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Year 2 Medicine > Anaesthetic Drugs > Flashcards

Anaesthetic Drugs Flashcards

1
Q

What is anaesthesia?

A

A reversible drug induced absence of sensation and awareness

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2
Q

What is anaesthesia?

  • Anaesthesia is any … soluble agent that causes depression of the brain in a predictable order:
    • C…
    • M…
    • S… …
    • M…
A
  • Anaesthesia is any lipid soluble agent that causes depression of the brain in a predictable order:
    • Cortex
    • Midbrain
    • Spinal cord
    • Medulla
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3
Q

Ethanol

  • Tranquillization
  • E…
  • Dysarthria
  • Ataxia
  • S../hypnosis
  • A…
  • Coma
  • … depression
  • Death
A
  • Tranquillization
  • Excitation
  • Dysarthria
  • Ataxia
  • Sedation/hypnosis
  • Anaesthesia
  • Coma
  • Medullary depression
  • Death
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4
Q

History of anaesthetic drugs:

A
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5
Q

How do anaesthetics work?

  • Diverse range
  • … solubility
  • Cell membrane
  • Stereo-selectivity
  • Interaction with membrane proteins
  • Modulation of … gated ion channels
  • Global … in neuronal activity
A
  • Diverse range
  • Lipid solubility
  • Cell membrane
  • Stereo-selectivity
  • Interaction with membrane proteins
  • Modulation of ligand gated ion channels
  • Global depression in neuronal activity
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6
Q

How do anaesthetics work?

  • Stimulation of … receptors
    • GABAA
    • Glycine
  • Inhibition of … receptors
    • Nicotinic
    • Serotonin
    • Glutamate/NMDA
A
  • Stimulation of inhibitory receptors
    • GABAA
    • Glycine
  • Inhibition of excitatory receptors
    • Nicotinic
    • Serotonin
    • Glutamate/NMDA
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7
Q

How do anaesthetic agents stimulate inhibitory receptors - e.g. GABA(A) receptor?

A
  • GABAA
  • Pentameric
  • Single amino acids
  • influx of Chloride ions = Hyperpolarisation
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8
Q

How do we give anaesthesia?

A
  • Inhale
  • inject
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9
Q

Inhalational agents

  • …
  • … oxide
  • Ideal properties
  • Isoflurane
  • Other volatile agents
A
  • Oxygen
  • Nitrous oxide
  • Ideal properties
  • Isoflurane
  • Other volatile agents
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10
Q

Oxygen

A

is a drug

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11
Q

Oxygen – side effects

  • O2 free …
  • CNS …
  • Pulmonary oxygen toxicity
  • Retrolental fibroplasia
  • CO2 …
    • Oxygen is generally … for you
A
  • O2 free radicals
  • CNS convulsions
  • Pulmonary oxygen toxicity
  • Retrolental fibroplasia
  • CO2 narcosis
    • Oxygen is generally good for you
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12
Q

Nitrous oxide

  • Odourless gas in blue cylinder
  • Liq/vapour at 44bar
  • Poor … MAC 105%
  • Good …
  • … onset/offset
  • Cardio respiratory …
  • Neuropathy/BM …
  • 35x more soluble than N2
A
  • Odourless gas in blue cylinder
  • Liq/vapour at 44bar
  • Poor anaesthetic MAC 105%
  • Good analgesic
  • Quick onset/offset
  • Cardio respiratory depressant
  • Neuropathy/BM depression
  • 35x more soluble than N2
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13
Q

Nitrous oxide is a poor … but a good …

A

Nitrous oxide is a poor anaesthetic but a good analgesic

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14
Q

Physical properties of inhalational agents

  • Cost
  • Chemical …
  • Non-…/…
  • V…
  • E… stable
  • Effect on …
A
  • Cost
  • Chemical stability
  • Non-flammable/explosive
  • Vapourizable
  • Environmentally stable
  • Effect on enviroment
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15
Q

Chemical properties of inhalational agents

  • Non …
  • … blood:gas solubility
  • High … MAC
  • Minimal … … (pharmacodynamics)
  • Biotransformation (phamacokinetics)
  • Non-…
A
  • Non irritant
  • Low blood:gas solubility
  • High potency MAC
  • Minimal side effects (pharmacodynamics)
  • Biotransformation (phamacokinetics)
  • Non-toxic
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16
Q

Older inhalation agents

  • E…
  • Chloroform
  • Cyclopropane
  • Methoxyflurane
  • Halothane
  • Enflurane
A
  • Ether - caused sickness
  • Chloroform - caused dysrhythmias
  • Cyclopropane - highly explosive
  • Methoxyflurane - predisposition to fits
  • Halothane - modern agent, 1940’s - some stayed in body, toxic products - halothane hepatitis
  • Enflurane - better than H^, but fit predisposition
17
Q

Ether caused what ?

18
Q

Isoflurane

  • Halogenated ether
  • 1965
  • Relatively …
  • Stable and non …
  • Vapourizable BP 49C
  • … to airway
  • Relatively … MAC 1.1% B:G co 1.4
  • … effects CVS/RS
  • …% metabolised
A
  • Halogenated ether
  • 1965
  • Relatively cheap
  • Stable and non flammable
  • Vapourizable BP 49C
  • Irritable to airway
  • Relatively potent MAC 1.1% B:G co 1.4
  • Side effects CVS/RS
  • 0.2% metabolised
19
Q

Isoflurance causes what side-effects? (all IV and inhalation agents causes this)

A

CVS/RS depression

20
Q

Sevoflurane

  • Non …
  • … onset/offset
  • MAC 2%
  • …% metabolised
  • … stability
  • Emergence phenomena
  • …
A
  • Non irritable
  • Quick onset/offset
  • MAC 2%
  • 5% metabolised
  • CVS stability
  • Emergence phenomena
  • Expensive
21
Q

Desflurane

  • quick onset/offset
  • 0.02% metabolised
  • Moderately …
  • I…
  • Special …
  • MAC 6.35%
  • … damaging
A
  • quick onset/offset
  • 0.02% metabolised
  • Moderately expensive
  • Irritant
  • Special vaporizer
  • MAC 6.35%
  • Enviromentally damaging
22
Q

Machine/vapourizer

23
Q

Intravenous agents

  • … history
  • Induction agents/iv opiate
  • Rapid and …
  • … soluble
  • Redistribution short acting
  • m..
  • …/… depression
A
  • Shorter history
  • Induction agents/iv opiate
  • Rapid and pleasant
  • Lipid soluble
  • Redistribution short acting
  • Metabolised
  • CVS/RS depression
24
Q

Thiopentone

  • Thiobarbituate 1933
  • Powder
  • Smell of garlic
  • Anti…
  • …/… depression
  • Anaphylaxis/ arterial
  • Half life … hours
A
  • Thiobarbituate 1933
  • Powder
  • Smell of garlic
  • Antiepileptic
  • CVS/RS depression
  • Anaphylaxis/ arterial
  • Half life 10 hours
25
_Propofol_ * **Solvent** * **Redistribution half life 4 minutes** * **Elimination half life ... hours** * **Minimal accumulation TIVA** * **Anti ...** * **Anti ...** * **... to inject** * **... movements** * **.../... effects**
* **Solvent** * **Redistribution half life 4 minutes** * **Elimination half life 4 hours** * **Minimal accumulation TIVA** * **Anti emetic** * **Anti epileptic** * **Painful to inject** * **Abnormal movements** * **CVS/RS effects**
26
Others - Anaesthetic drug - Intravenous (3)
* Ketamine * Etomidate * Midazolam
27
_Muscle relaxants_ * ... drugs * Muscle ... * Facilitate ... * Maintain paralysis for surgery/ventilation * Depolarising * Non depolarising * ... only
* **Dangerous drugs** * **Muscle paralysis** * **Facilitate intubation** * **Maintain paralysis for surgery/ventilation** * **Depolarising** * **Non depolarising** * **Anaesthetists only**
28
_Depolarising agents_ * ...methonium * Post-synaptic membrane * Mimics ... * Rapid onset offset * ... half life ~ 2min * Plasma cholinesterase * Multiple side effects
* **Suxamethonium** * **Post-synaptic membrane** * **Mimics acetylcholine** * **Rapid onset offset** * **Short half life ~ 2min** * **Plasma cholinesterase** * **Multiple side effects**
29
_Non-depolarising blockers_ * ... with Ach * Ach moiety blocks Na channel with size * Duration is ... * ... onset * ... offset * Steroid group rocuronium * Benzylisoquinoliniums atracurium
* **Competitive with Ach** * **Ach moiety blocks Na channel with size** * **Duration is variable** * **Slower onset** * **Slower offset** * **Steroid group rocuronium** * **Benzylisoquinoliniums atracurium**
30
_N-m blocking agents_ * I... * S... * V... * Transfer * Side effects * R...
* **Intubation** * **Surgery** * **Ventilation** * **Transfer** * **Side effects** * **Reversal**
31
Only give muscle relaxant with a ...
anaesthetic agent - may be used to facilitate intubation - two types, non-depolarising and depolarising
32
... chloride Injection is an a ultra-short acting, depolarising, neuromuscular blocking agent.
**Suxamethonium** chloride Injection is an a ultra-short acting, depolarising, neuromuscular blocking agent.

Year 2 Medicine (162 decks)

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