1. Med Chem Tutoring - Anesthesia
By Alaina Darby

2. Local Anesthesia

3. Which of the following is not true of local anesthesia?
Reversible loss of sensation
Includes loss of consciousness
Does not affect pain mechanisms
Interferes with sodium permeability B

4. Which of the following is not properly paired?
Unionized binding site: internal membrane
Ionized binding site: hydrophobic pathway
Unionized binding site: hydrophobic pathway
Ionized binding site: external membrane B

5. Which of the following is responsible for cocaine’s addictive liability?
Tropine moiety
Benzoyl group
Carbomethoxy group
Benzoic acid group C

6. Which of the following is an undesirable property of cocaine that is not true of tetracaine?
Low potency
Short duration of action
Addiction liability
Tissue irritation C

7. Removing which of the following groups is essential for activity?
Aromatic group
Aromatic substitution
Alkyl substitutions on intermediate chain
Terminal amino functionality A

8. Which of the following substitutions decreases activity?
Para- Cl
Ortho- NH2
Meta- NHR
Ortho- NO2 D

9. Which of the following LA’s would have faster onset and lower toxicity?
Lower pKa and lower lipophilicity
Higher pKa and lower lipophilicity
Lower pKa and higher lipophilicity
Higher pKa and higher lipohilicity C

10. Which of the following is most likely to antagonize sulfonamide antibiotics?
Benzocaine
Lidocaine
Bupivicaine
Prilocaine A
Ester will break down into PABA metabolite via ester bond hydrolysis and this antagonizes the sulfas
Remember the trick that if “i“ comes before the –caine, it is an amide.

11. Which of the following can prilocaine cause?
Increased toxicity of anticholinergics
Hypersensitivity reaction
Convulsions
Methemoblobinemia D

12. Which of the following reactions can produce CNS toxicity?
N-dealkylation of lidocaine
N-alkylation of lidocaine
N-demethylation of lidocaine
N-methylation of lidocaine A

13. Remember the mechanisms that you can use to prevent CNS toxicity!!
Prevent generation of acetaldehyde… e.g. tocainide
Prevent CNS entry… e.g. tolycaine
There was a question about this last year!!

14. General Anesthesia

15. Which of the following stages of anesthesia is optimal for surgery due to relaxation of the skeletal muscles?
Stage I
Stage II
Stage III
Stage IV C

16. Which of the following has the fastest induction and recovery?
Methoxyflurane
N2O
Halothane
Desflurane D

17. Which of the following has the Slowest induction and recovery?
Methoxyflurane
N2O
Halothane
Desflurane A

18. Remember!!
High blood solubility:
Low blood solubility:
Slow induction
Slow recovery
Fast induction
Fast recovery
Therefore: MAC (potency) is roughly inversely proportional to partition coefficient (solubility)… If they are very soluble (slow induction/recovery) then they are usually not as potent

19. How much of the MAC is required for surgery?
0.7 1
1.3
1.5 C
MAC is only calculated for 50% of patients… need more for the other 50%

20. Which of the following can increase MAC?
Hyperthermia
Alcohol ingestion
Increased age
Opioids A
Think of it as “revving up” for increased MAC HYPER states (natremia/thermia) and increased catecholamines
Decreased MAC (makes anesthesia more effective) is due to decreases in things HYPO states (natremia/tension/thermia/oxia), drugs that can cause these states, and decreased catecholamines

21. Which of the following has no effect on MAC?
Pregnancy
Lidocaine
Hypertension
Alcohol C

22. Which of the following theories is properly matched?
Meyer-Overton: stereoselective effects
Meyer-Overton: squeezing of nerves impedes conduction
Receptor theory: expansion of membranes plays a role
Receptor theory: correlation between lipid solubility and MAC B

23. Which of the following receptors/channels is not involved in the receptor theory?
GABA
Chloride channels
NMDA receptors
Beta receptors D

24. Which of the following has the highest risk of hepatotoxicity?
Isoflurane
Enflurane
Methoxyflurane
Halothane D

25. Which of the following ions contributes to nephrotoxicity?Cl Br Ca A

26. Which of the following is most likely to cause seizures?
Isoflurane
Enflurane
Methoxyflurane
Halothane B

27. Which has the least toxicity?
Isoflurane
Enflurane
Methoxyflurane
Halothane A

28. Which of the following is the drug of choice for induction of anesthesia?
Ketamine
Propofol
Etomidate
Thiopental B

29. Which of the following has an active metabolite?
Ketamine
Propofol
Etomidate
Thiopental A

30. Which of the following has an advantage in elderly and shock patients?
Ketamine
Propofol
Etomidate
Thiopental A

31. Which of the following puts patients at increased risk for 30 day mortality?
Ketamine
Propofol
Etomidate
Thiopental C

32. Midazolam can prevent the side effects of which of the following?
Ketamine
Propofol
Etomidate
Thiopental A

33. I made these last year to study…
This is helpful for getting familiar with the structures!!