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supporting life > Anaesthetic agents (sedatives and opioids > Flashcards

Anaesthetic agents (sedatives and opioids Flashcards

1
Q

name 5 induction agents

A 
Propofol
 Benzodiazepines
 Barbiturates
 Etomidate
 Ketamine
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2
Q

name 5 opioids

A 
 Morphine
 Fentanyl
 Codeine
 Tramadol
 Remifentanil
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3
Q

what are the main uses of propofol

A

Anaesthetic induction, maintenance

of anaesthesia, sedation, anti-emesis.

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4
Q

what effects does propofol have on respiratory system

A

decreases tidal volume increases respiratory rate, apnoea greater than 30 secs, possible bronchodilation

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5
Q

what effects does propofol have on cardiovascular system

A

decreases cardiac output and systemic vascular resistance and bP. inhibits baroreceptor reflex, decreases myocardial blood flow, decreases oxygen consumption. can supress atrial tachycardia and it is cardio protective with anaesthetic gases

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6
Q

what are the pros of using propofol

A 
 Not an MH trigger
 No adrenal suppression
 Pleasant dreams
 Relieves pruritis from opiates
 Anti-emetic even at low doses
(10mcg/kg/min)
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7
Q

what does anti emetic mean

A

prevents vomiting and nausea

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8
Q

what are the cons of propofol

A

Anaphylactoid reactions.
 Pancreatitis (Hyper TG)
 Pain on injection (rare); thrombophlebitis
 Propofol infusion syndrome
 Acute bradycardia leading to asystole with
metabolic acidosis, rhabdo, hyperlipidemia,
fatty liver, hyperkalemia

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9
Q

what are the uses of barbiturates

A

Thiopental: Induction, cerebral protection (e.g. status epilepticus)
 Methohexital: Induction, especially for ECT
 Phenobarbital: Seizure suppression
 Anxiolysis

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10
Q

how does barbituates affect respiratory system

A

tidal volume decreases, respiratory rate decrease and apnoea

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11
Q

how does barbituates affect cardiovascular system

A

Peripheral vasodilation
Negative inotropy
Increased HR
Can prolong QT interval

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12
Q

how does barbituates affect neurological system

A 
Loss of consciousness
decreases CMRO2, decrease ICP, decreases CBF.
Seizure suppression
Prolonged effects
(Bioaccumulation)
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13
Q

how does propofol affect neurological system

A 
Loss of consciousness
Seizure suppression
Decrease ICP
Decrease IOP / CPP
Autoregulation intact
Antiemesis
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14
Q

what are cons of barbituates

A 
Garlic or onion tastes
 Allergic reactions
 Local tissue irritation or rarely necrosis
 Induction of P450 system
 Bronchoconstriction in asthmatics
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15
Q

name a short acting intermediate acting and long acting benzodiazepines

A

Midazolam (short acting)
 Lorazepam and Temazepam (intermediate)
 Diazepam (long acting)

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16
Q

what receptor does benzodiazepines act on and what are the desired effects

A

Bind to GABA-A receptor, enhance response
to GABA
 Leading to hypnotic, sedative, anxiolytic,
amnestic, anticonvulsant, muscle-relaxation
properties
 Increases seizure threshold

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17
Q

what effects does benzodiazepines have on the respiratory system

A

decreases musclar tone in upper airway, decreased response to increased co2, decrease hypoxic response

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18
Q

what effects does benzodiazepines have on the cardiovascular system

A

decrease in systemic vascular resistance. maintains cardiac output and barorecptor reflexes

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19
Q

what effects does benzodiazepines have on the neuro system

A

Anxiolysis
Sedation
Amnesia
Anticonvulsant

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20
Q

what does anxiolysis mean

A

What are Anxiolytics, sedatives, and hypnotics? Anxiolytics, sedatives and hypnotics are medicines that work on the central nervous system to relieve anxiety, aid sleep, or have a calming effect.

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21
Q

name some adverse effects of benzodiazepines

A

Lorazepam and Diazepam can cause venous irritation and thrombophlebitis
 All can have extended effects
 Post-operative delirium
 Give appearance of sleep without restorative sleep

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22
Q

why do you have to be careful using flumazenil with patients on chronic benzos

A

can cause seizures

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23
Q

what receptor does ketamine act on

A

Phencyclidine-binds to NMDA Receptor

antagonist

24
Q

which isomer is more potent in for ketamine s or r

A

S

25
Q

what is dissociative anesthesia

A

Produces “dissociative anesthesia” because
patients may not appear asleep (eyes open,
reflexes intact.caused by ketamine

26
Q

what are the main uses of ketamine

A

Anaesthetic induction
 Sedation (maintains RR, common in paeds)
 Analgesia (opioid sparing / acute procedures)
 Bronchodilatation

27
Q

what does ketamine do to respiratory system

A

increase salivation and relaxes bronchial smooth muscle, less mechanicial ventilation

28
Q

what does ketamine do to cardiovascular system

A

increase bp hr co and myocardial oxygen consumption.

increases sns and can cause pulmonary hypertension

29
Q

what does ketamine do to neuro system

A 
increases cmr02 cbf icp
Emergence reactions
Vivid dreams, Extracorporeal
experiences Hallucinations
Nystagmus
Increased muscle tone
30
Q

what is special about etomidate interaction with gaba a receptor

A

GABA-A facilitation (lower dose of GABA
required to activate receptor)
 At higher doses can activate receptor
independently

31
Q

what does etomidate do to respiratory system

A

hyperventilation followed by briefr apnea, decrease hypercapnic response

32
Q

what does etomidate do to cardiovascular system

A

haemodynamically stable, can cause increase bp and pr

33
Q

what does etomidate do to neuro system

A

No analgesic effect
Can prolong seizures in ECT
lowers cbf cmro2 and icp by 50%

34
Q

what are the endocrine effects of etomidate

A

Dose dependent inhibition of 11B-hydroxylase.
 Occurs at lower doses than hypnosis by more than 20x so suppression lasts much
longer, up to 72h
 Can be used to treat hypercortisolaemia

35
Q

what is dexmedetomidine

A

Alpha-2 receptor agonist (brain /spine)
 Used for sedation, anxiolysis, withdrawal,
delirium, opioid sparing analgesia. causes bradycardia, reduces co and initial increase in Bp

36
Q

ascending pain pathway does what with stimulus

A

transmits it to cortex where it is perceived. fast and slow efferent

37
Q

descending pain pathway does what to with stimulus

A

inhibits transmission. substantia gelantinosa

38
Q

name four opioid receptors

A

MOP mu KOP kappa DOP delta NOP noiceptors

39
Q

how do opioids work generally

A

bind to opioid receptors as agonists causing decreased release of pain transmission

40
Q

how long does it take morphine to kick in and why

A

slow acting due to low lipid solubility, slow BBB penetration to act on the brain

41
Q

describe morphine potency for recpetors

A

highly potent opioid especially for MOP > dop kop

42
Q

what is morphine used for

A

analgesia, palliation, peri operative

43
Q

what does morphine do to respiratory

A

supresses respiration and less response to co2

44
Q

what does morphine do to cardiovascular system

A

vagal centre stimulation causing bradycardia, vasomotor suppression(area of the brain for breathing and bp)

45
Q

what does morphine do to neuro system

A

sedation, analgesia, euphoria, supresses coughs, can cause vomiting

46
Q

what is receptors does fentanyl target

A

mu and delta receptors

47
Q

at what rate does fentanmyl act and why

A

fast acting high lipid soloubility enters brain rapid;y short duration of action though.

48
Q

fentanyl or morphine which is more potent

A

fentanyl

49
Q

how strong is codeine compared to fentanyl and morphine

A

not nearly as strong 50 % potency of morphine

50
Q

what receptors does codeine target

A

weakly targets mu and kappa

51
Q

what enzyme metabolises codeine(oral drug) and what do you have to consider

A

cyp2d6, cautious with ultra metabolisers and lack of efficacy in poor metabolisers, drug interactions

52
Q

comment on tramadol potency , acion, side effects and effects on cardio

A

safer cardio profile, 1/10 potency compared to morphine acts on mu receptors and downards inhibiition pathways

53
Q

what is remifentanil

A

potent mu agonist, short acting

54
Q

what are remifentanil uses

A

Sedation in ICU
 PCA in obstetrics
 Pain relief during surgery
 Total IntraVenous Anaesthesia ( TIVA)

55
Q

what is tiva

A

The provision anaesthesia solely exclusively via the intravenous route. (Propofol +
Remifentanil infusions).

56
Q

what are pros of tiva

A

Avoids conventional anaesthetic gases
 Improved cardiovascular profile
 Less nausea and vomiting
 Improved tube tolerance

57
Q

what are cons of tiva

A

Need dedicated IV line
 Based on algorithms ( Compartment model assumptions)
 Risk of awareness

supporting life (20 decks)

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