Anesthesia Pharmacology Quiz

Questions and Answers

What is the primary risk associated with prolonged exposure to enflurane?

Nephrotoxicity (correct)

Carcinogenicity

Neurotoxicity

Hepatotoxicity

Which intravenous anesthetic is most commonly used for induction of anesthesia?

Bupivacaine

Fospropofol

Propofol (correct)

Lidocaine

Which of the following is a potential side effect of the anticoagulant direct thrombin inhibitors?

Bleeding (correct)

Bronchospasm

Ulcer

Thrombocytopenia

What is a common indication for using cilostazol?

Intermittent claudication Signup and view all the answers

What is the role of aspirin in the prevention of acute myocardial infarction?

Blocks thromboxane synthesis Signup and view all the answers

Which drug is specifically indicated for patients with heparin-induced thrombocytopenia (HIT)?

Argatroban Signup and view all the answers

What mechanism of action does Fospropofol utilize to produce its anesthetic effects?

Rapidly degrades to propofol Signup and view all the answers

Which adverse effect is associated with the use of ticlopidine?

Neutropenia Signup and view all the answers

Which factor is directly targeted by direct thrombin inhibitors?

Factor II-a Signup and view all the answers

The phenomenon known as 'coronary steal' is associated with which drug class?

Phosphodiesterase inhibitors Signup and view all the answers

Which of the following agents is not considered an indirect thrombin inhibitor?

Dabigatran Signup and view all the answers

The primary role of GIIb/IIIa inhibitors is to prevent what?

Platelet cross-linking or aggregation Signup and view all the answers

What is the key pharmacological action of adenosine and phosphodiesterase inhibitors?

Inhibit adenosine reuptake Signup and view all the answers

Which of the following is true regarding chronic toxicity of anesthetics?

It includes effects such as mutagenicity and teratogenicity. Signup and view all the answers

What condition is associated with COX-1 inhibition?

Nephrotoxicities Signup and view all the answers

Which NSAID is recognized as a selective COX-2 inhibitor?

Celecoxib Signup and view all the answers

What is the main risk associated with the use of COX-2 inhibitors?

Acute thrombotic events Signup and view all the answers

What effect do propionic acids like ibuprofen and naproxen have?

Analgesic and anti-inflammatory Signup and view all the answers

Which of the following NSAIDs is contraindicated in gout treatment?

Aspirin Signup and view all the answers

Which of the following is a characteristic of non-selective COX inhibitors?

They irreversibly inhibit COX enzymes. Signup and view all the answers

How does Indomethacin primarily act compared to other NSAIDs?

It blocks COX-1 more than COX-2. Signup and view all the answers

What additional property does naproxen possess besides being an NSAID?

Antipyretic activities Signup and view all the answers

Which class of drugs primarily consists of opioid antagonists?

Opioid antagonists Signup and view all the answers

Which NSAID is typically used for acute pain following surgery?

Ketorolac Signup and view all the answers

What is the primary mechanism of action of strong opioid agonists such as morphine?

Activating opioid receptors Signup and view all the answers

What condition may be treated with indomethacin besides gout?

Patent Ductus Arteriosus Signup and view all the answers

Which opioid classification includes drugs like codeine and morphine?

Opiate agonists Signup and view all the answers

What is the primary purpose of administering glucocorticoids in a clinical setting?

To protect and aid the healing process Signup and view all the answers

Which of the following drugs is specifically approved for managing acute venous thromboembolism?

Alteplase Signup and view all the answers

Which form of Vitamin K is known to prevent hemorrhagic disorders in newborns?

Vitamin K1 (phylloquinone) Signup and view all the answers

What is the primary mechanism of action for tranexamic acid?

Directly inhibits plasmin Signup and view all the answers

What condition is characterized by an overreactive immune response causing damage to the body’s own tissues?

Autoimmune diseases Signup and view all the answers

Which factor is primarily associated with hypercholesterolemia?

Elevated LDL levels Signup and view all the answers

Which of the following medications is considered a Fibric acid derivative?

Fenofibrate Signup and view all the answers

What adverse effect is commonly associated with high doses of nicotinic acid?

Flushing Signup and view all the answers

Which of the following best describes the role of PCSK9 inhibitors in cholesterol management?

Enhance LDL receptor recycling Signup and view all the answers

What is the primary mechanism of action of the COX inhibitors?

Inhibit prostaglandin synthesis Signup and view all the answers

What is a potential consequence of using aspirin in children during viral infections?

Reye's syndrome Signup and view all the answers

What serious complication can occur due to the use of NSAIDs?

Gastrointestinal bleeding Signup and view all the answers

Which of the following medications is primarily used as an add-on therapy to statins for lowering cholesterol?

Ezetimibe Signup and view all the answers

What is the classic symptom of rheumatoid arthritis affecting the joints?

Morning joint stiffness Signup and view all the answers

Which barbiturate is commonly used for providing sustained anesthesia?

Thiopental Signup and view all the answers

What is the primary reason for the decreased use of barbiturates in anesthesia?

Replacement by propofol Signup and view all the answers

Which benzodiazepine is least frequently used during the perioperative period?

Diazepam Signup and view all the answers

Which anesthetic agent is classified as a GABA-mimetic and is often chosen for its minimal hemodynamic effects?

Etomidate Signup and view all the answers

What characteristic of ketamine makes it distinct as an anesthetic agent?

NMDA receptor antagonism Signup and view all the answers

Which monitoring method is primarily used to assess the depth of anesthesia during surgery?

Cerebral monitoring (EEG) Signup and view all the answers

Which of the following is a mechanism of action for general anesthetics?

Increase inhibitory (GABA) synaptic activity Signup and view all the answers

What is the distinguishing feature of nitrous oxide as an anesthetic?

Non-volatile gas and weak anesthetic Signup and view all the answers

Which inhaled anesthetic is known to be less pungent and is often used in children?

Sevoflurane Signup and view all the answers

Which local anesthetic is part of the amide group?

Bupivacaine Signup and view all the answers

What factor does NOT influence the systemic absorption of local anesthetics?

Type of anesthesia used Signup and view all the answers

What is the mechanism of action for most local anesthetics?

Inhibition of voltage-gated sodium channels Signup and view all the answers

Which opioid is NOT classified as a strong opioid?

Oxycodone Signup and view all the answers

Which anesthetic is noted for its hepatotoxic effects?

Halothane Signup and view all the answers

What is the primary effect associated with Mu opioid receptors?

Analgesia and euphoria Signup and view all the answers

Which of the following opioids undergoes extensive first-pass metabolism?

Codeine Signup and view all the answers

Which opioid is considered a precursor in the synthesis of Naloxone?

Thebaine Signup and view all the answers

What is the primary clinical use of Methadone?

Long-term treatment of opioid addiction Signup and view all the answers

Which of the following opioids is classified as a weak agonist?

Tramadol Signup and view all the answers

Which opioid is known to be converted to a neurotoxic metabolite leading to seizures?

Meperidine Signup and view all the answers

Which opioid receptor is primarily associated with additional analgesia in women?

Kappa Signup and view all the answers

What is a notable adverse effect of using strong opioids like Fentanyl?

Respiratory depression Signup and view all the answers

Which of the following statements regarding opioid tolerance is correct?

It can develop to varying degrees with chronic use. Signup and view all the answers

Which medication is primarily used as an antitussive?

Dextromethorphan Signup and view all the answers

Which opioid is known to produce euphoria and has a high potential for abuse?

Heroin Signup and view all the answers

What is the main mechanism of action of opioid agonists?

Stimulation of endogenous opioid peptide release Signup and view all the answers

Which medication can be used to manage severe hyperuricemia?

Febuxostat Signup and view all the answers

Study Notes

Maintenance Anesthetics

Barbiturates: Include Thiopental and Methohexital; utilized for sustained anesthesia but largely replaced by Propofol.
Benzodiazepines (BZDs): Common perioperative agents include Midazolam, Lorazepam, and less frequently Diazepam. Provide minimal ventilation depression; transient apnea may occur after rapid IV administration of Midazolam.

Recovery from Anesthesia

Defined as the interval between discontinuation of anesthetic and the return of consciousness and protective reflexes.

Anesthesia Protocols

For Minor Procedures: Employ conscious sedation techniques, combining IV agents with local anesthetics.
For Major Surgeries: Use IV drugs for the induction phase, inhaled anesthetics for maintenance (with or without IV agents), and neuromuscular blocking agents for muscle relaxation.

Assessment During Surgery

Monitor vital signs and employ cerebral monitoring techniques (such as EEG) to gauge the depth of anesthesia.

Mechanism of Action in General Anesthetics

General anesthetics act as CNS depressants.
Increase GABA synaptic activity (inhaled anesthetics, Barbiturates, BZDs, Etomidate, Propofol).
Decrease excitatory synaptic activity (inhaled anesthetics and Ketamine).

Specific Anesthetic Agents

Etomidate: A GABA-mimetic IV anesthetic with hypnotic but not analgesic effects; selected for minimal hemodynamic impact.
Ketamine: NMDA receptor antagonist; induces dissociative anesthesia and significant analgesia; more potent in the S(+) form.
Dexmedetomidine: Selective α2-adrenergic agonist primarily used for short-term sedation in intubated patients.

Opioid Analgesics

Strong opioids include Morphine, Fentanyl, and Sufentanil; utilized for analgesia during and post-surgery, distinct from general anesthetics.

Local Anesthetics

Ester Type: Includes Cocaine, Procaine, Chloroprocaine.
Amide Type: Includes Lidocaine, Bupivacaine, Prilocaine.
Mechanism of action involves blockade of voltage-gated sodium channels.

Inhaled Anesthetics

Nitrous Oxide: Non-volatile, weakest anesthetic with potent analgesic properties.
Desflurane: Popular for outpatient procedures.
Sevoflurane: Preferred choice for children due to lower pungency.
Isoflurane, Enflurane, Halothane: Utilization varies based on patient condition; Halothane noted for hepatotoxicity.
Methoxyflurane: Potent anesthetic, weakest analgesic; used during labor.

Factors Affecting Local Anesthetics Absorption

Influenced by dosage, injection site, drug-tissue binding properties, local tissue blood flow, and the use of vasoconstrictors.### Anesthetic Toxicities
Acute nephrotoxicity risks with enflurane and sevoflurane due to metabolites.
Prolonged enflurane exposure can lead to significant renal injury.
Nitrous oxide associated with megaloblastic anemia as a hematotoxic effect.
Halothane is linked to hepatotoxicity, specifically halothane hepatitis.
Malignant hyperthermia is a critical cause of anesthetic-related morbidity and mortality.
Chronic toxicities may include mutagenicity, teratogenicity, and carcinogenicity.
Transient Neurologic Symptoms (TNS) may occur with lidocaine in spinal anesthesia.

Intravenous Anesthetics

Propofol is commonly used for induction and maintenance of anesthesia, notable for its milky emulsion formulation containing soybean oil and lecithin.
Fospropofol is a water-soluble prodrug of propofol, rapidly converted in the body and approved for monitored anesthesia care.

Coagulation Disorders and Drug Treatments

Coagulation involves a balance of vascular, cellular, and protein events, with thrombin playing a key role in the cascade.
Factors in intrinsic pathway: XII, XI, IX, X; Extrinsic pathway: III, VII, X.

Direct Thrombin Inhibitors

Hirudin is a natural product from leeches, while Lepirudin is a recombinant form used for Heparin-induced thrombocytopenia (HIT).
Bivalirudin acts as an antithrombotic after angioplasty, directly inhibiting factor II-a.

Oral Anticoagulants

Dabigatran, an oral factor II-a inhibitor, is used for venous thromboembolism (VTE) prophylaxis and as an alternative to warfarin.
Warfarin functions as a vitamin K epoxide reductase inhibitor, requiring frequent PT-INR monitoring to prevent adverse effects like bleeding.

Antiplatelet Aggregants

Aspirin inhibits thromboxane synthesis, irreversibly acetylating platelets to reduce acute myocardial infarction risk.
Thienopyridines (e.g., Clopidogrel) act as irreversible inhibitors of the P2Y12 receptor for preventing cardiovascular events.
Caution for adverse effects: Ticlopidine associated with thrombocytopenia and neutropenia.

GIIb/IIIa Inhibitors

These agents (e.g., Abciximab) block platelet aggregation by inhibiting GIIb/IIIa receptors, reducing thrombus formation during interventions.

Rheumatologic Disorders

Inflammatory autoimmune disorders have a significant impact on the musculoskeletal system, affecting joints, muscles, and connective tissues.
Non-specific immune responses characterize inflammation, which may manifest as pain or dysfunction in affected areas.### Microbial Invasion and Infusion Treatments
Premedications include antihistamines and glucocorticoids to mitigate reactions before running infusions.
APSAC (Aminosylated Plasminogen Streptokinase Activator Complex) is used for thrombolysis.
Recombinant t-PA (e.g., Alteplase) is administered in cases of acute venous thromboembolism and ischemic strokes, ideally within three hours for strokes and 30 minutes for ST-segment elevated myocardial infarctions.

Coagulation and Anticoagulation Management

Vitamin K exists in three forms: K1 (phylloquinone), K2 (menaquinone), K3 (menadione).
Vitamin K is critical in treating bleeding due to deficiency and preventing hemorrhagic disorders in newborns.
Epsilon aminocaproic acid and Tranexamic acid inhibit tPA and uPA, aiding in managing bleeding associated with t-PA.

Inflammatory Response Indicators

Cardinal signs of inflammation include Calor (heat), Rubor (redness), Tumor (swelling), Dolor (pain), and Functio laesa (loss of function).

Autoimmune and Rheumatologic Diseases

Autoimmune diseases stem from an overactive immune response, targeting the body’s own tissues, primarily mediated by T and B cells.
Examples include Rheumatoid Arthritis characterized by joint stiffness and inflammation, and Systemic Lupus Erythematosus, presenting with a butterfly-shaped rash and renal complications.

Dyslipidemia Overview

Dyslipidemia involves an abnormal lipid profile with high LDL or triglycerides and low HDL.
Key drug classes for management include HMG-COA reductase inhibitors (statins) which inhibit cholesterol biosynthesis, showing peak effectiveness during sleep.

Statin Treatments

Statins include long-acting (Atorvastatin, Rosuvastatin) and short-acting (Simvastatin, Pravastatin) drugs.
Statins can cause myalgia, muscle pain, or more severe rhabdomyolysis.

Other Dyslipidemia Drug Classes

Fibric acid derivatives (Fenofibrate, Gemfibrozil) enhance lipoprotein lipase activity, lowering triglycerides.
Nicotinic acid (Niacin) lowers VLDL synthesis and can cause flushing and hepatotoxicity in high doses.
Bile acid binding resins like Cholestyramine prevent bile acid recycling, often used with statins.
Ezetimibe inhibits intestinal cholesterol uptake and serves as a statin adjunct.

Analgesics Classification

Analgesic drugs, like acetaminophen, provide pain relief without anti-inflammatory effects, with a safe profile during pregnancy.
NSAIDs inhibit COX enzymes leading to reduced prostaglandin synthesis and offer analgesic and anti-inflammatory properties.

NSAID Side Effects

Common risks include gastric issues (e.g., gastritis), renal vasoconstriction leading to decreased GFR, and hypersensitivity reactions, especially in asthmatic patients.
Aspirin-related risks may include salicylism or Reye’s syndrome in children.

Pharmacological Mechanisms

COX enzymes facilitate prostaglandin production; inhibiting these reduces inflammation and pain.
Chronic inflammation has been linked to cancer development due to COX-2 overexpression.

Notable Toxicities and Management

Various drugs may lead to hematologic side effects, such as thrombocytopenia and aplastic anemia.
Specific treatments like PPIs can alleviate gastric effects from NSAID usage, while nephritogenic agents prevent nephropathy from excessive analgesic use.

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Description

Test your knowledge on anesthesia pharmacology, focusing on barbiturates like Thiopental and Methohexital, as well as benzodiazepines (BZDs) commonly used in perioperative settings. Explore the role of these agents in sustained anesthesia and their evolution with alternatives like propofol.