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Pharmacology > Week 4: Anesthetics > Flashcards

Week 4: Anesthetics Flashcards

1
Q

Local anesthetics directly affect the voltage sensitive _____ ___, _______ the permeability of the excitable membranes to ____.

A

Na+ channels

decreasing, Na+

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2
Q

What are the local anesthetic esters? (3)

A

Procaine
Chloroprocaine
Tetracaine

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3
Q

What are the local anesthetic amides? (6)

A 
Mepivacaine
Bupivacaine
LIdocaine
Prilocaine
Ropivacaine
Levobupivacaine
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4
Q

What is the onset and duration of Procaine?

A

Onset :2-5 minutes

Duration: 0.25-1 hour

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5
Q

What is the onset and duration of Bupivacaine?

A

Onset: 5 minutes
Duration: 2-4 hours

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6
Q

What is the onset and duration of lidocaine?

A

Onset: <2 minutes
Duration: 0.5-1 hr

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7
Q

What is the result of the aromatic ring structure?

A

increased lipid solubility

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8
Q

What determines the type of metabolism?

A

linkage

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9
Q

What linkage involves hepatic metabolism?

A

Amides

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10
Q

What linkage involves plasma esterases?

A

Esters

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11
Q

What influences aqueous solubility?

A

Terminal amine

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12
Q

What is the effect of lidocaine combined with a vasoconstrictor (epinephrine)?

A

constriction of surrounding blood vessels to keep anesthetic in contact with nerve.

causes prolonged duration of action and also controls bleeding

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13
Q

What is the max dose of lidocaine?

A

Lidocaine 2%
7mg/kg
total: 500

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14
Q

What is the most commonly used anesthetic?

A

Lidocaine

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15
Q

What anesthetic has a shorter duration of action compared to lidocaine?

A

Procaine

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16
Q

What anesthetic has a higher potency compared to lidocaine?

A

Bupivacaine

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17
Q

What is the maximum of lidoderm patched?

A

3 patches/daily

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18
Q

True allergies are ____.

A

rare

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19
Q

What type of local anesthetics are more common to cause allergic reaction?

A

more common with ester type

*if allergic to one, allergic to all

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20
Q

What is a systemic effect of local anesthesia?

A

death by respiratory depression

seizures!

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21
Q

What is the local anesthetic used in epidurals?

A

bupivacaine

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22
Q

EMLA is a topical cream with a combination of what?

A

lidocaine and prilocaine

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23
Q

What population are EMLA useful?

A

in pediatrics

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24
Q

What are the common uses for EMLA? (3)

A

starting IVs, biopsies
venous, arterial, finger, heel and lumbar punctures
removal of staples, sutures and lines

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25
Q

What toxicology emerged with chloroform use?

A

long term liver damage and sudden death

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26
Q

What toxicology emerged from methoxyflurance?

A

nephrotoxic

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27
Q

What was the problem that emerged from ether?

A

too flammable

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28
Q

What is a side effect of inhaled nitrous oxide?

A

increased post op N&V

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29
Q

What is a side effect of inhaled halothane (fluothane)?

A

hepatotox, arrhythmias

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30
Q

What is a side effect of inhaled enflurane (ethrane)?

A

hepato & renal toxicities

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31
Q

What is a common side effect of inhaled isoflurance (Forane)?

A

coronary steal- shunting of blood away from already ischemic myocardium

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32
Q

What is a common side effect of inhaled desflurane (soprane)?

A

tachycardia

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33
Q

What is a common side effect of sevoflurane (ultane)?

A

toxic metabolites

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34
Q

What are the advantages of inhalation anesthesia?

A

completely painless induction of anesthesia
No IV access
most rapid appearance of blood in arterial blood.

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35
Q

What are the differences between inhalation anesthetics?

A

metabolism

effects on the heart

36
Q

What is the indication for the use of sedatives?

A

facilitate tolerance to procedures
reduce unnecessary recall
mandatory adjust to neuromuscular blockade

37
Q

What are benzodiazepines commonly used for?

A 
sedation
hypnosis
anxiolysis
muscle relaxation
anticonnvulsant activity
anterograde amnesia

**No analgesia intrinsically

38
Q

What is a long acting benzodiazepine that is the most lipid soluble?

A

Diazepam (valium)

39
Q

Since diazepam (valium) is propylene glycol vehicle what is a common side effect?

A

Hypotension

40
Q

Where is diazepam metabolized?

41
Q

What are the 3 active metabolites of diazepam?

A

desmethyldiazepam
temazepam
Oxazepam

42
Q

What is the half life of desmethyldiazepam?

A

100-200 hour

43
Q

What are the uses of diazepam (valium)? (3)

A

conscious sedation
anxiety/muscle relaxation
status epilepticus (IV)

44
Q

What is important for dosing of valium in hepatic disease?

A

reduce dose by 50%

45
Q

What is a risk of continuous lorazepam infusion?

A

propylene glycol-induced metabolic acidosis

46
Q

What is the drug of choice in prevention of alcohol withdrawal, delirium tremens?

A

lorazepam (Ativan)

47
Q

What are the common indications of lorazepam (Ativan)?

A

anxiety and sedation

status epilepticus

48
Q

What is the dosage of lorazepam (Ativan) for preprocedural anxiety?

A

1-2mg 1 hour prior

49
Q

What is the dosage for lorazepam for status epilepticus?

A

4mg/dose slow IVP (over 2-5 minutes)

50
Q

What is a relative shirt acting benzodiazepine and is water soluble?

A

Midazolam (versed)

51
Q

Are there propylene glycol issues with Midazolam (versed)?

A

NO its water soluble

52
Q

What is midazolam metabolized by?

A

CYP3A4

hepatic

53
Q

Where is midazolam (Versed) metabolized to active 1-OH metabolite?

A

metabolized in the liver

renally eliminated

54
Q

What pts have the potential for prolonged activity with midazolam (versed)?

A

elderly patients
patients in renal disease
patients with liver failure
patients in shock

55
Q

What is the dose of midazolam (versed) in pre-op sedation?

A

5mg IM 30-40 minutes prior

56
Q

What is the dose of midazolam (versed) for conscious sedation?

A

usual dose 2.5-5mg

57
Q

How should the dose of midazolam be changed in the elderly?

A

decrease initial dose by 50%

58
Q

What medication is used for benzodiazepine reversal?

A

Flumazenil (Romazicon)

59
Q

How does Flumazenil (Romazicon) work to reverse benzodiazepines?

A

reverses excessive CNS depression

60
Q

What is significant about Flumazenil (Romazicon)’s duration of action?

A

short duration of action (30-45 minutes), relative to the prolonged effects of the benzodiazepines (resedation)

61
Q

What is significant about propofol (diprivan) short duration of action?

A

decreased time to weaning and extubation

rapid assessment of neurologic status

62
Q

When does tubing of propofol (diprivan) need to be changed every 12 hours?

A

supports microbial growth

63
Q

What medication counts as a calorie source?

A

Propofol (diprivan)
1.1 calories/ml
hyperlipidemia

64
Q

What are SE of propofol (diprivan)?

A

hypotension
rapid development of tolerance
variable half life

65
Q

What is a sedative with some analgesic activity that has no respiratory depression and is 95% really excreted?

A

Dexmedetomidine (Precedex)

66
Q

What is common with dexmedetomidine (precedex)?

A

hypotension
bradycardia
patients appear awake and alert
expensive

67
Q

When is a dissociative anesthetic agent?

A

ketamine (ketalar)

68
Q

What procedures is ketamine (ketalar) useful for?

A

debridement of wounds

transport of a patient in pain

69
Q

What is significant about ketamine onset?

A

rapid onset-30 seconds

70
Q

What can commonly occur during recovery with ketamine?

A

can produce hallucinations and vivid dreams in recovery

71
Q

What is the drug of choice for urgent endotracheal intubation?

A

Etomidate (Amidate)

72
Q

What drug is commonly used in the OR and ER with a rapid onset(seconds) of unconsciousness and short duration (3-10min)

A

Etomidate (amidate)

73
Q

Why should etomidate (amidate) be used only short term?

A

depresses cortisol synthesis

74
Q

What is significant about etomidate?

A

minimal hypotension or disruption of ventilation

75
Q

What are the 2 mechanisms of action of NMBAs?

A

depolarizing (non-competitive)

Nondepolarizing (competitive)

76
Q

What is an example of a NMBA that is used primarily for rapid sequence intubation?

A

Succinylcholine (Anectine)

77
Q

What are the intermediate acting NMBAs? (20-30 minutes)

A

Antacurium (Tracrium)
Cisatracurium (Nimbex)
Rocuronium (Zemubron)
Vecuronium (Norcuron)

78
Q

What are the indications of use of NMBAs?

A

intubation

mechanical ventilation synchrony (improve pt compliance with vent)

79
Q

What is significant about NMBA use?

A

must have adequate sedation and analgesia at start and during NMB therapy

80
Q

What are the precautions associated with Succinylcholine?

A

malignant hyperthermia

81
Q

What are the steroid based NMBA precautions?

A

pancuronium
rocuronium
vecuronium

82
Q

What are the Benzylisoquinolinium compounds (NMBA)?

A

atracurium

mivacurium

83
Q

What is a precaution of mivacurium?

A

histamine release- hypotension

84
Q

What are the drug interactions of NMBA?

A 
steroids
aminoglycosides
Calcium channel blockers
beta blockers 
furosemide
85
Q

What is the net result of NMBA resistance?

A

increased bolus and infusion doses to induce and maintain paralysis

86
Q

Benzodiazepines provide the greatest ____.

A

amnesia

NO ANALGESIA

87
Q

When should neuromuscular blocking agents be used and what do they require?

A

when absolutely required

provide sedation and analgesia

Pharmacology (17 decks)

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