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Pharm U3 > 8) General Anesthetics > Flashcards

8) General Anesthetics Flashcards

1
Q

What is the class for Nitrous Oxide

A

Inorganic gas

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2
Q

What is the mechanism for Nitrous Oxide

A

NMDA receptor antagonist

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3
Q

What are the therapeutics for Nitrous Oxide

A

Mask induction in children; adjuvant to volatile anesthetics, opioids

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4
Q

What are the important side effects for Nitrous Oxide

A

Post-operative nausea and vomiting; inactivates vitamin B (leading to abnormal embryonic development, abortion); accumulates in closed, air-containing spaces (bowel, middle ear, pneumothoraces, air emboli) because N2O insoluble in blood

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5
Q

What are the miscellaneous for Nitrous Oxide

A

No muscle relaxation

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6
Q

What is the class for Isoflurane (Forane)

A

Volatile anesthetic

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7
Q

What is the mechanism for Isoflurane (Forane)

A

Most potent

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8
Q

What are the therapeutics for Isoflurane (Forane)

A

Gold standard for maintenance of anesthesia

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9
Q

What are the important side effects for Isoflurane (Forane)

A

Pungent; dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; increase in HR; malignant hyperthermia

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10
Q

What is the class for Desflurane (Suprane)

A

Volatile anesthetic

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11
Q

What is the mechanism for Desflurane (Suprane)

A

Least soluble, least potent (allows for rapid emergence from anesthesia)

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12
Q

What are the therapeutics for Desflurane (Suprane)

A

Maintenance of anesthesia

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13
Q

What are the important side effects for Desflurane (Suprane)

A

Most pungent (airway irritation symptoms); dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; increase in HR; malignant hyperthermia

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14
Q

What is the class for Sevoflurane (Ultane)

A

Volatile anesthetic

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15
Q

What is the mechanism for Sevoflurane (Ultane)

A

Less soluble, less potent (but not irritating)

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16
Q

What are the therapeutics for Sevoflurane (Ultane)

A

Mask induction in children and adults; maintenance of anesthesia

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17
Q

What are the important side effects for Sevoflurane (Ultane)

A

Can form CO if not combined with CO2 correctly; dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; malignant hyperthermia

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18
Q

What is the class for Methohexital (Brevital)

A

Barbiturates

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19
Q

What is the mechanism for Methohexital (Brevital)

A

GABAa receptor agonist, antagonist of NMDA-glutamate receptor; produce hypnosis & sedation, but is anti-analgesic

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20
Q

What are the therapeutics for Methohexital (Brevital)

A

Induce general anesthesia

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21
Q

What are the miscellaneous for Methohexital (Brevital)

A

Redistribute from brain to muscle and fat, metabolized by liver; dosed based on lean body mass

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22
Q

What is the class for Propofol (Diprivan)

A

Alkylphenol (a fatty acid)

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23
Q

What is the mechanism for Propofol (Diprivan)

A

GABAa receptor agonist, antagonist of NMDA-glutamate receptor; some a2 receptor activity; rapid onset and offset

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24
Q

What are the therapeutics for Propofol (Diprivan)

A

Anti-emetic at low doses; induction and maintenance of general anesthesia; sedation in ICU, procedural sedation

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25
Q

What are the important side effects for Propofol (Diprivan)

A

Propofol infusion syndrome: being given for several days leads to metabolic acidosis, rhabdomyolysis, heart & renal failure, lowering of BP, bradycardia, and death (likely due to fatty acid oxidation)

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26
Q

What are the other side effects for Propofol (Diprivan)

A

Painful injection site; supports bacterial growth

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27
Q

What are the miscellaneous for Propofol (Diprivan)

A

Administered IV in a lipid emulsion (cause of pain); be aware of allergies (egg and soy in emulsion); no malignant hyperthermia

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28
Q

What is the class for Etomidate (Amidate)

A

Carboxylated imidazole

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29
Q

What is the mechanism for Etomidate (Amidate)

A

GABAa receptor agonist (only D-isomer)

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30
Q

What are the therapeutics for Etomidate (Amidate)

A

Hypnosis; no analgesic activity

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31
Q

What are the important side effects for Etomidate (Amidate)

A

Pain on administration (due to solvent, propylene glycol); involuntary myoclonic movements due to subcortical disinhibition (not a seizure); post-operative nausea and vomiting; single dose inhibits cortisol synthesis

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32
Q

What are the miscellaneous for Etomidate (Amidate)

A

Minimal cardiorespiratory depression (good agent in patients with minimal cardiac reserve)

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33
Q

What is the class for Ketamine (Ketalar)

A

Phencyclidine

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34
Q

What is the mechanism for Ketamine (Ketalar)

A

NMDA receptor antagonist, kappa opiate agonist; leads to dose-dependent unconsciousness, amnesia, analgesia

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35
Q

What are the therapeutics for Ketamine (Ketalar)

A

Sedative/anesthetic for pediatric/developmentally delayed patients; induction in patients with reactive airway disease, hypovolemia (trauma patients), cardiac disease; with propofol for IV procedural sedation; adjuvant during and after surgery to reduce opiod use; part of multimodal pain therapy regimen; depression treatment

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36
Q

What are the important side effects for Ketamine (Ketalar)

A

Stimulates sympathetic nervous system outflow; increases cerebral blood flow, ICP; emergence delerium; nystagmus, lacrimation, salivation, and dissociative anesthesia

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37
Q

What are the miscellaneous for Ketamine (Ketalar)

A

Racemic mixture (S more potent); metabolized by P450 (norketamine, a third to a fifth as effective); great bronchodilator; contraindicated in CAD patients and those with with intracranial lesions

38
Q

What is the class for Dexmedetomidine (Precedex)

A

a2 adrenergic agonist

39
Q

What is the mechanism for Dexmedetomidine (Precedex)

A

Binds a2a and a2b in locus coeruleus and spinal cord (produces sedation, sympatholysis, and analgesia)

40
Q

What are the therapeutics for Dexmedetomidine (Precedex)

A

Awake intubations, awake craniotomies; adjunct to general anesthesia in patients susceptible to narcotic-induced post-op respiratory depression; withdrawal/detoxification

41
Q

What are the important side effects for Dexmedetomidine (Precedex)

A

Limited respiratory depression (wide safety margin)

42
Q

What are the miscellaneous for Dexmedetomidine (Precedex)

A

Since GABA not hit, sedation is easier to wake from and is similar to non-REM sleep; FDA approved only for ventilation of ICU patients for under 24 hours

43
Q

What is the class for Succinylcholine (Anectine)

A

Depolarizing NMB

44
Q

What is the mechanism for Succinylcholine (Anectine)

A

Divalent ACh molecule; attaches to all ACh receptors, overstimulating them (first seen as disorganized muscular contractions (fasiculations), then paralysis)

45
Q

What are the therapeutics for Succinylcholine (Anectine)

A

Skeletal muscle relaxant (intubation)

46
Q

What are the important side effects for Succinylcholine (Anectine)

A

Malignant hyperthermia; cardiac dysrhythmias, hyperkalemia, increased intraocular pressure, increased intracranial pressure

47
Q

What are the other side effects for Succinylcholine (Anectine)

A

Increased intragastric pressure, myalgias, masseter spasm

48
Q

What are the miscellaneous for Succinylcholine (Anectine)

A

Hydrolyzed by pseudocholinesterase (in plasma); blockade cannot be reversed; only NMB with rapid onset and ultra-short duration of action

49
Q

What is the class for Pancuronium (Pavulon)

A

Amino steroid non-depolarizing NMB

50
Q

What is the mechanism for Pancuronium (Pavulon)

A

Competitive blockade of ACh (no depolarization); vagolytic

51
Q

What are the therapeutics for Pancuronium (Pavulon)

A

Skeletal muscle relaxant; avoid in patients with renal insufficiency

52
Q

What are the important side effects for Pancuronium (Pavulon)

A

Increase in HR

53
Q

What are the miscellaneous for Pancuronium (Pavulon)

A

Only long acting non-depolarizing agent; supplied as liquid; 80% excreted unchanged in liver (low metabolism in liver); reverse with AChEI

54
Q

What is the class for Vecuronium (Norcuron)

A

Amino steroid non-depolarizing NMB

55
Q

What is the mechanism for Vecuronium (Norcuron)

A

Competitive blockade of ACh (no depolarization)

56
Q

What are the therapeutics for Vecuronium (Norcuron)

A

Skeletal muscle relaxant

57
Q

What are the important side effects for Vecuronium (Norcuron)

A

No cardiovascular effects

58
Q

What are the miscellaneous for Vecuronium (Norcuron)

A

Intermediate acting; supplied as a powder (reconstitute); hepatic metabolism, hepatic and renal excretion; reverse with AChEI

59
Q

What is the class for Rocuronium (Zemuron)

A

Amino steroid non-depolarizing NMB

60
Q

What is the mechanism for Rocuronium (Zemuron)

A

Competitive blockade of ACh (no depolarization)

61
Q

What are the therapeutics for Rocuronium (Zemuron)

A

Skeletal muscle relaxant (can substitute succinylcholine in rapid sequence intubation)

62
Q

What are the important side effects for Rocuronium (Zemuron)

A

No cardiovascular effects

63
Q

What are the miscellaneous for Rocuronium (Zemuron)

A

Intermediate acting; supplied as a liquid; hepatic metabolism, hepatic and renal excretion; can speed onset with higher dose; reverse with AChEI

64
Q

What is the class for Sugammadex (Bridion)

A

Selective relaxant binding agent

65
Q

What is the mechanism for Sugammadex (Bridion)

A

Complexes with rocuronium, rendering it inactive; no effect on AChesterase

66
Q

What are the therapeutics for Sugammadex (Bridion)

A

Immediate reversal of rocuronium

67
Q

What are the important side effects for Sugammadex (Bridion)

A

Decrease in blood presure, nausea and vomiting, dry mouth

68
Q

What are the miscellaneous for Sugammadex (Bridion)

A

Not yet FDA approved

69
Q

What is the class for Atracurium (Tracrium)

A

Isoquinoline non-depolarizing NMB

70
Q

What is the mechanism for Atracurium (Tracrium)

A

Competitive blockade of ACh (no depolarization)

71
Q

What are the therapeutics for Atracurium (Tracrium)

A

Skeletal muscle relaxant; use in patients with liver or renal dysfunction

72
Q

What are the important side effects for Atracurium (Tracrium)

A

Histamine release (especially if given as rapid IV bolus), with resultant hypotension and tachycardia

73
Q

What are the miscellaneous for Atracurium (Tracrium)

A

Undergoes spontaneous, non-enzymatic degradation (Hofman elimination); intermediate acting; reverse with AChEI

74
Q

What is the class for Cis-atracurium (Nimbex)

A

Isoquinoline non-depolarizing NMB

75
Q

What is the mechanism for Cis-atracurium (Nimbex)

A

Competitive blockade of ACh (no depolarization)

76
Q

What are the therapeutics for Cis-atracurium (Nimbex)

A

Skeletal muscle relaxant; use in patients with liver or renal dysfunction

77
Q

What are the important side effects for Cis-atracurium (Nimbex)

A

Unlike atracurium, no histamine release or downstream effects

78
Q

What are the miscellaneous for Cis-atracurium (Nimbex)

A

Undergoes spontaneous, non-enzymatic degradation (Hofman elimination); intermediate acting; reverse with AChEI

79
Q

What is the class for Edrophonium (Enlon)

A

AChE-I

80
Q

What are the therapeutics for Edrophonium (Enlon)

A

Reversal of NMB

81
Q

What are the miscellaneous for Edrophonium (Enlon)

A

Short-acting, fast onset

82
Q

What is the class for Neostigmine (Prostigmin)

A

AChE-I

83
Q

What are the therapeutics for Neostigmine (Prostigmin)

A

Reversal of NMB (most commonly used)

84
Q

What are the miscellaneous for Neostigmine (Prostigmin)

A

More complete antagonism than edrophonium

85
Q

What is the class for Pyridostigmine (Mestinon)

A

AChE-I

86
Q

What are the therapeutics for Pyridostigmine (Mestinon)

A

Reversal of NMB

87
Q

What are the miscellaneous for Pyridostigmine (Mestinon)

A

Longer duration of action than neostigmine, edrophonium

88
Q

What is the class for Glycopyrrolate (Robinul)

A

Anti-muscarinic

89
Q

What are the therapeutics for Glycopyrrolate (Robinul)

A

Reversal of neuromuscular blockade’s muscaranic effects

90
Q

What are the important side effects for Glycopyrrolate (Robinul)

A

DUMBELLS

91
Q

What are the miscellaneous for Glycopyrrolate (Robinul)

A

Could also use atropine

Pharm U3 (13 decks)

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