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Surgical Skills > Anesthesia Medications > Flashcards

Anesthesia Medications Flashcards

1
Q

Goals for anesthetic therapy should be to reduce likelihood of complications, such as ________.

A

Long term pain

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2
Q

Pre-anesthesia meds should decrease _____ without producing excessive ______, provide ______ for the perioperative period, and relieve preoperative ____.

A

Anxiety; drowsiness; amnesia; pain

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3
Q

T/F One of the goals of anesthesia is to reduce the volume and acidity of gastric contents

A

True

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4
Q

Examples of pre-anesthetic medications include ____, ____, and others, such as ____, ____, and ____.

A

Benzodiazepines
Barbiturates
Others (antihistamine, phenothiazine, butyrophenes)

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5
Q

Intravenous anesthetics include medications such as ____, ____, ____, ____, and ____.

A

Propofol, Barbiturates, Etomidate, Opioids, and Ketamine

pneumonic: P[lease], BE OK

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6
Q

Benzodiazepines raise the threshold for ____ ____ of local anesthetics

A

CNS toxicity

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7
Q

What are the effects of taking a BZD?

A

Reduce anxiety and have “calming” effects

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8
Q

BZDs have a (gradual/rapid) onset and a (long/short) duration of action

A

BZDs have a rapid onset and short duration of action

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9
Q

What are three examples of BZDs that can be used pre-operatively? Which of the three has the most limited use? Why?

A

Diazepam, Lorazepam, and Midazolam

Diazepam is limited due to its lipophilicity

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10
Q

Which of the the three examples of BZDs that can be used pre-operatively is the most frequently used? Why?

A

Lorazepam is frequently used due to multiple administration routes, and it is hepatically metabolized and eliminated “cleanly”. It is thus usable in the more limited/older populations.

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11
Q

Midazolam causes retrograde amnesia and is therefore useful in what type of procedures and what type of population?

A

Colonoscopy

Children

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12
Q

What are two adverse effects of BZDs?

A

Sedation

Disorientation

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13
Q

Barbiturates may provide ____ and reduce ______ prior to surgery. They may also yield _____ if pain is present.

A

sedation; apprehension; disorientation

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14
Q

Tolerance to barbiturate is observed in patients w/ what SHx?

A

Chronic alcohol use

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15
Q

Barbiturates have an onset of ____ and a duration of ____.

A

Onset: <1 minute
Duration: 5-10 minutes

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16
Q

What are two examples of barbiturates that are used pre-operatively/intravenously for anesthesia?

A

Pentobarbital

Thiopental

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17
Q

What are two possible adverse effects of barbiturates?

A

Cardiac and respiratory depression

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18
Q

The use of barbiturates should be avoided in patients with what medical condition?

A

Porphyria

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19
Q

Why are barbiturates of limited availability in the US?

A

They have been politically associated with the death penalty and thus drug companies do not want their names associated with them

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20
Q

Describe etomidate as an intravenous anesthetic

A

Potent ultra-short acting hypnotic without analgesic properties

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21
Q

Etomidate modulates signaling at ______ receptors and helps to mediate pain response and _____

A

GABA [A]; memory

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22
Q

Other uses for Etomidate, other than as an intravenous anesthetic, include _______ and _______

A

Conscious sedation

Rapid sequence induction for cardioversion

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23
Q

The administration of Etomidate must be followed with the administration of _____ and ______ drugs

A

Analgesic

Muscle relaxant

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24
Q

An IV injection of Etomidate ____ mg/kg will induce sleep for ____ min

A

0.3 mg/kg

5 minutes

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25
Q

Potential side effects of Etomidate include (hypotension/hypertension), ____ retention, and suppression of _____ synthesis at the ______ _____

A

Hypotension
CO2 retention
Suppression of corticosteroid synthesis at the adrenal cortex

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26
Q

What is the MOA of opioids?

A

Selectively inhibit nociceptive reflexes and induce analgesia through action at the mu receptors

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27
Q

How do opioids interact with substance P? What does this cause?

A

Inhibits the release of neurotransmitters such as substance P and therefore antagonizes the effect of exogenous substance P
This changes how substance P is received in the CNS.

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28
Q

Morphine, an opioid, is associated with ______ release

A

histamine

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29
Q

What are potential adverse effects of opioids?

A

Respiratory depression
Nausea / vomiting
Constipation

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30
Q

What is ketamine used for? Often in what setting?

A

Induction of dissociative anesthesia

Often for emergency surgical procedures (i.e. ortho, children, and OR adults)

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31
Q

Ketamine acts on receptors in the _____ and the ____ _____

A

cortex and the limbic system

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32
Q

The onset of action of Ketamine is _____ min

A

<1 minute

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33
Q

Does ketamine require a lot or a little monitoring after administration?

A

Ketamine requires minimal monitoring in healthy individuals

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34
Q

What are some adverse effects of ketamine?

A

Hallucinations, bad dreams, increased muscle tone (very rare, <1% pts)

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35
Q

Is propofol chemically related to other IV anesthetics?

A

No

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36
Q

At room temperature, what type of solution is propofol?

A

Oil based emulsion

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37
Q

Propofol acts to potentiate ____ receptor activity and block ____ channels

A

GABA; sodium

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38
Q

Does propofol have a slow or rapid onset?

A

Rapid onset of anesthesia

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39
Q

Propofol is frequently used in _____ _____ settings

A

neuro ICU

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40
Q

Possible adverse effects of propofol include _____, _____, and _____.

A

Significant respiratory depression, hypotension, and injection site pain

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41
Q

A perfect inhaled anesthetic would have fast onset and offset of action, have a wide safety margin, provide rapid changes in depth of anesthesia, and have no adverse effects in normal doses. Which anesthetic agent meets this description?

A

NOTHING IS PERFECT, except unicorns, which don’t exist, just like the aforementioned drug

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42
Q

Inhaled anesthetics are used for ____ and/or as an ____. They are not as ____ as other drugs, and thus are not as widely used.

A

induction; adjuvant; stable

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43
Q

T/F Inhaled anesthetics are lipophilic

A

True

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44
Q

How are inhaled anesthetics classified?

A

By their side chains

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45
Q

Inhaled anesthetics act to alter ______ ion channels to (decrease/increase) tissue excitability

A

neuronal; decrease

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46
Q

Speed of induction of inhaled anesthetics is (directly/inversely) related to solubility in most body tissues

A

inversely

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47
Q

What are four examples of inhaled anesthetics?

A

Nitrous Oxide
Sevoflurane
Isoflurane
Desflurane

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48
Q

What are potential adverse effects of inhaled anesthetics? What is a rare adverse effect that we should be careful to monitor for?

A

Nausea, vomiting

Malignant hyperthermia is rare, but important for monitoring

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49
Q

Patients with what two organ dysfunctions should use inhaled anesthetics with caution?

A

renal / hepatic dysfunction

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50
Q

Isoflurane is often used because of it’s ability to maintain ______, but it has a _____ _____.

A

cardiac output; pungent odor (described as musty and ethereal…)

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51
Q

Local anesthetics (reversibly/irreversibly) block nerve conduction around site of administration by inhibiting ____ channels. This (decreases/increases) nerve cell membrane permeability to ____ ions and (decreases/increases) depolarization and (decreases/increases) excitability threshold, preventing the nerve _________ from forming

A

reversibly; sodium; decreases; sodium; decreases; increases; action potential

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52
Q

Can local anesthetics be used systemically?

A

Yes

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53
Q

Local anesthetics may be used for infiltration or nerve block prior to certain procedures.
Infiltration is preferred for _____ or _____ procedures. Nerve blocks are preferred for _____ or ____ procedures and for _____ management

A

Infiltration: Surgical or dental procedures

Nerve block: Surgical or diagnostic procedures and for pain management

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54
Q

Local anesthesia is administered _____ when starting an IV, performing a shave biopsy or placing sutures. Local anesthesia is administered _____ for dental or laceration repair situations, _______ for post-operative pain control, _______ for joint pain, and ______ for nerve blocks

A 
SubQ
Submucosal
In the wound
Intra articular
Infiltrative
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55
Q

How are amino amides metabolized?

A

Via hepatic pathways

56
Q

What are some examples of amino amides?

A

Lidocaine
Bupivacaine
Prilocaine
Dibucaine

57
Q

Which amino amide is used in epidural settings?

A

Bupivacaine

58
Q

Which amino amide can be used for suppository pain relief and analgesia associated with hemorrhoids?

A

Dibucaine

59
Q

Which amino amide is not usually used in an injectable formation?

A

Prilocaine

60
Q

What class of anesthetics should be used in pts who will not tolerate first pass as they remain local?

A

Amino esters

61
Q

How are amino esters metabolized?

A

Metabolized in plasma by plasma cholinesterase throughout the vasculature,

62
Q

What is the intermediate metabolite of amino esters?

A

PABA (para aminobenzoic acid)

63
Q

Administration of amino esters has an associated increased risk of allergy in ___% of the population, which most of the time (does not/does) result in anaphylaxis

A

~5%

Does not

64
Q

What are some examples of amino esters?

A

Benzocaine
Cocaine
Procaine
Tetracaine

65
Q

Which amino ester is used in dental procedures, with intubation, and called “Hurricane Spray”?

A

Benzocaine

66
Q

Which amino ester is used as a 4% topical solution for ENT surgeries? Why?

A

Cocaine
It is highly vasoconstrictive, which is good for controlling bleeding in the highly vascularized areas of the ears, nose, and throat

67
Q

Which amino ester is used in eye drops?

A

Tetracaine

68
Q

T/F Amino esters are considered “old” or “traditional” agents and are widely used

A

False; while amino esters are considered ‘old’ and ‘traditional’ agents, they are mostly relegated to topical or niche use

69
Q

Dose reduction of any anesthetic agent should be considered for what types of patients? (think generally, what ages, what debilities, what diseases, etc)

A 
Acutely ill pts
Debilitated pts
Very young or elderly individuals
Pts w/ significant hepatic impairment
Occlusive arterial dz 
Arteriosclerosis
70
Q

Use caution with epinephrine if patient has underlying _____ disease

A

Cardiovascular

71
Q

CNS (depression/stimulation) is usually noted first, then later, CNS (depression/stimulation) leads to ______ and _____. Amides may not augment the (depression/stimulation) phase, but only the (depression/stimulation) phase of this reaction. If epinephrine is present, it may augment the (depression/stimulation) phase of toxicity with the possible symptoms of _____, _____, _____.

A

stimulation; depression; respiratory failure and cardiac arrest; stimulation; depression; hypertension, tachycardia, angina

72
Q

If a patient has reported an allergy to lidocaine, it is possible that the reaction is actually associated with _______

A

preservatives in multidose vial preparations

73
Q

Adverse effects of anesthetic medications are usually associated with (decreased/increased) plasma concentrations, _______ dose or rate of injection, ______ in drug clearance, CNS effects such as ______, Cardiac effects such as ______ and ______, Respiratory effects such as _________, a ______ sensation, skin _______, tissue ______/______, and neuritis.

A

Adverse effects of anesthetic medications are usually associated with (increased) plasma concentrations, (excessive) dose or rate of injection, (reduction) in drug clearance, CNS effects such as (sz), Cardiac effects such as (bradycardia) and (arrhythmias), Respiratory effects such as (respiratory arrest), a (burning) sensation, skin (discoloration), tissue (necrosis)/(sloughing), and neuritis.

74
Q

What are some potential advantages or regional anesthesia over systemic anesthesia?

A

Anti inflammatory effects i.e. decreased cytokine formation and decreased tissue inflammation
Faster functional recovery
Cardiopulmonary effects
GI effects (less stasis/ileus)
Improved coagulation effects (prevents venous stasis and VTE occurrence)

75
Q

How is epidural anesthesia administered? Where is its primary site of action?

A

Administered by injecting local anesthetic into the epidural space, primary site of action in the spinal nerve roots

76
Q

What is the major difference between epidural anesthesia and spinal anesthesia?

A

Higher concentrations of anesthetic may be achieved after epidural absorption

77
Q

Which epidural anesthetic is longer acting and has some use in pain management situations?

A

Lidocaine

78
Q

Where is spinal anesthesia injected?

A

The CSF in the lumbar space

79
Q

Who should you avoid administering spinal anesthesia to?

A

pts on blood thinners

80
Q

Which three medications are most commonly used in spinal anesthesia?

A

Lidocaine, bupivacaine, and tetracaine

81
Q

Spinal anesthesia is most commonly used in surgeries involving what parts of the body?

A

lower abdomen, lower extremities, and perineum

82
Q

What are potential adverse effects of spinal anesthesia?

A

Infection, hematoma, and HA

83
Q

What are risk factors that affect pain control in peri-operative settings? (hint: similar to pts who will have post operative N/V)

A 
Preoperative pain
Anxiety
Genetics
Opioid tolerance
Female gender
84
Q

In regards to the pathophysiology of pain, there are both ______ and _____ components.

A

inflammatory and neuropathic

85
Q

What are the three mechanisms of chronic neuropathic pain?

A

Peripheral component, central component, central plasticity

86
Q

Describe the 3 central mechanisms of chronic neuropathic pain:

  1. Peripheral component, multiple inflammatory mediators responsible for (negative/positive) sx of _____, _____, and _____
  2. Central component, mediated through the ____ ____ neurons
  3. Central plasticity, where excess excitatory transmission and loss of (inhibitory/excitatory) transmission lead to barrage of CNS input from the _____ _____ of the spinal cord
A
  1. Peripheral component, multiple inflammatory mediators responsible for (positive) sx of (hypersensitivity), (allodynia), and (erythema)
  2. Central component, mediated through the (dorsal horn) neurons
  3. Central plasticity, where excess excitatory transmission and loss of (inhibitory) transmission lead to barrage of CNS input from the (dorsal horn) of the spinal cord
87
Q

Nociceptive stimulus from any source (thermal, mechanical, or otherwise) causes a release of multiple ______ substances into the affected tissue. This leads to _____ sensitization that supply affected area, a phenomenon known as peripheral sensitization. The CNS also becomes sensitized due to afferent input to the CNS, known as ______ sensitization.

A

Nociceptive stimulus from any source (thermal, mechanical, or otherwise) causes a release of multiple (inflammatory) substances into the affected tissue. This leads to (nerve) sensitization that supply affected area, a phenomenon known as peripheral sensitization. The CNS also becomes sensitized due to afferent input to the CNS, known as (central) sensitization.

88
Q

Preventive analgesia focuses on ____, ____, and ____ of analgesic therapy

A

timing, duration, and efficacy

89
Q

Preventive analgesia preserves total body _____ and enhances post-operative _____ and _____.

A

nitrogen; recovery and rehabilitation

90
Q

Dexmedetomidine and clonidine are _____ agonists

A

Alpha 2

91
Q

______ are considered the mainstay of peri-operative pain management, and judicious use offers analgesia through central and peripheral mechanisms.

A

Opioids

92
Q

_____ have been demonstrated to reduce opioid requirements of dosing and reduce side-effects of itching, constipation, and drowsiness. If bleeding is a concern, many suggest short-term use of ______ as these agents are more selective

A

NSAIDs

COX-2 inhibitors

93
Q

_______ in small doses (0.15mg/kg IV) may reduce opioid requirements and reduce progression to chronic pain

A

Ketamine

94
Q

_______ has shown opioid-sparing effects and increased post-op anesthesia, though does not limit opioid-related adverse effects

A

Gabapentin

95
Q

What are some examples of NSAIDs that may be used to reduce opioid requirements?

A

Ketorolac, ibuprofen, and naproxen

96
Q

In a pt with healthy kidney function, what is the absolute max amount of time that a pt can take Ketorolac?

A

5 days

97
Q

What are some examples of COX 2 inhibitors that may be used to reduce opioid requirements in pt with bleeding concerns?

A

Celecoxib

98
Q

Dexmedetomidine is used in inpatient ICU settings for _____ and in anesthesia for brief procedures due to ______ ______

A

sedation; administration difficulties

99
Q

Dexmedetomidine has ____, ____, and _____ properties

A

Sedative, anxiolytic, and analgesic

100
Q

What are some possible adverse events of Dexmedetomidine that require monitoring?

A

monitor HR, BP, sedative effects

101
Q

What are potential risk factors for developing post operative nausea and vomiting (PONV)? (hint: similar to pts in operative pain control)

A 
Female gender
Motion sickness / previous PONV
Non-smoking status
Post-operative use of opioids
Use of inhaled anesthetics (nitrous oxide and other volatile agents)
High-dose neostigmine
102
Q

By what percent does each risk factor increase a pt’s risk for developing PONV?

A

18-22%

103
Q

Post operative nausea incidence is ___-___% and vomiting incidence is ___-___%

A

22-38% N

12-26% V

104
Q

Anesthesia technique factors that affect PONV include….

A

Inhalation agents
Nitrous oxide
High-doses of neostigmine
Intra- and post-operative opioids

105
Q

Surgical risk factors that affect PONV include….

A

Longer duration of surgery, types of surgery

106
Q

T/F A multimodal approach to PONV is best

A

True

107
Q

A multimodal approach constitutes _____ and ___-_____ therapy

A

pharmacologic and non-pharmacologic

108
Q

Preoperative options for PONV include….

A 
BDZ (for anxiolysis)
Compassionate interaction w/ staff
Aprepitant (Emend)
Dexamethasone steroids 
Pre-hydration 1L NS or LR
109
Q

Intra-operative options for PONV include….

A 
Use of correct regional anesthetics
Propofol
Analgesia (non-opioid)
Ketamine
Anti-emetic therapy
110
Q

What are some examples of medications that can be used to treat PONV? (classes and examples of specific names)

A 
Serotonin antagonists (Odansetron)
Neurokinin inhibitors (Aprepitant)
Steroids (Dexamethasone)
Antihistamines (Dimenhydrinate [1st gen antihistamine], promethazine)
Butyrophenones (Droperidol)
Benzodiazepines
111
Q

What are some examples or serotonin antagonists that can be used for PONV?

A

Ondansetron

Granisetron

112
Q

Which serotonin antagonist is used in the tx of N/V in CA pts?

A

Granisetron

113
Q

At what receptor do serotonin antagonists act?

A

5HT-3 receptor

114
Q

What are some potential adverse effects of serotonin antagonists?

A 
Headache
Diarrhea
Constipation
Arrhythmia
Serotonin syndrome
115
Q

When neurokinin inhibitors are administered pre-anesthesia, they reduce nausea and vomiting up to ____ hours after surgery

A

48

116
Q

Neurokinin inhibitors are commonly used prior to ____ surgeries

A

abdominal

117
Q

Aprepitant is a neurokinin inhibitor that blocks _____ production

A

Substance P (this data came from chemotherapy pts)

118
Q

What are some potential adverse effects of neurokinin inhibitors?

A

Dizziness
Diarrhea
Headaches
Weakness

119
Q

While steroids have an unclear mechanism of action, they may affect _____ in the brain

A

prostaglandins

120
Q

_______ is a common steroid, available intravenously and in long term NV w/ pts w/ failure to thrive

A

Dexamethasone

121
Q

Possible adverse effects of steroids include…

A

Dizziness
Mood change
Nervousness

122
Q

______ work at emesis center and chemoreceptor trigger zone (CTZ) to reduce vomiting

A

1st gen antihistamines

123
Q

What are some possible adverse effects of 1st generation antihistamines?

A

Sedation!
Confusion
Dry mouth
Urinary retention

124
Q

_______ work at the chemoreceptor trigger zone (CTZ) to block nausea / vomiting and at the D2 receptor

A

Butyrophenones

125
Q

Droperidol, a Butyrophenone, is not utilized, except in a ____ or _____ ____ setting

A

hospital or ambulatory surgery

126
Q

Adverse effects of Butyrophenones include…. Which of the adverse effects carries a black box warning?

A

Prolonged QTc interval (black box warning)
Hypotension
Tachycardia
Extra-pyramidal sx

127
Q

T/F Prevention and multimodal approach is necessary to reduce post-operative nausea / vomiting

A

True

128
Q

T/F Systemic agents are most commonly used in nerve and infiltrative blocks to improve patient experience and pain control

A

False; Local agents are most commonly used

129
Q 
The dosing recommendation for Lidocaine is as follows:
Concentration: \_\_\_-\_\_\_%
Max dose: \_\_\_-\_\_\_ mg/kg (max: \_\_\_\_ mg) 
Onset: \_\_\_\_ min
Duration: \_\_\_-\_\_\_ hours
A

Concentration: 1-2%
Max dose: 4.5-5 mg/kg (max: 300 mg)
Onset: <2 min
Duration: 0.5-1 hours

130
Q 
The dosing recommendation for Lidocaine w/ epinephrine is as follows:
Concentration: \_\_\_-\_\_\_%
Max dose: \_\_\_ mg/kg (max: \_\_\_\_ mg) 
Onset: \_\_\_\_ min
Duration: \_\_\_-\_\_\_ hours
A

Concentration: 1-2%
Max dose: 7 mg/kg (max: 500 mg)
Onset: <2 min
Duration: 4-6 hours

131
Q 
The dosing recommendation for Bupivicaine is as follows:
Concentration: \_\_\_%
Max dose: \_\_\_-\_\_\_ mg/kg (max: \_\_\_\_ mg) 
Onset: \_\_\_\_ min
Duration: \_\_\_-\_\_\_ hours
A

Concentration: 0.25%
Max dose: 2.5 mg/kg (max: 175 mg)
Onset: 5 min
Duration: 2-4 hours

132
Q 
The dosing recommendation for Bupivicaine w/ epinephrine is as follows:
Concentration: \_\_\_%
Max dose: \_\_\_\_ mg 
Onset: \_\_\_\_ min
Duration: \_\_\_-\_\_\_ hours
A

Concentration: 0.25 %
Max dose: 225 mg
Onset: 5 min
Duration: 3-7 hours

133
Q 
The dosing recommendation for Procaine is as follows:
Concentration: \_\_\_-\_\_\_%
Max dose: \_\_\_-\_\_\_ mg/kg
Onset: \_\_\_-\_\_\_ min
Duration: \_\_\_-\_\_\_ hours
A

Concentration: 0.25-0.5%
Max dose: 350-600 mg/kg
Onset: 2-5 min
Duration: 0.25-1 hours

134
Q

What is the equipotent dosing of Morphine and its corresponding duration of action?

A

Morphine: 1-2mg, 90 min

135
Q

What is the equipotent dosing of Fentanyl and its corresponding duration of action?

A

Fentanyl: 0.05-0.1mg, 30 min

136
Q

What is the equipotent dosing of Sufentanil and its corresponding duration of action?

A

Sufentanil: 0.005-0.01mg, 15 min

137
Q

What is the equipotent dosing of Hydromorphone and its corresponding duration of action?

A

Hydromorphone: 0.1-0.2mg, 60 min

Surgical Skills (8 decks)

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