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Pharmacology > General Anesthetics, Local Anesthetics, Muscle Relaxants > Flashcards

General Anesthetics, Local Anesthetics, Muscle Relaxants Flashcards

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0
Q

Four stages of Anesthesia

A
  1. Analgesia
  2. Disinhibition
  3. Surgical anesthesia
  4. Medullary depression
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1
Q

A state characterized by unconsciousness, analgesia, amnesia, skeletal muscle relaxation and loss of reflexes

A

General Anesthesia

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2
Q

Stage of anesthesia: patient is unconscious, no pain reflexes, regular respiration and maintained blood pressure

A

Surgical anesthesia

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3
Q

Stage of anesthesia: severe respiratory and cardiovascular depression that requires mechanical and pharmacologic support

A

Medullary depression

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4
Q

Stage of anesthesia: patient is delirious or excited, amnesia occurs, reflexes are enhanced and respiration is typically irregular. Retching and incontinence may occur

A

Disinhibition

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5
Q

Stage of anesthesia: decreased awareness of pain, sometimes with amnesia. Consciousness is impaired not loss

A

Analgesia

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6
Q

Best measure of potency of inhaled anesthetics

A

Minimum Alveolar Anesthetic Concentration (MAC)

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7
Q

Defined as the alveolar concentration required to eliminate the response to a standardized painful stimulus in 50% of patients

A

Minimum Alveolar Anesthetic Concentration (MAC)

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8
Q

Most inhaled anesthetics are bronchodilators except for ____ which causes Asthma

A

Desflurane

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9
Q

Effect of having increased blood gas partition coefficient on action and recovery

A

Increased BG coefficient = slower onset of action, slower recovery
Decreased BG coefficient = faster onset of action, faster recovery

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10
Q

Inhalational general anesthetic for minor surgery and dental procedures. May cause megaloblastic anemia on prolonged used

A

Nitrous oxide

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11
Q

Lowest potency and least cardiotoxicity among inhalational anesthetics

A

Nitrous oxide

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12
Q

Inhalational general anesthetic with pungent smell. May cause bronchospasm and peripheral vasodilation

A

Desflurane

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13
Q

Inhalational general anesthetic, sweet-smelling and may cause peripheral vasodilation and renal insufficiency

A

Sevoflurane - facilitate GABA-mediated inhibition, blocks brain NMDA and ACh-N receptors

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14
Q

Inhalational general anesthetic that may cause arrhythmias, peripheral vasodilation and coronary steal syndrome

A

Isoflurane

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15
Q

Inhalational general anesthetic that may cause arrhythmias, myocardial depression and postoperative hepatitis

A

Halothane - may interact with succinyl choline causing malignant hyperthermia

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16
Q

Inhalational general anesthetic with highest potency and lowest MAC

A

Methoxyflurane

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17
Q

Ultrashort acting barbiturate that can be used as intravenous general anesthetic. May cause acute intermittent porphyria with additive CNS depression with Ethanol

A

Thiopental - SIMD: Methohexital, Thiamylal

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18
Q

Short-acting benzodiazepine used for intravenous general anesthetic. May cause anterograde amnesia, postoperative respiratory depression

A

Midazolam

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19
Q

IV general anesthetics, used for dissociative anesthesia. May cause emergence delirium, hypertension and increased ICP

A

Ketamine

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20
Q

IV general anesthetic with no analgesic property, for patients with limited cardiac and respiratory reserve. Less side effects

A

Etomidate - modulates GABA rceptors containing B3 subunits

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21
Q

IV general anesthetic, non selective opioid analgesic. May cause respiratory depression in M receptor, chest wall rigidity and constipation.

A

Fentanyl

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22
Q

Antidote for Fentanyl toxicity

A

Naloxone

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23
Q

IV general anesthetic that causes bradycardia and hypotension. Called as Milk of Amnesia, with additive effect with sedative-hypnotic drugs. MAC values decreases in elderly patient

A

Propofol - potentiates GABA receptors, blocks Na channels

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24
Results when sensory transmission from a local area of the body to the CNS is blocked. Can be administered locally by injection or topical application to the target area
Local anesthesia
25
Local anesthetic that has the shortest half-life of 1-2 mins
Procaine
26
Local anesthetic with the longest half life
Ropivacaine - half life of 4.2 hours
27
Condition that enhances local anesthetic activity
Hyperkalemia
28
Condition that antagonizes local anesthetic activity
Hypercalcemia
29
All local anesthetics are vasodilators except?
Cocaine
30
Ester Local anesthetic also for extravasation complications from venipuncture and inadvertent intraarterial injections. May cause antibody formation
Procaine - blockade of Na channels slows, then prevent axon potential propagation
31
Ester Local anesthetic also for topical anesthesia. Use cautiously when treating sunburns or large areas of skin
Benzocaine
32
Ester Local anesthetic, drug of abuse. May cause antibody formation, abuse liability, severe hypotension, cerebral hemorrhage, cardiac arrhythmia or MI
Cocaine - also has intrinsic sympathomimetic activity
33
Ester Local anesthetic for spinal anesthesia, epidural anesthesia. With highest allergic potential
Tetracaine
34
Amide Local anesthetic that has group 1B antiarrhythmic activity
Lidocaine
35
Toxic dose of lidocaine
5mg/kg
36
Amide Local anesthetic also for dental anesthesia. May cause methemoglobinemia
Prilocaine
37
Amide Local anesthetic for local, epidural and intrathecal anesthesia. May cause severe cardiovascular toxicity.With caution in pregnant women.
Bupivacine
38
Treatment for Bupivacaine induced cardiotoxicity
Intralipid (fat emulsion used in TPN)
39
Amide Local anesthetic for local and epidural anesthesia. May cause cardiotoxicity. Can be reversed with Intralipid. Had the longest half life
Ropivacaine
40
drugs used to produce muscle paralysis to facilitate surgery or assisted ventilation.
Neuromuscular blocking drugs
41
Drugs used to reduce abnormally elevated tone caused by neurologic or muscle end plate disease
Spasmolytic drugs
42
Two types of neuromuscular blockade
Depolarizing blockade | Non-depolarizing blockade
43
Blockade: neuromuscular paralysis that results from persistent depolarization of the end plate
Depolarizing blockade
44
Blockade: neuromuscular paralysis that results from pharmacologic antagonism at the acetylcholine receptor of the end plate.
Nondepolarizing or stabilizing blockade
45
Nondepolarizing neuromuscular blocker with the most rapid onset time
Rocuronium - onset time of 60-120s
46
Nondepolarizing neuromuscular blocker. May cause respiratory paralysis, histamine release and recurarization. Relatively contraindicated in MI
Tubocurarine
47
Nondepolarizing neuromuscular blocker, short acting, metabolized by pseudocholinesterase
Mivacurium
48
Nondepolarizing neuromuscular blocker, intermediate acting, it undergoes Hoffman elimination
Atracurium - SIMD: Cisatracurium
49
Nondepolarizing neuromuscular blocker, intermediate acting, undergoes elimination in the bile. Muscle relaxation is potentiated with inhaled anesthetics, aminoglycosides and quinidine
Vecuronium
50
Nondepolarizing neuromuscular blocker, intermediate acting. With ost rapid onset time
Rocuronium
51
Novel reversal agent for Rocuronium
Sugammadex
52
Treatment for malignant hyperthermia
Dantrolene and rapid cooling of the patient
54
Nondepolarizing neuromuscular blocker, long acting, with moderate block on cardiac muscarinic receptors. Used for lethal injection, euthanasia, strychnine poisoning
Pancuronium
55
Earliest sign of malignant hyperthermia?
Contraction of jaw muscles (trismus)
57
Side effects of all Nondepolarizing neuromuscular blocker can be reversed by what?
Neostigmine
58
Drugs used in lethal injection
Thiopental 5mg Pancuronium 100 mg - resp. paralysis Potassium chloride 100mg - stop the heart
59
Phases of Depolarizing blockade
Phase I: Depolarization | Phase Ii: Desensitization
60
Phase: membrane depolarizes with initial electric discharge, transient fasciculations followed by flaccid paralysis
Phase I: Depolarization
61
Earliest sign of malignant hyperthermia?
Trismus
62
Phase: membrane repolarizes but receptor is desensitized to the effects of acetylcholine
Phase II: Desensitization
63
Depolarizing neuromuscular blocker, that may cause muscle pain, hyperkalemia, in severe cases malignant hyperthermia. Metabolized by pseudocholinesterase
Succinylcholine

Pharmacology (11 decks)

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