(6) Neuro & Psych: Anesthetics & Analgesics (2.1-2.3)

Question 1

Indication(s) : Propofol

Answer 1

(1) Induction
(2) Maintenance
* (“Propo-fall-asleep”)*

Question 2

Name 2 anesthetics which potentiate Cl^- current through the GABA_A receptor complex

Answer 2

(1) Propofol
(2) Etomidate

Question 3

Which IV anesthetic produces the most profound hypotension?

Answer 3

Propofol

Question 4

Indication(s) : Etomidate

Answer 4

Induction

Question 5

Which induction anesthetic has minimal effect on cardiac function?

Answer 5

Etomidate

(Minimal changes to HR, BP, and contractility ∴ preferred for patients with heart disease)

Question 6

Indication(s): Ketamine

Answer 6

Induction

Question 7

MOA: Ketamine

Answer 7

NMDA receptor antagonist

Question 8

Which IV anesthetic causes “dissociative anesthesia”?

Answer 8

Ketamine

Question 9

Adverse Effects (2) : Ketamine

Answer 9

(1) “I’m trippppinnn balllz man” (e.g. vivid colorful dreams, hallucinations, out of body experiences)
(2) Cardiovascular stimulation

Question 10

Name a drug class used in conscious sedation

Answer 10

Benzodiazepines

Question 11

What aspect of anesthesia can barbituates be used for?

Answer 11

Induction

Question 12

Name 5 IV anesthetics

Answer 12

(1) Propofol
(2) Etomidate
(3) Ketamine
(4) Benzodiazepines
(5) Barbituates

Question 13

Are volatile anesthetics gaseous at room temperature?

Answer 13

No

Question 14

Suffix: Volatile anesthetics

Answer 14

“-ane”

(They’re all fluorinated)

Question 15

What is the relationship between an inhaled anesthetic’s solubility in blood and its rate of onset?

Answer 15

Rate of onset ∝ 1/Solubility

(The fat kid passed out before the skinnier kid)

Question 16

What is the relationship between an inhaled anesthetic’s blood: gas partition coefficient and its duration of action?

Answer 16

Blood: gas partition coefficient ∝ Duration of action

Question 17

When does the arterial tension curve for N₂O plateau relative to Halothane?

Answer 17

Earlier

(Because it’s less soluble)

Question 18

What value is used in place of ED₅₀ for inhaled anesthetics?

Answer 18

MAC

(Minimum alveolar concentration to render 50% of people unresponsive)

Question 19

When discussing inhaled anesthetics, what is the relationship between potency and MAC?

Answer 19

Potency ∝ 1/MAC

Question 20

Adverse Effects (4) : Inhaled anesthetics

Answer 20

(1) Cardiac depression
(2) Malignant hyperthermia
(3) Respiratory depression
(4) ↓ Cerebral vascular resistant ⇒ Edema
* (Note: N₂O is an exception, it does NOT cause respiratory depression or malignant hyperthermia)*

Question 21

What distinguishes Halothane’s adverse effects from the other inhaled anesthetics

Answer 21

Massive liver necrosis

(Also sensitizes heart to catecholamines ∴ contraindicated with pheochromocytoma)

Question 22

What distinguishes Enflurane’s adverse effects from the other inhaled anesthetics

Answer 22

(1) Nephrotoxicity
(2) Seizures

Question 23

Name an NMJ antagonist which can cause malignant hyperthermia

Answer 23

Succinylcholine

Question 24

What protein is defective in malignant hyperthermia?

Answer 24

Ryanodine receptor

Question 25

**MOA**: Malignant hyperthermia

Answer 25

Defective ryanodine receptor ⇒ Unregulated ↑ Ca2+ release from SR ⇒ ↑ ATP dependent reuptake of calcium ⇒ Heat

Question 26

Other than hyperthermia, what is a symptom of malignant hyperthermia?

Answer 26

Rhabdomyolysis

Question 27

**Treatment**: Malignant hyperthermia

Answer 27

Dantrolene

Question 28

**MOA**: Dantrolene

Answer 28

Inhibits ryanodine receptor

Question 29

Which opioid receptor mediates most of the clinical and adverse effects of opiates?

Answer 29

μ

Question 30

What ion channels are affected secondary to μ-opiate receptor stimulation?

Answer 30

(1) Open post-synaptic K+ channels (2) Close pre-synaptic Ca2+ channels * (Stimulation of κ receptor in dorsal horn also ⇒ ↓ Substance P)*

Question 31

**MOA**: Tramadol

Answer 31

(1) Weak μ-agonist (2) NET/SERT Inhibitor

Question 32

**MOA**: Loperamide

Answer 32

Locally active μ agonist *(Does not cross BBB ⇒ Only slows GI motility)*

Question 33

**Indication**: Diphenoxylate

Answer 33

Diarrhea

Question 34

**MOA**: Dextromethorphan

Answer 34

(1) μ agonist (2) NMDA antagonist

Question 35

**Adverse Effects** (6) : Opiates

Answer 35

(1) CNS depression (2) Respiratory depression (3) Miosis (4) Constipation (5) Biliary colic (6) Opiate induced hyperalgesia

Question 36

Name 2 effects of opiates to which tolerance does not develop

Answer 36

(1) Miosis (2) Constipation

Question 37

What phrase summarizes the symptoms of opiate withdrawal?

Answer 37

"Anxious, hot, and moist"

Question 38

Name a long-acting _full μ-agonist_ used to attenuate withdrawal symptoms

Answer 38

Methadone

Question 39

Name a long-acting _partial μ-agonist_ used to attenuate withdrawal symptoms

Answer 39

Buprenorphine

Question 40

**MOA**: Nalbuphine

Answer 40

Partial μ agonist

Question 41

What μ-opioid antagonist is used to reverse acute opioid toxicity?

Answer 41

Naloxone *(Naloxone is a shorter word than Naltrexone ∴ shorter acting)*

Question 42

Which μ-opioid antagonist is used to help maintain abstinence in heroin addicts?

Answer 42

Naltrexone

Question 43

Indications (3) : Naltrexone (unrelated to heroin)

Answer 43

(1) Alcohol addiction (2) Nicotine addiction (3) Weight loss