Pharmacology: Anesthetic Agents

Question 1

MAC

Answer 1

Mean Alveolar Concentration

Question 2

Ester anesthetics

Answer 2

gfdsgg

Question 3

Ester anesthetic metabolism: where, by which enzyme, and to which product?

Answer 3

In the blood
By pseudocholinesterase
To para-aminobenzoic acid (PABA) -> allergen

Question 4

How must nitrous oxide be administered?

Answer 4

Via inhalation, in combination with other agents (such as opioids) for general anesthesia (because is is not a potent, complete anesthesia alone).

Question 5

If all halogenated volatile agents can provide a complete general anesthetic at high doses, what are the clinically relevant differences between agents?

Answer 5

1) Anesthetic POTENCY
2) SOLUBILITY in fat and blood
3) Degree of noxious character/PUNGENCY
4) COST/mL

Question 6

What are the 5 “As” of general anesthesia?

Answer 6

Areflexia
Analgesia
Anesthesia
Amnesia
Akinesia

Question 7

How is the state of general anesthesia defined?

Answer 7

Aleep (hypnosis)
Forgetful (amnesia)
Comfortable (Analgesia)
Still (Immobility/muscle relaxation/akinesia)
Unresponsive - Blunting of autonomic reflexes)

Question 8

What are the cerebral effects of anesthesia?

Answer 8

Decreased metabolism
Changes in local patterns of activation
Increased local synchrony of brain activity

Question 9

Which of the IV anesthetics is contraindicated for egg allergies?

Answer 9

Propofol

Question 10

Rapid induction of anesthesia is achieved with inhaled or IV anesthetic?

Answer 10

IV anesthetics

Question 11

Maintenance of anesthesia is typically achieved with…

Answer 11

Inhalant anesthetics

Question 12

What is the effect of inhaled anesthetics on minute ventilation?

Answer 12

It decreases the minute ventilation because the increase in resp rate cannot compensate for the decreased tidal volume.

Question 13

Which gas is typically administered for analgesia?

Answer 13

Nitrous oxide

Question 14

Intravenous opioids increase/decrease MAC?

Answer 14

??

Question 15

What do the inhaled agents do to cerebral blood flow?

Answer 15

INCREASE

Question 16

What class of drugs are the inhaled anesthetics?

Answer 16

They are all halogenated ethers.

Question 17

What drug is contraindicated in patients with acute intermittent porphyria?

Answer 17

Thiopentol.

Question 18

What does propofol do to cerebral blood flow?

Answer 18

Propofol. This is a feature of IV anesthetics that is beneficial in patients with increased ICP.

Question 19

What is the amount of IV anesthetic needed to prevent awareness?

Answer 19

TRICK QUESTION. We don’t KNOW the dose for IV anesthetics.

Question 20

Which IV anesthetics can you also give IM?

Answer 20

Ketamine

Question 21

Which IV anesthetic is also used for lethal injections?

Answer 21

Thiopental

Question 22

What is the term for “ the longer you infuse a drug, the longer it takes to eliminate”?

Answer 22

Context-sensitive half life

Question 23

Term for how drugs get to the effect site?

Answer 23

Pharmacokinetics

Question 24

Term for the drug effect as the result of receptor binding?

Answer 24

Pharmacodynamics

Question 25

Which local anesthetic also has antiarrythmic properties?

Answer 25

Lidocaine

Question 26

What medication is added to local anesthetics to prolong the duration of blockade (by causing vasoconstriction)?

Answer 26

Epinephrine

Question 27

At which protein channel do local anesthetics work?

Answer 27

Voltage-gated sodium channel

Question 28

What type of local anesthetic is cocaine?

Answer 28

Ester

Question 29

Inhaled anesthetics have been linked to what condition in adults?

Answer 29

Alzheimer’s/neurodegeneration

Question 30

Which hair color leads to decreased MAC?

Answer 30

Red hair?

Question 31

The concentration of inhaled anesthetic to prevent awareness is (higher/lower) than that necessary to prevent movement to pain?

Answer 31

It is lower (the concentration to prevent movement to pain = MAC, and that necessary to prevent awareness = 0.6MAC).

Question 32

Which induction agent is also metabolized in the lung and liver?

Answer 32

Propofol!

Question 33

Which was the local anesthetic first used for surgery?

Answer 33

Cocaine

Question 34

Which organ metabolizes amide local anesthetics?

Answer 34

The liver

Question 35

Which organ metabolizes ester local anesthetics?

Answer 35

The blood

Question 36

Which depends on drug metabolism: the distribution half-life or the elimination half-life?

Answer 36

Elimination

Question 37

Neurotransmitter, propofol

Answer 37

GABA_A

Question 38

Local anesthetics bind to which configuration of the sodium channel?

Answer 38

The open or inactive state, but NOT the closed.

Question 39

Which local anesthetic has a higher likelihood of allergic reaction: lidocaine or tetracaine?

Answer 39

Tetracaine (ester, metabolized to the allergen PABA)

Question 40

Inhaled anesthetics have been linked to the progression of which disease in kids?

Answer 40

Neurodevelopmental delay

Question 41

bhj

Answer 41

tingling of tongue/metallic taste?

Question 42

Inhaled anesthetics with low blood solubility will have a (slow/fast) onset?

Answer 42

FAST

Question 43

When the entire body does not respond to noxious stimuli, that is also known as….?

Answer 43

General anesthesia

Question 44

What is the breakdown product of ester local anesthetics?

Answer 44

Para-aminobenzoic acid (PABA)