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Anesthetics Pharmacology Best Exam Solution
___________ anesthetics depress the CNS, alleviate pain, and cause a loss of consciousness. - Answ General The first anesthetic, ___________ _______ ("laughing gas"), was used for surgery in the early 1800s. It is still an effective anesthetic and is frequently used in dental procedures and surgery. - Answ nitrous oxide ______________ anesthetics rapidly diffuse into the arterial vascular system and cross the blood-brain barrier to produce amnesia, skeletal muscle relaxation, and hypnosis. - Answ Inhalation Inhalation anesthetics typically provide ___________ induction with a recovery of consciousness anywhere from a few minutes to one hour. - Answ smooth For outpatient surgery of _______ duration, an intravenous anesthetic might be the preferred form of anesthesia. - Answ short IV anesthetics have ________ onsets and ________ durations of action. - Answ rapid short Inhalation anesthetics are usually combined with what other 3 drugs for surgical procedures? - Answ barbiturate (e.g., thiopental) a strong analgesic (e.g., morphine) and a muscle relaxant (e.g., pancuronium) Adverse effects from inhalation anesthetics include: - Answ respiratory depression hypotension dysrhythmias hepatic dysfunction In patients at risk, anesthetics may trigger what condition? - Answ malignant hyperthermia The newer anesthetics primarily cause less __________ and _________ than the older anesthetics. - Answ nausea vomiting ______________ anesthesia is a combination of drugs that are frequently used to achieve what inhalation anesthetics alone are unable to achieve. - Answ Balanced ____________ anesthesia requires that a local anesthetic be injected into the subarachnoid space below the first lumbar space (L1) in adults and the third lumbar space (L3) in children. - Answ Spinal
What determines the level of spinal anesthesia achieved? - Answ The spread of the anesthetic, regulated by the density of anesthetic used and position of the patient These reduce pain sensations at the level of peripheral nerves, although this can involve neuraxial or central anesthesia - Answ local anesthetics Local anesthetics are also called ______________ anesthetics because they render a specific portion of the body insensitive to pain. - Answ regional These are most commonly used in clinical settings in which loss of consciousness is undesirable or unnecessary, like childbirth, dental procedures etc - Answ Local anesthetics Most local anesthetics belong to one of two major groups of organic compounds: - Answ esters and amides. ____________ anesthetics are most commonly given intravenously but may also be administered by various spinal injection techniques - Answ Parenteral ____________ anesthetics are applied directly to the skin and mucous membranes. They are available in the form of solutions, ointments, gels, creams, powders, suppositories, and ophthalmic drops. - Answ Topical _____________ anesthesia involves injection of anesthetic into the subarachnoid space - Answ Intrathecal ____________ anesthesia is commonly used for patients undergoing major abdominal or limb surgery for whom the risks of general anesthesia are too high or for patients who prefer this technique instead of complete loss of consciousness during their surgical procedure. - Answ Intrathecal ____________ anesthesia involves injection of anesthetic via a small catheter into the epidural space without puncturing the dura. - Answ Epidural This type of anesthesia is commonly used to reduce maternal discomfort during labor and delivery and to manage postoperative acute pain after major abdominal or pelvic surgery. - Answ epidural Small amounts of anesthetic solution are injected into the tissue that surrounds the operative site.
- Answ This approach to anesthesia is commonly used for such procedures as wound suturing and dental surgery. Often drugs that cause constriction of local blood vessels (e.g., epinephrine, cocaine) are also administered to limit the site of action to the local area. - Answ Infiltration:
Spinal anesthesia is injected into which subarachnoid space? Below L1 in adults Below C2 in adults Below L5 in children Below C4 in children - Answ Below L1 in adults Spinal anesthesia requires a local anesthetic be injected below the L1 subarachnoid space in adults. Which type of anesthesia is quickly absorbed systemically, has a rapid action, and is eliminated quickly? Inhalation anesthetics Infiltration anesthetics Local anesthetics Topical anesthetics - Answ Inhalation anesthetics Inhalation anesthetics provide smooth induction and a recovery of consciousness anywhere from a few minutes to 1 hour. Which type of anesthetic can be used for general anesthesia or for the induction stage of anesthesia? Intravenous Local Topical Spinal - Answ Intravenous Intravenous anesthetics can be used for general anesthesia or for the induction stage of anesthesia. IV anesthetics have a rapid onset and short durations of action. ______________ is the prototype of the amide-type agents. It is used as both a topical and injectable local anesthetic agent. - Answ Lidocaine a moderate-acting anesthetic used for nerve blocks as well as infiltration, epidural, and spinal anesthesia. - Answ Lidocaine
Lidocaine may be used to treat significant ventricular ____________ such as frequent premature ventricular contractions (PVCs), ventricular tachycardia, and ventricular fibrillation as an alternative agent to amiodarone. - Answ dysrhythmias (irregular heartbeats) Lidocaine exerts a local anesthetic effect on the heart, thus decreasing myocardial _____________. - Answ irritability Locally administered lidocaine can have systemic effects if absorbed into the _____________, especially when the absorption rate is faster than the metabolism or excretion rate. - Answ bloodstream 3 Things that increase the absorption rate of lidocaine - Answ applying it to an open area injecting it into capillary network Applying heat to the area of application Local anesthetics stop nerve conduction by blocking ______________ channels in the axon membrane. - Answ sodium Small, nonmyelinated neurons are blocked more __________ than large, myelinated neurons. - Answ rapidly ____________-______ anesthetics (eg, procaine) occasionally cause allergic reactions and are inactivated by esterases in the blood. - Answ Ester-type ____________-_____ anesthetics (eg, lidocaine) rarely cause allergic reactions and are inactivated by enzymes in the liver. - Answ Amide-type Termination of local anesthesia is determined in large part by regional blood flow. Coadministration of epinephrine, a vasoconstrictor, will __________ anesthesia. - Answ prolong When administering lidocaine as a local anesthetic, how long will the health care provider need to wait prior to suturing a wound? 0 seconds (no wait time) 4 minutes 10 minutes 1 hour - Answ 4 minutes Lidocaine is a local anesthetic that provides the temporary loss of motor, sensory, and autonomic nervous system function. It has an onset of action of 2-4 minutes. Which statement correctly describes the action of lidocaine as a local anesthetic? Nerve conduction is stopped by blocking sodium channels.
Review the patient's medical history to assess for any preexisting illnesses, such as vascular disease, aneurysms, or hypertension, because these may be contraindications to the use of a ______________ with the anesthetic. - Answ vasoconstrictor Lidocaine is contraindicated in patients with a history of: - Answ Adams-Stokes syndrome Wolff-Parkinson-White syndrome supraventricular arrhythmias sinoatrial (SA), atrioventricular (AV), or intraventricular heart block hypersensitivity to amide-type local anesthetics. Lidocaine should be used cautiously in patients with - Answ hepatic disease history of malignant hyperthermia shock, heart failure marked hypoxia hypovolemia severe respiratory depression. Lidocaine should also be used cautiously in the _____ adult population. - Answ older Significant adverse effects of Lidocaine include: - Answ CNS toxic effects such as twitching, convulsions, and confusion respiratory depression or arrest the cardiovascular effects of hypotension, bradycardia, and dysrhythmias. Interactions of Lidocaine: Class 1 ________________ may increase cardiac effects. - Answ antiarrhythmics Interactions of Lidocaine: St. John's wort may ______________ concentration. - Answ decrease IM lidocaine may increase _______ ________ level (used to diagnose acute myocardial infarction [MI]). - Answ creatinine kinase (CK) ____________________________ (evidenced by cyanosis) has occurred following topical application of lidocaine for teething discomfort and laryngeal anesthetic spray. - Answ Methemoglobinemia The most common Hypersensitivity reaction to lidocaine is ____________ ___________. - Answ contact dermatitis. Patient Teaching for Lidocaine: Oral mucous membrane anesthesia
Inform patients to not eat, drink, or chew gum for 1 hour after application (swallowing may be impaired, increasing risk of _____________ ; numbness of tongue, buccal mucosa may lead to bite trauma). - Answ aspiration Mrs. Vega is going to receive an injectable administration of lidocaine for a lumbar block, and the nurse has to prepare Mrs. Vega for this procedure. What step should the nurse take next? Restrain Mrs. Vega. Inject the lidocaine. Cleanse the injection site. Assess Mrs. Vega's vital signs. - Answ Cleanse the injection site. Before the injection of the lidocaine, the injection site should be prepped; hair should be clipped if needed, and the site should be cleansed. An adult patient is administered spinal anesthesia. Upon assessment the respiratory rate is 8. Which statement correctly explains this clinical manifestation? Respiratory depression can be an adverse reaction. This is a result of temporary loss of motor function. This is a result of temporary loss of sensory function. This is a normal respiratory rate. - Answ Respiratory depression can be an adverse reaction. A respiratory rate of 8 is bradypnea. Respiratory depression can be an adverse reaction of spinal anesthesia. A nurse is preparing to administer lidocaine to a patient who is also receiving St. John's wort for depression. Which statement is correct? The concentration of lidocaine may be decreased The concentration of lidocaine may be increased The effect of St. John's wort may be increased The effect of St. John's wort may be decreased - Answ The concentration of lidocaine may be decreased St. John's wort may decrease the concentration of lidocaine.
Tinnitus Blurred vision Which statement correctly describes the difference between the action of a spinal anesthesia and epidural anesthesia? Spinal anesthesia involves the injection into the subarachnoid space, and epidural anesthesia involves injection into the epidural space. Spinal anesthesia involves injection into the subdural space, and epidural anesthesia involves injection into the cerebrospinal fluid. Spinal anesthesia involves injection into the lower end of the spinal cord, and epidural anesthesia involves injection into the epidural space. Spinal anesthesia involves injection through the sacral hiatus and epidural anesthesia involves injection into the epidural space. - Answ Spinal anesthesia involves the injection into the subarachnoid space, and epidural anesthesia involves injection into the epidural space. Spinal anesthesia involves the anesthetic agent being injected into the subarachnoid space and epidural anesthesia involves the anesthetic agent being injected into the epidural space. The patient is undergoing surgery and receiving a neuromuscular blocking agent (propofol), a short-acting barbiturate, and nitrous oxide. In order to achieve balanced anesthesia what would need to be added to this medication regimen? An opioid An additional dose of propofol An additional dose of nitrous oxide A benzodiazepine - Answ An opioid An opioid for analgesia would complete the medication combination to reach balanced anesthesia. Which medication diffuses rapidly in the arterial vascular system and crosses the blood-brain barrier to produce amnesia, skeletal muscle relaxation, and hypnosis? Isoflurane Thiopental Sodium Diazepam
Propofol - Answ Isoflurane Isoflurane is an inhaled anesthetic that is rapidly diffused in the arterial vascular system and crosses the blood-brain barrier to produce amnesia, skeletal muscle relaxation, and hypnosis. A nurse is getting ready to start a peripheral IV on a pediatric patient. Which form of lidocaine would be appropriate? Topical preparation Subcutaneous injection Intramuscular injection Oral sedative - Answ Topical preparation Topical preparation of lidocaine does not cause pain. This is used for pediatric patients to numb the area before IV insertion. The health care provider has administered an appropriate dose of lidocaine for a local anesthetic. The patient still has sensation and mobility. Which statement describes what is happening? The medication is being absorbed more slowly than it is being metabolized. The medication is being absorbed rapidly. The medication is being absorbed much more rapidly than it is being metabolized. The medication is not being metabolized. - Answ The medication is being absorbed more slowly than it is being metabolized. The lidocaine is being absorbed slower than it is being metabolized and a therapeutic response is not being achieved. A patient with poor perfusion to the right lower extremity is receiving topical lidocaine for a wound debridement. The nurse will anticipate that the absorption rate of the lidocaine will be what? Slower Faster Dependent upon dosage Dependent upon frequency - Answ Slower
Nothing will be done since the patient does not know what actually happened. The surgery will be cancelled. A chest x-ray will be ordered. - Answ The health care provider orders a diagnostic test to further investigate the adverse reaction. When a patient has adverse reactions to anesthesia, diagnostic tests should be ordered to further investigate. Which clinical manifestation indicates that a patient is exhibiting central nervous system toxicity to lidocaine? Seizure Heart block Tachypnea Hypertension - Answ Seizure Seizures are a sign of central nervous system toxicity from lidocaine. The nurse should educate the patient that which symptoms may occur with topical lidocaine? Select all that apply. Redness Burning Stinging Swelling Tenderness - Answ Burning Stinging Tenderness Which statement is correct for patient teaching in preoperative preparation of receiving lidocaine for an epidural block? "You will temporarily lose feeling and the ability to move below the waist." "You will temporarily lose feeling below the waist, but you'll still be able to move your legs."
"We will only need to take vital signs to start, but won't have to bother your once the epidural is in place." "We will need to take vital signs every 5 minutes while the epidural is in place." - Answ "You will temporarily lose feeling and the ability to move below the waist." Lidocaine, as a local anesthetic, results in temporary loss of the motor and sensory function of the lower extremities by blocking sodium channels in the nervous system. The nurse teaches a patient prescribed a lidocaine patch that which symptoms need to be reported to the health care provider? Drowsiness Hypertension Increased urine output Decreased sensation - Answ Drowsiness Drowsiness is a warning sign of high levels of lidocaine and should be reported to the health care provider.
