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Pharmacology > General & Local Anesthetics > Flashcards

General & Local Anesthetics Flashcards

1
Q

What is a drug-induced reversible depression of the CNS resulting in loss of response to and perception of all external stimuli?

A

General anesthesia

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2
Q

What is a drug-induced state during which px respond normally to verbal commands?

A

Mnimal sedation (anxiolysis)

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3
Q

What are the stages of anesthesia?

A
  • Stage 1 = Amnesia & Analgesia
  • Stage 2 = Delirium/Disinhibition
  • Stage 3 = Surgical stage
  • Stage 4 = Respiratory paralysis (should not be reached)
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4
Q

How is respiration in the earlier stages of Anesthesia?

A

errratic or rapid in earlier stages & slow to shallow as it progresses to 3rd

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5
Q

What happens to eyeball movement in the stages of anesthesia?

A

greatest in stage 2, lesser in stage 3 (1st plane)

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6
Q

What happens to pupillary sizes in the stages of anesthesia?

A

pupils more dilated as px becomes more sedated

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7
Q

What are the diff anesthetic techniques?

A
  • Balanced anesthesia:combi of anesthetics & techniques to selectively direct components of anesthesia (inhaled & IV anesthetics)
    Total IV Anesthesia:**only IV gen anesthesia
    **    Monitored Anesthesia care    : Local anesthesia + oral/parenteral sedatives/anesthetic agents + monitoring of the px
    *IV induction: IV + monitor + rapid acting IV anesthetic for induction
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8
Q

What are the 2 types of inhaled anesthetics?

A

Volatile = Low vapor pressure, high boiling pt, liquid @RT (halothane, enfluoprane, isoflurane, desflurane, sevoflurane
Gaseous = high vapor pressure, low boiling point, gas @ RT (Nitrous oxide, Xenon)

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9
Q

In the elimination of anesthetics, what is the metabolic hierarchy of the diff inhaled anesthetics?

A

(Most to least metab)

Halothane > Enflurane > Sevoflurane > Isoflurane > Desflurane > N2O

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10
Q

Is N2O metabolized in humans?

A

no, but bacteria in our GIT can break them mdown

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11
Q

What is the minimum conc of anesthetic in the alveoli that prevents movement in response to surgical stimulation in 50% of px?

A

Minimum alveolar concentration (MAC)

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12
Q

What is the measure of anesthetic potency?

A

lower the MAC, more potent agent
higher the MAC, less potent the agent

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13
Q

What is the ratio of dissolved gas (by volume) in** 2 tissue compartments** at equilibrium?

refers to solubility also

A

bloodg gas partition coefficient

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14
Q

what is the rel of anesthetic solubility in blood to rate of rise?

A

the less soluble it is in the blood, the faster the rate of rise of the inhaled anesthetic to alveolar gas -> faster px falls asleep –> INC conc in brain

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15
Q

Which of the anesthetics is not used clinically anymore bcos of its nephrotoxicity effect?

A

Methoxyflurane

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16
Q

What is the most potent anesthetic?

A

Halothane (lowest MAC)

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17
Q

What are the diff Blood:gas partition coefficient rel?

A
  • **Higher PC **= Higher solubility = Slower induction = Longer effect
  • **Lower PC **= Lower solubility = Faster induction = Shorter effect
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18
Q

What are the effects of anesthetic to the CNS?

A
  • DEC cebral metab rate -> DEC cerebral blood flow
  • <1 MAC = no vasodilation
  • > or equial to 1.5 = vasodilation
  • DEC PaCO2 via hyperventilation -> cerebral vasocontriction
  • NO2 = INC Cerebral blood flow
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19
Q

What are the effects of anesthetic to the CVS?

A
  • Myocardial depression -> DEC arterial BP (Halothane & Enflurane)
  • Peripheral vasodilation min effect on CO so good for px with cardiac failure (Isoflurane, Desflurane, Sevoflurane)
  • N2O: slight myocardial depression & SNS activation -> preserves CO
  • Baroreceptor reflex (DEC BP, INC HR): Depressed: Halothane, Enflurane, Sevoflurane
    Unaffected: Isoflurane, Desflurane
    * DEC myocardial O2 consumption
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20
Q

What are the effects of anesthetics to respiration?

A
  • Bronchodilating
  • Pungency of Isoflurane & Desflurane (irritating)
    Respiratory depression: DEC response to CO2, INC apneic threshold
  • DEC Mucocillary functions: mucus plugging -> atelectasis, pulmonary infection
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21
Q

What are the effects of anesthetics to the kidneys?

A
  • DEC GFR, urine flow
  • DEC renal blood flow, INC filtration fraction
  • depends on minor or major surgery
  • resversible on discontinuation of anesthetic
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22
Q

What are the effects of anesthetics to the liver?

A
  • Concentration-dependendent DEC of portal blood flow
  • Hepatic artery flow may INC & preserve total hepatic blood flow
  • transient changes in liver enzymes
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23
Q

What are the effects of anesthetics to the uterine smooth muscle?

A
  • concentration-dependent uterine relaxation
  • profound uterine relaxation at higher dose of inhaled anesthetic & is necessary if intrauterine manipulations, extraction of retained placenta, bleeding after delivery under GA
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24
Q

What are the sites of anesthetic targets of Inhaled anesthetics?

A

INC inhibitory synaptic activity - mediated by GABA
DEC excitatory activity - mediated by Glutamate

25
Q

What are the 3 principle components of anesthetic action?

A

Immobility = Minimum alveolar concentration
Amnesia = explicit and implicit memories, prevented at 0.2-0.4MAC

Unconsciousness = reversible blockade

26
Q

What are the types of toxicity that can occur with inhaled anesthetics?

A

Nephrotoxicity
Hematotoxicity = CarboxyHgb, Megaloblatic anemia
Malignant hyperthermia
Hepatotoxicity = Halothane hepatitis
Mutagenicity, Teratogenecity

27
Q

What triggeers Malignany hyperthermia?

A

All inhalational anesthetics except for N2O & Succinylcholine

28
Q

What are clinical syndromes assoc with Malignany hyperthermia?

A

INC sympathetic activity
INC CO2 production
Muscle rigidity, fever as high as 43C
INC metabolic state

29
Q

What are tx for Malignany hyperthermia?

A

Remove trigger agent
Support vital functions
Lower body temp

30
Q

What is the DOC for Malignant hyperthermia?

A

Dalontrene

31
Q

What is the MOA of Dantrolene?

A

Interferes with releae of Ca from the SER via ryanodine receptor channel

Prevents excitation-contraction coupling

32
Q

What are the AEs of Dantrolene?

A

Muscle weakness, sedation, occasional hepatitis
Cardiac smooth muscle depressed slightly
Spasmolytic

33
Q

What are the different IV aneshtetics?

A

Thiopental
Propofol
Etomidate
Ketamine
Dexmedetomidine

34
Q

What is the ultra-short acitng IV anesthetics?

A

Thiopental

Used in execution chambers for convicts in death row

35
Q

What is the most widely used IV anesthetic?

A

Propofol

36
Q

What is the phenomena experienced in Propofol?

A

Excitatory phenomena

37
Q

What IV anesthetic maintains hemodynamic stability, cerebral protection, temporary inhibition of steroid synthesis in adrenals?

A

Etomidate

38
Q

What IV anesthetic causes dissociative amnesia?

A

Ketamine

39
Q

What is the MOA of Ketamine?

A

Mainly NMDA receptor antagonist -> blocks membrane effects of the excitatory NT glutamate

40
Q

What phenomena occurs with Ketamine?

A

Emergence phenomena = + postop disorientation, sensory & perceptual hallucinations, vivid dreams,nightmares

41
Q

What IV anesthetic is an a2-adrenergic agonist where it maintains spotaneous respirations?

A

Dexmedetomidine

42
Q

What are other uses of Dexmedetomidine?

A
  • rapid opioid detoxification, cocaine withdrawal
  • iatrogenic-induced benzodiazepine and opioid tolerance after prolonged sedation
43
Q

What IV anesthetic’s effet is terminated by redistribution?

A

Etomidate

44
Q

What are the 3 basic parts of local anesthetic?

A

Lipophilic grp
Intermediate bond
Hydrophilic group

45
Q

What is an atypical local anesthetic?

A

Benzocaine

46
Q

What prototype of amide is the most commonly used in PH and used as an alternative for px wtih PABA allergy?

A

Lidocaine

47
Q

What metabolite formed from Esters can produce allergic reactions?

A

Para-aminobenzoic acid (PABA)

48
Q

What enzyme is responsible for hydrolyzing the action of esters in the blood?

A

Butyrylcholinesterase

49
Q

What are the 3 topical local anesthetics?

A

1.Benzocaine
2. EMLA (Eutectic mixture of LA ointment) Lidocaine + Prilocaine
3. Lidocaine (gel)

50
Q

What is the MOA of local anesthetics?

A

Blockate of voltage-gated Na channels

51
Q

What marine toxin is found in shellfish in “red tide” that causes paralysis?

A

Saxitoxin

52
Q

What is added to local anesthetics?

A

Epinephrine
- to DEC rate of vascular absorption
- INC depth and duration of anesthesia

53
Q

What are the effects of local anesthetics in CNS with low concentrations?

A

Sleepiness, light-headedness
Visual/auditory disturbance
Restlessness

54
Q

What are early symptoms of CNS toxicity?

A

Circumoral
Tongue numbness

55
Q

What are CNS effects of Local anesthetics in high conc?

A

Nystagmus
Muscular twitching
Tonic-clonic seizure
CNS depression
Death

56
Q

What are othetr toxicities that can happen with admin of local anesthetics?

A

Neural toxicity
Transient neurologic symptoms: concentration dependent

57
Q

What are the commonly used local anesthetics?

A

Articaine
Benzocaine
Cocaine
Bupivacaine
Levobupivacaine
Lidocaine
Ropovacaine

58
Q

What are the different local anesthetics with Ester properties?

A

Cocaine
Procaine
Tetracaine

59
Q

What are the diff local anesthetics with Amide compoentns?

A

Lidocaine
Bupivacaine
Prilocaine

Pharmacology (19 decks)

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