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4.1 > N16/17 - Anesthetics (Zhu) > Flashcards

N16/17 - Anesthetics (Zhu) Flashcards

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1
Q

Types of local anesthetics (chemical property)

A

Esters

Amides

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2
Q

local anesthetic that mainly exists in neutral form (pka 3.5)

A

Benzocaine

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3
Q

hydrophobicity of most effective LAs

A

moderate

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4
Q

2 changes due to binding of LA to binding site

A

occlusion

restriction of conformational change

  • AP generation is blocked (prevented channel opening)
  • AP conduction is blocked (prolonged refractory period)
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5
Q

modulated receptor hypothesis

A

Low binding affinity at resting state

High binding affinity at:

  • intermediate closed state
  • open state
  • inactivated state: LA stabilizes channel in innactivated state, channel cannot be reopened even after repolarization
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6
Q

channel states when LAs have major effect

A

Intermediate closed - prevents opening

Inactivated - extends refractory period

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7
Q

attenuates effectiveness of LAs

A

hypocalcemia - increased Na excitability

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8
Q

Potentiates the effectivenss of local anesthetics

A

Hyperkalemia - membrane is persistently depolarized

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9
Q

General blockade order

A

First pain

Second pain

Temperature

Touch, proprioception (pressure, position, stretch)

Motor function

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10
Q

blocks pain, without significant motor block

A

Epidural bupivacaine

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11
Q

A-gamma fibers

A

muscle tone

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12
Q

A-delta fibers

A

First pain & temperature

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13
Q

C fibers

A

second pain & temperature

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14
Q

to avoid systemic absorption of LAs

A

co-administration of vasoconstrictors

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15
Q

Co-administered vasoconstrictor:

Except in which areas?

A

epinepherine

Except in: fingers, toes, ears, nose, penis

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16
Q

Pain relief

oral, nasal, laryngeal, rectal disorders, surgery

A

Topical: Mucous membrane application

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17
Q

Tx: pruritus

poison ivy, insect bites, eczema, venipuncture, chickenpox, etc

A

topical anesthesia: skin application

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18
Q

suturing wounds

removal of foreign bodies

dental procedures

A

Infiltration LA - intradermal or subq

Lidocaine, procaine, bupivacaine

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19
Q

toxicity due to

A

systemic absorption

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20
Q

systems affected by LA toxicity

A

CNS - excitement followed by depression (inhibition of inhibitory pathways, then both excite & inhib)

Cardiovascular - vasoconstriction, then vasodilation

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21
Q

Acts as antiarrhythmic at very low concentration

A

Lidocaine

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22
Q

hypersensitivity

A

Ester-type LAs

met. product = p-aminobenzoic acid (PABA)

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23
Q

cautioned use for potentiation of neuromuscular blockers

A

Myasthenia gravis

(use great caution)

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24
Q

Vasoconstriction

cardiotoxicity

CNS stimulation

Tx: opthalmic, nasal surgery (blocks bleeding), topical

A

Cocaine

(Ester-type)

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25
nasal surgery
Cocaine
26
No topical application
Procaine (Novocain) Chloroprocain (Nesacaine) (Ester-type)
27
High hydrophobicity Fast onset High potency Long acting Spinal & topical
Tetracaine | (Ester-type)
28
Weak Used in nonprescription topicals
Benzocaine | (Ester-type)
29
Risk for hypotension & cardiotoxicity
Bupivacaine
30
Similar to bupivacaine less cardiotoxicity
Levobupivacaine Ropivacaine - structural analog Mepivacaine - structural analog (Amide-type)
31
Amide-type drugs - name hint
2 I's
32
Ester-type drugs: name hint
1 "I" in name
33
Topical & infiltraion anesthesia
Prilocaine
34
Infiltration and nerve block anesthesia
Etidocaine
35
Amide-type with ester group dental procedures
Articaine
36
Lidocaine + Prilocaine combo Topical - Venipuncture, lumbar, dental
EMLA (Eutectic mixure of local anesthetic)
37
Contain halogens in chemical structure
Inhaled anesthetics | (except nitrous oxide)
38
Contain ether bond in chemical structure
Intravenous anesthetics
39
Stage I anesthesia
Analgesia
40
Stage II anesthesia
Excitement
41
Stage III anesthesia
Surgical anesthesia - unconscious - regular respiration - decreased eye movement
42
Stage IV anethesia
Medullary depression - respiratory arrest - cardiac depression & arrest - no eye movement AVOID THIS STAGE - REVERSE STAGES IN RECOVERY
43
Ion channel hypothesis
Potentiation of inhibitory channels - GABA(A) receptors Glycine receptors
44
No significant action on GABA(A) or glycine receptors
Ketamine Nitrous oxide
45
Inhibits excitatory channels - NMDA glutatmate receptors
ketamine
46
Activates K channels
inhalational anesthetics
47
Partial pressure
P = (# Mol. of gas A / # Mol. of mixture) x 760 mmHg
48
coefficient correlated directly with potency inversely correlated with minimal alveolar concentration (MAC)
Oil : gas partition coefficient
49
Coefficient inversely related with anesthesia induction rate No relation to potency
Blood : gas partition coefficient
50
Meyer-Overton rule
Anesthetics with larger oil/gas are more potent
51
Most common cause of malignant hyperthermia
Halothane Tx: Dantrolene
52
Driving force for equilibrium
alveolar partial pressure gradient NOT blood concentration
53
Speeds up induction
High partial pressure of anesthetic High ventilation rate - agents with high blood/gas are affected most
54
Smaller blood:gas partition coefficient =
faster induction
55
Larger blood:gas partition coefficient =
slower induction
56
Low cardiac output
high induction rate
57
high cardiac output
low induction rate
58
Reflects tissue uptake of drug
venous blood partial pressure
59
Drug significantly metabolized by the liver
Halothane
60
Inversely proportion to blood:gas delayed w/ increased duration of anesthesia profoundly decreased w/ long duration & high blood/gas
recovery rate
61
malignant hyperthermia
halothane
62
maintenence of in-patient anesthesia pungent odor
isoflurane
63
fluoride ions formed from metabolism may cause renal toxicity
enflurane
64
outpatient surgery not for induction usually used with IV agent
desflurane
65
outpatient surgery anesthesia induction in children sweet-tasting "compound A" may be renal toxic
Sevoflurane
66
diffusional hypoxia
nitrous oxide
67
primarily used as adjuct dental procedures when full anesthesia isnt needed
nitrous oxide
68
N2O diffuses from blood to alveoli, reduces PO2 in lung
diffusional hypoxia
69
upon discontinuation of N2O
100% O2 to avoid hypoxia
70
contraindications to nitrous oxide use
air-filled cavities (embolus, pneumothorax, etc) Vit B12 deficiency
71
Most potent inhaled anesthetic
halothane
72
Least potent anesthetic
nitrous oxide
73
most analgesic of inhaled anesthetics
nitrous oxide
74
least analgesic of inhaled anesthetics
halothane
75
barbiturate contraindicated w/ variegate prophyria hepatic metabolism renal excretion not analgesic hypotension
Thiopental
76
Rapid onset & recovery even w/ repeat dosing Anti-emetic action short day-surgery procedures
Propofol
77
young or head-injured patients higher-dose infusions metabolic acidosis, hyperlipidemia, rhabdomyolysis, liver enlargement
propofol infusion syndrome (PRIS)
78
minimal cardiovascular effects
etomidate
79
anesthesia induction in patients with cardiovascular diseases
etomidate
80
dissociative anesthesia - awake with profound analgesia and amnesia
ketamine
81
cardiovascular stimulating effects bronchodilation
ketamine
82
benzodiazepines
midazolam diazepam lorazepam
83
opioids
morphine fentanyl sufentanil
84
pre-operative anti-anxiety and anterograde amnesia
benzodiazepines
85
anestesia with a combination of several inhaled and/or IV anesthetics, and adjuvant drugs
balanced anesthesia

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