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BMB W9 > 10-08 L2 General Anesthetics > Flashcards

10-08 L2 General Anesthetics Flashcards

1
Q

Components of Anesthesia

A
  • Unconsciousness
  • Skeletal muscle relaxation
  • Analgesia (reduced pain)
  • Amnesia
  • Inhibition of autonomic reflexes
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2
Q

Propofol

A
  • Unconsciousness
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3
Q

Benzodiazepine

A
  • Amnesia
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4
Q

Fentanyl

A
  • Analgesia
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5
Q

Glycopyrrolate

A
  • Inhibition of reflexes
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6
Q

Vecuronium

A
  • Skeletal muslce relaxation
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7
Q

Elimination of Benzodiazepine

A
  • Liver (Conjugated to glucuronides)
  • Body (Redistribution most important)
  • Kidney (Eliminated by the kidney)
  • Elimination slowed in the elderly, critially ill, (especially in sepsis)
  • Pharmacogentic abnormalites (6% of patients accounting for slow metabolism of midazolam)
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8
Q

Benzodiazepines (short acting)

A

Short acting -Oxazepam (Serax) 5-15 none -Lorazepam (Ativan) 10-20 None -Midazolam (Versed) 6 alpha-hydroxymidazolam

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9
Q

Benzodiazepines (long acting)

A

Diazepam 20-80 N-desmethyldiazepam, N-methyloxazepam (temazepam), Oxazepam

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10
Q

Morphine

A

Active metabolite (M6G; Morphine-6-glucuronide excreted in the urine) -Elimination may be delayed in renal failure -During acidemia, 1/2 life of morphine in the brain prolonged by >50%

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11
Q

Fentanyl

A

-short duration of action (after a single dose due to high lipid solubility & redistribution) -Elimination 1/2 is longer than that of morphine (2-16 h v 1.5-6 h)

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12
Q

IV Anesthetics

A

Propofol -Ketamine -Etomidate -Dexmedetomidine Secondary -Methohexital, thiopental

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13
Q

Propofolo (Diprivan)

A

Advantages: rapid induction & emergence, pleasant, minimal ‘hangover’ Disadvantages: Danger of contamination, hypotension (decreased SVR), pain on injection, Respiratory depression, Expensive Dose Ranges: Bolus (1.0-2.5 mg/kg), Infusion: (0.05-0.2 mg/kg/min)

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14
Q

Ketamine

A

Dissociative state, side effects may be useful, sympathomimetic vagolytic (increases heart rate, blood pressure, bronchodilators) slow arousal, hallucinations may be a problem.

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15
Q

Etomidate

A

-Inhibits 11B-hydroxylase (converts 11B-deoxycortisol to cortisol) -Single dose may inhibit cortisol production for up to 48 h -Independent risk factor for death in CORTICUS study (28d mortality 43% v 30%, P=0.03) Less likely to respond to corticotropin (60% v 43.4%, P=0.004)

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16
Q

Dexmedetomidine (Precedex)

A

Alpha-2 adrenergic agonist, aprroved for sedation of intubated and ventilated patietns in an ICU setting -Administered by continuois infusion for up to 24 hours -Sedative, anxiolytic and analgesic effects -Not controlled substance.

17
Q

Anesthetic uptake

A

Depends on alveolar concentration, Variables, inspired concentration- higher = faster (overpressure), solubility lower =faster, Alveolar ventilation - increased= faster, Cardiac output - lower = faster, Alveolar- venous difference - smaller = faster

18
Q

Potency

A

Concentration of volatile anesthetics measured as partail pressure or % by volume. -site of action is the brain - but difficult to measure anesthetic concentration. -Use alveolar concentration as a surrogate for brain concentration.

19
Q

MAC (Minimum Alvelar Concentration)

A

-Alveolar partial pressure of an inhaled anethetic that prevents movement of 1/2 the subjects in response to a noxious stimulus -The lower the MAC the more potent the drug. -MAC of individual drugs are additive -Amnesia occurs at 0.2-0.4 MAC

20
Q

Factors affecting MAC

A

Decreases MAC (Extreems of age, hypothermia, hypotensino, other CNS depressents (opioids, alcohol) Increases MAC (youth, vigor, hyperthermia, drug tolerance)

21
Q

Nitrous Oxide

A

Bone marrow depression and peripheral nueropathies w/long-term exposure -Diffusion into and expansion of closed gaseous spaces (bowel, pneumothorax)

22
Q

What are some disadvantages to Fentanyl?

A

Patient recall during a surgery.

23
Q

What are some disadvantages of using Desflurane?

A
  • has high incidence of coughing
  • sometimes brochospasms
24
Q

What is a cause of malignant hyperthermia?

A
  • halogenated anesthetics
  • skeletal muscle relaxants (succinylcholine and tubocurarine)
25
Q

What is the genetic presdiposition of malignant hyperthermia?

A
  • Mutations in the gene for ryanodine receptor of L-type calcium channels
26
Q

What should you use for treatment of Malignant hyperthermia?

A
  • Dantrolene
  • MOA: prevents release of calcium from the sarcoplasmic reticulum of skeletal muscle cells.
27
Q

Which inhalation anesthetic has the fastest onset?

  • A) Enflurane
  • B) Isolflurane
  • C) Nitric oxide (NO)
  • D) Nitrogen dioxide (NO2)
  • E) Nitrous oxide (N2O)
A

anwser is E. Nitrous oxide (N2O) this is used an inhalation anesthetic agent.

  • realize that they can trick you on the names or just give you the molecular formula.
  • Nitric oxide (NO) powerful vasodilator
  • NO2:is a pulmonary irritant generated in fermenting silage; it may cause lethal pulmonary damage in farm workers.
28
Q

What does ketamine do?

A
  • causes analgesia and amnesia
  • preservation of muscle tone and minimal depression of repiration.
29
Q

What local anesthetic is reversed by flumazenil?

A
  • Midazolam
  • fluazenial (is a benzodiazepine receptor antagonist.
30
Q

Which drug is associated with a high incidence of disorientation , sensory and perceputal illusions and vivid dreams during recovery?

What other drug would be given to reduce the side effects of the drugs mentioned?

A
  • Ketamine
  • Must adminstrate diazepam immediately before ketamine anesthesis
    • (this reduced the incidence of these effects).
31
Q

Halothane

A

Hepatic metabolism -Rarely caused immune-mediated hepatitis

32
Q

Isoflurane

A

Weak coronary vasodilator

33
Q

Desflurane

A

Low solubility, rapid induction and emergence, Rapid increase in concentration can produce tachycardia and hypertension

34
Q

Sevoflurane

A

Least pungent volatile anesthetic Bronchodilator

BMB W9 (9 decks)

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