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4 Clinical Pharmacology and Intro to Prescribing > 17 Anaesthetics > Flashcards

17 Anaesthetics Flashcards

1
Q

How are anaesthetics administered IV?

A

Administer to:

  • achieve plasma concentration at which specific end point reached (eg loss of eyelash reflex)

How?:

  • Initial induction bolus
  • Infusion system to maintain unconcious state
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2
Q

What does the blood:gas partition mean in terms of anaesthetics? What does a low value mean?

A

Blood:Gas partition= describes solubility of a volatile anaesthetic in blood

Low value= fast induction and recovery of patient

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3
Q

What does the Oil:Gas partition describe in terms of anaesthetics?

A

Oil:Gas partition: solubility in fat- determines potency

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4
Q

Why is it that it can take patients a long time to wake up if they have a high oil:gas partition?

A

Higher Oil:Gas partition- greater ability of anaesthetic to travel through fat

Anaesthetic can accumulate in fat - takes longer for patient to wake up

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5
Q

Give 3 examples of local/regional anaesthetics which can be used.

A
  1. Lidocaine
  2. Bupivacaine
  3. Ropivacaine
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6
Q

Administering anaesthetics involves the use of polypharmacy. What are the 6 steps involved?

A
  1. Premedication
  2. Induction
  3. Analgesia (usually opioid)
  4. Muscle paralysis
    1. Facilitate intubation
  5. Maintenance
    1. Typically gaseous
  6. Reversal and provision for PONV
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7
Q

Volatile anaesthetic potency is described in terms of minimum alveolar concentration.

What is the minimum alveolar concentration? (with relation to anaesthetics)

A

[Alveolar] (at 1atm) at which 50% of subjects fail to move to surgical stimulus

At equilibrium [alveolar]=[spinal cord]

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8
Q

List some factors that increase MAC (anaesthetics). (4)

A
  1. Age
  2. Hyperthermia
  3. Pregnancy
  4. Alcoholism
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9
Q

Other anaesthetics and opioids decrease MAC. What substance is commonly added to other volatile anaesthetics to decrease the MAC (less of drug needed so less side effects) and why?

A

Nitric oxide added- venodilates

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10
Q

What stages do we use to describe the level at which anaesthetics are working? What are the different stages?

A
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11
Q

There are 3 types of targets which are targeted by anaesthetic drugs. What are these 3 targets?

A
  1. GABA receptors (most anaesthetics)
  2. NMDA Glutamate receptors
  3. Voltage Gated Sodium channels
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12
Q

How do anaesthetics that target GABA receptors work?

(modulate balance between Glutamate- excitatory and GABA- inhibitory)

A
  • Cl- ions flow into cell
  • Cell hyperpolarises
  • Can’t produced AP
  • Depressed neural activity

Depressed reticular system inc:

  • Hippocampus- memory
  • Brainstem- CVS and resp
  • Spinal cord- analgesia
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13
Q

What compounds act on NMDA Glutamate receptors as anaesthetics?

A

Xenon (good neuroprotective anaesthetic)

N2O

Ketamine

(glutamate used to wake patients up)

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14
Q

How do voltage gated sodium channel blockers work as anaesthetics?

(usually local anaesthetics)

A

Local anaesthetics-charged once inside cell

Charged agents blocks voltage gated soidum channel

Channel blocked- Na can’t pass through

AP can’t be achieved

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15
Q

What are the 2 ways we can administer general anaesthetics?

A
  1. Inhalation (volatile)
  2. Intravenous
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16
Q

What is conscious sedation and how is it carried out?

A

Use of small amounts of anaesthetic or benzodiazapines to produce ‘sleepy’ state (maintain verbal contact but feel comfortable)

17
Q

Give some examples of IV anaesthetics.

A
  1. Propofol
  2. Barbiturates
  3. Etomidate
  4. Ketamine
18
Q

Anaesthesia is a combination or 4 effects on the body. What are these 4 effects?

A
  1. Analgesia
  2. Hyponosis (LOC)
  3. Depression of spinal reflexes
  4. Muscle relaxation
19
Q

In what order are the following functions lost as anaesthetic concentration increases?

  1. Cardiovascular response
  2. Conciousness
  3. Movement
  4. Memory
A

Memory

Conciousness

Movement

CVS response

20
Q

How do the loacl anaesthetics esters and amides differ in terms of length of action?

A

Esters= short acting

Amides= long acting

4 Clinical Pharmacology and Intro to Prescribing (27 decks)

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