Week 4: Anesthetics Flashcards by Danielle Chambers

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

Na+ channels

decreasing, Na+

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What are the local anesthetic esters? (3)

Procaine
Chloroprocaine
Tetracaine

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What are the local anesthetic amides? (6)

Mepivacaine
Bupivacaine
LIdocaine
Prilocaine
Ropivacaine
Levobupivacaine

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What is the onset and duration of Procaine?

Onset :2-5 minutes

Duration: 0.25-1 hour

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What is the onset and duration of Bupivacaine?

Onset: 5 minutes
Duration: 2-4 hours

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What is the onset and duration of lidocaine?

Onset: <2 minutes
Duration: 0.5-1 hr

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What is the result of the aromatic ring structure?

increased lipid solubility

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What determines the type of metabolism?

linkage

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What linkage involves hepatic metabolism?

Amides

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What linkage involves plasma esterases?

Esters

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What influences aqueous solubility?

Terminal amine

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

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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What is the max dose of lidocaine?

Lidocaine 2%
7mg/kg
total: 500

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What is the most commonly used anesthetic?

Lidocaine

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

Procaine

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What anesthetic has a higher potency compared to lidocaine?

Bupivacaine

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What is the maximum of lidoderm patched?

3 patches/daily

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True allergies are ____.

rare

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

more common with ester type

*if allergic to one, allergic to all

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What is a systemic effect of local anesthesia?

death by respiratory depression

seizures!

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What is the local anesthetic used in epidurals?

bupivacaine

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EMLA is a topical cream with a combination of what?

lidocaine and prilocaine

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What population are EMLA useful?

in pediatrics

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What are the common uses for EMLA? (3)

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

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What toxicology emerged with chloroform use?

long term liver damage and sudden death

What toxicology emerged from methoxyflurance?

nephrotoxic

What was the problem that emerged from ether?

too flammable

What is a side effect of inhaled nitrous oxide?

increased post op N&V

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

hepatotox, arrhythmias

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

hepato & renal toxicities

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

coronary steal- shunting of blood away from already ischemic myocardium

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

tachycardia

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

toxic metabolites

What are the advantages of inhalation anesthesia?

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

What are the differences between inhalation anesthetics?

metabolism | effects on the heart

What is the indication for the use of sedatives?

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

What are benzodiazepines commonly used for?

``` sedation hypnosis anxiolysis muscle relaxation anticonnvulsant activity anterograde amnesia ``` **No analgesia intrinsically

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

Diazepam (valium)

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

Hypotension

Where is diazepam metabolized?

liver

What are the 3 active metabolites of diazepam?

desmethyldiazepam temazepam Oxazepam

What is the half life of desmethyldiazepam?

100-200 hour

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

conscious sedation anxiety/muscle relaxation status epilepticus (IV)

What is important for dosing of valium in hepatic disease?

reduce dose by 50%

What is a risk of continuous lorazepam infusion?

propylene glycol-induced metabolic acidosis

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

lorazepam (Ativan)

What are the common indications of lorazepam (Ativan)?

anxiety and sedation | status epilepticus

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

1-2mg 1 hour prior

What is the dosage for lorazepam for status epilepticus?

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

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

Midazolam (versed)

Are there propylene glycol issues with Midazolam (versed)?

NO its water soluble

What is midazolam metabolized by?

CYP3A4 | hepatic

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

metabolized in the liver | renally eliminated

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

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

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

5mg IM 30-40 minutes prior

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

usual dose 2.5-5mg

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

decrease initial dose by 50%

What medication is used for benzodiazepine reversal?

Flumazenil (Romazicon)

How does Flumazenil (Romazicon) work to reverse benzodiazepines?

reverses excessive CNS depression

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

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

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

decreased time to weaning and extubation | rapid assessment of neurologic status

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

supports microbial growth

What medication counts as a calorie source?

Propofol (diprivan) 1.1 calories/ml hyperlipidemia

What are SE of propofol (diprivan)?

hypotension rapid development of tolerance variable half life

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

Dexmedetomidine (Precedex)

What is common with dexmedetomidine (precedex)?

hypotension bradycardia patients appear awake and alert expensive

When is a dissociative anesthetic agent?

ketamine (ketalar)

What procedures is ketamine (ketalar) useful for?

debridement of wounds | transport of a patient in pain

What is significant about ketamine onset?

rapid onset-30 seconds

What can commonly occur during recovery with ketamine?

can produce hallucinations and vivid dreams in recovery

What is the drug of choice for urgent endotracheal intubation?

Etomidate (Amidate)

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

Etomidate (amidate)

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

depresses cortisol synthesis

What is significant about etomidate?

minimal hypotension or disruption of ventilation

What are the 2 mechanisms of action of NMBAs?

depolarizing (non-competitive) | Nondepolarizing (competitive)

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

Succinylcholine (Anectine)

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

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

What are the indications of use of NMBAs?

intubation | mechanical ventilation synchrony (improve pt compliance with vent)

What is significant about NMBA use?

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

What are the precautions associated with Succinylcholine?

malignant hyperthermia

What are the steroid based NMBA precautions?

pancuronium rocuronium vecuronium

What are the Benzylisoquinolinium compounds (NMBA)?

atracurium | mivacurium

What is a precaution of mivacurium?

histamine release- hypotension

What are the drug interactions of NMBA?

``` steroids aminoglycosides Calcium channel blockers beta blockers furosemide ```

What is the net result of NMBA resistance?

increased bolus and infusion doses to induce and maintain paralysis

Benzodiazepines provide the greatest ____.

amnesia | NO ANALGESIA

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

when absolutely required | provide sedation and analgesia

Week 4: Anesthetics Flashcards

(87 cards)