CNOR Pharmacology Exam 2025

What does local anesthesia entail? - -NO IV!! Anesthesia injected right at the site What is another term for MAC? - -TIVA (total IV anesthesia) What is a nerve block? - -Injecting meds into the nerve root Neuraxial anesthesia - -- spinal/epidural - targets the spinal nerve roots and spinal cord ASA 1 - -Normal healthy ASA 2 - -A patient with mild systemic disease Pregnancy, smoker, controlled/medicated HTN ASA 3 - -A patient with severe systemic disease or people who have health concerns relating to their disease. Diabetic with unsealing wounds or cataracts. ASA 4 - -A patient with severe systemic disease that is a constant threat to life "frequent flyers" like renal dialysis pts ASA 5 - -near death pt that is not expected to survive without IMMEDIATE medical intervention ECMO, trauma pts that are hemorrhaging ASA 6 - -A declared brain-dead patient whose organs are being removed for donor purposes Why are some asa classifications followed by the letter E? - -Means they need more monitoring Example: ASA1E/P1E What herbal meds put you at risk for liver damage? - -Echinacea and Kava Damage liver when given with propofol CNOR CNOR CNOR What meds increases risk of bleeding? - -Ginger GINKGO Garlic Fever few Saw palmetto Meds that cause prolonged emergence from anesthesia? - -Gingko St. John's wort Valerian What are the different ways patients are induced by anesthesia? - -Barbituates (brevital) Inhalation Sedatives/hypnotics (propofol and etomidate) What med is used commonly for ECT? - -Brevital because it lowers the seizure threshold Etomidate - -Causes bad N/V so it is commonly given with a prophylactic antiemetic. Used only with large grafts (AAA) because it helps prevent big booming blood pressure Cricoid pressure - -Sellick's maneuver!!! What are the two times during the surgical process a patient is most at risk of an MI? - INDUCTION and 2-3 days post-op Pain scales go by... - -developmental age and not chronological age (ie. an old man with mental age of 8 - use faces, not numbers) What is an endorphin rush? - -Fight or flight response! Example: you turn into superman when a loved one gets hit by a car. Your body's endorphins rush so that you do not feel temporary pain. Shifts body into fight or flight and surpresses pain temporarily. What are the only two natural opioids we give? - -Morphine and codeine! What are the four key opioids to know... - -Hydromorphone (Dilaudid) Meperidine (Demerol) Sublimaze (Fentanyl) Duramorph (Morphine) What opioid do we give for shivering? - -Demerol! What is the opioid reversal agent? - -Naloxone (narcan) Tamper the dose up. We don't wanna reverse all of the opioid, but enough to reverse toxicity. CNOR CNOR What is an adverse effect of Valium? - -Respiratory depression/hyperventilation You hyperventilate in order to blow off CO2. What is the reversal agent for Benzos? - -Flumazenil (Romazicon) Reverses seizure meds and tricyclic antidepressants, so be careful with these! What is succ. primarily used for? - -Paralysing during induction. It is super rapid acting and the duration is short, so we give to intubate pts quickly. What is the reversal agent for succ (depolarizing agent)? - -there isn't one!!! Pseudocholinesterase disease - -patient doesn't produce enough and so metabolizing succ. can take days! Patient wakes up paralyzed, very scary Contraindications of succ - -Glaucoma Elevated ICP MH family hx degenerative muscular diseases (elevates potassium too much) What are the side effects of non-depolarizing agents? - -Think "rest and digest" Bradycardia, increased GI peristalsis, bronchospasm, and increased oral secretions What are the NDMR? - -Neotsigmime (mixed with glycopyrrolate/robinall) Edrophonium and Elon plus (mixed with atropine) Both are mixed with anticholinergic to prevent side effects Reversal agent for MDMR? - -Sugammadex What is a caffeine halothane test? - -Small amount of tissue is excised from pt and halothane is injected into it. When can we not give isoflurane? - -When a tourniquet is used. We use Sevoflurane in these pts instead. When is Ethrane contraindicated? - -In patients with seizures! Lowers the seizure threshold, bad news bears Desflurane - -Not commonly used with neuro procedures because it causes coughing What is the only non-volatile inhaled gas? - -Nitrous Oxide. CNOR We always give this when using a volatile gas because it has opioid properties with it. What can nitrous oxide cause? - -Diffusion hypoxia. So these pts will come out of surgery on supplemental oxygen What chromosome does MH affect? - -Chromosome 19 What are triggering agents for MH? - -Succ and all volatile gases (desflurane, Ethrane, isoflurane, halothane, and sevoflurane) What are the early signs of MH? - -Trismus (locked jaw) Increase in end tidal CO2 Increased HR and BP Increase in muscle rigidity What are the late signs of MH? - -Increase in body temp Hyperkalemia Hypoxia Myoglobinuria MI What kind of IV fluid do you NOT wanna give someone with MH? - -LR!! Has potassium in it, and we do not need anymore potassium What medication is contraindicated with dantrolene? - -Varapemil CNOR