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Pharm Exam 3 > 36: General Anesthetic Agents > Flashcards

36: General Anesthetic Agents Flashcards

1
Q

anesthesia =

A

loss of sensation or a state without any feeling

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2
Q

advantages and disadvantages of general v. local anesthesia

A

local: minimal system disturbance, but may not be adequate
general: body wide anesthesia, but disturbance of all organ systems

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3
Q

general anesthesia =

A

clinical state where there is an induced loss of consciousness or total insensibility in a reversible manner

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4
Q

general anesthesia is associated with _____ respiration and __________ blood pressure

A

decreased; decreased

myocardial depression and vasodilation

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5
Q

“triad of anesthesia”

A

asleep
pain-free
still

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6
Q

6 characteristics of ideal anesthetic agent

A
  • unconsciousness
  • amnesia
  • analgesia
  • skeletal muscle relaxation
  • areflexia
  • good minute-to-minute control
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7
Q

why are adjuvant drugs used prior to anesthesia?

A

to make it more safe and pleasant

  1. relieve anxiety = benzodiazepines
  2. prevent allergic reactions = antihistaminics
  3. prevent nausea and vomiting = antiemetics
  4. provide analgesia = opiods
  5. prevent bradycardia and secretion = atropine and glycopyrrolate
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8
Q

what kinds of clinical conditions might be important to know about when a patient is to undergo anesthesia?

A

**prior anesthetic history of patient and blood relatives

  • family history of malignant hypothermia
  • cardiovascular problems
  • respiratory disease
  • allergies to medicine and food
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9
Q

4 phases of general anesthesia

A
  • induction
  • maintenance
  • emergence
  • recovery
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10
Q

4 stages of general anesthesia

A

I: analgesia
II: excitement
III: surgical anesthesia
IV: medullary depression

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11
Q

what are inhalable anesthetics generally used for?

A

maintenance of anesthesia

can be used for induction in pediatrics

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12
Q

what are IV or fixed anesthetics generally used for?

A

induction and short surgical procedures

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13
Q

what ion channels may anesthetics alter?

A
  • increase GABAa receptor Cl- channel activity
  • activate voltage-gated K channels
  • inhibit glutamate NMDA receptors
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14
Q

advantages of inhalable anesthetic agents over IV

A

+ easy to control depth of anesthesia
+ readily reversible, minute-to-minute control

  • induction not as fast or smooth as with fixed agents
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15
Q

increasing inspired anesthetic concentration in inspired air —> _________ partial pressure in lungs —>

A

increased

faster achievement of anesthetic concentration in the blood

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16
Q

increasing alveolar ventilation —> ____ gas molecules/time —>

A

more

faster anesthesia onset; better ventilation results in more rapid onset of anesthesia

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17
Q

partial pressure of anesthetics with higher solubility are affected by _______

A

ventilation rate

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18
Q

what does the otswald coefficient tell you?

A

solubility in blood

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19
Q

lower otswald coefficient –> _____ soluble —> ______ rise in partial pressure in blood —> ______ equilibration with brain and induction

A

less; more rapid; faster

ex: NO which is less soluble reaches a higher partial pressure in the blood faster and thus is able to reach anesthetic concentrations in the brain more rapidly

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20
Q

brain:blood partition coefficient is related to…

A

solubility in lipid

more soluble = more potent

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21
Q

high pulmonary blood flow = ______

lower pulmonary blood flow = _________

A

slower onset

faster onset

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22
Q

the greater the uptake of an agent, the alveolar concentration rises _________ —> ____ rate of induction

A

slower
slower

ex: insoluble agents are taken up slowly –> alveolar concentration rises fast –> fast induction

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23
Q

less soluble per otswald coefficient = ______ elimination

A

faster

24
Q

what is minimum alveolar concentration MAC?

A

the concentration of anesthetic in the inspired air at equilibrium when there is no response to noxious stimulus in 50% of patients

25
Q

lower MAC = ____ potent anesthetic

A

more

26
Q

higher lipid solubility = _______ potent anesthetic

A

more

lower MAC

27
Q

anesthesia is produced when anesthetic px is brain is ____ MAC

A

greater than or equal to

28
Q

MAC values of inhaled anesthetics are _______

A

additive

ex: nitrous oxide can be used as a carrier gas producing40% of a MAC, therby decreasing the anesthetic requirement of both volatile and IV anesthetics

29
Q

CNS depressants _______ MAC

A

decrease

elderly also decreases MAC; young increases

30
Q

“laughing gas”

A

nitrous oxide

31
Q

pros and cons of nitrous oxide

A

pro: rapid onset and recovery, good analgesia, safe!
con: incomplete anesthetic; insufficient potency for surgical anesthesia, lack of potency

32
Q

“2nd gas effect”

A

reduces the induction time for the primary agent

ex: No speeds up mask induction of sevoflurane
decreases: induction time for primary agent, required concentration of primary agent, and toxicity of primary agent

33
Q

2 major side effects of NO2

A
  1. diffusion hypoxia (with abrupt discontinuation it quickly diffuses out of the body into the alveoli and dilutes oxygen)
  2. increased risk of spontaneous abortion and decreased probability of conception
34
Q

can NO2 be used as the sole anesthetic agent?

A

NO

analgesic for minor procedures or EMS
mostly used as complimentary agent

35
Q

effects of halogenating the volatile agents

A
  • nonexplosive and non-flammable
  • increased potency
  • increased toxicity and side effects
36
Q

systemic effects of halothane

A

decreased CO and hypotension

37
Q

side effects of enflurane

A

not as popular as others due to CNS stimulation effects

  • EEG convulsive pattern
  • jerking
  • twitching
38
Q

fastest onset and recovery halogenated agent

A

desflurane

39
Q

advantages and disadvantages for desflurane

A

+ fastest onset and recovery
+ excellent minute-minute control
- more irritating to respiratory passages than others –> bronchial irritation with cough and laryngeal spasm

40
Q

why is sevoflurane the most commonly used inhalable anesthetics?

A
  • rapid onset and recovery
  • very potent
  • excellent controllability due to low solubility and high potency
  • low airway irritation –> used for mask induction and those with irritable airway
41
Q

malignant hyperthermia?

A

occurs in genetically susceptible individuals with inhalable anesthetics combined with paralytics

42
Q

what are IV anesthetic used for?

A

induction! and maintenance of anesthesia

43
Q

major IV disadvantage

A

can’t reverse the effects, except via metabolism

44
Q

what is thiopental used for?

A

induction - not maintenance or sole anesthetic

does NOT cause any analgesia

45
Q

“milk of magnesia”

A

propofol

46
Q

99.9% of all inductions =

A

propofol

excellent quality of recovery

47
Q

which drug causes dissociative anesthesia?

A

ketamine

characterized by intense analgesia, catalepsy and amnesia

48
Q

MOA ketamine

A

non-competetive glutamate NMDA receptor antagonist

49
Q

what is emergence phenomenon?

A

unpleasant dreams, hallucinations and disorientationduring emergence

side effect of ketamine

50
Q

what agent might you want to use for a patient with compromised cardiac status?

A

ketamine

51
Q

contraindication for ketamine

A

psychiatric history

52
Q

pre-anesthetic medication = adjuvant drug. Why use them?

A
  • increase rate of induction
  • decrease anxiety
  • decrease pre and post operative pain
  • decrease side effects of general anesthetics
  • reduce amount of general anesthesia required
53
Q

what is midazolam good for?

A

sedation
amnesia
anxiolytic properties

54
Q

MOA midazolam

A

potentiation at GABAa receptors

55
Q

what are the uses for midazolam?

A

sedation for painful procedures, can be used as induction agent, or substitute for thiopental/propofol in high risk patients

Pharm Exam 3 (11 decks)

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