Part 4.7 - CNS-ANESTHESIA

Anesthesia is defined as the loss of ________ with or without loss of consciousness.

a. movement
b. sensation
c. memory
d. speech

b. sensation

Anesthesia may occur with or without loss of ________.

a. reflexes
b. consciousness
c. respiration
d. movement

b. consciousness

a state characterized by unconsciousness, analgesia, amnesia, skeletal muscle relaxation, and loss of reflexes

a. General anesthesia

b. Local anesthesia

a. General anesthesia

refers to loss of sensation in a limited region of the body

a. General anesthesia

b. Local anesthesia

b. Local anesthesia

Can be given by inhalation or intravenously

a. Local anesthesia
b. General anesthesia

b. General anesthesia

[Stages and Depth of Anesthesia]

Analgesia

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

a. Stage 1

[Stages and Depth of Anesthesia]

Patient has decreased awareness of pain sometimes with amnesia

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

a. Stage 1

[Stages and Depth of Anesthesia]

Consciousness may be impaired but not lost

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

a. Stage 1

[Stages and Depth of Anesthesia]

Excitatory

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

b. Stage 2

[Stages and Depth of Anesthesia]

Patient is delirious and excited

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

b. Stage 2

[Stages and Depth of Anesthesia]

Amnesia occurs, reflexes are enhanced, and respiration is typically irregular

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

b. Stage 2

[Stages and Depth of Anesthesia]

retching and incontinence may occur

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

b. Stage 2

[Stages and Depth of Anesthesia]

Surgical

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

c. Stage 3

[Stages and Depth of Anesthesia]

Patient is unconscious and has no pain reflexes

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

c. Stage 3

[Stages and Depth of Anesthesia]

respiration is very regular, and BP is maintained

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

c. Stage 3

[Stages and Depth of Anesthesia]

Medullary Depression

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

d. Stage 4

[Stages and Depth of Anesthesia]

Patient develops severe respiratory and CVS depression that requires mechanical and pharmacologic support

a. Stage 1

b. Stage 2

c. Stage 3

d. Stage 4

d. Stage 4

The time from administration of a potent anesthetic to development of effective anesthesia

a. Induction

b. Maintenance

c. Recovery

a. Induction

Provides sustained anesthesia

a. Induction

b. Maintenance

c. Recovery

b. Maintenance

Time from discontinuation of anesthetic until consciousness and protective reflexes return

a. Induction

b. Maintenance

c. Recovery

c. Recovery

[Anesthesia Protocols]

Conscious sedation techniques (IV agents with local anesthetics)

a. For minor procedures

b. For more extensive surgical procedures

c. Assessment of depth of anesthesia during surgery

a. For minor procedures

[Anesthesia Protocols]

IV drugs to induce the anesthetic state, inhaled anesthetics (with or without IV agents) to maintain an anesthetic state, and neuromuscular blocking agents to effect muscle relaxation

a. For minor procedures

b. For more extensive surgical procedures

c. Assessment of depth of anesthesia during surgery

b. For more extensive surgical procedures

[Anesthesia Protocols]

Vital sign monitoring

a. For minor procedures

b. For more extensive surgical procedures

c. Assessment of depth of anesthesia during surgery

c. Assessment of depth of anesthesia during surgery

[Anesthesia Protocols]

Cerebral monitoring (EEG)

a. For minor procedures

b. For more extensive surgical procedures

c. Assessment of depth of anesthesia during surgery

c. Assessment of depth of anesthesia during surgery

[MOA General Anesthetics]

General anesthetics primarily act as ________ depressants.

a. CVS
b. CNS
c. renal
d. endocrine

b. CNS

[MOA General Anesthetics]

General anesthetics increase ________ synaptic activity to produce inhibition.

a. dopamine
b. glutamate
c. serotonin
d. GABA

d. GABA

[MOA General Anesthetics]

Inhaled anesthetics, barbiturates, benzodiazepines, etomidate, and propofol enhance ________ activity.

a. dopamine
b. glutamate
c. GABA
d. serotonin

c. GABA

[MOA General Anesthetics]

Benzodiazepines and barbiturates promote ________ synaptic activity.

a. inhibitory
b. excitatory

a. inhibitory

[MOA General Anesthetics]

Etomidate and Propofol promote ________ synaptic activity.

a. inhibitory
b. excitatory

a. inhibitory

[MOA General Anesthetics]

General anesthetics may decrease excitatory neurotransmission involving ________.

a. acetylcholine or dopamine
b. serotonin or GABA
c. dopamine or serotonin
d. glutamate or acetylcholine (ACh)

d. glutamate or acetylcholine (ACh)

[MOA General Anesthetics]

Another mechanism of general anesthetics is decreasing ________ synaptic activity.

a. inhibitory
b. excitatory

b. excitatory

[MOA General Anesthetics]

Inhaled anesthetics decrease excitatory activity by acting as ________ receptor antagonists.

a. nicotinic
b. muscarinic
c. GABA-A
d. dopamine D2

a. nicotinic

[MOA General Anesthetics]

Ketamine acts mainly as an ________ receptor antagonist, decreasing excitatory synaptic activity

a. AMPA
b. GABA-A
c. NMDA
d. nicotinic

c. NMDA

[Inhaled Anesthetics]

Non-volatile gas

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

a. Nitrous Oxide

[Inhaled Anesthetics]

Weakest anesthetic

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

a. Nitrous Oxide

[Inhaled Anesthetics]

potent analgesic

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

a. Nitrous Oxide

[Inhaled Anesthetics]

Popular anesthetic for out-patient procedures

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

b. Desflurane

[Inhaled Anesthetics]

AOC: children (less pungent)

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

c. Sevoflurane

[Inhaled Anesthetics]

AOC: for asthmatic patient

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

e. Enflurane

[Inhaled Anesthetics]

Most hepatotoxic

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

f. Halothane

[Inhaled Anesthetics]

Potent anesthetic

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

g. Methoxyflurane

[Inhaled Anesthetics]

weakest analgesic

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

g. Methoxyflurane

[Inhaled Anesthetics]

AOC: during labor

a. Nitrous Oxide

b. Desflurane

c. Sevoflurane

d. Isoflurane

e. Enflurane

f. Halothane

g. Methoxyflurane

g. Methoxyflurane

[Inhaled Anesthetics]

Most inhaled anesthetics are in the form of volatile ________.

a. solids
b. liquids
c. powders
d. tablets

b. liquids

[Inhaled Anesthetics]

Moving downward from N → M indicates increasing anesthetic ________.

a. toxicity
b. potency
c. MAC
d. metabolism

b. potency

[Inhaled Anesthetics]

Moving upward from M → N indicates increasing ________.

a. potency
b. toxicity
c. MAC
d. duration

c. MAC (minimum alveolar concentration)

[Inhaled Anesthetics]

MAC is the ________ of an anesthetic.

a. LD50
b. TD50
c. ED50
d. EC90

c. ED50

[Inhaled Anesthetics]

MAC is expressed as the percentage of ________ in a mixture required to achieve an effect.

a. liquid
b. gas
c. blood
d. vapor only

b. gas

[Inhaled Anesthetics]

Nephrotoxicity is considered an ________ toxicity of inhaled anesthetics.

a. chronic
b. acute

b. acute

[Inhaled Anesthetics]

Hematoxicity is considered an ________ toxicity of inhaled anesthetics.

a. chronic
b. acute

b. acute

[Inhaled Anesthetics]

Hepatotoxicity is considered an ________ toxicity of inhaled anesthetics.

a. chronic
b. acute

b. acute

[Inhaled Anesthetics]

Malignant hyperthermia is considered an ________ toxicity of inhaled anesthetics.

a. chronic
b. acute

b. acute

[Inhaled Anesthetics]

Mutagenicity is considered an ________ toxicity of inhaled anesthetics.

a. chronic
b. acute

a. chronic

[Inhaled Anesthetics]

Teratogenicity is considered an ________ toxicity of inhaled anesthetics.

a. chronic
b. acute

a. chronic

[Inhaled Anesthetics]

Carcinogenicity is considered an ________ toxicity of inhaled anesthetics.

a. chronic
b. acute

a. chronic

[Inhaled Anesthetics]

Nephrotoxicity metabolism of ____and _____may generate compounds that are potentially nephrotoxic enflurane with prolonged exposure significant renal injury

a. isoflurane and sevoflurane

b. enflurane and sevoflurane

c. nitrous Oxide and enflurane

d. enflurane and halothane

b. enflurane and sevoflurane

[Inhaled Anesthetics]

Nitrous oxide toxicity may result in ________.

a. thrombosis
b. aplastic anemia
c. leukopenia
d. megaloblastic anemia

d. megaloblastic anemia

[Inhaled Anesthetics]

Nitrous oxide is associated with ________ toxicity.

a. hematoxicity
b. nephrotoxicity
c. hepatotoxicity
d. neurotoxicity

a. hematoxicity

[Inhaled Anesthetics]

Hepatotoxicity associated with inhaled anesthetics is classically linked to ________.

a. sevoflurane

b. halothane

c. nitrous oxide

d. enflurane

b. halothane

[Inhaled Anesthetics]

___ is an important cause of anesthetic morbidity and mortality

a. Nephrotoxicity

b. Hematoxicity

c. Malignant hyperthermia

d. Hepatotoxicity

c. Malignant hyperthermia

[Intravenous Anesthetics]

Most frequently administered for induction of anesthesia

a. Propofol

b. Fospropofol

c. BZDs

d. Etomidate

a. Propofol

[Intravenous Anesthetics]

Also used for maintenance of anesthesia (continuous infusions)

a. Propofol

b. Fospropofol

c. BZDs

d. Etomidate

a. Propofol

[Intravenous Anesthetics]

Propofol appearance

a. Milky white appearance; highly viscous; pH ~2

b. Milky white appearance; slightly viscous; pH ~7

c. Clear appearance; slightly viscous; pH ~10

d. Clear appearance; highly viscous; pH ~10

b. Milky white appearance; slightly viscous; pH ~7

[Intravenous Anesthetics]

Propofol is formulated as an emulsion containing: ___% soybean oil ___% glycerol 1___% lecithin

a. 10% soybean oil, 1.2% glycerol, 2.25% lecithin

b. 10% soybean oil, 2.25% glycerol, 1.2% lecithin

c. 1.2% soybean oil, 2.25% glycerol, 10% lecithin

d. 1.2% soybean oil, 2.25% glycerol, 10% lecithin

b. 10% soybean oil, 2.25% glycerol, 1.2% lecithin

[Intravenous Anesthetics]

Susceptible patient may experience allergic reactions

a. Propofol

b. Fospropofol

c. BZDs

d. Etomidate

a. Propofol

[Intravenous Anesthetics]

Act as hypnotic but does not have analgesic properties

a. Propofol

b. Fospropofol

c. BZDs

d. Etomidate

a. Propofol

[Intravenous Anesthetics]

Has antiemetic action

a. Propofol

b. Fospropofol

c. BZDs

d. Etomidate

a. Propofol

[Intravenous Anesthetics]

A water-soluble prodrug of propofol

a. Propofol

b. Fospropofol

c. BZDs

d. Etomidate

b. Fospropofol

[Intravenous Anesthetics]

Fospropofol is rapidly metabolized by ________ phosphatase.

a. acid
b. alkaline

b. alkaline

[Intravenous Anesthetics]

Metabolism of fospropofol produces ___, ____, and ________.

a. acetaldehyde, methanol, and propofol
b. dopamine, phosphate, and formaldehyde
c. methanol, acetaldehyde, and phosphate
d. propofol, phosphate, and formaldehyde

d. propofol, phosphate, and formaldehyde

[Intravenous Anesthetics]

Licensed by the FDA in 2008 as a sedating agent for use in adult patients during monitored anesthesia care

a. Propofol

b. Fospropofol

c. BZDs

d. Etomidate

b. Fospropofol

[Intravenous Anesthetics]

Examples of barbiturates used in anesthesia include _______and ________.

a. thiopental and diazepam
b. diazepam and propofol
c. propofol and ketamine
d. thiopental and methohexital

d. thiopental and methohexital

[Intravenous Anesthetics]

Barbiturates such as thiopental and methohexital have largely been replaced by ________.

a. halothane
b. propofol
c. diazepam
d. ketamine

b. propofol

[Intravenous Anesthetics]

Benzodiazepines are commonly used during the ________ period.

a. postpartum
b. perioperative
c. recovery only
d. rehabilitation

b. perioperative

[Intravenous Anesthetics]

A commonly used benzodiazepine in the perioperative period is ________.

a. ketamine
b. propofol
c. halothane
d. midazolam

d. midazolam

Others:

• lorazepam

• less frequently diazepam

[Intravenous Anesthetics]

Benzodiazepines generally produce ________ depression of ventilation.

a. severe
b. moderate
c. minimal
d. complete

c. minimal

[Intravenous Anesthetics]

Rapid IV administration of midazolam may cause transient ________.

a. hypertension
b. apnea
c. seizures
d. tachycardia

b. apnea

[Intravenous Anesthetics]

Midazolam may cause transient apnea when rapidly administered by the ________ route.

a. oral
b. intramuscular
c. intravenous (IV)
d. topical

c. intravenous (IV)

[Intravenous Anesthetics]

Etomidate is classified as a ________-mimetic drug.

a. dopamine
b. glutamate
c. GABA
d. serotonin

c. GABA

[Intravenous Anesthetics]

An IV anesthetic with hypnotic but not analgesic effects and is often chosen for its minimal hemodynamic effects

a. ketamine
b. propofol
c. halothane
d. etomidate

d. etomidate

[Intravenous Anesthetics]

Ketamine acts primarily as an ________ receptor inhibitor.

a. GABA-A
b. nicotinic
c. NMDA
d. dopamine D2

c. NMDA

[Intravenous Anesthetics]

Ketamine is partially ________-soluble and highly ___-soluble.

a. partially lipid-soluble and highly water-soluble.
b. partially water-soluble and highly lipid-soluble.

b. partially water-soluble and highly lipid-soluble.

[Intravenous Anesthetics]

Ketamine is a derivative of ________.

a. propofol
b. phencyclidine
c. halothane
d. diazepam

b. phencyclidine

[Intravenous Anesthetics]

Ketamine produces significant ________.

a. sedation
b. analgesia
c. paralysis
d. amnesia

b. analgesia

[Intravenous Anesthetics]

Ketamine produces this type of anesthesia called ________ anesthesia.

a. spinal anesthesia
b. dissociative anesthesia
c. local anesthesia
d. balanced anesthesia

b. dissociative anesthesia

[Intravenous Anesthetics]

Ketamine-induced dissociative anesthesia is characterized by a ________ state.

a. hyperactive
b. paralytic
c. unconscious only
d. cataleptic

d. cataleptic

[Intravenous Anesthetics]

The ________ (+) form of ketamine is more potent.

a. R
b. D
c. S
d. L

c. S

[Intravenous Anesthetics]

The R(–) isomer of ketamine is ________ potent than the S(+) form.

a. more
b. equally
c. less
d. completely non

c. less

[Intravenous Anesthetics]

Dexmedetomidine is an ________-adrenergic agonist.

a. alpha (α₂)
b. beta-1
c. beta-2
d. dopamine D2

a. alpha (α₂)

[Intravenous Anesthetics]

Dexmedetomidine is principally used for ________-term sedation.

a. long
b. permanent
c. short
d. lifelong

c. short

[Intravenous Anesthetics]

Principally used for the short-term sedation of intubated & ventilated

a. Ketamine

b. Dexmedetimidine

c. Etomidate

d. Methohexital

b. Dexmedetimidine

[Intravenous Anesthetics]

strong opioid

a. Lorazepam
b. Morphine
c. Propofol
d. Diazepam

b. Morphine

Others:

• fentanyl

• sulfentanyl

[Intravenous Anesthetics]

Opioid analgesics are routinely used to achieve postoperative ________.

a. amnesia
b. analgesia
c. paralysis
d. unconsciousness

b. analgesia

[Intravenous Anesthetics]

Opioids may be used ________operatively as part of a balanced anesthesia regimen.

a. pre
b. post
c. intra
d. peri

c. intra

[Local Anesthetics]

Cocaine

a. Ester Type

b. Amide Type

a. Ester Type

[Local Anesthetics]

Procaine

a. Ester Type

b. Amide Type

a. Ester Type

[Local Anesthetics]

Chloroprocaine

a. Ester Type

b. Amide Type

a. Ester Type

[Local Anesthetics]

Lidocaine

a. Ester Type

b. Amide Type

b. Amide Type

[Local Anesthetics]

Bupivacaine

a. Ester Type

b. Amide Type

b. Amide Type

[Local Anesthetics]

Prilocaine

a. Ester Type

b. Amide Type

b. Amide Type