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MOHD4: Exam 4 Drugs > Anesthesia > Flashcards

Anesthesia Flashcards

(67 cards)

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1
Q

Put in order the stages of anesthesia:

  1. Disorientation
  2. Surgical anesthesia
  3. Respiratory paralysis
  4. Excitatory stage
A

1, 4, 2, 3

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2
Q 
Which of the following has the highest perfusion rate?
A. Liver, lungs
B. muscle, skin
C. Adipose tissue
D. Bone
A

A. Also heart and brain

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3
Q

Drug is redistributed to ____ first from blood

A

Brain and viscera: follows concentration gradient.

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4
Q

Name the 3 volatile anesthetics most commonly used

A

Isoflurane
Desflurane= ideal b/c fast in, fast out (That’s what she said!)(according to the tutor review…?)
Sevoflurance

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5
Q

Which of the following about volatile agents is FALSE?
A. Vaporized at room temperature
B. Potent
C. High solubility in blood
D. Minimal metabolized
E. Depth of anesthesia depends on partial pressure in brain

A

C. Low solubility. Good b/c otherwise it would take a long time for partial pressure of drug to build up to a level that can drive it to the brain.

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6
Q

T/F: Oil:gas partition coefficient determines speed of anesthetic induction and recovery

A

False. Oil:gas partition coefficient determines lipid solubility –> potency
High oil:gas = highly lipophilic –> more potent

Blood:gas partition coefficient determines speed of anesthetic induction and recovery
Low blood:gas = fast in, fast out

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7
Q

T/F: The higher the MAC, the higher the dose of a drug needed to reach potency.

A

True

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8
Q

Concentration of an inhaled anesthetic at which 50% of patients do not move in response to standard surgical stimulation.

A

1 MAC = Minimum alveolar concentration

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9
Q

Name the anesthetic:

Can be used as inhaled anesthetic

A

Sevoflurane w/ or w/o NO

Desflurane and isoflurane not used b/c very pungent and can cause bronchospasms and airway irritation.

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10
Q

Physiological effects of inhaled anesthetic include all of the following EXCEPT:
A. Decreased cerebral metabolism
B. Decrease in heart rate and systemic vascular resistance
C. Decrease in tidal volume
D. Decrease in vagal tone

A

D. Totally made option up.

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11
Q

All inhaled anesthetics except nitrous oxide and succinylcholine (muscle relaxant) have this undesired effect

A

Malignant hyperthemia: mms release a lot of energy –> fatal if not treated

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12
Q 
Which of the following is NOT a commonly used intravenous agent?
A. Propofol
B. Pentothal sodium
C. Ketamine
D. Enflurane 
E. Etomidate
A

D. Enflurane is a volatile agent

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13
Q

Which of IV agents is preferred for the fact that it causes less of a hangover.

A

Propofol

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14
Q

Which of the following is FALSE about Propofol?
A. Rapid onset
B. Long duration
C. Can cause hypotension and profound respiratory depression
D. Rapid hepatic metabolism
E. Lipid soluable

A

B. Short duration –> less hangover

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15
Q

Which of the following is TRUE about Sodium Pentothal?
A. Can be used as infusion
B. Slow onset
C. Long duration
D. Causes hypotension, tachycardia, upper airway obstruction and apnea

A

D

A. Long elimination half-life –> can NOT be used as infusion
B. Rapid onset
C. Short duration

*Sodium Pentothal is hardly used anymore due to its adverse effects.

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16
Q

Name the drug:
Most cardio-stable of IV induction agents.
Ventilation less affected than other agents.

A

Etomidate

Use when in high sympathetic state and difficult to sedate

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17
Q

Name the drug:
30-60% incidence of myoclonus
May cause adrenocortical suppression –> not used in ICU

A

Etomidate

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18
Q

Name the 2 drugs that are safer agents b/c of its stable cardiac and respiratory profiles and short half life.

A

Etomidate

Ketamine

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19
Q

Name the drug:
Causes central stimulation of sympathetic nervous system.
Beneficial in hypovolemic shock

A

Ketamine

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20
Q

Which of the following is TRUE?
A. Benzodiazepines are GABA antagonists
B. Midazolam is used more frequently for premedication and procedural sedation
C. Benzodiazepine causes minimal respiratory depression
D. Benzodiazepines are enhanced by flumazenil

A

B. More than laorazepam and diazepam

A. GABA agonist
C. POTENT respiratory depressant
D. Antagonized by flumazenil

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21
Q

T/F: Local anesthetics work easier on thinner unmeylinated nerve bundles.

A

False. MEYLINATED

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22
Q

Arrange the following in order of blockade:

  1. pain
  2. touch
  3. deep pressure
  4. motor
  5. cold
  6. warmth
A

1, 5, 6, 2, 3, 4

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23
Q

Esters or amides?

Rapid metabolism by plasma cholinesterase

A

Esters

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24
Q

Esters or amides?

More likely to cause systemic toxicity

A

Amides

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25
Esters or amides? | Slow metabolism by hepatic carboxylesterase
Amides
26
Esters or amides? | Slow onset of action
Esters
27
Esters or amides? | pKa close to pH
Amides
28
Esters or amides? | Moderate to fast onset of action
Amides
29
Esters or amides? | pKa higher than pH
Esters
30
Local anesthetics work by ____
reversible intracellular binding of voltage gated sodium channels
31
T/F: Higher lipid solubility causes lower potency and longer duration of action
False: Higher solubility, higher potency, longer duration
32
T/F: In alkalic tissue, less nonionized LA is available to cross the cell membrane.
False. In acidotic tissue More ionized LA in acidic pH, less non-ionized
33
LA that has the highest pKa --> longest onset of action
Procaine: 14-18 min onset
34
LA that has the lowest pKAa
Mepivacaine: 2-4 min onset
35
``` Which of the following is NOT an ester? A. Cocaine B. Lidocaine C. Procaine D. Tetracaine E. Benzcaine ```
B. Lidocaine is an amide | all the amides have two "I"s in their name
36
Name the 3 amides
Lidocaine Mepivacaine Bupivacaine
37
Ester with short duration of action
Procaine
38
Ester used only topically
Benzocaine
39
Cocaine has ___ duration of action
medium
40
Tetracaine has ___ duration of action
long
41
Lidocaine and mepivacaine have ___ duration of action
medium
42
Bupivacaine has ___ duration of action
long
43
``` Which of the following LA is NOT used topically? A. Benzocaine B. Mepivacaine C. Lidocaine D. Tetracaine ```
B
44
``` Which TWO of the following LA is used via infiltration of peripheral nerve ending? A. Lidocaine B. Mepivacaine C. Benzocaine D. Tetracaine ```
A, B C. Benzocaine is only used topically
45
``` Which TWO of the following LA is used as nerve block? A. Lidocaine B. Mepivacaine C. Benzocaine D. Tetracaine ```
A, B
46
``` Which of the following is used epidurally? A. Bupivacaine B. Mepivacaine C. Lidocaine D. Tetracaine ```
A
47
``` Which TWO of the following LA is used via spinal? A. Bupivacaine B. Mepivacaine C. Lidocaine D. Tetracaine ```
A, D
48
``` Which TWO of the following LA is used cadually? A. Bupivacaine B. Mepivacaine C. Lidocaine D. Tetracaine ```
A, C
49
T/F: Epinephrine slows absorption of LA which allows us to give more LA without getting high blood concentrations.
True
50
Effective treatment of LA toxicity
Intralipid IV administration: Chelates LA and takes it away from blood concentration
51
Area of slowest absorption of LA
Subcutaneous
52
Which of the following is TRUE about procedural sedation? A. It is a loss of consciousness induced by medication B. Response to verbal and/or stimulation is not preserved C. Airway reflexes, latency and cardiopulmonary function are preserved. D. Used for surgery on extremities.
C. A. REDUCED level of consciousness B. Response to verbal and/or stimulation is preserved D. Used to facilitate diagnostic or therapeutic procedures
53
T/F: Propofol has short context-specific half life
True. Thus have least hangover effect
54
T/F: Propofol is used as a procedural anesthetic and an induction agent
True
55
T/F: Midazolam is used as a procedural anesthetic and induction anesthetic.
False. Procedural anesthetic and premedication agent
56
The effect of Midazolam is reversed by ___
Flumazenil
57
T/F: Midazolam is a anxiolytic and hypnotic.
False. Anxiolytic and amnestic
58
The effects of Fentanyl are reversed by ____
Naloxone
59
T/F: Fentanyl has a short context-specific half-life.
False. Prolonged b/c its lipophilic, so its absorbed into fat.
60
T/F: Fentanyl causes respiratory depression
True
61
Fentanyl belongs to what class of drugs?
Opioid | Used as procedural anesthetic
62
Name the drug: | Ultra-short acting opioid used as a procedural anesthetic that most often has to be administered as an infusion.
Remifentanil
63
The effects of Remifentanil are reversed by ____
Naloxone
64
Higher doses of Remifentanil will cause ___
Chest rigidity and respiratory depression
65
T/F: Ketamine can be used as a procedural anesthetic and causes minimal respiratory depression and indirect sympathetic stimulation.
True. Its an NMDA receptor antagonist
66
Side effect of Ketamine (2)
Sialorrhea: excessive oral secretions | Hallucinations
67
Which of the following about Dexmedetomidine is FALSE? A. Its an alpha-2 agonist B. Causes minimal respiratory depression C. Side effects cause tachycardia and hypertension D. Has some analgesia effects
C. Bradycardia, hypotension Dexmedetomidine used as procedural anesthetic.

MOHD4: Exam 4 Drugs (5 decks)

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