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Chapter 26 & 27

Pharmacology Exam 3

QuestionAnswer
_____ _____ stop nerve conduction by blocking sodium channels in the axon membrane local anesthetics
small, nonmyelinated neurons are blocked more _____ than large, myelinated neurons rapidly
what are the two classes of local anesthetics? ester-type and amide-type
_____ anesthetics occasionally cause allergic reactions and are inactivated by esterase in the blood ester-type
_____ is an example of an ester-type local anesthetic procaine
_____ anesthetics rarely cause allergic reactions and are inactivated by enzymes in the liver amide-type
the onset of anesthesia occurs most rapidly with anesthetics that are what? small, lipid-soluble, and nonionized at physiologic pH
termination of local anesthesia is determined in large part by what? regional blood flow
coadministration of epinephrine, a vasoconstrictor, will _____ anesthesia? prolong
local anesthetics can cause systemic toxicity if they are absorbed in sufficient doses. true or false? true
what are the principal concerns of local anesthesia causing systemic toxicity? cardiac dysrhythmias and CNS effects (seizures, unconsciousness, coma)
(1) using the smallest amount needed (2) avoiding application to large areas (3) avoiding application to broken our irritated skin (4) avoiding strenuous exercise and use of dressings or heating pads are all ways to reduce risk of what? systemic toxicity from topical anesthetics
_____ _____ produce unconsciousness and insensitivity to painful stimuli general anesthetics
_____ reduce sensitivity to pain but do not reduce consciousness analgesics
the term _____ _____ refers to the use of several drugs to ensure that induction of anesthesia is smooth and rapid and that analgesia and muscle relaxation are adequate balanced anesthesia
a low MAC indicates what? high anesthetic potency
_____ _____ work by enhancing transmission at inhibitory synapses and by inhibiting transmission at excitatory synapses inhalation agents
inhalation agents undergo minimal hepatic metabolism and are eliminated almost entirely by what? expired air
what are the principal adverse effects of general anesthetics> depression of respiration and cardiac performance
coadministration of _____ with general anesthetics increases the risk of malignant hyperthermia succinylcholine
opioids reduce the required dosage of a general anesthetic by doing what? enhancing muscle relaxation
_____ _____ differs from other general anesthetics in 2 important ways: (1) it has a very high MAC and therefore cannot be used alone to produce general anesthesia (2) it has high analgesic potency and therefore is frequently combined with other general nitrous oxide
what drug is a rapid-acting agent with an ultrashort duration of action? propofol
propofol is widely used along for what? diagnostic procedures
as a component of balanced anesthesia, propofol is combined with what? an inhalation anesthetic
an IV anesthetic that produces a state known as dissociative anesthesia ketamine
patients recovering from ketamine may experience adverse _____ reactions psychologic
local anesthesia effects _____ fibers first, then _____ fibers small; large
(1) autonomic activity (2) pain (3) other senses is the order in which anesthetics do what? induce paralysis
recovery from paralysis happens in what order? motor, sensory, autonomic activity
systemic effects from local anesthetics can be caused by what? systemic blockade of epinephrine and NE
the onset of local anesthesia depends on what? molecular size, lipid solubility, and the degree of ionization
the duration of action of local anesthetics is determined by what? molecular size, lipid solubility, and the degree of ionization
in what manner does blood flow affect the duration of action? the higher the blood flow, the quick and shorter the duration of action
vasoconstrictors are often given with local anesthetics to reduce blood flow to the area and prolong anesthesia. however, they have an additional benefit of what? reducing the risk for toxicity by slowing absorption
vasoconstrictors are metabolized by what organ? liver
what is one example of a vasoconstrictor that can be given with a local anesthetic? epinephrine
what are some adverse effects of local anesthetics related to their local blocking of sensations? skin breakdown, self-injury because of the loss of sensation, and loss of skin integrity
restlessness, anxiety, tremors, dizziness, blurred vision, and backache are all possible adverse effects on the CNS of what? local anesthetics
_____ is an adverse effect of local anesthetics that happen especially often with epidural or spinal anesthesia headache
seizures caused by local anesthesia can be managed by what drug? thiopental
peripheral vasodilation, myocardial depression, arrhythmias, blood pressure changes, fatal cardiac or respiratory arrest, heart block, bradycardia, and reduction in the force of ventricular contraction are all examples of what? potential adverse effects of local anesthetics on the cardiovascular system
procain, a local anesthetic, is primarily used for what? dental procedures
is procain an ester or amide anesthetic? ester-type
how is procain administered? injection into the tissue
what is the brand name for procain? novocain
all _____ have an i before the word caine amides
lidocaine is what type of local anesthetic? amide-type
which group of the local anesthetics produces the most allergic reactions? amide-type
what is the most widely used local anesthetic? lidocaine
lidocaine is also used for what? cardiac dysrhythmias
what pregnancy category is lidocaine in? pregnancy b
lidocaine is available alone and in different concentrations with what? epinephrine
- cream -ointment -jelly -solution -aerosol -patch are all the preparations in which what drug is available? lidocaine
lidocaine has a _____ onset fast
what was the first local anesthetic? cocaine
what surgeries is cocaine still used in today? ear, nose, and throat
_____ cannot be given with vasoconstrictors cocaine
generalized stimulation, euphoria, reduced fatigue, and increased social ability and alertness are the CNS effects of what? cocaine
heart muscle stimulation, vasoconstriction, tachycardia, potentially fatal dysrhythmias, and risk for hypertension are the possible cardiovascular effects of what? cocaine
when local anesthetics are applied topically, they are applied directly where? dry, intact skin or mucous membranes
the therapeutic uses of topical anesthetic include what? relief of pain, itching, burning, and generalized soreness
multiple small injections to produce a more limited or local anesthetic fields infiltration
local anesthetic of a specific peripheral nerve that involves relatively deep injections of the drug into locations adjacent to the major nerve trunk or ganglia that focuses on a relatively large body region nerve block
injection of parenteral anesthetic drugs into an area near the spinal cord that is generally used to block all peripheral nerves that branch out distally from the injection sight spinal (subarachnoid)
what drugs are usually given by spinal injection? opioids and lidocaine
what innervates the surgical site for several days during postop? pumps
a state of reduced neurologic function is called what? anesthesia
how do anesthetics reduce or eliminate pain? by depressing nerve conduction in the CNS or in the PNS
general anesthetics produce a complete loss of body reflexes, including what? respiratory support
loss of sensibility of pain analgesia
loss of pain and loss of all other sensations anesthesia
what are the 2 main groups of general anesthetics? inhalation and IV
inhalation anesthetics are what? volatile liquids or gases
inhalation anesthetics are very rapidly absorbed because they go through what? pulmonary circulation
what is the biggest drawback of inhalation anesthetics? pungent odor
__ anesthetics are used for the induction or to maintain the general anesthesia IV
what are some side effects of IV general anesthetics? respiratory, cardiac, and blood pressure depression
_____ _____ is a combination of drugs used to accomplish the desired effects of anesthesia that allows us to give the lowest dose of anesthesia necessary and decreases the cardiovascular risk and risk to any other organs balance anesthesia
why are short-acting barbiturates commonly combined with inhalation anesthetics? to help with the induction of anesthesia
why are neuromuscular agents commonly combined with inhalation anesthetics? to aid in neuromuscular relaxation
why are opioid or nitrous oxides commonly combined with inhalation anesthetics? pain relief
it is believed that inhalation anesthetics _____ activation of GABA receptors and increase sensitivity of GABA receptors enhance
MAC stands for what? minimum alveolar concentration
the concentration of anesthesia needed that will produce immobilization in approximately 50% of patients MAC
the _____ the concentration of anesthetic, the more rapid the upatke greater
distribution of anesthetics to the CNS and other tissues is determined by what? regional blood flow
inhalation anesthetics can cause what? malignant hyperthermia and aspiration of gastric contents
benzodiazepines are given as a preanesthetic addict to inhalation anesthesia for what purpose? to reduce anxiety and create some amnesia for the patient
opioids are given as a preanesthetic addict to inhalation anesthesia for what purpose? reduction of pre and post operative pain
clonidine, an alpha2-adrenergic agonist, is given as a preanesthetic addict to inhalation anesthesia for what purpose? relieve high blood pressure and help with pain
anticholinergic drugs are given as a preanesthetic addict to inhalation anesthesia for what purpose? reduce the risk for bradycardia and prevent excessive secretion
neuromuscular blocking agents reduce the amount of anesthesia need and prevent contraction of all skeletal muscles, including what? the diaphragm and muscles of respiration
postoperative mild pain is treated with what? aspirin-like drugs
an example of an antiemetic used postoperatively is what? ondansetron
postoperative severe pain is treated with what? opioids
muscarine antagonists are given postoperatively in order to treat what? abdominal distention and urinary retention
(1) halothane (2) isoflurane (3) enflurane (4) desflurance (5) sevoflurane are all examples of what? inhalation anesthetics
which inhalation anesthetic is no longer available in the US? halothane
_____ _____ is unstable at room temperature, releases gases that are inhaled but he patient, and act like a gas anesthetic volatile liquid
hypotension, respiratory depression, promotion of dysrhythmias, malignant hyperthermia, and hepatotoxicity are all adverse effects of what? halothane
respiratory depression as a result of anesthesia requires treatment with what? oxygen-rich gas mixture
promotion of dysrhythmias as a result of anesthesia can be treated cautiously with what? epinephrine and catecholamines
what is the most widely used inhalation anesthetic? isoflurane
what is isoflurane's onset of action? 1-2 minutes
recovery from the effects of isoflurane starts how long after administration? approximately 15 minutes
what inhalation anesthetic has a structure nearly identical to isoflurane? desflurane
which volatile anesthetic induces its action faster than any other anesthetic? desflurane
nitrous oxide has a very ____ anesthetic potency and very _____ analgesic potency low; high
nitrous oxide is ____ used as an anesthetic NEVER
there are no serious side effects to nitrous oxide. however, it can cause _____ and _____ nausea; vomiting
what is the onset of action for nitrous oxide? 1-2 minutes with rapid recovery
what drugs can be used as IV anesthetics? short-acting barbiturates, Benzos, propofol, and ketamine
short-acting barbiturates can be given intravenously to do what? induce rapid anesthesia
what is the only legal drug remaining in the short-acting barbiturates class? methohexital
methohexital produces unconsciousness within _____ after administration 10-20 seconds
methohexital lacks _____ properties analgesic
methohexital is contraindicated for patients with what? silicone implants
what are some adverse effects of methohexital directly related to CNS depression? bradycardia, hypotension, decreased GI activity, nausea, and vomiting
methohexital can cause decreased effectiveness with what? oral anticoagulants, beta blockers, and normal contraceptives
what are the 2 benzodiazepines commonly administered IV as anesthetics? diazepam and midazolam
IV diazepam can produce unconsciousness within _____ 1 minute
IV midazolam can produce unconsciousness within _____ 80 seconds
when _____ is given IV for anesthesia, it causes very little muscle relaxation diazepam
when _____ is given IV for anesthesia, it can cause dangerous cardiorespiratory effects midazolam
mechanically ventilated patients are frequently on what medication because it is quickly removed from the system once administration is stopped? propofol
propofol can cause what? severe hypotension
propofol is a controlled substance is a controlled substance. true or false? false
ketamine can cause _____ _____, sedation, immobility, analgesia, and amnesia dissociative anesthesia
adverse psychologic reactions to ketamine include what? hallucinations, disturbing dreams, and delirium
a ____ _____ should be provided for patients recovering from anesthesia by ketamine because of the psychologic effects it can cause soothing environment
Created by: meaganherlein
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