Anesthetics Pharm and principles, Pain pharm

Question 1

What are the major side effects of Halothane?

Answer 1

Hepatitis and depression of circulation and respiration

Question 2

Which inhalation anesthetic do you use for obese patients?

Answer 2

Desflurane

Question 3

What is the MAC?

Answer 3

Minimal Alveolar Concentration

- concentration of drug that results in 50% of patients immobile

Question 4

How does solubility of a drug influence the onset?

Answer 4

Lower solubility leads to faster onset

Question 5

What two of the inhaled anesthetics are the least metabolized?

Answer 5

Isoflurane and Desflurane

Question 6

What produces Compound A?

Answer 6

Degradation of Sevoflurane in the CO2 absorber

Question 7

What is the MOA of Compound A?

Answer 7

depress spontaneous and evoke activity of neurons in the brain

Question 8

What does the Meyer Overton Theory state?

Answer 8

Anesthetic potency is determined by lipid solubility

- membrane expansion

Question 9

Which two inhalation anesthetics are upper airway irritants?

Answer 9

Isoflurane and Desflurane

Question 10

What inhalation anesthetic is used for pediatric mask induction?

Answer 10

Sevoflurane

Question 11

What do you use to treat Malignant Hyperthermia?

Answer 11

Dantrolene = older; Ryanodex = newer

Question 12

What intravenous anesthetic is best for patients with increased ICP?

Answer 12

Thiopental

Question 13

Which intravenous anesthetic is used for burn dressing?

Answer 13

Ketamine

Question 14

Which intravenous anesthetic causes corticoadrenal suppression?

Answer 14

Etomidate

Question 15

What intravenous anesthetic is used in short outpatient cases?

Answer 15

Propofol

Question 16

What is the MOA of Dexmedetomidine?

Answer 16

Alpha 2 agonist

Question 17

Where is Dexmedetomidine metabolized?

Answer 17

The liver

Question 18

What is the MOA for local anesthetics?

Answer 18

prevent increased permeability of Na ions

- no depolarization to threshold

Question 19

What are the three states of the modulated receptor model?

Answer 19

1. rested closed
2. activated open
3. inactivated closed

Question 20

In what state of the receptor model do localized anesthetics have high affinity?

Answer 20

inactivated closed state

Question 21

What two groups make up the local anesthetic structure?

Answer 21

aromatic ring and tertiary amine

-hydrocarbon chain in middle

Question 22

In what form do local anesthetics cross the nerve membrane?

Answer 22

non -ionized form

Question 23

In what form do local anesthetics block the sodium channel?

Answer 23

ionized form

Question 24

How does pKa affect time of onset?

Answer 24

closer to physiological pKa (7.4) will have faster onset

Question 25

How does tissue acidosis affect use of localized anesthetic?

Answer 25

slow onset of nerve blockade and causes poor quality of block

Question 26

How does hydrophobicity affect localized anesthetic ?

Answer 26

Higher coefficient means more potency

Question 27

How does vasodilation affect localized anesthetics?

Answer 27

increased Vd causes the diffusion of drug from site

Question 28

How does protein binding affect localized anesthetic?

Answer 28

increased binding leads to increased duration of action

Question 29

How does addition of epinephrine affect localized anesthetics?

Answer 29

causes vasoconstriction and dec absorption--> decreased diffusion away from the site

Question 30

Where are amide localized anesthetics metabolized?

Answer 30

in the liver | - more likely to cause toxicity

Question 31

Where are ester localized anesthetics metabolized?

Answer 31

in the plasma via PCE

Question 32

How is cardiac toxicity caused by localized anesthetics?

Answer 32

blockage of Na fast channels in cardiac membranes | - widens QRS

Question 33

What two localized anesthetics cause severe heart rhythm problems?

Answer 33

Bupivacaine and Etidocaine

Question 34

Which specific pathway carries nociceptive, temp, and crude touch?

Answer 34

Spinothalamic tract

Question 35

What generates arachidonic acid?

Answer 35

Phospholipase A2

Question 36

How long is the trial for an NSAID?

Answer 36

One month

Question 37

Which NSAID is commonly used for gout?

Answer 37

Indomethacin

Question 38

Tetracaine is an anesthetic that is used for what kinds of procedures?

Answer 38

Bronchoscopy, Bronchography, Esophagoscopy

Question 39

Which two alpha 2 agonists are used to treat post op pain?

Answer 39

Clonidine and Dexmedetomidine

Question 40

What is the drug of choice for severe pain?

Answer 40

Morphine

Question 41

What is fentanyl used for?

Answer 41

help ongoing pain and when opioid tolerance is starting to show