Anesthetics Flashcards
1
Q
Lidocaine MOA ?
A
Inhibits Na ion channels, stabilizing neuronal cell membranes and inhibiting nerve impulse initiation and conduction (amide local anesthetic)
2
Q
Lidocaine BBW ?
A
dose-related toxicity
3
Q
Lidocaine contraindications ?
A
Infection at injection site
Obstetrical paracervical block
Obstetrical anesthesia (0.75% INJ form)
IV regional anesthesia
Intra-articular continuous infusion
4
Q
Lidocaine Major Adverse reactions ?
A
CNS toxicity
myocardial depression
seizures
unconsciousness
respiratory arrest
5
Q
Lidocaine common adverse reactions ?
A
hypotension
nausea/vomiting
paresthesia
pain, non-specific
bradycardia
6
Q
Lidocaine Indications ?
A
Local
Regional
Spinal
anesthesia
7
Q
Most lidocaines for SC anesthetics offer with ?
A
epinephrine
8
Q
The addition of EPI creates ? and is great for ?
A
Creates local vasoconstriction (decreases bleeding)
Great for scalp, face (except nose)
9
Q
Avoid epinephrine if what is involved ?
A
Fingers
Nose
Penis
Toes
Low blood flow areas
** topical nitro on top of the finger if you accidentally give epi in finger
10
Q
Inhalational anesthetics inhalation examples ?
A
Sevoflurane
Isoflurane
**sedation, pain control and paralysis ( they meet all the criteria) no other class do all three, only the inhalations do all three
lower the # the more potent it is
**
11
Q
Sevoflurane MOA ?
A
alters neuronal ion channels such as GABA, glutamate, and glycine receptors, resulting in decreased tissue excitability
**Benzos also hit GABA
glutamate - stimulating NT , paralysis **
12
Q
Sevoflurane BBW ?
A
NONE
13
Q
Sevoflurane contraindications ?
A
Malignant hyperthermia hx.
14
Q
Sevoflurane pregnancy category ?
A
B
15
Q
Lidocaine pregnancy category ?
A
C
16
Q
Sevoflurane major adverse reactions ?
A
malignant hyperthermia
apnea
hyperkalemia
arrhythmias
seizures
hepatotoxicity
ICP incr.
17
Q
Sevoflurane major DRUG reactions ?
A
thioridazine - antipsychotic
dronedarone
cisapride
saquinavir
toremifene
18
Q
Sevoflurane common adverse reactions ?
A
agitation
cough
hypotension
laryngospasm
breath holding
nausea/vomiting
19
Q
Sevoflurane indications ?
A
general anesthesia induction
general anesthesia maintenance
20
Q
Sevoflurane monitoring ?
A
ECG
end-tidal CO2
end-tidal sevoflurane
concentration
oxygen saturation
vital signs continuously
21
Q
Propofol aka ?
A
Diprivan
22
Q
Propofol MOA ?
A
induces hypnosis
**meaning sedation, does not help with pain and it does not paralyses folks **
23
Q
Propofol BBW ?
A
none
24
Q
Propofol pregnancy category ?
A
B
25
Propofol Contraindications ?
Labor and delivery
avoid abrupt W/D
26
Propofol major adverse reactions ?
Propofol infusion syndrome
Bradycardia
Asystole
Hypotension
Cardiac arrest
seizures
**if they unstable then this is not a good choice
but anxious and about to have shoulder reduction then prob a good choice **
27
Propofol drug interactions ?
Sodium oxybate
28
Propofol common reactions ?
resp. acidosis during weaning
injection site rxn
hypotension
involuntary muscle movements
Hyperlipidemia
29
Propofol indications ?
General anesthesia induction
General anesthesia maintenance
Monitored anesthesia care induction
Monitored anesthesia care maintenance
ICU sedation
30
Propofol monitoring ?
ECG
oxygen saturation
vital signs continuously
Renal function - cause
acidosis
31
Propofol patient educations ?
Propofol can cause severe drowsiness or dizziness, which may last for several hours. You will need someone to drive you home after your surgery or procedure.
Do not drive yourself or do anything that requires you to be awake and alert for at least 24 hours after you have been treated with propofol.
32
Ketamine aka ?
Ketalar
**beneficial for Kids and is good in cases where there is pulmonary issues cause it cause bronchial dilation but it can increase ICP ( so if trauma or brain damage it can make it worse ) **
33
Ketamine MOA ?
Acts on cortex and limbic receptors, producing dissociative analgesia and sedation
**kinda like PCP **
34
Ketamine BBW ?
incidence 12%; psychologic manifestations vary in severity from pleasant dream-like states, to vivid imagery, hallucinations, or emergence delirium; may be assoc. w/ confusion, excitement, and irrational behavior; duration usually a few hours, recurrences up to 24h post-op in few cases; no residual psychological effects;
decr. incidence in <15 yo and >65 yo
35
Ketamine pregnancy ?
B
36
Ketamine Contraindications ?
HTN
Stroke
Head trauma
Intracranial mass or
hemorrhage
37
Ketamine major adverse reactions ?
Respiratory depression
Laryngospasm
ICP increased
IOP increased
Hypertension
38
Ketamine drug interactions ?
Carbinoxamine
Cocaine topical
Doxylamine
39
Ketamine common rxns ?
sialorrhea - profuse saliva
BP elevated
HR elevated
anorexia
nausea/vomiting
40
Ketamine Indications ?
General anesthesia induction
General anesthesia maintenance
41
Ketamine patient education ?
This medicine may impair your thinking or reactions. You will probably not be allowed to drive yourself home after your surgery or medical procedure. Avoid driving or operating machinery for at least 24 hours after you have received ketamine.
May cause hallucinations
42
Ketamine monitoring ?
ECG
vital signs continuously
43
Ketofol - ketamine plus profolol, with both = less incidence of ?
hypoTN or HTN ?
44
Etomidate aka ?
Amidate
45
Etomidate MC use ?
MC used for intubation plus a paralytic ( succinylcholine)
46
Etomidate MOA ?
May have GABA-like effects, depresses brain stem reticular formation activity and produces hypnosis
**like a benzo**
47
Etomidate BBW ?
none
48
Etomidate pregnancy ?
C
49
Etomidate contraindications ?
none
50
Etomidate major reactions ?
shock
51
Etomidate drug interactions ?
Carbinoxamine
Doxylamine
52
Etomidate common reactions ?
Myoclonic movements, transient
Tonic movements, transient
Injection site pain
Averting movements
Nausea
Vomiting
Apnea
53
Etomidate indications ?
General anesthesia induction
54
Etomidate monitoring ?
ECG
vital signs continuously
55
Depolarizing Neuromuscular blocker ?
Succinylcholine
56
Non-Depolarizing Neuromuscular blocker ?
Rocuronium
Vecuronium
Pancuronium
Atracurium
57
Succinylcholine aka ?
Anectine
58
Succinylcholine purpose ?
Neuromuscular paralytic
**stops muscle movement, flaccidity **
59
Succinylcholine MOA ?
Stimulates motor endplate acetylcholine receptors (depolarizing neuromuscular blocker
**stimulates the muscles but it may catch it when it is in depolarization and then a separate depolarization and it sticks to the receptor so when Acetly choline hit the receptors, it just gets taken away from the enzyme cause the SUCCINYLCHONIE is blocking the receptor **
60
Succinylcholine BBW ?
Cardiac Arrest Risk (peds pts)
61
Succinylcholine pregnancy category ?
C
62
Succinylcholine Contrindications ?
Malignant hyperthermia hx
Myopathy
Major trauma or burns, acute
Glaucoma, angle-closure
Penetrating eye injury
Extensive muscular denervation, acute
Upper motor neuron injury, acute
63
Succinylcholine major reactions ?
Malignant hyperthermia
Prolonged paralysis
Respiratory depression
Apnea
Arrhythmias
64
Succinylcholine common reactions ?
Myalgia, postop
Muscle fasciculation
Jaw rigidity
IOP elevated
HTN
```
Hypotension
Bradycardia
Tachycardia
Sialorrhea
Rash
```
65
Succinylcholine indications ?
Neuromuscular blockade induction
Neuromuscular blockade maintenance
*Rapid sequence intubation = off-label
** induction first then paralysis !**
66
Succinylcholine monitoring ?
ECG
peripheral nerve stimulation
vital signs continuously
serum electrolytes
67
Rocuronium aka ?
Zemuron
68
Rocuronium purpose ?
Intubation
Paralytic
**purely blockade **
69
Rocuronium MOA ?
antagonizes motor endplate acetylcholine receptors (non-depolarizing neuromuscular blocker)
**stops depolarization where the other one stimulated first ……**
70
Rocuronium BBW ?
None
71
Rocuronium pregnancy ?
B
72
Rocuronium Contraindications ?
None
73
Rocuronium major reactions ?
bronchospasm
respiratory depression
apnea arrhythmias
prolonged paralysis (long-term use)
myopathy (long-term use)
74
Rocuronium drug interactions ?
Aminoglycosides
quinidine (antiarrhythmic)
75
Rocuronium common reactions ?
hypotension, transient
HTN
tachycardia
76
Rocuronium Indications ?
endotracheal intubation
rapid sequence intubation
neuromuscular blockade induction
neuromuscular blockade maintenance
77
Rocuronium monitoring ?
peripheral nerve stimulation
vital signs continuously
serum electrolytes
78
Malignant hyperthermia inherited ?
Genetically
**runs in families **
79
Malignant hyperthermia induced by ?
anesthetics
80
Malignant hyperthermia results from ?
uncontrolled release of calcium from the sarcoplasmic reticulum and massive increase of intracellular calcium in skeletal muscle due to the inability of the calcium to be reabsorbed
81
Malignant hyperthermia tx. ?
Dantrolene– multiple vials are available to mix
Most operating rooms have treatment protocols
82
Dantrolene aka ?
Dantrium
83
Dantrolene purpose ?
Malignant hyperthermia reversal
84
Dantrolene MOA ?
dissociates excitation-contraction coupling in skeletal muscle by decreasing intracellular calcium, inducing skeletal muscle relaxation
**causes relaxation **
85
Dantrolene BBW ?
Hepatotoxicity
86
Dantrolene pregnancy category ?
C
87
Dantrolene Contraindications ?
hepatic disease
active spasticity-dependent posture, balance, or function
avoid breastfeeding during tx and x2 days after D/C
88
Dantrolene major reactions ?
hepatotoxicity
pleural effusion
pericarditis
heart failure
aplastic anemia
leukopenia
89
Dantrolene drug interactions ?
Calcium channel blockers
Carbinoxamine
Doxylamine
sodium oxybate
**additive if taking a CCB **
90
Dantrolene common reactions ?
Drowsiness
Dizziness
```
Weakness
Malaise
Fatigue
Diarrhea
Photosensitivity
Nausea
tachycardia
```
91
Dantrolene Indications ?
*Malignant hyperthermia
off label
spasticity, chronic
92
Dantrolene Patient Education ?
This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Drinking alcohol can increase certain side effects of dantrolene.
Avoid exposure to sunlight or tanning beds. Dantrolene can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.
93
Dantrolene Monitoring ?
LFTs at baseline, then periodically (if long term)
cause risk of hepatotoxicity
94
Potent gases, such as, Sevoflurane have all three effects ?
Unconscious (amnesia) (anxiolytics)
Analgesia
Muscle relaxation (paralysis)
95
IV drugs for unconscious (amnesia) ?
Benzos
Barbituates
Etomidate
Ketamine
96
IV drugs for analgesia ?
Opioids (Fentanyl, Morphine, Hydromorphone)
Nonopioid (ketamine)
97
Ketamine does both ?
amnesia (Unconscious) and analgesia
98
IV drugs for muscle relaxation (paralysis) Depolarizer ?
Succinylcholine
99
IV drugs for muscle relaxation (paralysis) Non-depolarizer ?
Roncuronium
100
Nitrous Oxide is a weak gas for ?
Unconscious (amnesia) and Analgesia
**like ketamine**
101
_________________ provide all three characteristics of general anesthesia: unconsciousness, analgesia, and muscle relaxation.
inhalational agents
102
Ketamine advantages ?
Airway reflexes maintained
No respiratory depression
kids
103
Etomidate advantages ?
Rapid onset
short duration
Minimal CV effects
Cerebral protective
104
Propofol advantages ?
Rapid onset
Short duration
Antiemetic
Cerebral protective
105
Nitrous Oxide advantages ?
Rapid onset
Short duration
Minimal CV effects
106
Ketamine best for ?
children
107
Etomidate best for ?
Elderly
Critically ill
108
Rapid sequence intubation paralytic choice ?
Succinylcholine
Rocuronium if succinylcholine contraindicated
-malignant hyperthermia
109
Rapid sequence intubation, Induction choice by condition
| - Status asthmaticus ?
Lidocaine
Ketamine
110
Rapid sequence intubation, Induction choice by condition - increased ICP ?
Lidocaine
Etomidate
111
which of the following local anesthetics have the longest duration of action ?
Bupivvacaine
112
which of the following anesthetics is inhalation ?
Sevoflurane
113
which of the following meds is most likely to cause malignant hyperthermia ?
succinylcholine
114
which of the following anesthetics would be best for status asmaticus ?
ketamine
