Unit 1 Pharmacology Guiding Questions

Question 1

what is general anesthesia?

Answer 1

a reversible state of unconsciousness

Question 2

An ideal anesthetic agent must be able to produce each of the following conditions:

Answer 2

-rapid onset of anesthesia
-skeletal muscle relaxation
-inhibition of sensory and autonomic reflexes
-easy adjustment of the anesthetic dosage during procedure
-a minimum of toxic side effects
-rapid, uneventful recovery after administration is terminated
-amnesia

Question 3

Two primary routes of administration of anesthetic agents:

Answer 3

IV or inhaled

Question 4

advantage of IV anesthetics

Answer 4

rapid onset, allowing patient to pass through first two stages of anesthesia very quickly

Question 5

disadvantage of IV anesthetics

Answer 5

there is a relative lack of control over the level of anesthesia if too much is injected

Question 6

what is balanced anesthesia?

Answer 6

when a combination of IV and inhaled agents are used to provide optimal anesthetic effects with minimal side effects

Question 7

primary form of inhaled anesthetics

Answer 7

halogenated volatile liquids (enflurane, halothane, insoflurane)

Question 8

uniform distribution of general anesthetics is largely due to

Answer 8

their high degree of lipid solubility

Question 9

why does it take a while for anesthetics to leave a patients system?

Answer 9

it may become temporarily stores in adipose tissues

Question 9

why does it take a while for anesthetics to leave a patients system?

Answer 9

it may become temporarily stores in adipose tissues

Question 10

elimination of anesthetics occurs primarily through

Answer 10

excretion from the lungs, biotransformation in the liver, or a combination of both.

Question 11

adjuvant drugs used to balance the effects of general anesthetic include

Answer 11

preoperative medications and neuromuscular blockers

Question 12

when are preoperative sedatives given to patients

Answer 12

1-2 hours before the administration of general anesthesia

Question 13

how are sedatives normally administered

Answer 13

orally or by intramuscular injection

Question 14

some commonly used preoperative sedatives include

Answer 14

barbiturates, opioids, and benzodiazepines

Question 15

what goals to antihistamines achieve?

Answer 15

produce sedation and reduce vomiting during and after surgery

Question 16

how do neuromuscular blockers work?

Answer 16

they block the postsynaptic acetylcholine receptor located at the skeletal neuromuscular junction

Question 17

possible side effects if neuromuscular blockers include

Answer 17

cardiovascular problems, increased histamine release, increased plasma potassium levels, residual muscle pain and weakness, and immunological reactions

Question 18

local anesthetics can be applied directly to

Answer 18

the surface of skin, mucous membranes, cornea, and other regions to produce analgesia

Question 19

local anesthetics can be applied topically to

Answer 19

reduce pain prior to minor surgical procedures

Question 20

preliminary studies suggest that topical anesthesia can be used to improve

Answer 20

motor function in patients with skeletal muscle hypertonicity resulting from a CVA or head trauma

Question 21

how can transdermal administration of local anesthetics be enhanced?

Answer 21

by the use of electrical current or ultrasound

Question 22

what percentage of lidocaine is used in transdermal patches to treat localized pain in musculoskeletal conditions and neuropathic pain?

Answer 22

5%

Question 23

With this method, the drug is injected directly into the selected tissue, allowing it to diffuse to sensory nerve endings within that tissue.

Answer 23

infiltration anesthesia

Question 24

the anesthetic is injected close to the nerve trunk so that transmission along the peripheral nerve is interrupted

Answer 24

peripheral nerve block

Question 25

polonged administration of local anesthetics within skeletal muscle can produce

Answer 25

localized muscle pain and necrosis

Question 26

injection of the drug into the epidural space (the space between the bony vertebral column and the dura mater)

Answer 26

epidural nerve blockade

Question 27

what is a caudal block?

Answer 27

injecting the local anesthetic into the lumbar epidural space via the sacral hiatus

Question 28

injection within the subarachnoid space (the space between the arachnoid membrane and the pia mater)

Answer 28

spinal nerve blockade

Question 29

where are epidural and spinal blocks usually administered?

Answer 29

L3-4 or L4-5 vertebral interspace

Question 30

the anesthetic is injected into a peripheral vein located in a selected arm or leg

Answer 30

IV regional anesthesia

Question 31

why is a tourniquet applied during IV regional anesthesia?

Answer 31

to localize the drug temporarily within the extremity and to prevent the anesthetic from reaching the systemic circulation where it would cause toxic side effects on the heart and CNS

Question 32

the ability of a local anesthetic dose to block specific nerve fiber groups depending on the size (diameter) of the fibers

Answer 32

differential nerve block

Question 33

what is local anesthetic systemic toxicity

Answer 33

when the anesthetics are absorbed into the general circulation and exert toxic effects on other organs and tissues

Question 34

local anesthetics most important systemic effects involve

Answer 34

the CNS and cardiovascular system

Question 35

what happens if local anesthetics reach the systemic circulation?

Answer 35

they can inadvertently disrupt the excitability of the CNS and cardiac tissue

Question 36

symptoms such as ___ can occur if sufficient amounts of anesthetics reach the brain

Answer 36

somnolence, confusion, agitation, excitation, and seizures

Question 37

The primary cardiovascular effects associated with local anesthetics include

Answer 37

decreased cardiac excitation, heart rate, and force of contraction

Question 38

Early symptoms of CNS toxicity typically include

Answer 38

ringing/buzzing in the ears (tinnitus), agitation, restlessness, and decreased sensation in the tongue, around the mouth, or other areas of the skin

Question 39

what indicates cardiotoxicity?

Answer 39

Changes in heart rate (bradycardia), electrocardiogram (ECG) abnormalities, or clinical signs of cardiac depression (fatigue, dizziness)

Question 40

characterized primarily by an exaggerated muscle stretch reflex. occurs in many patients following injury to the CNS

Answer 40

spasticity

Question 41

typically arise from an orthopedic injury to a musculoskeletal structure or peripheral nerve root. often a continuous tonic contraction of specific muscles

Answer 41

spasms

Question 42

how does diazepam work?

Answer 42

by increasing the central inhibitory effects of gamma-aminobutyric acid. it binds to receptors located at GABAergic synapses and increases the GABA-induced inhibition at that synapse

Question 43

use of Diazepam

Answer 43

used to treat spasms associated with musculoskeletal injuries. also to control muscle spasms associated with tetanus toxin

Question 44

primary side effect of diazepam

Answer 44

produces sedation and general reduction in psychomotor ability can also produce tolerance and physical dependence, and sudden withdrawal after prolonged use can cause seizures, anxiety, agitation, tachycardia, and even death.

Question 45

what do centrally acting antispasm drugs do?

Answer 45

they may decrease polysynaptic reflex activity in the spinal cord

Question 46

how are centrally acting antispasm drugs used?

Answer 46

as adjuncts to rest and physical therapy for short term relief of muscle spasms associated with acute, painful musculoskeletal injuries. given with NSAIDS

Question 47

primary side effects of centrally acting antispasm drugs

Answer 47

drowsiness and dizziness additional: nausea, light-headedness, vertigo, ataxia, and headache

Question 48

how does baclofen work?

Answer 48

Preferential binding to GABAB receptors enables baclofen to act as a GABA agonist, inhibiting transmission within the spinal cord at specific synapses.

Question 49

How is baclofen used?

Answer 49

administered orally to treat spasticity associated with lesions of the spinal cord, including traumatic injuries resulting in paraplegia or quadriplegia and spinal cord demyelination resulting in MS

Question 50

most common side effect of baclofen?

Answer 50

drowsiness others: fatigue, nausea, dizziness, muscle weakness, and headache

Question 51

how does gabapentin work?

Answer 51

by inhibiting calcium entry into presynaptic nerve terminals that release glutamate and other excitatory neurotransmitters

Question 52

what is gabapentin used for?

Answer 52

decreasing the spasticity associated with spinal cord injury and multiple sclerosis also helpful in treating various types of neuropathic pain

Question 53

primary side effects of gabapentin?

Answer 53

sedation, fatigue, dizziness, and ataxia

Question 54

what is botulinum toxin used for (clinically)?

Answer 54

control localized muscle dystonias, including conditions such as spasmodic torticollis, blepharospasm, laryngeal dystonia, strabismus, and several other types of focal dystonias