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Pharmacology > Anaesthesia > Flashcards

Anaesthesia Flashcards

1
Q

What is the affect of anesthetics on the body?

A

Depress CNS, which causes:

  • Loss of conciousness
  • Loss of reponsiveness to sensory stimuli
  • Relaxation of muscles
  • Analgesia
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2
Q

In what forms are general anesthetics typically administered?

A
  • Volatile liquids or gases vaporized in oxygen

- Administered by inhalation as a gas or by injection as a liquid

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3
Q

What are the 5 drug responses of general anesthesia?

A
  • Analgesia
  • Amnesia
  • Inhibition of reflexes
  • Skeletal muscle relaxation
  • Rapid hypnosis
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4
Q

Can a single drug provide all 5 drug responses of general anesthesia? What must be done to have all 5 effects?

A

No.

Must combine multiple drugs

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5
Q

What other benefits can combinations of general anesthetics provide besides producing all 5 drug responses?

A
  • Reduce dosing requirements, increasing safety
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6
Q

What are the 4 stages of general anesthesia?

A

1: Analgesia/ Loss of pain
2: Excitement and hyperactivity
3: Surgical Anesthesia
4: Imminent Death/ Paralysis of medulla

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7
Q

What stage of general anesthesia should be patients be in during surgery?

A

Stage 3

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8
Q

What is manipulated depending on the type of surgery in terms of stages of surgical anesthesia?

A

Different planes of stage 3

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9
Q

What are the 5 mild adverse effects of gas anesthesia?

A
  • Dizziness
  • Drowsiness
  • Nausea
  • Euphoria
  • Vomiting
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10
Q

What are the 3 more severe adverse effects of gas anesthesia?

A
  • Malignant hyperthemia
  • Apnea
  • Cyanosis
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11
Q

What are the 3 mild adverse effects of volatile liquid anesthesia?

A
  • Drowsiness
  • Nausea
  • Vomiting
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12
Q

What are the 4 more severe adverse effects of volatile liquid anesthesia?

A
  • Myocardial depression
  • Marked hypotension
  • Pulmonary vasoconstriction
  • Hepatotoxicity
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13
Q

What is the Minimum Alveolar Concentration? What are the 2 units?

A
  • Concentration of drug in gas form at which 50 % of patients do not move during surgery.
  • Percent of gas mixture, or percent 760 mmHg pressure
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14
Q

What is the relation of MAC to anesthetic potency?

A
  • MAC is inversely proportional to anesthetic potency
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15
Q

What is the number 1 factor for variation in MAC?

A
  • Age of the patient
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16
Q

What is meant by MAC having a steep dose-response curve?

A
  • Small jump in dosage between the stages of anesthesia
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17
Q

What is the mechanism of action of general anesthetics?

A
  • They are highly lipophilic, which disrupts the membrane lipid bilayer of cells
  • Increases threshold to fire
  • Also penetrates blood brain barrier
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18
Q

What 3 factors affect MAC?

A
  • Pulmonary ventilation
  • Pulmonary blood flow
  • Water solubility
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19
Q

How does pulmonary ventilation affect MAC?

A

The more rapidly air is exchanged, the more rapidly anesthesia is achieved

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20
Q

How does pulmonary blood flow affect MAC?

A

Faster blood flow through alveoli –> longer it takes for concentration to increase

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21
Q

How does water solubility affect MAC?

A

More water soluble will mix in watery blood reservoir before sufficient concentrations reach levels capable of inducing unconsciousness. More water soluble –> less potent.

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22
Q

What are the 5 pharamacological effects of general anesthesia?

A
  • Block flow of sodium into neurons
  • Enhance inhibitory action of GABA
  • Delays impulses and reduces neural activity
  • Produces unconsciousness
  • Produces lack of responsiveness to painful stimuli
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23
Q

In what type of situations is intravenous anesthesia used?

A

When short duration anesthesia is required (out patient surgery)

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24
Q

What does intravenous anesthetic typically supplement?

A
  • Inhalation anesthetics
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25
Q

What is administered first; IV or inhalation anesthetics?

A
  • IV
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26
Q

Which type of anesthesia will rapidly induce unconsciousness?

A
  • IV anesthesia
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27
Q

What type of IV anesthetic will have a rapid and potent onset, but without analgesia?

A

Barbituate

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28
Q

What are 2 barbiturates used for IV anesthesia?

A
  • Thiopental

- Methohexital

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29
Q

What type of IV anesthetic produces sedation, but not analgesia, and will also produce amnesia?

A

Benzodiazepines

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30
Q

What are 3 examples of benzodiazepines?

A
  • Diazepam
  • Lorazepam
  • Midazolam
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31
Q

What type of IV anesthetic provides strong analgesia, and is useful for intra-operative pain?

A

Opioids

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32
Q

What is an example of an Opoid used as an IV anesthetic?

A

Fentanyl

33
Q

What type of IV anesthetic is used during procedures in the ICU?

A

Propofol

34
Q

What type of IV anesthetic produces good analgesia and delusions, and is rarely used in adults?

A

Ketamine

35
Q

** Come back to slide 16 **

A

** Come back to slide 16 **

36
Q

What are the 5 techniques for applying local anesthetics?

A
  • Topical
  • Nerve block
  • Infiltration
  • Spinal
  • Epidural
37
Q

What is the effect of local anesthetics?

A

Rapid loss of sensation in a limited part of the body

38
Q

How do local anesthetics block sensation?

A

Stop axonal conduction by blocking sodium channels

39
Q

What are the 2 types of local anesthetics?

A
  • Amides

- Esters

40
Q

Why may local anesthetics be contraindicated in patients with cardiovascular conditions?

A
  • Have antiarrhythmic properties
41
Q

How long does short-acting procaine last?

A

1 hour

42
Q

How long does intermediate-acting-lidocaine last?

A

1 - 2.5 hours

43
Q

How long does long-acting teracaine last?

A

3 - 9 hours

44
Q

Why are vasoconstrictive substances such as norepinephrine co-administered with local anesthetics?

A
  • Limit absorption and concentrate local anesthetics at site of injection
  • Also limit bleeding
45
Q

To what are topical anesthetics applied?

A

Directly to the skin or mucous membrane

46
Q

What is the major drug of topical anesthetics? What are the 2 more minor drugs?

A

Benzocaine is major

Lidocaine and tetracaine are minor

47
Q

What is the use of a topical anesthetic?

A
  • Relieve or prevent pain from minor burns, irritation, itching
  • Also numb area before injection
48
Q

What type of adverse effects can be expected from topical anesthetics?

A
  • Skin irritation

- Hypersensitivity reactions

49
Q

What are the 2 types of muscle relaxants?

A
  • Neuromuscular blockers

- Spasmolytics

50
Q

Which type of muscle relaxant is used to cause paralysis, and as an adjunctive to anesthesia?

A

Neuromuscular blockers

51
Q

Which type of muscle relaxant is used to reduce spasticity in a variety of neurologic disorders?

A

Spasmolytics

52
Q

What are the 3 indications for neuromuscular junction blockers?

A
  • Surgery
  • Muscle spasms from electrically induced convulsions
  • Patients fighting mechanical ventilation
53
Q

What are the 2 types of NMJ blockers?

A
  • Non-depolarizing agents

- Depolarizing agents

54
Q

What are 4 non-depolarizing NMJ blocker drugs?

A
  • Tubocurarine
  • Pancuronium bromide
  • Pipecuronium
  • Vecuronium
55
Q

Do NMJ non-depolarizing blockers cross the blood-brain barrier?

A

No.

56
Q

Do NMJ blockers affect the CNS?

A

No.

57
Q

Is anesthesia induced before or after NMJ blockers are applied?

A

Before

58
Q

What type of drug may reverse tubocurarine (a non-depolarizing NMJ blocker)?

A
  • Anticholinesterases
59
Q

What is the most common depolarizing NMJ blocker?

A
  • Succinylcholine
60
Q

What is the mechanism of action of succinylcholine?

A
  • Excessive depolarization

- Desensitizes muscles rendering them unresponsive

61
Q

** See slide 25 **

A
    • See slide 25 **

- Assess the different levels at which the drug may block the endplate

62
Q

How are tonic stretch reflexes affected in spasticity?

A
  • Increased
63
Q

Are flexor or extensor muscle spasms caused more commonly in spasticity?

A

Flexor

64
Q

Are muscles weaker or stronger in spasticity?

A

Weaker

65
Q

What internal systems of motor systems are affected by spasticity?

A

Reflex arcs

66
Q

Why are motor neurons hyper excitable in spasticity?

A

Loss of inhibition from higher centers.

Upper motor neuron lesion

67
Q

What type of NMJ is used to block spasticity?

A

Spasmolytics

68
Q

What are the 4 types of central spasmolytics?

A
  • Carisoprodol
  • Baclofen
  • Diazepam
  • Tizanidine
69
Q

What central spasmolytic is used to treat acute, painful musculoskeletal conditions due to trauma, inflammation, and anxiety?

A

Carisoprodol

70
Q

What central spasmolytic is used for acute and chronic spasticity, especially in patients with spinal cord lesions or cerebral palsy?

A

Diazepam

71
Q

What central spasmolytic enhances pre and postsynaptic inhibition in the spinal cord, as well as nociceptive transmission?

A

Tizanidine

72
Q

What central spasmolytic is a GABA analog that acts at GABA receptors depressing neuronal activity and frequency and degree of muscle spasms/ tone?

A

Baclofen

73
Q

Why is Baclofen the drug of choice?

A
  • Less sedation than diazepam

- Less peripheral muscle weakness than dantrolene

74
Q

What drug is indicated for patients with spinal cord lesions caused by multiple sclerosis or trauma?

A

Baclofen

75
Q

What type of administration is Baclofen given when spasticity/ pain are nonresponsive to medication by other routes of administration?

A

Intrathecal

76
Q

What central spasmolytic is vicadin?

A

Diazepam

77
Q

What spasmolytic is most effective for spasticity with a cerebral origin, such as MS or CP?

A
  • Dantrolene
78
Q

Why is dantrolene effective when treating MS or CP?

A
  • It works direction on the muscle
79
Q

How does Dantrolene work directly on the muscle?

A

It inhibit calcium release necessary for muscle relaxation

Pharmacology (9 decks)

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