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!Neuropharm Anesthetics Flashcards

(72 cards)

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1
Q

Local anesthetic

A

Localized analgesia for minorprocedures and epidurals

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2
Q

How do local anesthetic pls work

A

Inhibit intracellular Na influx by blocking Na channels

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3
Q

Local anesthetic are state dependent.what does that mean

A

Neuronal blockade works best in rapidly firing neurons and they preferentially block activated sodium channels

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4
Q

Why are local anesthetic often combined with vasoconstrictors for minor procedures

A

Vasoconstricteres lead to increased concentration of the anesthetic agent and also decreased local bleeding

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5
Q

__ tissues decrease the action of local anesthetic and a larger amount is needed in an infected area to provide the same effects as in healthy tissue

A

Infected

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6
Q

What are the two groups of local anesthetic

A

Esters (one i in name)

Amides (two i in name)

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7
Q

Why are u given an ester or aimed

A

Depending on allergies and liver function

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8
Q

Side effects of local anesthetic

A

Arrhythmia

Cardiotoxicity

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9
Q

Indication for local anesthetic

A 
Minor procedures (stitches)
Epidurals  (needle into l2-l3 and catheter def to bathe the epidural space)
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10
Q

How do local anesthetic work

A

Prevent sodium influx by blocking sodium channels int he neuronal membrane.
This prevents action potential from arising, inhibiting signal conduction

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11
Q

State dependency of local anesthetic

A

Exhibit preferential binding to activated Na channels and their neuronal blockage works best in rapidly firing neurons

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12
Q

Why are local anesthetics given with. Vasoconstrictors

A

Increased anesthetic action and decreased bleeding

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13
Q

Why does infected tissue require a higher dose of local anesthetic

A

Infected tissue is acidic and ionized local anesthetics and decreases their ability to cross the cell membrane and reach sodium channels, decreasing the drugs overall action. This it takes a greater amount of local anesthetic to provide its effects.

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14
Q

Ester local anesthetics

A

More prone to cause allergic reaction

One i in name

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15
Q

Examples of ester local anesthetics

A

Procaine, cocaine, tetracaine

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16
Q

Ester local anesthetics are hydrolyzed by _____ in the plasma

A

Pseudocholinesterases

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17
Q

Amide local anesthetics

A

Two i

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18
Q

Examples of amide local anesthetics

A

Lidocaine, mepivacaine, bupivacaine

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19
Q

Amide local anesthetics are metabolized in the __ and should not be given to patients with __ ___

A

Liver

Liver failure

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20
Q

Cocaine, levobupivacaine, ropivacaine causes __ ___ and may give rise to ___

A

Cocaine
Levobupivacaine
Ropivacaine

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21
Q

Bupivicain is considered to be __ bc it blocks cardiac na channels and can lead to malignant arrhythmia

A

Bupivicain

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22
Q

Inhaled anesthetics are highly __ soluble

A

Lipid

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23
Q

Commonly used inhaled anesthetics

A

HEISMN

Halothane, enflurane, isoflurane, devoflurane, ,ethoxyflurance, nitrous oxide

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24
Q

Effects of inhaled anesthetics

A

Respiratory depression
Myocardial depression
Depressing the SA node
Decreasing bp

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25
How do inhaled anesthetics cause respiratory depression
Decreasing medullary drive to breathe
26
How do inhaled anesthetics cause myocardial depression
Decreasing cardiac contractility
27
Inhaled anesthetics have profound CNS effects and lower ___ __ __ but increase __ __ ___ by ___ ___
Cerebral metabolic demand Cerebral blood flow Mediating vasodilation
28
Side effects inhaled anesthetics
Hepatotoxicity (halothane) Nephrotoxicity (methoxyflurane) Seizure (enflurane) Malignant hyperthermia
29
What is malignant hyperthermia
Severe catabolic condition characterized by increased temperature, CO2 production, O2 production, respiration, acidosis and rhabdomyolysis
30
Which inhaled anesthetic doesn’t cause malignant hyperthermia
Nitrous oxide
31
Problem with nitrous oxide
Expansion of trapped gas, which becomes a problem when it affects areas which cannot expand such as sinuses and the middle ear
32
Inhaled anesthetic MOA
Unknown
33
How work with respiratory depression with inhaled anesthetics
Mechanical ventilation
34
How do inhaled anesthetics increase cerebral blood flow
Vascular vasodilation
35
Halothane and hepatotoxicity
Due to oxidative reactions in the liver”halothane hepatitis” | Rarely used! Not safe
36
Nephrotoxicity and methoxyflurane
Broken down by liver and kidney and its metabolites lead to irreversible dose dependent nephrotoxicity. Linked to hepatotoxicity as well Not used anymore really
37
Seizure enflurane
Lower the seizure threshold and used should cautioned in patients with epilepsy Can also cause nephrotoxicity
38
Nitrous oxide problem
Trapped gas when blood containing NO equilireiates with closed air containing spaces in the body
39
What tissues is nitrous oxide a problems with
Not a problem with Compliant tissue (gut lumen) but may cause increased pressure and trauma if the space cant expand (sinuses, middle ear)
40
IV anesthetics
CNS drugs and cross the BBB due to their lipid solubility
41
Examples of IV anesthetics
``` Barbiturates Benzodiazepines Ketamine Opioids Proposal ```
42
Barbiturate and thiopental
Ultra short action
43
Benzodiazepines(midazolam)
Preoperatively and can be used for endoscopes or non invasive procedures
44
Ketamine
Arylcyclohexadine IV anesthetic NMDA receptor antagonist and can cause vivid nightmare like hallucinations in adults
45
Opioids
In combination with other CNS depressants to provide analgesia during procedures
46
Propofol
For rapid induction and sedation in an ICU setting and works by potentiating GABA A
47
Side effects benzodiazepines
Severe postoperative respiratory depression, amnesia and lowered bp
48
__, used as amnestic with other anesthetics has a side effect of severe postoperative respiratory depression
Midazolam
49
How treat benzodiazepine overdose
Flumazenil
50
Ketamine
Arylcycloheexylamine which is a class of PCP analogs that act as dissociative anesthetics
51
How does ketamine work
Arylcyclohexylamines are PCP analogs that act by blocking the effects of glutamic acid at NMDA receptors. This interferes with pain transmission int he spinal cord and also leads to a dissociative amnesia
52
Why does ketamine cause hallucinations
It is a cardiovascular stimulant that increases cerebral blood flow and may result in disorientation, distortions of reality, and bad dreams ,espicially in adults
53
Opoids
Morphine and fentanyl are given preoperatively together with inhalation and IV anesthetics to help reduce pain
54
Propofol
For sedation in the ICU , for rapid anesthesia induction and short procedures.
55
Why use propofol over thiopental
Less nausea
56
Who shouldn’t use propofol
Pop stars at home
57
MOA propofol
Potentiating GABA-A and leads to rapid anesthesia induction
58
Lidocaine (xylocaine)
Sodium channel blocker that inhibits neuronal impulses
59
Indication for lidocaine
Ventricular dysrhythmias and induce local anesthesia
60
Side effects of lidocaine
Drowsiness, confusion, paresthesia, seizures, and respiratory arrest
61
Lidocaine is an __-type anesthetic and it metabolized by the _
Amide | Liver
62
MIA lidocaine
Stops neuronal conduction by blocking Na channels and inhibiting AP By blocking Na channels in neurons of the skin, this drug prevents action potentials from creating pain perception. Lidocaine also blocks na channels in heart and suppresses neuronal excitability present in ventricular dysrhythmias Class IB antiaarhythmic
63
Indications for lidocaine
Ventricular arrhythmia | Anesthetic
64
Lidocaine and ventricular arrhythmia
Blocks Na channels and slows nerve conduction in ther heart | Also slows the hearts depolarization activity and accelerates depolarization duration.
65
Unlike other antidysrhythmic medications, lidocaine does not cause ___ effects
Anticholinergic
66
What kind of anesthetic is lidocaine
Nonselective amide local anesthetic
67
How does lidocaine work as an anesthetic
Blocks both conduction to both sensory and motor neurons. Degree of blockage depends on volume and concentration of drug
68
What is the order in which lidocaine blockers impulses
Autonomic, somatic sensory, somatic motor
69
How is lidocaine administered
Topically or injection
70
Side effects of lidocaine
Paresthesia Seizures Respiratory depression Drowsiness
71
Why may lidocaine cause seizure
Excessive amounts may cause CNS excitation | -give benzodiazepine to manage convulsions
72
Why give a vasoconstrictor (epinephrine) with lidocaine
Extends duration of the local anesthetic By decreasing local blood flow and delaying systemic absorption of the anesthetic, epinephrine prolongs anesthesia and decreases the risk of toxicity. Delaying systemic absorption of lidocaine allows a lower dosage to obtain the desired effect

Pharmacology (52 decks)

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