Chapter 9 - Surgical Pharmacology And Anesthesia

Front 1

a) Is the study of medication and their actions.
b) This include:
c) Is defined as a substance used in medicine for the diagnosis, treatment, cure, mitigation or prevention of disease or conditions.

Back 1

a) Pharmacology
b) Origins, properties and uses
c) Drugs

Front 2

a) How many sources does drugs are derivate from:
b) The newest source of drugs from the lab comes to us from genetic engineering
c) This technology is referred as

Back 2

a) 5
b) Biotechnology
c) Recombinant DNA technology

Front 3

a) At one time most drugs were originated from, a number of medication from this source still in use at this days
b) Example

Back 3

a) Plant source
b) Morphine and digitalis

Front 4

c) Primarily hormones are derived from this source.
d) Example

Back 4

c) Animal source
d) Heparin sodium and thrombin

Front 5

Drugs obtained from:
- Cows are:
- Pigs are:

Back 5

- Bovine
- Porcine

Front 6

e) From the Earth are available in several forms:
f) Example
g) The majority of drugs used today are manufactured at this type of source, and can be accomplished by 2 ways

Back 6

e) Mineral source
f) Calcium, gold, iron, magnesium, silver and zinc
g) Lab synthesis

Front 7

h) Are manufactured totally from lab chemicals
I) example
j) Begin w/ natural substance which is then chemically altered
k) Example

Back 7

h) Synthetic drugs
I) Meperidine sulfate (Demerol)
j) Semisynthetic drugs
k) Aminoglycoside( group of antibiotics)

Front 8

The hepatitis B vaccine is produced as a results of____

Back 8

Recombination DNA technology

Front 9

a) Involves the study of interaction of drug molecules w/ a target cell of living organism
b) The results of this interaction have both ____

Back 9

a) Pharmacodynamics
b) Biochemical and physiological effects

Front 10

TO KNOW
- Types of drugs interactions include the inhibition or destruction of foreign organism or malignant cell, protecting the cells from foreign agent, supplementation or replacement of specific -----

Back 10

hormones, vitamins or enzymes and increase or decrease the speed of physiological function.

Front 11

What affect the different aspect of pharmacodynamics

Back 11

Type of drug - dosage
Route of administration
Pt conditions

Front 12

Can interact w/ pt tissues and w/ one another in several ways, can occur when two substances are prescribed currently causing modification of the action of one or both drugs, this may be intentional (beneficial) or undesirable (detrimental)

Back 12

Drug interaction

Front 13

a) Interaction occur when a drug potentiates or enhance the effect of another substance
b) Examples

Back 13

a) Agonist
b) Synergist and additives

Front 14

Act in combination to produce stronger or more powerful effect than would be demonstrated if each agent was administrated individually

Back 14

Synergistic agents

Front 15

TO KNOW:
- In a synergistic relationship the action of one agent increase the action of the other agent when delivered together, as a result each can be delivered in lower, safe dose while obtain the same desired effect.-----

Back 15

- The use of midazolam (sedative) and fentanyl (narcotic analgesic) permits the use of lower concentrations of volatile gases during the administration of general inhalation anesthesia

Front 16

a) Alter some aspect of the action of the original agent
b) Example

Back 16

a) Additives agent
b) Epinephrine (Adrenaline) is added to lidocaine hydrochloride (Xylocaine) to prolong the anesthetic action of this short - term local anesthesia

Front 17

a) Is a medication that binds to a specific receptor site in the body, producing an alteration in biological function and resulting in a desired effect.
b) Example

Back 17

a) Antagonists
b) When flumazinil (Mazicon) is given to reverse the sedative side effects of midazolam (Versed)

Front 18

Is listing of the medical condition that the medication is known to treat, the dosage of each indication as well as the delivery form may vary according to the medical condition and pt factors such as weight and age

Back 18

Indications

Front 19

Are a list of circumstances or medical conditions under which medication should not be used, common areas for the medication include pregnancy, liver or renal failure

Back 19

Contraindication

Front 20

The medication period of time required for the effects of the medication to begin to be demonstrated in the pt

Back 20

Onset

Front 21

Is the period of time when maximum effects of the medication are demonstrated in the pt

Back 21

Peak effect

Front 22

Is the overall period of the time when the effect from medication can be demonstrated in the pt

Back 22

Duration

Front 23

The timing of medication doses will depend on:

Back 23

Time of onset
Peak effect and
Duration of action

Front 24

The concentration or dose of a medication used to produce the desired result without producing harmful effect

Back 24

Therapeutic effect

Front 25

An expected, undesirable, but tolerable effect of medication, these can include dry mouth, constipation, diarrhea, dizziness or drowsiness

Back 25

Side effect

Front 26

a) An undesirable and potentially harmful effect of medication that can lead to organ damage or failure
b) Susceptible organs include:
c) Common reaction is

Back 26

a) Adverse effect
b) Brain, liver, kidney and cardiovascular system
c) Hypersensitivity or allergic reaction which can lead to mild skin rash to a anaphylaxis

Front 27

The undesirable and unacceptable effect of a medication, the effect can promote the growth of cancerous tumor (carcinogen) or the development of birth defect ( teratogens)

Back 27

Toxic effect

Front 28

The reduction of the effect of a medication given at the same dose over a period of time, the dosage of the medication must to be increased in order to demonstrate the desired effect

Back 28

Tolerance

Front 29

A physical or psychological dependency on the effect of the medication

Back 29

Addiction

Front 30

a) Is the term used to describe the entire process of the drug within the body
b) This process involve

Back 30

a) Pharmacokinetics
b) Absorption - distribution - biotransformation and excretion

Front 31

a) A drug must be _____ to produce an effect, occur at the side of administration
b) The site of administration is where the substance is taken into the bloodstream by the capillaries, the process is referred as:

Back 31

a) Absorbed _ Absorption
b) Passive transport

Front 32

a) Explain the passive transport
b) Does it require energy?

Back 32

a) A drug substance is transferred from an area of high concentration to a low concentration on both side of membrane.
b) No

Front 33

c) Is required for a limited number of drugs, glucose and amino acids
d) Explain
e) Does it require energy?

Back 33

c) Active transport
d) In the form of cation such as sodium it required to carry the substance from a area of low concentration to a higher concentration
e) Yes

Front 34

Absorption is influenced by several factors that include

Back 34

Type of drug preparation
Dosage
Route of administration
Pt.'s condition

Front 35

Involve the transport of the medication within the body once it enters the circulatory system, this is effected by the rate of absorption, systemic circulation and regional blood flow to the target organ or tissue

Back 35

Distribution

Front 36

TO KNOW:
- The medication is distributed to the target cell for action to the liver for biotransformation and to the liver or kidneys for elimination

Back 36

- Distribution of med is also effected or limited by plasma protein binding, tissue binding and certain barriers established by the body

Front 37

This most often occur in the liver, but other tissues including intestinal mucosa, lungs, kidneys and blood plasma may be involved

Back 37

Biotransformation or metabolism

Front 38

TO KNOW:
- Several medications are converted to an active substance by the liver, but the main function of the liver in metabolism is to break down the drugs molecules

Back 38

- The breakdown of products of metabolism are called METABOLITES.

Front 39

a) The effect medication in the body is continue until___
b) Medication are physiologically removed from target organ or tissue via:

Back 39

a) Bio transformed or/and excreted
b) Circulatory system

Front 40

a) The primarily organ for filtration of medication is/are:
b) Some medication and metabolites may be eliminated by:

Back 40

a) Kidneys
b) Fecally - sweat or saliva - exhale and also in breast milk

Front 41

a) Is used to administrate medication
b) The most common route use in the OR is:

Back 41

a) Route of administration
b) Parenteral w/ IV being the most common

Front 42

a) To the gastrointestinal tract
b) Placed into the rectum
c) Other than through the GI tract
d) Between the layers of the skin

Back 42

a) Oral - PO means per os or by mouth
b) Rectal
c) Parenteral
d) Intradermal

Front 43

e) Under the skin into the adipose tissue layer
f) Within a muscle
g) Into a vein
h) Within a joint
I) Into the subarachnoid

Back 43

e) Subcutaneous (SC or SQ)
f) Intramuscular (IM)
g) Intravenous (IV)
h) Intra - articular
I) Intrathecal

Front 44

j) Into the heart
k) Applied to the skin or mucous membrane to provide a localized or systemic effect
l) Is placed between the cheek and teeth until dissolve

Back 44

j) Intracardia
k) Topical
l) Buccal

Front 45

m) Medication is placed under the tongue until is dissolved or absorbed
n) Is placed in the hollow or cavity such as conjunctiva fold or bladder
o) Directly administrated via the respiratory tract

Back 45

m) Sublingual
n) Instillation
o) Inhalation

Front 46

Contains information on single drugs and the formulas for drugs mixtures, including testing and purity information, list drug using generic names, list of medications no longer included in the USP

Back 46

National formulary

Front 47

Contains information on medication used in current practice, list drugs using generic names, including the medication source, properties, categories/classification, dosage range and therapeutic dosage

Back 47

USP - United States pharmacopeia or Pharmacopeia of the United States

Front 48

Present medical information arranged in therapeutic or pharmacological classes according to generic name

Back 48

American Hospital Formulary Service Index

Front 49

Not an official pharmacological listing, but commonly used by physicians for referencing medication for prescription, medication are listed by manufacture using brand names

Back 49

PDR - Physician's Desk References

Front 50

Drugs are prepared for administration in several different forms, type of preparation or form in which the drug is available will determine the rout of administration as well as_____ ( 2 answers)

Back 50

- Drug forms
- Pharmacodynamics and pharmacokinetics

Front 51

a) O2 and nitrous oxide are included in this category
b) Two primary types of liquid preparation
c) Drugs is dissolved in a liquid
d) Solution prepared w/ water
e) Sweetened aqueous solution

Back 51

a) Gas
b) Solution and suspension
c) Solution
d) Aqueous
e) Syrup

Front 52

f) Solution prepared w/ alcohol
g) Sweetened alcohol solution
h) Solid particles are suspended in a liquid, particle may settle and must be redistributed by shaking prior to use

Back 52

f) Tincture
g) Elixir
h) Suspension

Front 53

I) Combination of two liquids that cannot be mixed, small droplets of one liquid are dispersed through another
j) Cream, foams. gels, ointments and suppositories

Back 53

I) Emulsion
j) Semisolid

Front 54

k) It may be in powder state contained within a capsule or compressed in tablet, some must have a liquid added prior to use

Back 54

Solid

Front 55

The 3 legal drugs classification that are most commonly used are:

Back 55

Controlled substance,
Prescription substance
OTC over - the - counter substance

Front 56

Are those drugs w/ high potential to cause psychological and/or physiological dependence and abuse

Back 56

Controlled substance

Front 57

TO KNOW:
- Controlled substance are categorized according to the level of addictiveness and therapeutic potential

Back 57

- The labeling of these substances include the symbol "C" w/ the schedule number (1 - V) included next to the letter

Front 58

Include substance for which there is a high potential and no current approved medical use
- example

Back 58

Schedule or Class I
- Heroin, marijuana, LSD, other hallucinogen and certain opiates and opium derivatives

Front 59

Include drugs that have a high abuse potential and high ability to produce physical and/or psychological dependence and for which there is a current approved or acceptable medical use

Back 59

Schedule or Class II

Front 60

Includes drugs for which there is less potential for abuse than drugs in Class II and for which there is a current approved medical use.
- Some contain limited quantities of:

Back 60

Schedule or Class III
- Codeine, anabolic steroids

Front 61

Include drugs for which there is a relatively low abuse potential and for which there is a current approved medical use

Back 61

Schedule or Class IV

Front 62

Drugs in this category consist mainly of preparation containing limited amounts of narcotic drugs for use of antitussives and antidiarrheal

Back 62

Schedule or Class V
* This may be purchased by an individual at least 18 years old and must be purchased from a pharmacy.

Front 63

Are those medication that is, if used inappropriately could cause significant harm to the pt, this include the name, dose, quantity and timing of medication.

Back 63

Prescription medication

Front 64

Are pharmacological agent that are prepared in a dosage that are generally safe to administer without the direction of a physician

Back 64

OTC = over-the-counter

Front 65

Three different names are assigned to each drug, they are:

Back 65

1 - Trade, brand or proprietary
2 - Generic
3 - Chemical

Front 66

The medication name is capitalized and may be followed by the "R" symbol, indicating that the name an chemical formula used by a specific company have been registered w/ the federal government

Back 66

Trade, brand or proprietary name
- The trader name is prominently displayed on the medication label

Front 67

The nonproprietary name of the drug, it is often a shortened version of chemical name, this name is often selected by the original developer and is written using all low - case letter

Back 67

Generic name
- The generic name is prominently displayed on the medication label

Front 68

Is complex and difficult to use, is not include on medication label but is included in the package insert that accompanies the medication from the manufactured

Back 68

Chemical name

Front 69

Give an examples of
a) Trade name:
b) Generic name
c) Chemical name:

Back 69

a) Marcaine or Sensorcaine
b) Bupivicaine hydrochloride
c) 2-piperidinecarboxamide, 1-butyl-N-(2-6-dimethylphenyl), monohydrochloride, monohydrate

Front 70

TO KNOW:
- The use of generic name in health care setting is to avoid confusion between medication w/ similar names, example:

Back 70

- Pitocin is oxytocin
- Pitressin is vasopressin

Front 71

Drug action defines as the effect of substance at the target site. Three main theories have been developed to explain the ways that drugs produce their effect, these theories are:

Back 71

1 - Drug receptor interaction
2 - Drug enzyme interaction
3 - Non - specific drug interaction

Front 72

a) State that the active substance in the drug has an affinity for a specific chemical constituent of a cell.
b) Argues that a drug may combine w/ specific enzyme to inhibit the action of the enzyme or alter the cellular response

Back 72

a) Drug receptor interaction
b) Drug - enzyme interaction

Front 73

c) Is related to drugs that do not act by either of the two previously described methods, these drugs accumulate in the cell membrane or penetrate the membrane

Back 73

Non - specific drug interaction

Front 74

Is the amount of medication delivered to the patient in order to achieve the desired therapeutic effect.

Back 74

medication dose.

Front 75

a) The dose will depend on several factors, including the:
b) Is commonly expressed in a ratio of medication concentration per kilograms of pt body weight
c) Give an example

Back 75

a) Age, weight, overall medical condition and delivered rout of medication
b) Dosage
c) Dentrolene sodium - 2.5 mg/Kg

Front 76

a) IS the ratio of solute to solvent, the two components of a solution
b) Is the overall amount of medication delivered to the pt, this have two names:

Back 76

a) Concentration
b) Dose or dosage

Front 77

a) The cumulative dose is the total amount of medication given is calculated by:
b) to convert lb. to kg you have to:
c) In the emergency situation weight can be estimated by

Back 77

a) Taking the amount of solution delivered and multiply it by the amount of solute from the ratio above
b) Divide the # of lb. by 2.2.
c) Divide the lb. in half then subtract the first digit of the answer from the answer: 185/2 = 93 - 9 = 84

Front 78

Medication error can be minimized by following some basic safety guidelines, these are:

Back 78

1 - Know the pertinent state and federal laws
2 - Know the policies of the health care facility
3 - Follow the procedures set forth by the health care facility

Front 79

There are 6 basic rights for correct drug handling which are absolute, they are:

Back 79

1 - Right pt 2 - Right drug
3 - Right dose 4 - Right rout of administration
5 - Right time and frequency
6 - Right documentation including labeling

Front 80

a) Types of common container of medications are:
b) No matter which type of packaging in used, all drugs must be labeled by the manufactured and the label must contain the follow information:

Back 80

a) Ampule - vial - preloaded syringe - tube
b) Drug name ( trade or generic) - manufacture - strength - amount - expiration date - rout of administration - lot number - handling/storage precautions and warning - controlled substance class

Front 81

The medication name, strength, amount and expiration date should n=be verified a minimum _____ times prior to administration, these are:

Back 81

3 times
1 - First is when drugs is listed
2 - Second is done prior to preparation for use or placement on the sterile field
3 - Third is done once the med is prepared for used on field

Front 82

a) Glass container that requires the top to be broken off to access the contents - usually contains liquid
b) Plastic or glass container that is a rubber stopper at top that is held in place w/ metal retainer ring - may contain liquid, powder or compressed powder

Back 82

a) Ampule
b) Vial

Front 83

c) Metal or plastic - may contain gel, cream or ointment
d) Usually contains liquid

Back 83

c) Tube
d) Preloaded syringe

Front 84

Optimal balanced anesthesia is achieved when all components are addressed:
a) Result from the altered state of consciousness related to pt's perception of the surgical environment and procedure

Back 84

Hypnosis
- These drugs are classified as those that induce to sleep

Front 85

b) Freedom from pain is the major focus
c) Provide a lack of recall of perioperative event.
d) Neuromuscular blockage in combination w/ inhalation agents are capable to produce profound relaxation to the point of paralysis

Back 85

b) Anesthesia
c) Amnesia
d) Muscle relaxation

Front 86

a) Anesthetics agents can be administrated in two ways:
b) Focus in altering the pt's level of consciousness, minimizing the pain and awareness of the surgical environment

Back 86

a) General and nerve conduction blockage
b) General anesthesia

Front 87

c) Involves the prevention of sensory nerve impulse transmission in a specific region of the body, allowing the pt remain conscious but not feeling pain, it's also called:

Back 87

c) Nerve conduction blockage or regional anesthesia

Front 88

The American Society of Anesthesiologist (ASA) has set classification system to assessing pt risk, these classes are:
- Class 1

Back 88

No organic, physiological, biochemical or psychiatric disturbance

Front 89

- Class 2

Back 89

Mild to moderate systemic dz disturbance such as controlled hypertension, history of asthma, anemia, smoker, controlled diabetes, mild obesity, age less than 1 and greater than 70

Front 90

- Class 3

Back 90

Severe systemic disturbance or dz such as angina, post - myocardial infraction (MI), poor controlled hypertension, symptomatic respiratory dz, massive obesity.

Front 91

- Class 4

Back 91

Pt w/ severe systemic dz, disorder that are life - threatening, such as unstable angina, congestive heart failure, debilitation respiratory dz, hepatorenal failure.

Front 92

- Class 5

Back 92

Moribund pt w/ little chance of survival who is operated on in desperation

Front 93

- Class 6

Back 93

Brain dead, life support provided, organ procurement intent

Front 94

- Emergency modifier (E)

Back 94

Applied when doing emergency surgery

Front 95

Involves in the alteration of pt's perception of their environment through alteration in their level of consciousness, these are accomplished using three techniques, which are those

Back 95

General anesthesia
1 - Inhalation agents
2 - Injection agents
3 - Instillation agent

Front 96

Involves the delivery of gases across the alveolar membrane to the vascular system, where the agent is able to cross the blood - brain barrier affecting CNS function

Back 96

Agent inhalation

Front 97

Administration of medication direct to the bloodstream intravenous

Back 97

Agent injection

Front 98

The administration of medication into an area as a rectum, where the agent is absorbed via mucous membranes and transported to the CNS by the circulatory system

Back 98

Agent instillation

Front 99

There are four stage of depth of general anesthesia
- Stage 1

Back 99

Is referred to amnesia stage, begins w/ initial administration of anesthetic agents to loss of conscious

Front 100

- Stage 2

Back 100

Consist of period from the loss of conscious to the return of regular breathing and loss of eyelid reflex.

Front 101

- Stage 3

Back 101

Consist of period between the onset of regular breathing and loss of eyelid reflex to the cessation of breathing

Front 102

- Stage 4

Back 102

Dilated and nonreactive pupils mark this stage as do the cessation of respiration and marked hypotension leading to circulatory failure

Front 103

There are fourr phases of general anesthesia
- Phase 1
Induction phase

Back 103

Involves altering pt's level of consciousness from the conscious (alert) state to unconsciousness ( asleep) state

Front 104

Induction may be carried out in two ways:
a) One
b) Two

Back 104

a) The use of an IV induction agent
b) Inhalation of gaseous vapors

Front 105

TO KNOW:
- Mamagement and maintenance of the pt's airway is critical and may involve the use of oral or nasal airway mask, laryngeal mask airway (LMA) or endotracheal intubation

Back 105

0

Front 106

- Phase 2
Maintenance phase

Back 106

Surgical intervention take place during this phase, maintenance of homeostatic function of all vital organs w/ the provision of appropriate operating conditions is critical for both successful anesthetic delivery and surgical outcome

Front 107

Anesthesia administration is most dynamic during this period, as the anesthesia provider need to monitor closely pt for:

Back 107

any change in O2 saturation
Blood loss
Muscle relaxation status
Cardiac status

Front 108

- Phase 3
Emergence phase

Back 108

Occur as surgical intervention is being completed, the goal is to have the pt as awake as possible at the end of surgical intervention.

Front 109

The primary focus in this period is the monitoring of:

Back 109

Adequate independent respiratory rate and function
Restoration of gag reflex

Front 110

a) At this state of consciouness increase the pt is at risk for:
b) Is common see the pt doing

Back 110

a) Laryngospasm
b) Rigidity and tremor

Front 111

- Phase 4
Recovery phase

Back 111

Is the period of time in which the pt returns to the optimun level of consciousness and well - being, usially begins in the OR and carries through the PACU

Front 112

Advantages of general surgery

Back 112

Pt is unaware of activities and noise
Once the airway is secured, the depth & rate of respiration can be controlled
Medication can be easy titrated
Muscle relaxation for intubation

Front 113

TO KNOW:
Risk and complication of general anesthesia is the aspiration of secretions or gastric contents in trauma pt w/ full stomach.

Back 113

- Induction agents and neuromuscular blockage both permit relaxation of the cardioesophageal sphincter causing the pt to vomit and the secretion enter in the esophagus.

Front 114

Without adequate protection of the trachea by functioning epiglottis "gag reflex" application of what should be performed:

Back 114

Cricoid pressure

Front 115

The gastric secretion or contents may be aspirated into the airway, resulting in and this is referred as:

Back 115

Chemical pneumonitis that could become bacterial.
Aspiration pneumonia

Front 116

a) Is performed to reduce the risk of aspiration
b) This is designed to:

Back 116

a) Sellick's maneuver or cricoid pressure
b) Prevent stomach content from ejection during vomiting and reduce the risk of aspiration into the respiratory tract

Front 117

Describe how to apply the pressure

Back 117

Firm pressure is applied w/ a thumb and index finger forming a V to the cricoid cartilage, located inferior to the prominence of the thyroid cartilage.

Front 118

a) Are reactions demonstrated by a lightly anesthetized pt
b) This may be triggered by:
c) This may occur during:

Back 118

a) Laryngospasm or bronchospasm
b) Saliva on the back of throat or inflammation due to endotracheal tube placement
c) Induction of or emergence from anesthesia

Front 119

a) Is potentially fatal hypermetabolic state of muscle activity
b) Resulted by

Back 119

a) Malignant hyperthermia or hyperpyrexia
b) Defect in calcium transportation within the muscle fibers of the skeletal muscle

Front 120

c) Due to the inability of the calcium release the muscles cannot:
d) MH is what type of dz.

Back 120

c) relax, resulting in rigidity, heat generation, biuld up lactic acid and carbon dioxide, tachycardia.
d) Genetically transmitted dz more commonly seen in male than female.

Front 121

MH can be triggered by:

Back 121

Succinylcholine
Curare
Halogenated inhalation agents
Strenouss exercises
Stress or trauma

Front 122

a) The first sign of MH is
Followed by:
c) The last sign is

Back 122

a) Unexplained tachycardia - tachypnea and increase level of CO2
b) Unstable blood pressure, perspiration, muscle rigidity and cyanotic
c) Rise in body temp sometimes as high as 107F

Front 123

Describe the treatment in order for MH

Back 123

1 - Dentrolene mixed w/ sterile injectable H2O, a loading dose of 2.5 mg/Kg followed dose of 1 mg/Kf every 5 minutes until a maximun dose of 10 mg/Kg
2 - Administration of sodium bicarbonate to assist metabolic and respiratory acidose.

Front 124

-

Back 124

3 - Dextrose or insulin to maintain cellular metabolism
4 - Furosemide or mannintol to promote renal clearance
5 - Heparin to prevent intravascular clot formation

Front 125

Is a deficiency syndrome, genetically transmitted trait that decrease the amount of ACh-ase (acetylcholinesterase) available in the neuromuscular junction to break down ACh during muscle stimulation

Back 125

Pseudocholinesterase deficiency syndrome
(PCDS)

Front 126

Treatment for PCDS

Back 126

There is NO treatment beside the respiratory support of the pt until the body eliminates the neuromuscular blockage

Front 127

a) May be mild ( skin irritation) to life threatening (anaphylaxis)
b) Treatment

Back 127

a) Allergic reaction
b) Depend on the severity of reaction

Front 128

a) Is an abnormal psysiological state that indicated by a presence of reduction cardiac output, tachycardia, hypotension and diminished urinary output
b) The goal treatment is

Back 128

a) Shock
b) Promote optimal circulatory load and function

Front 129

a) Involve abnormal heart rate or rhythm
b) This may be:
c) Life treatening include
d) Treatment is

Back 129

a) Cardiac dysrhythmias
b) Atrial or ventricular
c) Ventricular tachycardia or ventricular fibrillation
d) IV administration of lidocaine hydrochloride

Front 130

a) Involves the cessation of heart pumping action and blood circulation
b) The initial treatment is
c) Followed by

Back 130

a) Cardiac arrest
b) CPR
c) ACLS - advance cardiac life support

Front 131

Anesthetic agents are divided in three categories:

Back 131

1 - Inhalation agents
2 - Intravenous agent
3 - Local/Regional agents

Front 132

a) These agents pass into the bloodstream via pulmonary functions
b) Is not classified as anesthesic agents but is a component

Back 132

a) Inhalation agents
b) Oxygen (O2)

Front 133

a) Is a clear, colorless gas w/ subtle fruity odor and is the only true gas still in use
b) How this gas is diffused

Back 133

a) Nitrous oxide
b) Closed spaces such as middle ear, bowel and pleural space

Front 134

TO KNOW:
- Nitrous oxide is not sufficiently potent to be used alone for general surgical anesthesia, but may be used in conjuction w/ another gases to reduce the use of high concentration of other more potent and

Back 134

dangerous inhalation agents
- N2O is eliminated by exhalation and may contribute to postop nause and vomiting.

Front 135

Consist of group of liquids whose potent evaporative vapor, when inhalad produce general anesthesia through interaction w/ CNS

Back 135

Volatiles agents

Front 136

a) These agents also produce:
b) These agents are delivered from

Back 136

a) Myocardial and respiratory depression, muscle tone decrease enhancing the ease of exposure to the surgical site
b) vaporizers attached in the anesthesia machine

Front 137

a) Is a series of tubings from anesthesia machine called
b) Agents commonly use today include
c) Less commonly used:
d) What agents are considered triggering agents for MH

Back 137

a) Anesthesia circuit
b) Sevoflurane - Desflurane and Isoflurane
c) Enflurane and Halothane
d) Halogenated agents

Front 138

a) Is an odorless, non-pungent inhalation agent that does not cause irritation to the respiratory three, it has a rapid onset
b) This agent causes
c) This agent does not cause damage in what organs:

Back 138

a) Sevoflurane ( Ultane)
b) Bradycardia, hypotension and cardiac dysrhythmias, reduce cardiac input, nausea, vomiting
c) Liver but may cause mild to moderate renal complications

Front 139

a) Requires the use of heated vaporizer for administration, it has a pungent aroma, contra - indicated its use during inhalation induction, it provides rapid onset
b) Its safe for pt w/

Back 139

a) Desflurane ( Suprane)
b) Is not biotransformed in the liver. Pt w/ hepatic insufficiency

Front 140

a) Is a mildly pungent, musty smelling halogenate inhalation agent, provides moderate to rapid induction and recovery
b) It can causes

Back 140

a) Isoflurane ( Forane)
b) Respiratory depressant and may cause hypotension

Front 141

a) These are less commonly used agents, but have a pleasant, non=irritating aroma and are rapid acting.
b) Which one can cause alteration in renal function

Back 141

a) Enflurane ( Ethrane) and Halothane ( Fluothane)
b) Enflurane (Ethrane)

Front 142

a) It was intriduced in 1930s, is delivered direct into the bloodstream and act quickly
b) The access is through
c) Are removed from body by

Back 142

a) Intravenous agents
b) Placement of catheter in peripheral vein of the upper extremities
c) Redistribution and biotransformation in the liver and kidneys

Front 143

IV agents are grouped into:

Back 143

Induction agents Dissocoative agents
Opioids Sedative/Tranquilizers
Neuromuscular blocking agents
Antimuscarinic (anticholanergetic) agents
Adjunctive agents

Front 144

TO KNOW:
- IV induction agemts are used to permit rapid and pleasant transition from a state of consciouness to unconsciousness, while they DO NOT provide pain relief or motor- impulse blockage, it does produces sedation
and amnesia

Back 144

- Hypotension and respiratory depression are common side effects.

Front 145

a) Is a sedative - hypnotic introduced in practice in the early 1900s.
b) Nickname
c) When administrating what causes in the pt and why
d) What can do to prevent

Back 145

a) Propofol ( Diprivan)
b) Milk of amnesia
c) Irritating the vein and discomfort, because its alkaline nature
d) Lidocane hydrochloride prior to adminstration of it

Front 146

Is a non - barbiturate hypnotic agent used for induction and does NOT produce amalgesia

Back 146

Etomidate (Amidate)

Front 147

Is a short - acting potent barbiturate that does NOT provide anesthesia or muscle relaxation but does have hypnotic amnesic and sedative effect

Back 147

Thiopental sodium ( Pentothal Sodium)

Front 148

a) In combination w/ ____ and ____ has a ____ effect
b) Disadvantages are:

Back 148

a) N2O, opioids, synergistic
b) Minor stimulation during lighter stage causing laryngospasm and may locally irritate the vein due the nature alkaline

Front 149

Is similar in action as propofol and thiopental sodium, it has an ultrashort onset and duration of action

Back 149

Methohexital sodium ( Brevital)

Front 150

a) Produces amnesia and profound analgesia.
b) Is the most commonly used and is administrated IM or IV, but itself DOES NOT produce relaxation
c) What this agent can cause

Back 150

a) Dissociative agents
b) Ketamine hydrochloride (Ketalar)
c) ICP, IOP and hypertension

Front 151

a) Are group of narcotics classified ad analgesics in which produces sedation
b) How they act

Back 151

a) Opioids/Opiate
b) Binding into CNS and spinal cord receptors decreasing in pain impulse transmission, euphoria and happiness also may be experienced

Front 152

c) If high dosage is administrated what happens?
d) Are biotransformed primarily on
e) These are classified as by the FDA
f) Drugs in this classification are the:

Back 152

c) Loss of consciuousness and respiratory depression
d) Liver and eliminated in urine
e) Class II controlled substance (narcotics)
f) Opiate morphine sulfate - synthetic opioid

Front 153

Synthetic opioids include:

Back 153

Meperidine (Demerol)
Fentanyl ( Sublimaze)
Sufentanil (Sufenta)
Alfentanil (Alfenta)
Remifentanil (Ultiva)

Front 154

a) Is used to control severe pain and its administrated IM, IV or intrathecally
b) Side effects are:

Back 154

a) Morphine sulfate
b) Bradycardia, hypotension, vasodilation, nausea, vomiting, confusion and respiratory depression

Front 155

a) Is used to treat moderate to severe pain, may be administrated IM but is given IV
b) Side effects

Back 155

a) Meperidine (Demerol)
b) Respiratory depression, increased ICP, tachycardia and vasodilation

Front 156

a) Is the first synthetic narcotic analgesic to be used for anesthesia administration, given IV has a rapid onset and short duration in action
b) Adverse effect

Back 156

a) Fentanyl citrate (Sublimaze)
b) Bradycardia, laryngospasm and cardio - respiratory arrest

Front 157

a) Is narcotic analgesic, given an IV has a rapid onset but is 5x more potent than fentanyl citrate, produces analgesia w/ marked sedation and euphoria
b) Side effects are:

Back 157

a) Sufentanil citrate ( Sufenta)
b) Respiratory depression

Front 158

a) Is similar in action and usage to fentanyl and sufentanil but acts on pain receptors of the limbic system, thalamus, midbrain and hypothalamus and its has a short acting analgesic
b) Side effects are:

Back 158

a) Alfentanil hydrochloride (Alfenta)
b) Respiratory depression

Front 159

a) Is an ultra- short acting synthetic opioid metabolized in blood and muscle tissue
b) Side effects

Back 159

a) Remefentanil hydrochloride (Ultiva)
b) Respiratory depression, bradycardia, hypotension and muscle rigidity

Front 160

a) The opiods effect can be ____ or ____ by the administration of ______
b) This agent may cause

Back 160

a) antagonized, reversed, naloxone hydrochloride (Narcan)
b) Tachycardia and hypertension

Front 161

a) These agents are used in anesthesia in two ways:
b) The two most commonly used are:

Back 161

a) Benzodiazepines (sedative tranquilizers)
1 - Reduce anxiety
2 - Adjunct to general anesthesia to reduce the amount and concentration of other more potent agent.
b) Diazepan (Valium) and Midazolam (Versed)

Front 162

c) These group have the ability to produce:

Back 162

c) Produce amnestic, anticonvulsive, hypnotic, muscle relaxation and sedative effects.

Front 163

a) Valium and versa are what type of class
b) Valium acts by:

Back 163

a) Class IV controlled substance
b) increasing the action of gamma-amino butyric acid (GABA) receptors site, particular in the limbic system

Front 164

TO KNOW:
- Diazepan (Valium) reduces anxiety and provide some muscle ralaxation, it also provides retrograde amnesia of short duration.

Back 164

- Given an IV has an onset of 5 minutes w/ 15 minutes duration and is metabolized in the liver for renal excretion

Front 165

- Midazolam (Versed) has a rapid onset and short - acting benzodiazepine, its similar to diazepam, but its memory impairment is short duration.

Back 165

- Since midazolam is twice as potent as diazepam the IV dosage is commonly diluted w/ injectable dextrose/water or saline for adminstration.

Front 166

a) Is a butyrophenone which produces marked sedation w/ a long duration of action in additional is an antiemetic both intra and postoperativelly
b) Is also come premixed w/ ____ under the trade name of _____

Back 166

a) Droperidol (Inapsine)
b) Fentanyl citrate - Innovar

Front 167

a) The benzodiazepines may be antagonized by the administration of:
b) The functions are:

Back 167

a) Flumazenil (Mazicon)
b) Reverse the sedative effect but may not reverse the amnesia effect

Front 168

a) NMBs
b) Interfere w/ the passage of impulse from motor nerves to skeletal muscle
c) What it's causes

Back 168

a) Neuromuscular blockers
b) Skeletal muscle relaxants or NMBs
c) muscle weakness and paralysis

Front 169

NMBs agents are divided into 2 major categories

Back 169

Depolarizing agents
Nondepolarizing agents

Front 170

Work by mimicking a release of ACh across the neuromuscular junction

Back 170

Depolarizig agents

Front 171

The agents bind to the postsynaptic receptors causing the contraction to occur, the contraction and relaxation in the muscle is strong enough to be visible, this action is referred as

Back 171

Fasciculation

Front 172

a) Is an ultrashort - acting agent and is the main depolarizing agent in anesthetic used today
b) It also can cause
c) And can trigger

Back 172

a) Succinylcholine (Anectine)
b) Increase in ICP and IOP
c) MH

Front 173

a) Work by competing for postsynaptic receptors sites at the neuromuscular junction, preventing ACh from being able to stimulate muscle contraction
b) These agents further may be divided in

Back 173

a) Nondepolarizing agents
b) Short - intermediate and long - acting agents

Front 174

a) Name a short - acting nondepolarizing w/ intermediate onset
b) Name a short - acting nondepolarizing w/ rapid onset
c) Name an intermediated - acting w/ short onset

Back 174

a) Mivacurium chloride (Mivacron)
Vecuronium bromide (Norcuron)
b) Rocuronium bromide (Zemuron)
c) Atracurium besylate ( Tracrium)

Front 175

d) Name an intermediated - acting w/ intermediated duration of action
e) Name a long - acting w/ rapid onset
f) Name a long - acting w/ intermediate onset

Back 175

d) Cisatracurium besylate (Nimbex)
e) Tubocurarine chloride (Curare)
f) Pancuronium bromide (Pavulon)

Front 176

The reversal or antagonism of non- depolarizing neuromuscular agents can be produced through the use of one of two drugs

Back 176

1 - Edrophonium chloride (Tensilon)
2 - Neostigmine (Prostigmin)

Front 177

a) Agents act as blockers of cholinergic effect, it has 2 names
b) This agents are used to limit:
c) The 2 most common used are:

Back 177

a) Antimuscarinic or Anticholenergic
b) Undesirable parasympathetic nervous system response such as salivation and bradycardia
c) Atropine sulfate - Glycopyrrolate (Robinul)

Front 178

a) NSAID
b) Is a NSAID used for moderate pain control

Back 178

a) Nonsteroidal anti - inflammatory drugs
b) Ketorolac ( Toradol)

Front 179

a) Are agents used to alter the pH of gastric secretions and reduce gastric volume, they are given periop or intraop.
b) Include in this group oral
c) Include in this group IV

Back 179

a) Histamine H2 - antigonist and antiacids
b) Citric acid (Bicitra)
c) Cimetidine (Tagamet) - Ranitidine (Zantac)

Front 180

Is a cholinergic agent in which promotes pyloric emptying

Back 180

Metoclopramide (Reglan)

Front 181

Is a water based solution for injection that contains essential serum electrolytes in the forms of sodium chloride, potassium chloride and calcium chloride

Back 181

Ringer's solution

Front 182

Has a sodium lactate added in addition to the electrolytes which enables it to serve glucose source for body metabolism

Back 182

Lactated Ringer's solution (LR)

Front 183

Is a solution of water for injection w/ 5% concentration of dextrose monohydrate added, this correct hypoglycemia and replace water loss during normal metabolism

Back 183

5% dextrose solution (D5W)

Front 184

Is a solution of water for injection w/ an addition of sodium chloride, is used to correct deficits of sodium and chloride and treat metabolism alkalosis

Back 184

0.9% sodium chloride - Normal saline NS

Front 185

Types of treatment incorporated into balanced anesthesia are:

Back 185

Induced hypothermia
Induced hypotension
Neuroleptanalgesia
Neuroleptanesthesia

Front 186

a) Involves in the artificial, deliberate lowering of the body's core temp below normal limits
b) The resulting of lower temperature causes:

Back 186

a) Induced hypothermia
b) Reduction of body metabolism, oxygen and glucose consumption and waste production

Front 187

There are four levels involved w/ induced hypothermia

Back 187

1 - Light hypothermia = 98.6 - 89.6
2 - Moderate hypothermia = 89.6 - 78.8
3 - Deep hypothermia = 78.8 - 68
4 - Profound hypothermia = 68 and below

Front 188

a) Is an adjunctive therapy involving a controlled decrease of arterial pressure during anesthesia administration.
b) The results are:

Back 188

a) Induced hypotension
b) Decrease in bleeding to increase ability to visualize the site

Front 189

a) Utilizes high doses of neuroleptics and narcotics analgesics agents to induce a state of diminished anxiety, sedation and amnesia
b) Two most common medication used are:

Back 189

a) Neuroleptanalgesia
b) Fentanyl citrate and Meperidine hydrochloride

Front 190

Occur when Neuroleptanalgesia is reinforced w/ an inhalation or IV anesthetic agent

Back 190

Neuroleptanesthesia

Front 191

Involves the use of pharmaceutical agents to prevent the initiation and/or transmission of sensory nerve impulse

Back 191

Nerve conduction blockage

Front 192

A variety of technique are used for nerve conduction blockage

Back 192

Topical anesthesia - Regional anesthesia
Local anesthesia - Nerve plexus block
Spinal block ( Intrathecal)
Epidural block
Bier block

Front 193

It act by competing for Ca site in nerve sheaths, inhibiting sodium transportation in sodium - potassium pump preventing impulse transmission, these are commonly referred as

Back 193

Local or regional anesthesia

Front 194

Are used in low concentrations w/ exception of cocaine hydrochloride, these agents are divided in two groups

Back 194

Nerve conduction blockage
Amino amides - Amino esters

Front 195

This drugs group are metabolized in the liver and excreted by the kidneys and include :

Back 195

Amino amide group
Lidocaine hydrochloride (Xylocaine, Lignocaine)
Mepivacaine HCl (Carbocaine) - Etidocaine HCl (Duranest
Bupivacaine HCl (Marcaine, Sensorcaine)

Front 196

a) Can be administrated topically for application on mucous membranes, infiltrated locally on peripheral nerve block or injected epidural
b) Maximum dose for infiltration is:

Back 196

a) Lidocaine HCl (Xylocaine - Lignocaine)
b) 7 mg/Kg or 500 mg
- It can be prepared in packaging w/ or without epinephrine

Front 197

a) Acts similar to lidocaine but has longer action
b) Maximum dose is:

Back 197

a) Mepivacaine HCl ( Carbocaine)
b) 5 - 6 mg/Kg or 500 mg

Front 198

a) Is an agent that is four times more potent than lidocaine and has longer onset of action and longer duration of effect
b) Maximum dose is:

Back 198

a) Bupivacaine (Marcaine, Sensorcaine)
b) 400 mg in 24 hrs period
175 mg plain or 225 mg w/ epi 1:200.000

Front 199

a) Is an agent w/ prolonged onset and longer duration of action, is highly toxic and contraindicated for children young than 12 years old
b) Maximum recommended is

Back 199

a) Etidocaine HCL ( Duranest)
b) 400 mg or 8 mg/Kg

Front 200

a) Is an agent slightly less potent than bupivacaine but has less overall toxicity, has a long onset and duration of action, is used in concentration less than 1% and is not combined w/ epi.

Back 200

Ropivacaine HCl (Naropin)

Front 201

b) Is commonly use for:
c) Maximum dose recommended is:

Back 201

b) Major nerve conduction blockage - Epidural for labor and delivery - postop pain management special followed by a major abdominal, cardiac and thoracic surgery
c) 0.5 - 1% is 250 mg

Front 202

a) Drugs in this group are bio transformed by pseudocholonesterase in plasma
b) And include:

Back 202

a) Amino esters
b) Procaine HCl ( Novocaine) - Tetracaine HCl (Pontocaine and Cetacaine)

Front 203

a) Cocaine HCl is still in use in the OR today but only for
b) In concentration of 4 - 10% produces:
c) Maximum dose is:

Back 203

a) Topical agent of the upper aerodigestive tract due to its high toxicity
b) Anesthesia and vasoconstriction causing shrinkage of mucous membrane
c) 200 mg or 4 mg/Kg

Front 204

Has similar properties of cocaine HCl but is less toxic and is available for SC, IM or Intrathecal injection

Back 204

Procaine HCl (Novocaine)

Front 205

a) Is an agent w/ slow onset of action but prolonged duration
b) Is primarily used for

Back 205

a) Tetracaine HCL (Cetacaine, Pontocaine)
b) Topical anesthesia on otopharyngeal mucous membrane and ocular membrane or for Intrathecal injection during spinal anesthesia administration

Front 206

Two adjunctive agents commonly associated w/ nerve conduction blockage are:

Back 206

1 - Hyaluronidase ( Wydase)
2 - Epinephrine (Adrenaline)

Front 207

a) Is an agent added to local infiltration to assist in their distribution into the subcutaneous tissue for contact w/ peripheral nerve
b) This is useful during___

Back 207

a) Hyaluronidase ( Wydase)
b) Retrobulbar eye block

Front 208

a) Is a potent vasoconstriction
b) And provides two main benefits for surgeon and for the pt.

Back 208

a) Epinephrine (Adrenaline)
b) 1 - Area's of blood supply is limited and intraop. bleeding is reduced
2 - Due to blood supply limited in the area the body is unable to redistribute the anesthetic effectively, prolonging the overall anesthesia

Front 209

a) Caution w/ administration of epi to pt w/
b) Epinephrine should be limited during administration of

Back 209

a) Hypertension and cardiac dz
b) Digital and penile block
- The label of this premixed med w/ epi is usually color coded red to indicate the addition of epi.

Front 210

a) Involves the placement of a nerve conduction blocking agent onto a tissue layer
b) And is used to provide anesthesia on:

Back 210

a) Topical anesthesia
b) Mucous membrane of upper aerodigestive tract, urethra, vagina, rectum and skin

Front 211

a) Involves the reduction of nerve conduction/transmission by localized cooling
b) Examples of agents typically used for topical anesthesia

Back 211

a) Cryoanesthesia
b) Lidocaine and cocaine

Front 212

Involves the injection of a nerve conduction blocking agent into a tissue surrounding a peripheral nerve or nerves that serve only the tissue at the site of surgical intervention

Back 212

Local infiltration

Front 213

Involves a combination of nerve conduction blockage on the topical or local level that is supplemented w/ analgesics, sedatives or amnesic

Back 213

MAC - monitored anesthesia care

Front 214

a) Involves the administration of an anesthetic along a major nerve tract
b) Commonly types include:

Back 214

a) Regional blockade
b) Nerve plexus block - Bier block - Spinal block and Epidural block

Front 215

Is usually accomplished w/ the injection of an anesthetic solution in an area of major plexus, such as:

Back 215

Nerve plexus block
Brachial plexus

Front 216

Provides anesthesia to the distal portion of the upper extremities by injecting a large volume of low concentration anesthetic agent into a vein at the level below the tourniquet

Back 216

Bier block

Front 217

TO KNOW:
- The proximal tourniquet is inflated to a level approximately 100 mm Hg above the systolic blood pressure.

Back 217

- Bier block is used on intervention of the extremities of 1 hours duration or less, at the conclusion of the surgical intervention the tourniquet is slowly release permitting the agent to circulate through the body.

Front 218

a) Also referred as Intrathecal block, is an injection of an anesthetic agent into the CSF in the subarachnoid space between the meningeal layers

Back 218

Spinal block

Front 219

a) In spinal anesthesia, refers to the specific gravity of the anesthetic solution in comparison to CSF.
b) Solution w/ high gravity are referred as:
c) Solution w/ low gravity are referred as:
d) Solution w/ same specific gravity are referred as:

Back 219

a) Baricity
b) Hyperbaric solution
c) Hypobaric solution
d) Isobaric

Front 220

a) Hyperbaric
b) Hypobaric
c) Isobaric

Back 220

a) Solution tends to settle toward gravity
b) Solution tends to move away from gravity
c) Solution w/ same specific gravity

Front 221

a) Involves the administration of anesthetic agent into the tissue directly or above the Dura mater, through which is absorbed into CSF.
b) Involve in the administration of nerve conduction - block into epidural space in the sacral canal

Back 221

a) Epidural anesthesia
b) Caudal anesthesia

Front 222

a) Are devices placed on pt's nose or mouth, between the vocal cord and into the trachea to provide airway intraop or during ventilation support.
b) Is made of malleable metal or stiff plastic and is placed within the lumen of the tube

Back 222

a) Endotracheal tube (ET)
b) Stylet

Front 223

c) Is an instrument used for aid and facilitate the placement of nasotracheal tubes and nasogastric tube or to insert pharyngeal package
d) Is a device used to expose the glottis to facilitate ET intubation

Back 223

c) McGill forceps
d) Laryngoscope

Front 224

e) LMA
f) Is used to cover the nose and mouth are of the pt and permit the delivery of anesthetic agents and O2 to pt.
g) Are devices used to provide passageway around the relaxed tongue, establishing an unobstructed airway for gas exchange

Back 224

e) Laryngeal mask airway
f) Face mask
g) Oropharyngeal and nasal airways

Front 225

Types to monitoring devices are:

Back 225

Electrocardiogram - BP monitor
Arterial and venous catheterization
Temperature monitors - Pulse oximeter

Front 226

continue next side

Back 226

Bispectral Index (BIS)
System for anesthetic and Respiratory Analysis (SARA)
Doppler - ultrasonic device to identity vascular status
Peripheral nerve stimulator
Arterial blood gases (ABG)