Anes Midterm Flashcards by Frankie Aguinot

enhances affinity for GABA

presynaptic
post synaptic
polysynaptic

postsynaptic

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. Lidocaine is already on its ionized form even before entry into the cell.
.
True or False

. true

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bradycardia, respiratory depression, bronchoconstriction

A) Naloxone
B) Droperidol
C) Ketamine
D) Fentanyl
E) Morphine

fentanyl

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IV barbituates have rapid induction

true or false

.true

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agonist of sigma receptor

A) Mu-1 Receptor
B) Nalbuphine
C) Ketamine
D) Modulted MU Receptor
E) Noloxone
F) Morphine

ketamine

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coded information is relayed to the CNS

transduction
transmission
modulation
perception

transmission

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. Bradycardia and vasodilation are not observed with cocaine.
.
True or False

. True

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pain at the actual incision

a. primary hyperalgesia
b. secondary hyperalgesia

primary hyperalgesia

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barbiturates depress what type of response

presynaptic
post synaptic
polysynaptic

polysynaptic

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cardiovascular stimulation, nausea, vomiting

A) Naloxone
B) Droperidol
C) Ketamine
D) Fentanyl
E) Morphine

naloxone

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ancitconvulsant activity

phenobarbital
methohexital
thiopental
thiamylal

phenobarbital

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. Ester anes are chiefly metabolizsed in the liver
.
True or False

. False

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Chronic cancer pain is described as

pain is evoked

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. In general, low potent anesthetic will have a slow onset and longer duration of action.
.
True or False

. False (fast onset and short duration of action)

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parin arising from lesion of the central nervous system

central pain

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(decreases/increases) release of acetylcholine

presynaptic
post synaptic
polysynaptic

decreases - presynaptic

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has 3 major neural components

transduction
transmission
modulation
perception

transmission

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IV barbituates have secretions

true or false

. False

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. Lidocaine will have a slow onset upon infiltration into an infected tissue.
.
True or False

. True

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In order, what are the effects at the onset of blockade

. Loss of pain and temp
. Loss of pressure and touch
. Loss of proprioception
. Motor paralysis

. Loss of pain and temp > . Loss of proprioception > . Loss of pressure and touch > .Motor paralysis

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flumazenil is the specific benzodiazepine antagonist drug which antagonises the sedative effects of adenosine

true or false

. true

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to prevent inadvertent subarachnoid injection of the anesthetic when doing epidural block, the following is done

. Adding epinephrine to the anesthetic
. Doing the block with the patinet in Buie position
. Use of a “test” dose

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. Potency and penetrability of a local anesthetic is directly related to its lipid solubility
.
True or False

. True

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with sulfur group, fast onset

A) Methohexital
B) Phenobarbital
C) Thiamyal
D) Thiopental

thiopental (thiamyal)

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. Type A nerve fibers are classified in alpha, beta, gamma, and delta. . True or False

. true

site of action for epidural anesthesia

nerve root

. Among alpha, beta, gamma, and delta fibers; alpha fibers are the most difficult to block . True or False

. true

. The presence of a methyl groups in tetracaine enhances its lipid solubility . True or False

. True

. Bradycardia and vasodilation are potential systemic toxicity effects of loca anesthesia. . True or False

. True

contraindicated in porphyria ``` A) Barbiturates B) Diazepam C) Fentanyl D) Ketamine E) Innovar ```

barbiturates

desmethyldiazepam is its metabolite ``` A) Diazepam B) Midazolam C) Lorazepam D) Flumazenil E) Physotigmine F) Aminophylline ```

diazepam

. Local anesthetic with pKa close to the physiological pH has more rapid onset. . True or False

. True

Name the ester local anesthetics

Cocaine Procaine Chloroprocaine Tetracaine

methemoglobinemia

prilocaine

. Local anes with poor lipid solubility has low potency. . True or False

. True

. Upon entry into the cell, local anes become cations blocking sodium influx. . True or False

. True

No histamine release A) Methohexital B) Phenobarbital C) Thiamyal D) Thiopental

Phenobarbital (methohexital)

neural activity leading to control of the pain transduction transmission modulation perception

modulation

sulfur group phenobarbital methohexital thiopental thiamylal

thiopental | thiamylal

principle site of action of anesthetics in neuraxial block

ner roots of the spinal nerve

4 neural pathways in order

transduction transmission modulation perception

hypotension in pt is subjected to neuraxial bock may be safely managed by rapid IV fluid infusion provided that

the pt has a normal cardiac and renal function

Cocain, chloroprocaine and prilocane are examples of ester anesthetics True or False

. False

Specific benzodiazepine antagonist ``` A) Diazepam B) Midazolam C) Lorazepam D) Flumazenil E) Physotigmine F) Aminophylline ```

flumazenil

pain in the surrounding normal tissue a. primary hyperalgesia b. secondary hyperalgesia

secondary hyperalgesia

Spinal anesthesia for surgeries of the lower extremities can have a block up to the umbilicus which is consistent with the ff. dermatomal level: A. T4 B. T6 C. T10 D. T12

C. T10

Amides are chiefly metabolized by

in the liver by CYP 450

agonist of kappa receptor ``` A) Mu-1 Receptor B) Nalbuphine C) Ketamine D) Modulted MU Receptor E) Noloxone ```

nalbuphine

demonstrate differential block

bupivacaine, ropivacaine

antagonist of Mu-2 receptor ``` A) Mu-1 Receptor B) Nalbuphine C) Ketamine D) Modulted MU Receptor E) Noloxone ```

nalbuphine

``` . Injection done superficial to the ligamentum favum . A. epidural anesthesia B. spinal anesthesia C. both D. Neither ```

D. Neither

naloxone is an angonist and antagonist drug which is used to detect suspicious physical dependence true or false

. False; antagonist only

3 ways to prepare tetracaine

saline solution - isobaric D10W - hyperbaric distilled water - hypobaric

The ff. approach is directed towards insertion of the spinal needle into the largest interspace in the vertebral column: A. midline B. paramedian C. lumbosacral D. caudal

C. lumbosacral

barbiturates are contraindicated with patient who has porphyria true or false

. true

somnolence without total unconsciousness ``` A) Barbiturates B) Diazepam C) Fentanyl D) Ketamine E) Innovar ```

innovar (aka neurolept analgesia)

antagonizes sedative effects of adenosine ``` A) Diazepam B) Midazolam C) Lorazepam D) Flumazenil E) Physotigmine F) Aminophylline ```

aminophylline

for supraventricular tachycardia

lidocaine

Barbiturates antagonist

none (benzodiazepines do)

Convulsant A) Methohexital B) Phenobarbital C) Thiamyal D) Thiopental

Methohexital

antagonist of kappa receptors ``` A) Mu-1 Receptor B) Nalbuphine C) Ketamine D) Modulted MU Receptor E) Noloxone ```

naloxone

supraspinal analgesia ``` A) Naloxone B) Droperidol C) Ketamine D) Fentanyl E) Morphine ```

morphine

used for electroconvulsive treatment ``` A) Barbiturates B) Diazepam C) Fentanyl D) Ketamine E) Innovar ```

diazepam (benzodiazepine)

other than polysynaptic depression what are (2) other mechanisms of action of barbituates

1. Depress reticular activating system | 2. Depress transmission in the sympathetic nervous system ganglia

desmethyldiazepam is the component which is responsible for the long duration of action of diazepam true or false

. true

``` . CSF clue . A. epidural anesthesia B. spinal anesthesia C. both D. Neither ```

B. spinal anesthesia

profound degree of motor block

etidocaine

. pKa is the pH at which the anes is completely on it's ionized form. . True or False

. False

Synthetic narcotic only A) Droperidol B) Fentanyl C) Innovar

fentanyl

In neuraxial block, the follow is seen a. Motor block about 2 segments below b. Sensory block about 2 segments above the motor block c. Autonomic block about 2 segments below motor block

b. Sensory block about 2 segments above the motor block

in general, local anesthetics causes. What is the exception? Bradycardia Tachycardia

Bradycardia, except coaine

Antici-convulsant A) Methohexital B) Phenobarbital C) Thiamyal D) Thiopental

Phenobarbital

. Early warning sign of local anesthetic toxicity includes circumoral numbness, tongue parasthesia, and respiratory depression . True or False

. False (and dizziness, tinnitus, blurred vision)

With histamine release A) Methohexital B) Phenobarbital C) Thiamyal D) Thiopental

thiamyal (thiopental)

extrapyramidal symptoms ``` A) Naloxone B) Droperidol C) Ketamine D) Fentanyl E) Morphine ```

droperidol

venoirritating due to propylene glycol ``` A) Diazepam B) Midazolam C) Lorazepam D) Flumazenil E) Physotigmine F) Aminophylline ```

diazepam (lorazepam? sam)

Ester anesthesia is chiefly metaboized by

in the by plasma cholinesterase

question

answer

how does barbiturates cause respiratory depression

1. direct depression of the medullary and the pnotine centers 2. decreased tidal volume and slight increase in respiratory rate - decrease in minute volume

basic make up for barbituric acid

urea + malonic acid =

placebo given to

psychogenic pain

depolarization of nociceptor by noxious stimuli leads to electrical activities transduction transmission modulation perception

transduction

agonist of Mu-1 receptor ``` A) Mu-1 Receptor B) Nalbuphine C) Ketamine D) Modulted MU Receptor E) Noloxone F) Morphine ```

morphine

supraspinal analgesia ``` A) Mu-1 Receptor B) Nalbuphine C) Ketamine D) Modulted MU Receptor E) Noloxone ```

Mu-1 Receptor

how does barbiturates lead from mild sedation to coma

reduced cerebral metabolism and oxygen consumption leading to decrease in cerebral blood flow

nonspecific benzodiazepine antagonist ``` A) Diazepam B) Midazolam C) Lorazepam D) Flumazenil E) Physotigmine F) Aminophylline ```

physostigmine

water soluble, shortest duration of action ``` A) Diazepam B) Midazolam C) Lorazepam D) Flumazenil E) Physotigmine F) Aminophylline ```

midazolam

convulsant activity phenobarbital methohexital thiopental thiamylal

methohexital

. With ropivacaine and bupivacaine, loss of pain and temperature senstion precedes the loss of proprioceptive sense. . True or False

. True

management of pain involves

adequate pain relief multidisciplinary approach graduated somatic approach

. Paraaminobenzoic-derevied anesthetics like procaine can trigger activation of IgE antibodies. . True or False

. True

Leu-Enkephalin ``` A) Mu-1 Receptor B) Nalbuphine C) Ketamine D) Modulted MU Receptor E) Noloxone ```

Modulted MU Receptor

Sensitises the autonomic tissues of the heart to the catecholamines true or false

. False; some sedative reduce the HR but barbiturates do not sensitise the ANS

. Methemoglobinemia is observed in Etidocaine. . True or False

. False (prilocaine)

If the sensory block of a neuroaxial blockade is at T8, what is the level of the sympathetic blockade A. T4 B. T6 C. T8 D. T10

D. T6

. Differential block is seen in ropivacaine and bupivacaine. . True or False

. True

IV barbiturates

phenobarbital methohexital thiopental thiamylal

fast onset of action and short duration of action phenobarbital methohexital thiopental thiamylal

thiopental | thiamylal

``` . Needs a greater volume of anesthetic . A. epidural anesthesia B. spinal anesthesia C. both D. Neither ```

A. epidural anesthesia

``` . Done with patient assuming the fetal position . A. epidural anesthesia B. spinal anesthesia C. both D. Neither ```

C. both

not recommended for OB. Why?

mepivacaine: placental transfer

a sign that fibers of the cauda equina are hit by the advancing needle in the subarachnoid space.

paresthesia on the lower limb

in general, local anesthetics causes. What is the exception? Vasoconstriction vasodilation

vasodilation, except cocaine

how does barbiturate effect (direct/indirect) myocardial depression

direct depression of medullary vasomotor center > peripheral vasodilation > decreased venous return > decreased cardiac output > hypotension (histamine release)

hallucination ``` A) Naloxone B) Droperidol C) Ketamine D) Fentanyl E) Morphine ```

ketamine

neurolept analgesia A) Droperidol B) Fentanyl C) Innovar

innovar

PABA derivative - PABA metabolite

Derivative: procaine, tetracaine Metabolite: chloroprocaine

. Chloroprocaine, among local anesthetics, has the fastest onset. . True or False

. True

agonist of sigma receptor ``` A) Mu-1 Receptor B) Nalbuphine C) Ketamine D) Modulted MU Receptor E) Noloxone ```

ketamine

Which of the ff. is the correct sequence of modalities lost after spinal anesthesia? Motor Pain Pressure Temperature

Pain > Temperature > Pressure > Motor

fundamentals of pain (5)

1. response to acute painful stimuli 2. Peripheral sensitization 3. central sensitizatoin 4. disinhibition 5. structural reorganization of central connections

Neuroleptic only A) Droperidol B) Fentanyl C) Innovar

Droperidol

muscle rigidity ``` A) Barbiturates B) Diazepam C) Fentanyl D) Ketamine E) Innovar ```

fentanyl (truncal most common)

. Alkalization of the solution may enhance onset of lidocaine. . True or False

. True

IV barbituates are non-emetic true or false

. true

. In the awake patient, early warning signs of local anesthetic toxicity is provided by its effects on the central nervous system. . True or False

. False

dissociative anesthesia ``` A) Barbiturates B) Diazepam C) Fentanyl D) Ketamine E) Innovar ```

ketamine

autonomic block produced by regional anesthesia may lead to

arterial dilation

Layers SSSSILEDAS

``` skin subcutaneous tissue superficial fascia suprasprinous ligament interspinous ligament ligamentum flavum epidural space dura mater arachnoid mater subarachnoid (with free CSF) ```

. Allergic reactions to local anesthetic, although uncommon, is mostly seen among the ester anesthetics. . True or False

. True

subjective correlate of pain transduction transmission modulation perception

perception

describe why there is referred pain

spinal convergence of visceral and somatic afferent fibers on spinothalamic neurons

Anes Midterm Flashcards

(122 cards)