritation, cough, bronchospasm

Answer 50

desflurane

Question 51

(INHALATION) fast induction recovery, few reported adverse effects, theoretical risk of renal toxicity owing to fluoride

Answer 51

sevoflurane

Question 52

(INHALATION) used for day- case surgery because of fast onset and recovery (comparable to NO)

Answer 52

Desflurane | Sevoflurane

Question 53

Fat patients

Answer 53

low bloodflow and high capacity to take up anesthetics, increased fat soluble anesthetic means delayed recovery prolonged hangover

Question 54

increased heat production in skeletal muscle, excessive release of CA 2+ from sarcoplasmic reticulum, muscle contracture, acidosis, increased metabolism and dramatic rise in body temp

Answer 54

malignant hyperthermia

Question 55

halogenated and depolarizing neuromuscular blocking drugs are triggers for

Answer 55

malignant hyperthermia