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303 MEDIMAGE > 11b. Drugs used in radiology II: anaesthetics and analgesics - Anasthetics > Flashcards

11b. Drugs used in radiology II: anaesthetics and analgesics - Anasthetics Flashcards

1
Q

what is anasthetics

A

controlled and reversible loss of conciousness, loss of pain perception and/or amnesia

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2
Q

what 5 reversible effects do general anaesthesia typically require

A 
immobility
analgesia
amnesia
unconciousness
supression of stress response
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3
Q

what is local anasthesia

A

blockade of pain perception from peripheral nerves

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4
Q

what are the 2 ways that GA is administered

A

IV or inhalation

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5
Q

what 4 agents does GA require

A

induction
maintenance
analgesia
+/- paralysis

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6
Q

what is induction of GA

A

going off to sleep

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7
Q

what is maintenance of GA

A

staying asleep

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8
Q

how is GA induced - 2 ways

what is the most common way

A

IV or inhalation

generally IV as in inhalation you get agitation which is hard to deal with in adults

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9
Q

how is GA maintained - 2 ways

A

IV or inhalation

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10
Q

do acute patients get GA via IV or inhalation

A

IV

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11
Q

do paeds patients get GA via IV or inhalation

A

inhalation

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12
Q

how does GA work

A

no unifying theory of how GA works

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13
Q

are current GA agents selective for a single ion channel

A

no

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14
Q

many IV anesthetics do what to the inhibitory effects

what is an exception

A

enhance inhibitory effects by acting on GABA receptors leading to unconsciousness and amnesia

ketamine is an exception

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15
Q

what receptors does ketamine target

A

NMDA receptors

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16
Q

how do inhalation anaesthetics work in terms of where does it act

A

act on both brain and spinal cord

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17
Q

what does inhalation anaesthetics do to inhibitory pathways and how

A

increase inhibitory pathways through GABA neurotransmitter release and increased GABA receptor activity

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18
Q

what does inhalation anaesthetics do to excitatory pathways and how

A

suppress excitatory pathways through reduced glutamate release and increased GABA receptor activity

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19
Q

what is the IV anaesthetic agent for propofol

A

diakeylphenol

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20
Q

what is the most widely used IV anaesthetic

A

propofol

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21
Q

what is propofol used for in terms of anesthesia

A

induction or maintenance and sedation

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22
Q

propofol’s action is mostly via what

A

GABA

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23
Q

how is propofol formulated

A

formulated in lipid emulsion as it has low water solubility

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24
Q

what is propofol’s onset time and return to consciousness time like following bolus dose

A

fast for both

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25
Q

can propofol be used as infusion and why

A

yes due to rapid clearance via kidney resulting in reasonable recovery times

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26
Q

what does propofol appear white

A

poor solubility

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27
Q

what happens to the time it takes to wear off if you give propofol as an infusion

A

accumulates in body so if you give it as infusion eg for 8hrs, itll take 40 mins to wear off

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28
Q

can you give GA as intramuscular, what is the downside of this

A

yes but will only transiently cause anaesthesia and will need something else to keep it going

29
Q

does propofol offer analgesia

A

no

30
Q

what are the 5 side effects of propofol

A

pain on injection and increase in microbial growth
respiratory depressant
loss of airway reflexes
lowered BP
HR effects as rate drops with bolus, increased with low BP

31
Q

why do you need to give propofol slowly

A

due to its BP effects

32
Q

what does propofol do to your breathing and is this intentional

A

stops breathing and is intentional

33
Q

how can propofol help heart functions

A

it increases HR with low BP

34
Q

what is thiopentone’s IV anaesthetic agent

A

barbituate

35
Q

what is thiopentone used for

A

induction

no longer used for maintenance

36
Q

why is thiopentone no longer used for maintenance

A

metabolism is slow and repeated doses have a cumulative effect and recovery is much slower

has very long recovery time if given as infusion

37
Q

what kind of mixture is thiopentone and what form is more potent

A

racemic mixture

S form is 2x as potent as R form

38
Q

what does thiopentone cause - 4 things

A

sedation and hypnosis
EEG slowing but this is dose dependent
anticonvulsant effects
respiratory depression

39
Q

what is thiopentone’s lipophilicity

A

highly lipophilic

40
Q

what is the speed of thiopentone’s onset of action

A

occurs quickly after bolus dosing

lose consciousness within 30-50sec

41
Q

what dies thiopentone do to neural output and seizures

A

decreases both

42
Q

what are the 4 side effects of thiopentone

A

respiratory depressant
loss of airway reflexes
lowered blood pressure
heart rate effects = drops rate with bolus and increases with low BP

43
Q

does thiopentone have analgesia properties

A

no

44
Q

what kind of sedation does ketamine provide

A

dissociative sedation

45
Q

does ketamine provide analgesia

A

yes

46
Q

what does ketamine do to NMDA receptors

A

antagonist at NMDA receptors in spinal cord and brain to mediate analgesia

47
Q

most anaesthetics do what to sympathetic tone

A

decreases it

48
Q

what does ketamine do to CO and vasc resistance

A

increases CO and vascular resistance

49
Q

what does ketamine do to resp drive and muscle tone

A

maintains respiratory drive and muscle tone with bronchodilation

50
Q

in what conditions should ketamine be avoided and why

A

neuroanaesthesia due to cerebral blood flow (theoretical risk of increasing intracerebral pressure that can worsen injury)

51
Q

what are 3 side effects of keetamine

A

intense dreams/nightmares/hallucinations/delirium
dose related increase in HR and BP
hypersalivation, nausea and vomiting

52
Q

is there loss of airway reflexes and respiratory depression in ketamine use

A

no, less respiratory depression than other drugs

53
Q

why is ketamine a commonly used field and emergency dept anaesthetic - 4 reasons

A

can be given intramuscularly via injection if no IV access

increases HR and BP by sympathetic stimulation = good for the bleeding unstable patient

doesnt depress respiration and maintains airway reflexes

provides analgesia

provides analgesia

54
Q

what are the 3 classes of inhalational agents

A

esthers
alkanes
gases

55
Q

what is the potency of inhalational agents

A

potency is related to lipid solubility

56
Q

how are inhalational agents taken in body

A

lungs alveolus -> blood -> brain

57
Q

what is inhalational agents’ onset wash in related to

4 things

A

conc delivered
flow rate of gas delivered
ventilation
cardiac output

58
Q

how is ventilation related to an inhalational agents’s onset

A

increased vent = increase speed of onset

59
Q

how is cardiac output related to an inhalational agents’s onset

A

Low CO = slow delivery blood to lungs = blood has more time to pick up agent = fast onset

60
Q

metabolism of inhalation agents is via what

A

P450s and metabolised by liver

61
Q

inhalation is commonly used for maintenance for which people

A

children

62
Q

inhalation agents have an effect on where

A

brain and spinal cord

63
Q

what is sedation

A

drug induced state of reduced level of consciousness that allows tolerance of an uncomfortable or painful procedure

64
Q

what is sedation a continuum of

A

minimal to general anasthesia

65
Q

what are 4 examples of sedative agents

A

benzodiazepines
ketamine
Propofol
opioids

66
Q

what do benzodiazepines bind to

A

receptor sites in GABA system

67
Q

what is the most commonly used benzodiazepines

A

midazolam

68
Q

what are 3 uses of benzodiazepines - midazolam

A

anxiolysis
sedation
amnesia

69
Q

what are the 5 side effects of benzodiazepines midazolam

A 
no analgesia
respiratory depressant
loss of airway reflexes
lowered BP
HR effects

303 MEDIMAGE (14 decks)

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