ACP 212 - Anesthetics & Analgesics Flashcards

A structured vocabulary flashcard set reviewing key concepts, definitions, mechanisms, and pharmacological details from ACP 212 Module 2 (Anesthetics and Analgesics).

Prototypic Amide

A major class of local anesthetic represented by Lidocaine, containing an amine bond.

Prototypic Ester

A major class of local anesthetic represented by Procaine, containing an ester bond.

Local Anesthetic Mechanism of Action

Stops axonal conduction by blocking sodium channels in the axonal membrane, preventing action potential propagation non-selectively.

Order of Effect (Lidocaine)

The precise sequence of sensory and motor loss following administration: 1) Temperature, 2) Pain, 3) Touch/Pressure, 4) Proprioception, and 5) Motor function.

Local Anesthetic Systemic Toxicity (LAST)

A severe reaction caused by systemic distribution featuring CNS toxicity (seizures, respiratory depression, coma) and cardiotoxicity (bradycardia, heart blocks, decreased contractility, hypotension, cardiac arrest).

EMLA

A topical anesthetic cream composed of a mixture of lidocaine and prilocaine that must be applied to clean, intact skin.

Tetracaine

An ester topical local anesthetic supplied as a $0.5\%$ solution for ophthalmic application that blocks sodium channels on axons.

Procedural Sedation

Anesthesia administration that depresses consciousness without causing complete loss of consciousness or normal respiratory arrest.

Balanced Anesthesia

An anesthesia technique combining sedatives, analgesics, and neuromuscular blocking agents to achieve unconsciousness, pain relief, and muscle relaxation.

Medication Facilitated Intubation (MFI)

A planned, controlled intubation protocol involving strategic administration of sedatives, analgesics, and potentially neuromuscular blocking agents.

Malignant Hyperthermia

A rare, life-threatening hypermetabolic reaction to anesthetics linked to heat-hypersensitive mutant calcium channel proteins ($\text{RyR1}$).

Dantrolene

A skeletal muscle relaxant medication specifically indicated for the intravenous treatment of malignant hyperthermia.

GABA Receptor Binding Sites

Inhibitory ligand-gated ion channels in the CNS containing distinct binding sites for GABA, Benzodiazepines, Barbiturates, Propofol, Etomidate, Volatile anesthetics, and alcohols.

Midazolam

A short-acting benzodiazepine sedative that enhances GABA activity but possesses no inherent analgesic properties.

Propofol Infusion Syndrome

A severe toxic reaction associated with high-dose or prolonged propofol infusions, characterized by metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac failure, and renal failure.

Ketamine

A Schedule I dissociative anesthetic and NMDA-type glutamate receptor antagonist that provides potent analgesia while maintaining cardioprotective sympathomimetic effects.

Emergence Reactions

Psychological adverse reactions occurring in approximately $12\%$ of patients recovering from ketamine, often managed with midazolam.

A-Delta Fibers

Large, myelinated nerve fibers that transmit intense, harmful stimuli rapidly and act to close the spinal pain gate.

C-Fibers

Small, unmyelinated nerve fibers that slowly transmit poorly localized, dull, aching pain and act to open the spinal pain gate.

Opioid-Induced Neurotoxicity (OIN)

A toxic state resulting from an inability to clear opioid metabolites, presenting with delirium, agitation, myoclonus, and paradoxical worsening pain.

Morphine

The prototype strong opioid analgesic that activates central $\mu$ (mu) and $\kappa$ (kappa) receptors to reduce intracellular calcium and inhibit neurotransmitter release from nociceptive neurons.

Fentanyl

A synthetic opioid approximately $100$ times more potent than morphine that acts strongly on $\mu$ (mu) receptors with minimal cardiovascular depression.

Rigid Chest Syndrome

A complication caused by rapid IV push or high doses ($> 5\,\text{mcg/kg}$) of fentanyl, resulting in respiratory muscle spasms and difficulty with assisted ventilation.

Hydromorphone (Dilaudid)

A strong, long-acting opioid agonist where $2\,\text{mg}$ IV is equipotent to $10\,\text{mg}$ of IV morphine.

Buprenorphine

An opioid medication functioning as a partial agonist/antagonist at $\mu$ (mu) and $\kappa$ (kappa) receptors, used for acute/chronic pain and suppression of opioid withdrawal.

Cyclooxygenase-1 (COX-1)

A constitutive enzyme found in all tissues that protects gastric mucosa, promotes platelet aggregation via TXA2, and maintains renal blood flow.

Cyclooxygenase-2 (COX-2)

An inducible enzyme expressed at sites of tissue injury that promotes inflammation, hyperalgesia, fever, and renal vasodilation.

NSAID Mechanism of Action

Inhibition of cyclooxygenase (COX-1 and/or COX-2) enzymes to block the conversion of arachidonic acid into prostanoids.

Ibuprofen

A non-selective COX-1 and COX-2 inhibitor NSAID indicated for mild-to-moderate musculoskeletal pain and fever over $39\,^\circ\text{C}$.

Ketorolac

A potent non-selective COX inhibitor NSAID with powerful analgesic efficacy comparable to morphine, indicated for moderate to severe pain such as kidney stones.

DRESS Syndrome

Drug Reaction with Eosinophilia and Systemic Symptoms; a severe adverse reaction characterized by fever, rash, lymphadenopathy, and facial swelling.

Acetaminophen

A non-opioid central analgesic and antipyretic that selectively inhibits CNS cyclooxygenase without anti-inflammatory or anti-platelet effects.

Methoxyflurane (Penthrox)

A volatile, self-administered inhaled halogenated hydrocarbon gas used for short-term relief of moderate to severe acute pain in conscious adult trauma patients.

Nitrous Oxide

An inhaled gas mixture with potent analgesic properties, where a $20\%$ inhaled concentration yields analgesic equivalence to $5\,\text{mg}$ to $7\,\text{mg}$ of morphine.