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Anaesthetics & Genetics > 1 - Principles of Pharmacology > Flashcards

1 - Principles of Pharmacology Flashcards

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1
Q

Define general anaesthesia?

A

produces insensibility in the whole body, usually causing unconsciousness

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2
Q

which type of drugs can be used as general anaesthetics?

A

centrally acting drugs - hypnotics, analgesics etc.

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3
Q

define regional anaesthesia?

A

producing insensibility in an area or region of the body -

Local anaesthetics applied to nerves supplying relevant area

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4
Q

define local anaesthetics?

A

producing insensibility in only the relevant part of the body - applied directly to the tissues

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5
Q

describe what is meant by monotherapy?

A

when anaesthesia used to be delivered using high concentrations of single agents in spontaneously breathing patients

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6
Q

in which ways were monotherapies used?

A

chloroforms

ethers

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7
Q

what are the risks associated with monotherapy?

A

cardiac depression

respiratory depression

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8
Q

In terms of development, where is the area of major progress?

A

in techniques and equipment, rather than the drugs themselves

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9
Q

give an example of monitoring which has become far more accessible and affordable?

A

pulse oximetry

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10
Q

describe 4 functions of the modern anaesthetic machine?

A
  • Regulation of fresh gases and mixing to deliver precise concentrations of gaseous agents
  • Addition of precise concentrations of inhaled anaesthetic gases
  • CO2 removal to allow recirculation of inhaled gases
  • Mechanical ventilation
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11
Q

what system is used to determine safety of patient and risk of mortality?

A

ASA system

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12
Q

in ASA system, in which groups is mortality concentrated?

A

groups 3-5

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13
Q

describe ASA 1 patient?

A

normal, fit, healthy patient

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14
Q

describe ASA 2 patient?

A

patient with mild systemic disease

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15
Q

describe ASA 3 patient?

A

patient with severe systemic disease

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16
Q

describe ASA 4 patient?

A

patient with severe systemic disease that is constant threat to life

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17
Q

describe ASA 5 patient?

A

moribund patient, not expected to survive - surgery is carried out in desperation

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18
Q

describe ASA 6 patient?

A

patient declared brain dead - usually undergoing organ retrieval

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19
Q

what is the triad of anaesthetics?

A

hypnosis - unconsciousness

analgesia - pain relief

relaxation - skeletal muscle relaxation

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20
Q

what are 2 benefits of balanced anaesthetics - i.e. having different drugs doing different jobs?

A

allows a great degree of control over the individual components of the triad

Helps keep doses of individual drugs down

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21
Q

describe 3 potential problems with balanced anaesthetics?

A

polypharmacy

muscle relaxation

separation of relaxation and hypnosis - awareness

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22
Q

what do general anaesthetics provide?

A

unconsciousness and muscle relaxation

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23
Q

what separates GAs from sedatives?

A

the potency

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24
Q

how do GA agents act?

A

they interfere with neuronal ion channels + hyperpolarise neurones - this means they are less likely to ‘fire’ and suppresses excitatory synaptic activity

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25
Q

how do inhalation GA agents work?

A

dissolve in membranes and provide a direct physical effect

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26
Q

how do IV GA agents work?

A

bind allosterically to GABA receptors - this opens the Cl-channels

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27
Q

association with GA and cerebral function?

A

“lost from top down” -

most complex processes are interrupted first

28
Q

why is order of cerebral function under GAs fortunate?

A

it allows unconsciousness to be achieved while some automatic and autonomic functions are preserved such as respiration and blood pressure homeostasis

29
Q

in terms of time, are IV anaesthetics quick to work and why?

A

yes - because they cross the blood brain barrier rapidly and get into the neural tissues v quickly

30
Q

How are IV drugs able to cross the blood brain barrier?

A

they are highly fat-soluble drugs

31
Q

Do IV drugs stay in the blood for a long time?

A

no - the drug moves to other parts of the body before being metabolised

32
Q

what are inhalational anaesthetics AKA?

A

halogenated hydrocarbons

33
Q

how are inhalational anaesthetics almost exclusively taken up and excreted?

A

via the lungs

34
Q

how does the inhalational anaesthetic correspond to the pressure gradient?

A

it moves down the pressure gradient from lungs, to blood, to brain - causing unconsciousness

35
Q

define MAC?

A

minimum alveolar concentration of a drug which is required to produce anaesthesia

36
Q

what is MAC?

A

measure of potency - low number = high potency

37
Q

describe the induction of Inhalational Anaesthetics?

A

slow

38
Q

describe the maintenance of anaesthesia in Inhalational Anaesthetics?

A

prolong duration - very flexible drugs

39
Q

what is the most common sequence of general anaesthesia?

A

IV induction followed by inhalational maintenance

40
Q

describe 3 central effects of GAs on depressing the CVS centre?

A

reduce sympathetic outflow
negative

inotropic/chronotropic effect on heart

reduced vasoconstrictor tone → vasodilation

41
Q

describe 3 direct effects of GAs on CVS?

A

negatively inotropic

vasodilation
→ decreased peripheral resistance

venodilation:

  • decreased venous return,
  • decreased cardiac output
42
Q

effect of GAs on resp and CVS?

A

CVS and respiratory depressants

43
Q

4 effects which demonstrate GAs as respiratory depressants?

A

Reduce hypoxic and hypercarbic drive

Decreased tidal volume & increase rate

Paralyse cilia

Decrease FRC

44
Q

what do muscle relaxants do?

A

they paralyse (‘relax’) skeletal muscle

45
Q

which other component of the triad compliments the use of muscle relaxants?

A

unconsciousness

46
Q

give 4 indications for muscle relaxants?

A

ventilation & Intubation

microscopic surgery

neurosurgery

body cavity surgery (access)

47
Q

what is the biggest fear when using muscle relaxants?

A

awareness

48
Q

2 potential other issues using muscle relaxants?

A

airway obstruction/ respiratory insufficiency

need to maintain and protect the airway and provide ventilation of the lungs - if not = death

49
Q

with which other part of the triad is analgesia usually paired with (but not always)?

A

unconsciousness

50
Q

give 3 reasons for using intraoperative analgesia?

A

Prevention of arousal

Opiates contribute to hypnotic effect of GA

Suppression of reflex responses to painful stimuli

51
Q

give an example of an opiate used intraoperatively?

A

fentanyl

52
Q

name 2 opiates used intro and post-operatively?

A

morphine

oxycodone

53
Q

describe the action of remifentanil?

A

very highly potent and extremely short acting - therefore used as adjunct to inhalation/ IV agents but offers no post-op analgesia

54
Q

name 3 local anaesthetics?

A

lignocaine

bupivacaine

ropivacaine

55
Q

how do local anaesthetics work?

A

by blocking Na+ channels and preventing axonal action potential from propagating

56
Q

in which way are local anaesthetics NOT delivered?

A

IV

57
Q

benefit of delivering analgesia with local techniques?

A

avoidance of reliance on opioid analgesics

58
Q

what is a safe and conservative way to deliver local anaesthetic?

A

via US - ultrasound guided regional anaesthesia

59
Q

what is the main factor limiting use of local anaesthetic?

A

toxicity

60
Q

4 factors which toxicity depends on?

A

dose used

rate of absorption (site dependant)

patient weight

drug

61
Q

name 4 signs of local anaesthetic toxicity?

A

Light-headedness

Tinnitus, visual disturbances

Muscular twitching

Drowsiness

62
Q

describe the differential blockade of local anaesthetic?

A

motor fibres (due to high degree of myelination) are relatively spared -

pain fibres are easily blocked (due to being thinner)

63
Q

MAP equation?

A

MAP = CO x SVR

CO = venodilation 
SVR = arteriolar vasodilation
64
Q

in terms of neuraxial block, where is local anaesthetic injected into in spinal/ subarachnoid block?

A

CSF surrounding the cord +/- spinal roots

65
Q

how is epidural anaesthesia formed?

A

injection of local anaesthetic into the epidural space (fat layer)

66
Q

distinguish between local anaesthetic in subarachnoid space and epidural space?

A

subarachnoid - nerves are made up of neural tissue only - therefore LA penetrates easily and so low doses of LA are needed

epidural - nerves have thick fibrous layer, therefore difficult to penetrate - therefore much higher doses

67
Q

risk associated with LA in epidural space?

A

massive overdose if injected into subarachnoid space

Anaesthetics & Genetics (9 decks)

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