Pharmacology of Anesthetic Agents Flashcards

Which local anesthetic has the longest duration of action due to its high protein binding?

Answer: Bupivacaine

Bupivacaine's approximately 95% protein binding prolongs its duration of action to 4-12 hours depending on block type.

Propofol infusion syndrome is most associated with which metabolic derangement?

Answer: Severe metabolic acidosis with cardiac failure

Propofol infusion syndrome causes mitochondrial dysfunction leading to severe metabolic acidosis, rhabdomyolysis, and cardiac failure.

Which volatile anesthetic is most associated with triggering malignant hyperthermia?

Answer: Desflurane

All halogenated volatile anesthetics including desflurane can trigger malignant hyperthermia via uncontrolled RYR1 calcium release.

The Hofmann elimination pathway of cisatracurium degradation means its duration is:

Answer: Independent of organ function

Hofmann elimination is a spontaneous, temperature- and pH-dependent chemical degradation that does not rely on renal or hepatic function.

Neostigmine reverses non-depolarizing neuromuscular blockade by:

Answer: Inhibiting acetylcholinesterase to increase ACh at the NMJ

Neostigmine inhibits acetylcholinesterase, increasing ACh concentration at the neuromuscular junction to compete with the blocking agent.

Which property of methohexital makes it preferred over thiopental for electroconvulsive therapy (ECT)?

Answer: Pro-convulsant properties that prolong seizure duration

Methohexital lowers the seizure threshold and prolongs seizure duration, which is therapeutically beneficial in ECT.

The primary advantage of sugammadex over neostigmine for neuromuscular blockade reversal is:

Answer: Rapid reversal even at deep levels of aminosteroidal blockade

Sugammadex encapsulates rocuronium and vecuronium, enabling rapid reversal even at profound (PTC 1-2) levels of blockade where neostigmine is ineffective.