General Anesthetics - 8/22 Kruse

Question 1

What anesthetics can increase HR?

Answer 1

Desflurane

Isoflurane

Question 2

What are the primary inhibitory channels of anesthetic action?

Answer 2

Cl (GABA and Gly)

K+

Question 3

What anesthetic(s) have dramatic increase in context-sensitive half-life with prolonged infusion?

Answer 3

Diazepam

Thiopental

Question 4

What agents have high blood solubility?

What does this mean abut their onset of action?

What about high arterial pressure?

Answer 4

Halothane

Slow onset

Reaches high P slowly

Question 5

What are the effects of inhaled anesthetics on the cardiovascular system?

Answer 5

Decrease MAP in direct proportion to the [alveolar]

Increase RA pressure via depression of myocardial function

Question 6

What may cause hepatitis?

Answer 6

Halothane

Question 7

MOA of Propofol?

Metabolized how?

Rate of onset?

Answer 7

GABAa agonist and potentiates Cl current

Liver (phase I and II)

Rapid

Question 8

What are the types of barbiturates?

MOA?

Cause what?

Effect on CYP450 enzymes?

Answer 8

Thiopental (prototype)
Methohexital

GABAa agonist

Respiratory depression

Inducers

Question 9

Etomidate MOA?

Produces what?

Metabolized how?

Answer 9

GABA receptors

Rapid loss of consciousness w/less recovery time than Propofol

Liver and plasma

Question 10

Are agents more soluble in the blood or brain?

Answer 10

Brain

Question 11

Do gaseous anesthetics have a high or low vapor pressure?

BP?

What form at room temp?

Answer 11

High vp

Low BP

Gas

Question 12

Do volatile anesthetics have a high or low vapor pressure?

BP?

What form at room temp?

Answer 12

Low vp

High BP

Liquid

Question 13

Ketamine MOA?

What side effects?

Answer 13

NMDA antagonist

Lacrimation and salivation

Question 14

What properties do benzodiazepines have?

Answer 14

Potent anticonvulsant

Question 15

What adjunct may be preferred for short ambulatory procedures due to its rapid elimination?

Answer 15

Methohexital

Question 16

What are the effects of inhaled anesthetics on the CNS?

Answer 16

Decrease BMR of the brain

Increase cerebral blood flow

Question 17

What is the prodrug of Propofol?

What is the onset and recovery like?
Describe its administration

Adverse side effects?

Answer 17

Fospropofol

Prolonged onset and recovery
Less pain on admin

Parasthesias and pruritus

Question 18

What anesthetic produces a state characterized by catatonia, amnesia, analgesia, w/or w/out loss of consciousness and may induce a euphoric state?

Answer 18

Ketamine

Question 19

What is the blood:gas partition coefficient equal to?

Answer 19

Blood solubility

Question 20

High blood:gas coefficient means what?

Answer 20

High solubility, slow onset of action

Question 21

What are the benzodiazepines?

MOA?

When are they used?

Answer 21

Diazepam, lorazepam, midazolam

GABAa agonist

Perioperatively

Question 22

How can benzodiazepines actions be terminated?

Answer 22

Flumazenil

Question 23

What agents have low blood solubility?

What does this mean abut their onset of action?

What about high arterial pressure?

Answer 23

NO, desflurane

Rapid onset

Reaches high P rapidly

Question 24

What is the most commonly used parenteral anesthetic in the U.S.?

Answer 24

Propofol

Question 25

CNS effects of etomidate? Endocrine effects?

Answer 25

Cerebral vasoconstrictor Adrenocortical suppression (inhibits 11B-hydroxylase)

Question 26

What are the opioid analgesic adjuncts? MOA?

Answer 26

MRFS Morphine, remifentanil, fentanyl, sufentanil Opiate agonist

Question 27

What are common side effects of inhaled anesthetics?

Answer 27

Nausea and vomiting

Question 28

What is described by MAC?

Answer 28

Anesthetic potency which is required to prevent a response to a surgical incision

Question 29

Succinylcholine combined with inhaled volatile anesthetics causes what? What is the antidote?

Answer 29

Malignant hyperthermia dantrolene

Question 30

Partial pressure in the alveoli equation? What does a ratio of 1 mean?

Answer 30

FA/FI Fastest anesthesia will occur during inhalation

Question 31

What are the effects of inhaled anesthetics on the respiratory system?

Answer 31

Respiratory depression | Depression of mucociliary function

Question 32

Dexmedetomidine MOA? Affect on Cerebrovascular system? Used commonly for what?

Answer 32

alpha-2 agonist Decrease HR Decreases systemic vascular resistance and BP Short-term sedation of intubated patietns

Question 33

What is the only IV anesthetic to produce profound analgesia, stimulation of the SNS, bronchodilation, and minimal respiratory depression?

Answer 33

Ketamine

Question 34

What anesthetic can cause bradycardia?

Answer 34

Halothane

Question 35

1 MAC of idol furans is what volume %? Halothane?

Answer 35

1.4 volume % .75 volume %

Question 36

What benzodiazepine is the drug of choice for parenteral administration?

Answer 36

Midazolam

Question 37

What agents metabolized to produce fluoride ions may cause renal toxicity?

Answer 37

Enflurane | Sevoflurane

Question 38

What agent has useful antiemetic action and can cause hypotension?

Answer 38

Propofol

Question 39

Inhaled anesthetics may cause pooling of mucus and postoperative respiratory infections due to interaction of what system? Depression of what fx?

Answer 39

Respiratory system Mucociliary fx

Question 40

What are the main excitatory ion channels of anesthetic action? How?

Answer 40

nAChR and mAChR AMPA, NMDA, and serotonin (5-HT)