Pharm - Ch 25 - General Anesthetics

Front 1

MOA of general anesthetics

Back 1

Most are thought to act at GABA-A receptor - chloride channel (inhibition)

Front 2

Inhaled anesthetic with a low blood/gas partition coefficient

Back 2

Nitrous oxide

Front 3

Inversely related to potency of anesthetics

Back 3

Minimum alveolar anesthetic concentration (MAC)

Front 4

Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents

Back 4

Halothane and methoxyflurane

Front 5

Most inhaled anesthetics SE

Back 5

Decrease arterial blood pressure

Front 6

Inhaled anesthetics are myocardial depressants

Back 6

Enflurane and halothane

Front 7

Inhaled anesthetic, less likely to lower blood pressure than other agents, and has the smallest effect on respiration

Back 7

Nitrous oxide

Front 8

Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency

Back 8

Methoxyflurane

Front 9

Prolonged exposure to this inhaled anesthetic may lead to megaloblastic anemia

Back 9

Nitrous oxide

Front 10

DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics

Back 10

Dantrolene

Front 11

IV barbiturate used as a pre-op anesthetic

Back 11

Thiopental

Front 12

Benzodiazepine used adjunctively in anesthesia

Back 12

Midazolam

Front 13

Benzodiazepine receptor antagonist, it accelerates recovery from benzodiazepine overdose

Back 13

Flumazenil

Front 14

This produces "dissociative anesthesia", is a cardiovascular stimulant which may increases intracranial pressure, and hallucinations occur during recovery

Back 14

Ketamine

Front 15

Opioid associated with respiratory depression, but is used in high risk patients who may not survive full general anesthetia

Back 15

Fentanyl

Front 16

State of analgesia and amnesia produced when fentanyl is used with droperidol and nitrous oxide

Back 16

Neuroleptanesthesia

Front 17

Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension

Back 17

Propofol

Front 18

T or F? relaxation of bronchiolar smooth musc occurs during halothane anesthesia?

Back 18

TRUE

Front 19

T or F? mild generalized muscle twitching occurs at high doses of enflurane?

Back 19

TRUE

Front 20

T or F? chest muscle rigidity often follows the admin of fentanyl?

Back 20

TRUE

Front 21

T or F? intraop use of midazolam with inhaltion anesthetics may prolong postanestetsia recovery period?

Back 21

true; can be shortened with flumazenil (benzo receptor antagonist)

Front 22

T or F? severe hepatitis has been reported after use of desflurane?

Back 22

false; halothane

Front 23

Which drug shouldn't be used with pheochromocytoma surgery (ie increased catecholamines)?

Back 23

halothane (and isoflurane); sensitizes myocardium to catecholamines (arrhythmias)

Front 24

T or F about N2O? lacks CV depression

Back 24

TRUE

Front 25

T or F about N2O? anemia is common SE in those exposed for > 2h

Back 25

FALSE

Front 26

T or F about N2O? most potent inhaled anesthetic

Back 26

least potent (highest MAC)

Front 27

T or F about N2O? direct association b/t use of NO and malignant HTN

Back 27

FALSE

Front 28

T or F about N2O? 30-50% is elim via hepatic metab

Back 28

more than 98% is elim via exhalation

Front 29

T or F about MAC value? anesthetics with low MAC have low potency

Back 29

FALSE; inverse relationship

Front 30

T or F about MAC value? MACs give info about slope of dose-resp curve

Back 30

FALSE

Front 31

T or F about MAC value? N2O has extremely low MAC

Back 31

false; desflurane has lowest blood:gas coeff

Front 32

T or F about MAC value? decreases in elderly

Back 32

true; due to increased sensitivity

Front 33

T or F about MAC value? simultaneous use of opioid increases MAC for inhaled anesthetics

Back 33

FALSE

Front 34

T or F? IV opioids provide useful CV effects in frail elderly

Back 34

false; cause less cardiac depression than inhalation anesthetic agents; not cardiac stimulants

Front 35

T or F? opioids control HTN response to surgical stim

Back 35

false; HTN responses may occur and addition of beta blocker or vasodilators may be needed

Front 36

T or F? marked relaxation of skeletal muscles is anticipated with fentanyl admin in frail elderly

Back 36

false; causes muscle rigidity

Front 37

T or F? pt awareness may occur during surgery, with recal after with fentanyl

Back 37

TRUE; pt recall can be decreased with use of benzo

Front 38

T or F? pt is likely to experience pain during surgery with fentanyl

Back 38

false; full analgesia

Front 39

Which anesthetic has a low blood:gas coeff but isn't used for induction of anesthesia due to airway irritation?

Back 39

desflurane (bronchospasm)

Front 40

Malignant hyperthermia is most likely caused by?

Back 40

excessive release of Ca from sarcoplasmic reticulum

Front 41

Inhalation anesthetic with fastest onset of action:

Back 41

N2O (nitrous oxide)

Front 42

Effects of ketamine (3)

Back 42

CV stim, analgesia, amnesia

Front 43

Short lasting action of thiopental is due to:

Back 43

redistribution from brain to other body tissues (high lipophilicity)

Front 44

Flumazenil reverses resp depression associated with what agent?

Back 44

midazolam (benzo)

Front 45

What prevents the emergence phenomena of ketamine?

Back 45

diazepam (any benzo)

Front 46

With which agent are postop vomiting uncommon and ambulation is sooner?

Back 46

propofol (antiemetic, rapid recovery, short t1/2); also used for sedation in CCUs

Front 47

MOA of ketamine

Back 47

antagonizes action of excitatory glutamic acid on NMDA receptor

Front 48

CNS effects of inhaled anesthetics (2)

Back 48

decrease metabolic rate and increase blood flow (increase intracranial press)

Front 49

2 inhaled myocardial depressants

Back 49

enflurane and halothane

Front 50

3 inhaled agents that cause peripheral vasodilation

Back 50

isoflurane, desflurane and sevoflurane

Front 51

Resp effects of inhaled agents (3)

Back 51

decrease in tidal volume and minute vent, decrease vent response to hypoxia and bronchodilation (except desflurane)

Front 52

Fluoride released by which inhaled agent causes damage to what organ?

Back 52

methoxyflurane (lesser extent enflurane and sevoflurane); renal

Front 53

3 agents of neuroleptanesthesia

Back 53

N2O, droperidol and fentanyl

Front 54

IV agent used most often in those with limited cardiac or resp reserve

Back 54

etomidate (a imidazole)