Anesthesia Medications Flashcards
(137 cards)
1
Q
Goals for anesthetic therapy should be to reduce likelihood of complications, such as ________.
A
Long term pain
2
Q
Pre-anesthesia meds should decrease _____ without producing excessive ______, provide ______ for the perioperative period, and relieve preoperative ____.
A
Anxiety; drowsiness; amnesia; pain
3
Q
T/F One of the goals of anesthesia is to reduce the volume and acidity of gastric contents
A
True
4
Q
Examples of pre-anesthetic medications include ____, ____, and others, such as ____, ____, and ____.
A
Benzodiazepines
Barbiturates
Others (antihistamine, phenothiazine, butyrophenes)
5
Q
Intravenous anesthetics include medications such as ____, ____, ____, ____, and ____.
A
Propofol, Barbiturates, Etomidate, Opioids, and Ketamine
pneumonic: P[lease], BE OK
6
Q
Benzodiazepines raise the threshold for ____ ____ of local anesthetics
A
CNS toxicity
7
Q
What are the effects of taking a BZD?
A
Reduce anxiety and have “calming” effects
8
Q
BZDs have a (gradual/rapid) onset and a (long/short) duration of action
A
BZDs have a rapid onset and short duration of action
9
Q
What are three examples of BZDs that can be used pre-operatively? Which of the three has the most limited use? Why?
A
Diazepam, Lorazepam, and Midazolam
Diazepam is limited due to its lipophilicity
10
Q
Which of the the three examples of BZDs that can be used pre-operatively is the most frequently used? Why?
A
Lorazepam is frequently used due to multiple administration routes, and it is hepatically metabolized and eliminated “cleanly”. It is thus usable in the more limited/older populations.
11
Q
Midazolam causes retrograde amnesia and is therefore useful in what type of procedures and what type of population?
A
Colonoscopy
Children
12
Q
What are two adverse effects of BZDs?
A
Sedation
Disorientation
13
Q
Barbiturates may provide ____ and reduce ______ prior to surgery. They may also yield _____ if pain is present.
A
sedation; apprehension; disorientation
14
Q
Tolerance to barbiturate is observed in patients w/ what SHx?
A
Chronic alcohol use
15
Q
Barbiturates have an onset of ____ and a duration of ____.
A
Onset: <1 minute
Duration: 5-10 minutes
16
Q
What are two examples of barbiturates that are used pre-operatively/intravenously for anesthesia?
A
Pentobarbital
Thiopental
17
Q
What are two possible adverse effects of barbiturates?
A
Cardiac and respiratory depression
18
Q
The use of barbiturates should be avoided in patients with what medical condition?
A
Porphyria
19
Q
Why are barbiturates of limited availability in the US?
A
They have been politically associated with the death penalty and thus drug companies do not want their names associated with them
20
Q
Describe etomidate as an intravenous anesthetic
A
Potent ultra-short acting hypnotic without analgesic properties
21
Q
Etomidate modulates signaling at ______ receptors and helps to mediate pain response and _____
A
GABA [A]; memory
22
Q
Other uses for Etomidate, other than as an intravenous anesthetic, include _______ and _______
A
Conscious sedation
Rapid sequence induction for cardioversion
23
Q
The administration of Etomidate must be followed with the administration of _____ and ______ drugs
A
Analgesic
Muscle relaxant
24
Q
An IV injection of Etomidate ____ mg/kg will induce sleep for ____ min
A
0.3 mg/kg
5 minutes
25
Potential side effects of Etomidate include (hypotension/hypertension), ____ retention, and suppression of _____ synthesis at the ______ _____
Hypotension
CO2 retention
Suppression of corticosteroid synthesis at the adrenal cortex
26
What is the MOA of opioids?
Selectively inhibit nociceptive reflexes and induce analgesia through action at the mu receptors
27
How do opioids interact with substance P? What does this cause?
Inhibits the release of neurotransmitters such as substance P and therefore antagonizes the effect of exogenous substance P
This changes how substance P is received in the CNS.
28
Morphine, an opioid, is associated with ______ release
histamine
29
What are potential adverse effects of opioids?
Respiratory depression
Nausea / vomiting
Constipation
30
What is ketamine used for? Often in what setting?
Induction of dissociative anesthesia
| Often for emergency surgical procedures (i.e. ortho, children, and OR adults)
31
Ketamine acts on receptors in the _____ and the ____ _____
cortex and the limbic system
32
The onset of action of Ketamine is _____ min
<1 minute
33
Does ketamine require a lot or a little monitoring after administration?
Ketamine requires minimal monitoring in healthy individuals
34
What are some adverse effects of ketamine?
Hallucinations, bad dreams, increased muscle tone (very rare, <1% pts)
35
Is propofol chemically related to other IV anesthetics?
No
36
At room temperature, what type of solution is propofol?
Oil based emulsion
37
Propofol acts to potentiate ____ receptor activity and block ____ channels
GABA; sodium
38
Does propofol have a slow or rapid onset?
Rapid onset of anesthesia
39
Propofol is frequently used in _____ _____ settings
neuro ICU
40
Possible adverse effects of propofol include _____, _____, and _____.
Significant respiratory depression, hypotension, and injection site pain
41
A perfect inhaled anesthetic would have fast onset and offset of action, have a wide safety margin, provide rapid changes in depth of anesthesia, and have no adverse effects in normal doses. Which anesthetic agent meets this description?
NOTHING IS PERFECT, except unicorns, which don't exist, just like the aforementioned drug
42
Inhaled anesthetics are used for ____ and/or as an ____. They are not as ____ as other drugs, and thus are not as widely used.
induction; adjuvant; stable
43
T/F Inhaled anesthetics are lipophilic
True
44
How are inhaled anesthetics classified?
By their side chains
45
Inhaled anesthetics act to alter ______ ion channels to (decrease/increase) tissue excitability
neuronal; decrease
46
Speed of induction of inhaled anesthetics is (directly/inversely) related to solubility in most body tissues
inversely
47
What are four examples of inhaled anesthetics?
Nitrous Oxide
Sevoflurane
Isoflurane
Desflurane
48
What are potential adverse effects of inhaled anesthetics? What is a rare adverse effect that we should be careful to monitor for?
Nausea, vomiting
| Malignant hyperthermia is rare, but important for monitoring
49
Patients with what two organ dysfunctions should use inhaled anesthetics with caution?
renal / hepatic dysfunction
50
Isoflurane is often used because of it’s ability to maintain ______, but it has a _____ _____.
cardiac output; pungent odor (described as musty and ethereal...)
51
Local anesthetics (reversibly/irreversibly) block nerve conduction around site of administration by inhibiting ____ channels. This (decreases/increases) nerve cell membrane permeability to ____ ions and (decreases/increases) depolarization and (decreases/increases) excitability threshold, preventing the nerve _________ from forming
reversibly; sodium; decreases; sodium; decreases; increases; action potential
52
Can local anesthetics be used systemically?
Yes
53
Local anesthetics may be used for infiltration or nerve block prior to certain procedures.
Infiltration is preferred for _____ or _____ procedures. Nerve blocks are preferred for _____ or ____ procedures and for _____ management
Infiltration: Surgical or dental procedures
| Nerve block: Surgical or diagnostic procedures and for pain management
54
Local anesthesia is administered _____ when starting an IV, performing a shave biopsy or placing sutures. Local anesthesia is administered _____ for dental or laceration repair situations, _______ for post-operative pain control, _______ for joint pain, and ______ for nerve blocks
```
SubQ
Submucosal
In the wound
Intra articular
Infiltrative
```
55
How are amino amides metabolized?
Via hepatic pathways
56
What are some examples of amino amides?
Lidocaine
Bupivacaine
Prilocaine
Dibucaine
57
Which amino amide is used in epidural settings?
Bupivacaine
58
Which amino amide can be used for suppository pain relief and analgesia associated with hemorrhoids?
Dibucaine
59
Which amino amide is not usually used in an injectable formation?
Prilocaine
60
What class of anesthetics should be used in pts who will not tolerate first pass as they remain local?
Amino esters
61
How are amino esters metabolized?
Metabolized in plasma by plasma cholinesterase throughout the vasculature,
62
What is the intermediate metabolite of amino esters?
PABA (para aminobenzoic acid)
63
Administration of amino esters has an associated increased risk of allergy in ___% of the population, which most of the time (does not/does) result in anaphylaxis
~5%
| Does not
64
What are some examples of amino esters?
Benzocaine
Cocaine
Procaine
Tetracaine
65
Which amino ester is used in dental procedures, with intubation, and called "Hurricane Spray"?
Benzocaine
66
Which amino ester is used as a 4% topical solution for ENT surgeries? Why?
Cocaine
It is highly vasoconstrictive, which is good for controlling bleeding in the highly vascularized areas of the ears, nose, and throat
67
Which amino ester is used in eye drops?
Tetracaine
68
T/F Amino esters are considered "old" or "traditional" agents and are widely used
False; while amino esters are considered 'old' and 'traditional' agents, they are mostly relegated to topical or niche use
69
Dose reduction of any anesthetic agent should be considered for what types of patients? (think generally, what ages, what debilities, what diseases, etc)
```
Acutely ill pts
Debilitated pts
Very young or elderly individuals
Pts w/ significant hepatic impairment
Occlusive arterial dz
Arteriosclerosis
```
70
Use caution with epinephrine if patient has underlying _____ disease
Cardiovascular
71
CNS (depression/stimulation) is usually noted first, then later, CNS (depression/stimulation) leads to ______ and _____. Amides may not augment the (depression/stimulation) phase, but only the (depression/stimulation) phase of this reaction. If epinephrine is present, it may augment the (depression/stimulation) phase of toxicity with the possible symptoms of _____, _____, _____.
stimulation; depression; respiratory failure and cardiac arrest; stimulation; depression; hypertension, tachycardia, angina
72
If a patient has reported an allergy to lidocaine, it is possible that the reaction is actually associated with _______
preservatives in multidose vial preparations
73
Adverse effects of anesthetic medications are usually associated with (decreased/increased) plasma concentrations, _______ dose or rate of injection, ______ in drug clearance, CNS effects such as ______, Cardiac effects such as ______ and ______, Respiratory effects such as _________, a ______ sensation, skin _______, tissue ______/______, and neuritis.
Adverse effects of anesthetic medications are usually associated with (increased) plasma concentrations, (excessive) dose or rate of injection, (reduction) in drug clearance, CNS effects such as (sz), Cardiac effects such as (bradycardia) and (arrhythmias), Respiratory effects such as (respiratory arrest), a (burning) sensation, skin (discoloration), tissue (necrosis)/(sloughing), and neuritis.
74
What are some potential advantages or regional anesthesia over systemic anesthesia?
Anti inflammatory effects i.e. decreased cytokine formation and decreased tissue inflammation
Faster functional recovery
Cardiopulmonary effects
GI effects (less stasis/ileus)
Improved coagulation effects (prevents venous stasis and VTE occurrence)
75
How is epidural anesthesia administered? Where is its primary site of action?
Administered by injecting local anesthetic into the epidural space, primary site of action in the spinal nerve roots
76
What is the major difference between epidural anesthesia and spinal anesthesia?
Higher concentrations of anesthetic may be achieved after epidural absorption
77
Which epidural anesthetic is longer acting and has some use in pain management situations?
Lidocaine
78
Where is spinal anesthesia injected?
The CSF in the lumbar space
79
Who should you avoid administering spinal anesthesia to?
pts on blood thinners
80
Which three medications are most commonly used in spinal anesthesia?
Lidocaine, bupivacaine, and tetracaine
81
Spinal anesthesia is most commonly used in surgeries involving what parts of the body?
lower abdomen, lower extremities, and perineum
82
What are potential adverse effects of spinal anesthesia?
Infection, hematoma, and HA
83
What are risk factors that affect pain control in peri-operative settings? (hint: similar to pts who will have post operative N/V)
```
Preoperative pain
Anxiety
Genetics
Opioid tolerance
Female gender
```
84
In regards to the pathophysiology of pain, there are both ______ and _____ components.
inflammatory and neuropathic
85
What are the three mechanisms of chronic neuropathic pain?
Peripheral component, central component, central plasticity
86
Describe the 3 central mechanisms of chronic neuropathic pain:
1. Peripheral component, multiple inflammatory mediators responsible for (negative/positive) sx of _____, _____, and _____
2. Central component, mediated through the ____ ____ neurons
3. Central plasticity, where excess excitatory transmission and loss of (inhibitory/excitatory) transmission lead to barrage of CNS input from the _____ _____ of the spinal cord
1. Peripheral component, multiple inflammatory mediators responsible for (positive) sx of (hypersensitivity), (allodynia), and (erythema)
2. Central component, mediated through the (dorsal horn) neurons
3. Central plasticity, where excess excitatory transmission and loss of (inhibitory) transmission lead to barrage of CNS input from the (dorsal horn) of the spinal cord
87
Nociceptive stimulus from any source (thermal, mechanical, or otherwise) causes a release of multiple ______ substances into the affected tissue. This leads to _____ sensitization that supply affected area, a phenomenon known as peripheral sensitization. The CNS also becomes sensitized due to afferent input to the CNS, known as ______ sensitization.
Nociceptive stimulus from any source (thermal, mechanical, or otherwise) causes a release of multiple (inflammatory) substances into the affected tissue. This leads to (nerve) sensitization that supply affected area, a phenomenon known as peripheral sensitization. The CNS also becomes sensitized due to afferent input to the CNS, known as (central) sensitization.
88
Preventive analgesia focuses on ____, ____, and ____ of analgesic therapy
timing, duration, and efficacy
89
Preventive analgesia preserves total body _____ and enhances post-operative _____ and _____.
nitrogen; recovery and rehabilitation
90
Dexmedetomidine and clonidine are _____ agonists
Alpha 2
91
______ are considered the mainstay of peri-operative pain management, and judicious use offers analgesia through central and peripheral mechanisms.
Opioids
92
_____ have been demonstrated to reduce opioid requirements of dosing and reduce side-effects of itching, constipation, and drowsiness. If bleeding is a concern, many suggest short-term use of ______ as these agents are more selective
NSAIDs
| COX-2 inhibitors
93
_______ in small doses (0.15mg/kg IV) may reduce opioid requirements and reduce progression to chronic pain
Ketamine
94
_______ has shown opioid-sparing effects and increased post-op anesthesia, though does not limit opioid-related adverse effects
Gabapentin
95
What are some examples of NSAIDs that may be used to reduce opioid requirements?
Ketorolac, ibuprofen, and naproxen
96
In a pt with healthy kidney function, what is the absolute max amount of time that a pt can take Ketorolac?
5 days
97
What are some examples of COX 2 inhibitors that may be used to reduce opioid requirements in pt with bleeding concerns?
Celecoxib
98
Dexmedetomidine is used in inpatient ICU settings for _____ and in anesthesia for brief procedures due to ______ ______
sedation; administration difficulties
99
Dexmedetomidine has ____, ____, and _____ properties
Sedative, anxiolytic, and analgesic
100
What are some possible adverse events of Dexmedetomidine that require monitoring?
monitor HR, BP, sedative effects
101
What are potential risk factors for developing post operative nausea and vomiting (PONV)? (hint: similar to pts in operative pain control)
```
Female gender
Motion sickness / previous PONV
Non-smoking status
Post-operative use of opioids
Use of inhaled anesthetics (nitrous oxide and other volatile agents)
High-dose neostigmine
```
102
By what percent does each risk factor increase a pt's risk for developing PONV?
18-22%
103
Post operative nausea incidence is ___-___% and vomiting incidence is ___-___%
22-38% N
| 12-26% V
104
Anesthesia technique factors that affect PONV include....
Inhalation agents
Nitrous oxide
High-doses of neostigmine
Intra- and post-operative opioids
105
Surgical risk factors that affect PONV include....
Longer duration of surgery, types of surgery
106
T/F A multimodal approach to PONV is best
True
107
A multimodal approach constitutes _____ and ___-_____ therapy
pharmacologic and non-pharmacologic
108
Preoperative options for PONV include....
```
BDZ (for anxiolysis)
Compassionate interaction w/ staff
Aprepitant (Emend)
Dexamethasone steroids
Pre-hydration 1L NS or LR
```
109
Intra-operative options for PONV include....
```
Use of correct regional anesthetics
Propofol
Analgesia (non-opioid)
Ketamine
Anti-emetic therapy
```
110
What are some examples of medications that can be used to treat PONV? (classes and examples of specific names)
```
Serotonin antagonists (Odansetron)
Neurokinin inhibitors (Aprepitant)
Steroids (Dexamethasone)
Antihistamines (Dimenhydrinate [1st gen antihistamine], promethazine)
Butyrophenones (Droperidol)
Benzodiazepines
```
111
What are some examples or serotonin antagonists that can be used for PONV?
Ondansetron
| Granisetron
112
Which serotonin antagonist is used in the tx of N/V in CA pts?
Granisetron
113
At what receptor do serotonin antagonists act?
5HT-3 receptor
114
What are some potential adverse effects of serotonin antagonists?
```
Headache
Diarrhea
Constipation
Arrhythmia
Serotonin syndrome
```
115
When neurokinin inhibitors are administered pre-anesthesia, they reduce nausea and vomiting up to ____ hours after surgery
48
116
Neurokinin inhibitors are commonly used prior to ____ surgeries
abdominal
117
Aprepitant is a neurokinin inhibitor that blocks _____ production
Substance P (this data came from chemotherapy pts)
118
What are some potential adverse effects of neurokinin inhibitors?
Dizziness
Diarrhea
Headaches
Weakness
119
While steroids have an unclear mechanism of action, they may affect _____ in the brain
prostaglandins
120
_______ is a common steroid, available intravenously and in long term NV w/ pts w/ failure to thrive
Dexamethasone
121
Possible adverse effects of steroids include...
Dizziness
Mood change
Nervousness
122
______ work at emesis center and chemoreceptor trigger zone (CTZ) to reduce vomiting
1st gen antihistamines
123
What are some possible adverse effects of 1st generation antihistamines?
Sedation!
Confusion
Dry mouth
Urinary retention
124
_______ work at the chemoreceptor trigger zone (CTZ) to block nausea / vomiting and at the D2 receptor
Butyrophenones
125
Droperidol, a Butyrophenone, is not utilized, except in a ____ or _____ ____ setting
hospital or ambulatory surgery
126
Adverse effects of Butyrophenones include.... Which of the adverse effects carries a black box warning?
Prolonged QTc interval (black box warning)
Hypotension
Tachycardia
Extra-pyramidal sx
127
T/F Prevention and multimodal approach is necessary to reduce post-operative nausea / vomiting
True
128
T/F Systemic agents are most commonly used in nerve and infiltrative blocks to improve patient experience and pain control
False; Local agents are most commonly used
129
```
The dosing recommendation for Lidocaine is as follows:
Concentration: ___-___%
Max dose: ___-___ mg/kg (max: ____ mg)
Onset: ____ min
Duration: ___-___ hours
```
Concentration: 1-2%
Max dose: 4.5-5 mg/kg (max: 300 mg)
Onset: <2 min
Duration: 0.5-1 hours
130
```
The dosing recommendation for Lidocaine w/ epinephrine is as follows:
Concentration: ___-___%
Max dose: ___ mg/kg (max: ____ mg)
Onset: ____ min
Duration: ___-___ hours
```
Concentration: 1-2%
Max dose: 7 mg/kg (max: 500 mg)
Onset: <2 min
Duration: 4-6 hours
131
```
The dosing recommendation for Bupivicaine is as follows:
Concentration: ___%
Max dose: ___-___ mg/kg (max: ____ mg)
Onset: ____ min
Duration: ___-___ hours
```
Concentration: 0.25%
Max dose: 2.5 mg/kg (max: 175 mg)
Onset: 5 min
Duration: 2-4 hours
132
```
The dosing recommendation for Bupivicaine w/ epinephrine is as follows:
Concentration: ___%
Max dose: ____ mg
Onset: ____ min
Duration: ___-___ hours
```
Concentration: 0.25 %
Max dose: 225 mg
Onset: 5 min
Duration: 3-7 hours
133
```
The dosing recommendation for Procaine is as follows:
Concentration: ___-___%
Max dose: ___-___ mg/kg
Onset: ___-___ min
Duration: ___-___ hours
```
Concentration: 0.25-0.5%
Max dose: 350-600 mg/kg
Onset: 2-5 min
Duration: 0.25-1 hours
134
What is the equipotent dosing of Morphine and its corresponding duration of action?
Morphine: 1-2mg, 90 min
135
What is the equipotent dosing of Fentanyl and its corresponding duration of action?
Fentanyl: 0.05-0.1mg, 30 min
136
What is the equipotent dosing of Sufentanil and its corresponding duration of action?
Sufentanil: 0.005-0.01mg, 15 min
137
What is the equipotent dosing of Hydromorphone and its corresponding duration of action?
Hydromorphone: 0.1-0.2mg, 60 min
