pharmacology: anesthesia

Question 1

what are the inhaled anesthetics?

Answer 1

nitrous oxide and halothane

Question 2

which inhaled anesthetic is more potent? why?

Answer 2

halothane - lower MAC value (minimal alveolar anesthetic concentration)

Question 3

which inhaled anesthetic has the lower blood-gas ratio, minimal CV effects, and no metabolism?

Answer 3

Nitrous oxide

Question 4

side effects of halothane

Answer 4

malignant hyperthermia, hepatitis, cardiac arrhythmias

Question 5

what are the IV anesthetics?

Answer 5

thiopental, midazolam, propofol, fentanyl, ketamine

Question 6

thipental - use in anesthesia

Answer 6

barbiturate used for induction of anesthesia - lipid soluble so has rapid onset and short acting

Question 7

midazolam - use in anesthesia

Answer 7

benzo used for preoperative sedation, anterograde amnesia, induction, outpatient surgery

Question 8

propofol - use in anesthesia

Answer 8

used for induction and maintenance and also as an antiemetic

Question 9

which IV anesthestic looks like milk

Answer 9

propofol

Question 10

fentanyl- use in anesthesia

Answer 10

opiate - induction and maintence of anesthesis - depresses respiratory function

Question 11

ketamine - use in anesthesia

Answer 11

NMDA-receptor antagonist
dissociative anesthetic used for induction of anesthesia, causes hallucination and CV stimulation and increased intracranial pressure

Question 12

what are the local anesthetics groups?

Answer 12

esters (procaine, cocaine, benzocaine) and amides (lidocaine, bupivacaine, mepivacaine)

Question 13

problem with esters

Answer 13

slow/fast metabolizers

Question 14

problem with amides

Answer 14

liver function

Question 15

which nerve fibers are most sensitive to local anesthetics?

Answer 15

smaller diameter

type B&C > type A delta > type A beta and gamma > type A alpha

Question 16

what are local anesthetics administered with?

Answer 16

alpha 1 agonists

Question 17

side effects of local anesthetics?

Answer 17

neurotoxicity, CV toxicity, allergies (esters via PABA formation)
why you use the alpha 1 agonists

Question 18

which local anesthetic does not need an alpha 1 agonist?

Answer 18

cocaine - has its own vasconstriction by blocking NE reuptake

Question 19

what are the skeletal muscle relaxants?

Answer 19

nondepolarizing (atracurium and mivacurium)

depolarizing (sccinylcholine)

Question 20

how do the nondepolarizing skeletal muscle relaxants works? (atracurium and mivacurium)

Answer 20

nicotinic antagonists causing progressive paralysis - only effect NM receptors so no cardiac, smooth muscle, CNS effects

Question 21

atracurium uses

Answer 21

safe in hepatic or renal impairment

have spontaneous inactivation to laudanosine which can cause seizures

Question 22

mivacurium uses

Answer 22

very short duration - metabolized by plasma cholinesterases

Question 23

what is the depolarizing skeletal muscle relaxant? mechanism and use?

Answer 23

succinylcholine - nicotinic agonist
depolarization and desensitization
hydrolyzed by pseudocholinesterase so have short duration

Question 24

what are the centrally acting skeletal muscle relaxants?

Answer 24

benzos (GABA A receptors) baclofen (GABA B receptors)

used in spasticity

Question 25

what is used to treat malignant hyperthermia caused by succinylcholine?

Answer 25

dantrolene (blocks Ca release from SR that causes extreme muscle rigidity)