Anesthetics

Question 1

What are the volatile liquid general anesthetics?

Answer 1

halothane, isoflurane, desflurane, enflurane, sevoflurane (HIDES)

Question 2

What is the gas general anesthetic?

Answer 2

nitrous oxide

Question 3

What type of general anesthetics are inhaled?

Answer 3

volatile liquids and gas

Question 4

What type of general anesthetics are IV?

Answer 4

thiopental (barbiturates), midazolam (benzodiazepines), propofol (phenols), morphine (opioids)

Question 5

What are the local anesthetic drugs?

Answer 5

cocaine, procaine, tetracaine, lidocaine, bupivacaine

Question 6

General anesthetics use what type of channel?

Answer 6

ligand gated

Question 7

Local anesthetics use what type of channel?

Answer 7

voltage gated

Question 8

What are general anesthetics?

Answer 8

drug induced absence of ALL sensations

Question 9

What are the sensations that are absent with general anesthetics?

Answer 9

unconsciousness, analgesia, amnesia, loss of reflexes

Question 10

How are general anesthetics mainly administered?

Answer 10

inhalational and IV

Question 11

What is balanced anesthesia?

Answer 11

anesthesia with a mx of inhaled and intravenous anesthetics

Question 12

What are the classes of sedative-hypnotics from high to low?

Answer 12

general anesthesia> deep sedation> moderate sedation> minimal sedation

Question 13

What is the therapeutic indices range for inhalational anesthetics?

Answer 13

2 to 4

Question 14

What are the kinetics of uptake and distribution of inhalational anesthetics?

Answer 14

1. rate of entry controlled by respiration, a cyclic process
2. elimination occurs in the lungs

Question 15

What are the two drugs that are NOT eliminated by lungs?

Answer 15

methoxyflurane and halothane

Question 16

What is tidal volume?

Answer 16

amount of air in lung when you take a breath

Question 17

What is the rate of respiration?

Answer 17

number of breaths per minute

Question 18

What is minute ventilation?

Answer 18

amount of air going in and out of lungs per minute

Question 19

What is the minimum alveolar conc. (MAC)?

Answer 19

conc. that results in immobility in 50% of patients when exposed to noxious stimulus

Question 20

If the MAC is larger, what amount of conc. is needed to have an effect?

Answer 20

more

Question 21

If the MAC is smaller, what amount of conc. is needed to have an effect?

Answer 21

less

Question 22

What are the factors that affect uptake of inhalation anesthetics?

Answer 22

solubility in blood and conc. of anesthetic agent in the inspired gas

Question 23

What is the coefficient of of solubility in blood?

Answer 23

blood:gas partition coefficient

Question 24

What does the blood:gas partition coefficient/index of solubility define?

Answer 24

relative affinity of an anesthetic for blood in comparison to air

Question 25

How does solubility affect the rate of rise of its tension in the blood then brain?

Answer 25

the lower the solubility, the faster the rate (smaller B:G = more pressure = faster delivery to brain)

Question 26

What can increase the rate of induction?

Answer 26

an increase in teh inspired anesthetic conc.

Question 27

What is pulmonary ventilation?

Answer 27

when increased, it will speed up the uptake of an anesthetic with higher B:G partition coefficient

Question 28

What is the hypothesis of the pharmacodynamics of anesthetics?

Answer 28

direct correlation between lipid solubility and potency

Question 29

What receptor is the target for most general anesthetics?

Answer 29

GABAa

Question 30

GABAa channel activity is increased in the presence of what drugs?

Answer 30

benzodiazepines, barbiturates, propofol, enflurane

Question 31

What is the practical approach to evaluate the depth of anesthesia?

Answer 31

1. if the eyelid blinks when eyelashes are touched 2. if patient swallowing reflex disappears 3. if respiration becomes irregular in the rate and depth

Question 32

What can reduce the respiratory tidal volume?

Answer 32

an increase in the depth of anesthesia

Question 33

What happens when potent halogenated agents are used?

Answer 33

arterial blood tends to vary directly with the depth of anesthesia

Question 34

What can be used as an approximate index of dosage when potent halogenated agents are used?

Answer 34

hypotension

Question 35

What is the cardiovascular effect on halogenated general anesthetics?

Answer 35

dose dependent reduction in blood pressure

Question 36

What is the respiratory effect on halogenated general anesthetics?

Answer 36

reduce ventilation in conc.-dependent way by depressing medullary centers in the brainstem; reducing minute ventilation

Question 37

What is an adverse affect of anesthetics?

Answer 37

malignant hyperthermia: rapid rise in body temp.

Question 38

What are the symptoms of malignant hyperthermia?

Answer 38

hyperthermia, tachycardia, hypertension, acidosis, muscle rigidity

Question 39

What makes malignant hyperthermia most common?

Answer 39

use of halothane and succinylcholine

Question 40

What is the drug used to prevent death from malignant hyperthermia?

Answer 40

dantrolene

Question 41

What is the main application of nitrous oxide?

Answer 41

adjuvant with other inhalational anesthetics

Question 42

What is the percentage of nitrous oxide needed to have analgesia (no pain) as an effect?

Answer 42

20%

Question 43

Can nitrous oxide achieve behavioral disinhibition, amnesia, or unconsciousness?

Answer 43

yes 40%- behavioral disinhibition 60%- amnesia 80%- unconsciousness

Question 44

Are barbiturates good analgesics?

Answer 44

NO; can increase sensitivity to pain

Question 45

What type of circulation do barbiturates have?

Answer 45

one arm-to-brain circulation

Question 46

What occurs in the circulation of barbiturates?

Answer 46

decreases arterial pressure due to a reduction in cardiac output

Question 47

What occurs in the respiration of barbiturates?

Answer 47

reduces minute ventilation by lowering the sensitivity of medullary respiratory center to carbon dioxide

Question 48

Propofol induces anesthesia as rapidly as what other type of drug?

Answer 48

barbiturates; but has shorter half-life

Question 49

How does propofol affect systemic arterial pressure?

Answer 49

decreases it due to peripheral vasodilation

Question 50

What can occur at the site of injection for propofols?

Answer 50

apnea

Question 51

Propofol is used mainly for what type of surgery?

Answer 51

"day surgery"

Question 52

What type of drug is known as "milk of amnesia"?

Answer 52

propofol due to it being lipid soluble

Question 53

What can benzodiazepines cause?

Answer 53

sedation, reduction in anxiety, amnesia, moderate depression of circulation and respiration

Question 54

Are benzodiazepines analgesic?

Answer 54

NO; they are amnesic

Question 55

What drug is used to reverse the action of benzodiazepines?

Answer 55

flumazenil

Question 56

Out of diazepam, midazolam, and lorazepam, which has a more rapid onset?

Answer 56

midazolam

Question 57

Are opioids an analgesic?

Answer 57

YES and very powerful

Question 58

What are the effects of opioids?

Answer 58

1. mild decrease in blood pressure 2. impair ventilation, depress respiration 3. increase chest wall rigidity

Question 59

What is the antagonist used for opioid overdose?

Answer 59

naloxone

Question 60

What are local anesthetics?

Answer 60

reversibly block impulse conduction along nerve axons that use Na channels

Question 61

What are the effects of local anesthetics?

Answer 61

1. block pain sensation 2. cause vasoconstriction 3. reduces bleeding

Question 62

What type of chemistry do local anesthetics include?

Answer 62

lipophilic group connected by an intermediate chain to an ionizable group (aromatic ring + ester/amide + tertiary amine)

Question 63

What are the esters of local anesthetics?

Answer 63

1. cocaine (vasoconstrictor) 2. procaine (vasodilator) 3. tetracaine (vasodilator)

Question 64

What are the amides of local anesthetics?

Answer 64

lidocaine (vasodilator) and bupivacaine (vasodilator)

Question 65

What is the ONLY vasoconstrictor in local anesthetics?

Answer 65

cocaine

Question 66

Are local anesthetics weak acids or bases?

Answer 66

weak bases

Question 67

What form of local anesthetics penetrate the cell?

Answer 67

non-ionized form

Question 68

What form of local anesthetics occupy the Na channels?

Answer 68

ionized form

Question 69

What does epinephrine do during absorption in local anesthetics?

Answer 69

prolongs activity and reduces the dose and change of toxicity

Question 70

What are vasoconstrictor substances?

Answer 70

reduce the absorption of local anesthetics from depot site by decreasing the blood flow

Question 71

When should epinephrine NOT be administered?

Answer 71

when anesthetizing tissues with end arteries

Question 72

What type of local anesthetics have a shorter half-life?

Answer 72

esters

Question 73

What are amides metabolized by during elimination?

Answer 73

liver followed by hydrolysis (amidases)

Question 74

How do ester anesthetics become inactive products?

Answer 74

through hydrolysis by plasma cholinesterase and live esterase

Question 75

Local anesthetics have a HIGHER affinity for what states?

Answer 75

activated and inactivated states opposed to resting states

Question 76

What is conformational dependent?

Answer 76

the binding of local anesthetics to Na channel

Question 77

What type of channel do local anesthetics use?

Answer 77

voltage-gated Na channels

Question 78

What are the toxicity and adverse effects of the central nervous system?

Answer 78

excitation, convulsion, respiratory depression

Question 79

What are the toxicity and adverse effects of the cardiovascular system?

Answer 79

1. direct effect on cardiac and smooth muscle 2. indirect effect on autonomic nerves