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Year 2 - Theme 1 > 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 an anaesthetic agent

A 
• 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

Effects of ethanol

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

How do anaesthetics work

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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5
Q

Biochemical effects of anaesthetics

A

• Stimulation of inhibitory receptors

  • GABAA
  • Glycine

• Inhibition of excitatory receptors

  • Nicotinic
  • Serotonin
  • Glutamate/NMDA
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6
Q

Effect of anaesthetic on GABAa receptors

A
  • Pentameric
  • Single amino acids
  • Chloride ions
  • Hyperpolarisation
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7
Q

Examples of inhalational anaesthetic agents

A
  • Oxygen
  • Nitrous oxide
  • Ideal properties
  • Isoflurane
  • Other volatile agents
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8
Q

Features of oxygen

A
  • Priestly 1777
  • Gas above -119C
  • Distilling air
  • Supports combustion – not flammable
  • Black cylinders and white shoulders 137 bar
  • Piped VIE
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9
Q

Side effects of oxygen

A
  • O2 free radicals
  • CNS convulsions
  • Pulmonary oxygen toxicity
  • Retrolental fibroplasia
  • CO2 narcosis
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10
Q

Features of nitrous oxide

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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11
Q

Physical properties of inhalational agents

A
  • Cost
  • Chemical stability
  • Non-flammable/explosive
  • Vapourizable
  • Environmentally stable
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12
Q

Chemical properties of inhalational agents

A
  • Non irritant
  • Low blood:gas solubility
  • High potency MAC
  • Minimal side effects (pharmacodynamics)
  • Biotransformation (phamacokinetics)
  • Non-toxic
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13
Q

Older agents

A
  • Ether
  • Chloroform
  • Cyclopropane
  • Methoxyflurane
  • Halothane
  • Enflurane
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14
Q

Features of isoflurane

A
  • Halogenated ether
  • 1965
  • Relatively cheap
  • Stable and non flammable
  • Relatively potent MAC 1.1% B:G co 1.4
  • 0.2% metabolised
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15
Q

Vapourizable BP of isoflurane

A

Vapourizable BP 49C

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16
Q

Effect of isoflurane on airway

A
  • Irritable to airway
17
Q

Side effects of isoflurane

18
Q

Features of sevoflurane

A
  • Non irritable
  • Quick onset/offset
  • MAC 2%
  • 5% metabolised
  • CVS stability
  • Emergence phenomena
  • Expensive
19
Q

Features of desflurane

A
  • Very quick onset/offset
  • 0.02% metabolised
  • Moderately expensive
  • Irritant
  • Special vaporizer
  • MAC 6.35%
20
Q

What is MAC(minimum alveolar concentration)

A
  • Minimum alveolar concentration or MAC is the concentration of a vapour in the lungs that is needed to prevent movement (motor response) in 50% of subjects in response to surgical (pain) stimulus
21
Q

Features of intravenous agents

A 
• Shorter history
• Induction agents/iv opiate
• Rapid and pleasant
• Lipid soluble
• Redistribution    short acting
• Metabolised
CVS/RS depression
22
Q

features of thiopentone/thiobarbituate

A
  • Powder
  • Smell of garlic
  • Antiepileptic
  • CVS/RS depression
  • Anaphylaxis/ arterial
23
Q

Half life of thiobarbituate

24
Q

Redistribution half life of 2,6-diisopropylphenol

25
Q

Elimination half life of 2,6-diisopropylphenol

26
Q

Features of 2,6-diisopropylphenol

A 
Solvent 
• Anti emetic
• Anti epileptic
• Painful to inject
• Abnormal movements
• CVS/RS effects
27
Q

Other examples of intravenous anaesthestic agents

A
  • Ketamine
  • Etomidate
  • Midazolam
28
Q

Features of muscle relaxants

A
  • Dangerous drugs
  • Muscle paralysis
  • Facilitate intubation
  • Maintain paralysis for surgery/ventilation
  • Depolarising
  • Non depolarising
  • Anaesthetists only
29
Q

Features of depolarising agents with an example

A
  • Suxamethonium
  • Post-synaptic membrane
  • Mimics acetylcholine
  • Rapid onset offset
  • Short half life ~ 2min
  • Plasma cholinesterase
  • Multiple side effects
30
Q

Features of non-depolarising blockers

A
  • Competitive with Ach
  • Ach mostly blocks Na channel with size
  • Duration is variable
  • Slower onset
  • Slower offset
  • Steroid group rocuronium
  • Benzylisoquinoliniums atracurium
31
Q

Features of n-m blocking agents

A
  • Intubation
  • Surgery
  • Ventilation
  • Transfer
  • Side effects
  • Reversal

Year 2 - Theme 1 (30 decks)

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