Anesthesia

Question 1

weak bases that block the voltage gated Na channels of excitable membranes

Answer 1

local anesthetics

Question 2

local anesthetics affect smaller and myelinated fibers (C fibers) first and build to A. order that sensation is lost in

Answer 2

pain, cold, warmth, touch, deep pressure, motor

Question 3

indications: skin irritation, hemorrhoids, mouth/gum irritation, poison ivy, sore throat, gag reflex suppression

Answer 3

topical benzocaine

Question 4

contra: “Benzocaine (Orajel®, Dermoplast®)
Gels, sprays, liquids, and lozenges”

Answer 4

Oral formulations are not for children <2 years old

Question 5

max doses for “Benzocaine (Orajel®, Dermoplast®)
Gels, sprays, liquids, and lozenges”

Answer 5

4 doses/day

Question 6

local anesthetic FDA warning

Answer 6

FDA label warning about methemoglobinemia (oxidized iron in hemoglobin (confusion, discolored lips / nail beds/ skin, HA, SOB) on all OTC products

Question 7

group: “Benzocaine (Orajel®, Dermoplast®)
Gels, sprays, liquids, and lozenges”
Cocaine
“Tetracaine
topical or inj”

Answer 7

esters

Question 8

group: “Lidocaine(Icy Hot®,Salonpas®, Xylocaine®) max dose = 4mg/kg (NTE 300mg)
spray, patch, ointment, lotion, jelly, gel, mouthwash”
Bupivacaine (Marcaine®)

Answer 8

amides

Question 9

indications: Great for nose and throat procedures/injuries (sometimes eye) applied topically

Answer 9

cocaine

Question 10

lidocaine max dose

Answer 10

4mg/kg NTE 300mg

Question 11

MOA: metabolised in liver. Quickest onset (1-5 min) and shortest duration (20-60 min). Bleeds less and lasts longer if combined w/ epi (120-240 min) due to vasoconstriction

Answer 11

lidocaine

Question 12

lidocaine contra

Answer 12

AVOID epinephrine injection locally to digits in those with known PAD

Question 13

LAST order of symptom presentation

Answer 13

drowsiness, paresthesias in mouth/tongue, tinnitus / auditory hallucination, muscular spasm, seizures, coma, resp arrest, cardiac arrest

Question 14

how to make lidocaine injection sting less

Answer 14

warm to room temp, add Na bicarb

Question 15

LAST treatment

Answer 15

IV lipid emulsion, secure airway, anticonvulsant

Question 16

Bupivacaine (Marcaine®)
contra

Answer 16

Contraindicated for local infiltration in pregnant women

Question 17

higher risk of cardiotoxicity if systemically absorbed: lidocaine or marcaine?

Answer 17

marcaine

Question 18

effect of epi and Na bicarb on marcaine

Answer 18

nothing

Question 19

AEs: nerve damage, bleeding from accidental arterial puncture, injection of LA into vessel (systemic toxicity)

Answer 19

Peripheral Nerve Blocks

Question 20

Single injection of anesthetic drug into CSF (subarachnoid space)

Answer 20

Spinal block

Question 21

Tiny catheter placed into epidural space and anesthetic can be slowly infused in

Answer 21

Epidural block

Question 22

AEs: hypotension (in 50%), bradycardia, post-dural puncture HA, urinary retention

Answer 22

Neuraxial anesthesia (spinal and epidural)

Question 23

dissociative sedative, analgesic, amnestic

Answer 23

ketamine

Question 24

AEs: minimal cardiorespiratory depression. Does not inhibit protective reflexes. Symp stimulation, tachycardia, HTN (rare). Emergence reactions common (+/- n/v). Prolonged effect in elderly

Answer 24

ketamine

Question 25

AEs: minimal hypotension and histamine release.

Answer 25

fentanyl

Question 26

sedative, amnestic. No analgesia. Rapid onset and neuro recovery.

Answer 26

Propofol

Question 27

AEs: resp depression, hypotension, inj site pain.

Answer 27

Propofol

Question 28

special pop concern for propofol

Answer 28

Elderly: reduce dose by 20%, give slowly

Question 29

sedative. No analgesia. Does not change BP, cardiac output or heart rate

Answer 29

Etomidate

Question 30

Etomidate indication

Answer 30

hemodynamically unstable pts

Question 31

AEs: myoclonus, injection site pain, n/v

Answer 31

Etomidate

Question 32

Etomidate special pop concerns

Answer 32

lower dose in elderly, liver dz

Question 33

sedative, anxiolytic. No analgesia. Slow onset.

Answer 33

midazolam (Versed)

Question 34

midazolam (Versed) special pop concerns

Answer 34

Prolonged effect in elderly, obese, liver dz

Question 35

Block transmission of acetylcholine between motor nerve endings and skeletal muscle. Causes skeletal muscle paralysis. No sedation

Answer 35

Neuromuscular Blockers

Question 36

indication: Emergency / Surgical Procedures: Used w/ a sedative (induction agent); Facilitate endotracheal intubation; Facilitate muscle relaxation during surgery

Answer 36

Neuromuscular Blockers

Question 37

pseudocholinesterase enzyme breaks down ___

Answer 37

"Depolarizing Blocker: Succinylcholine (Anectine®) IV"

Question 38

AEs: CV: bradycardia, hypotension (use atropine), arrythmias. Myalgia. Increased introcular and intragastric pressure. Malignant hyperthermia (rare; treat w/ dantrolene IV, autosomal dominant)

Answer 38

"Depolarizing Blocker: Succinylcholine (Anectine®) IV"

Question 39

who is at risk of low pseudocholinesterase enzyme

Answer 39

enzyme deficiency aquired in elderly, renal failure, malnutrition, liver failure, pregnancy

Question 40

class that has AEs: "All: resp depression, prolonged paralysis. Panc: muscle weakness, elevated HR and BP Roc: mild hypotension Cisat: mild hypotension, flushing"

Answer 40

"Non-depolarizing Blockers: Rocuronium (Zemuron®) vecuronium Cisatracurium (Nimbex®) Pancuronium (Pavulon®)"

Question 41

how to reverse "Non-depolarizing Blockers: Rocuronium (Zemuron®) vecuronium Cisatracurium (Nimbex®) Pancuronium (Pavulon®)"

Answer 41

reverse w/ neostigmine

Question 42

treatment for malignant hyperthermia

Answer 42

dantrolene IV