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Pharmocolgy > Anaesthetics > Flashcards

Anaesthetics Flashcards

1
Q

what are the 2 routes for general anaesthetic ?

A

Volatile or Inhalation

IV

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2
Q

define conscious sedation

A

use of small amount of anaesthetic or benzodiazapines to produce sleepy like state - maintain verbal contact but feel comfortable

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3
Q

what is anaesthesia a combination of ?

A

Analgesia , Hypnosis, Depression of spinal reflexes muscle relaxation

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4
Q

what are stages of Guedel’s signs ?

A

Stage 1- Analgesia and consciousness
stage 2 - Unconscious, breathing erratic . Maybe delirium = excitement phase
Stage 3- Surgical Anaesthesia, 4 levels going down until breathing weak
Stage 4- Respiratory Paralysis and death

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5
Q

what is the order that brain functions go in Volatile anaesthetics?

A

Memory , Consciousness , Movement and CV response

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6
Q

what is potency ?

A

Docile concentration range at which you see a response

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7
Q

how is volatile anaesthetic potency described ?

A

Minimum Alveolar Concentration

MAC

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8
Q

What is MAC?

A

The Alveolar conc at which 50% of subjects fail to move to surgical stimulus

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9
Q

why is MAC used ?

A

at equilibrium conc of Alveolar = Conc of spinal cord

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10
Q

What is MAC-BAR used for ?

A

potency at which autonomic responses go

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11
Q

what factors affect induction and recovery ?

A

Partition Coefficient - Solubility :
Blood: Gas partition (in blood) lower the quicker

Oil: Gas (In fat)
higher the longer as it accumulates so longer induction

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12
Q

What can increase MAC?

A 
Low age 
Hyperthermia 
Pregnancy 
alcholism 
Central stimulus
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13
Q

What can decrease MAC?

A

Elderly
hypothermia
other anasethetics
Opioids

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14
Q

what is the effect of MAC by adding NO? What does this lead to ?

A

decrease in MAC

Allows less side effect profile as lower the MAC the better

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15
Q

what does the Meyer-Overton graph tell us ?

A

the higher the lipid solubility the higher the potentcy

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16
Q

what other factor is involved in Potency of Anaesthetics?

A

GABA receptor interaction

17
Q

what are effects of GABA?

A

anxiolysis
sedation
Anaestheisa

18
Q

How do GABA receptors work ?

A

LGIC - Cl- conductance . out to in to hyperpolarise neurones

19
Q

How do Anaesthetics work ?

A

Potentiate Cl- conductance in the GABA receptor

20
Q

How do Xe, N2O and Ketamine work ?

A

block NMDA receptor to stop glutamate receptor

21
Q

what is a feature of Reticular formation ?

A

lots of GABA receptors

22
Q

what does the thalamus do in consciousness ?

A

Transmits and modifies sensory information

23
Q

What other brain circuitry does Anaesthesia target ?

A

Hippocampus - Memory
Brainstem - Resp and CVS
Spinal cord - Dorsal horn for analgesia

24
Q

what are the main IV anaesthetics and what is their onset of action ?

A

Propofol - rapid
Barbiturates - Rapid
Ketamine - Slower

25
Q

what is TIVA?

A

All 3 IV aneasthetics combined - uses defined PK algorithm to infuse at certain rate with bolus to start

26
Q

how do we measure potency of IV anaesthetics ?

A

Plasma conc to achieve a specific end point

27
Q

What is done after induction of IV anaesthetics ?

A

Switch to volatile

28
Q

What are uses of local anaesthetics?

A 
dentistry 
Obs 
regional surgery 
post op 
Chronic pain
29
Q

What chemical properties determines time of onset of local anaesthetics ?

A

Lower pKa = faster onset

30
Q

what determines potentcy of local Anaesthetics ?

A

Lipid solubility

31
Q

What can affect duration of local anaesthetics ?

A

Protein binding

Ester based = ultra Short acting

Amide linked = long acting

32
Q

how does Bupivacaine work ? what can increase block?

A

Block VG SCs
the higher the rate of activity = higher the block
block small myelinated afferent nerves = prefencer in nociceptive

33
Q

what is given with locals ? why?

A

adrenaline to vasoconstrictor

opioids given as well

34
Q

what is difference between Bupivacaine, Lidocaine, Ropivacaine?

A

see table and interpret

35
Q

where do you give locals?

A

Upper = interscalene, supraclavicular,
infraclavicular, axillary.
• Lower extremity (e.g.,) ; femoral, sciatic, popliteal,
saphenous.

36
Q

what are General anaesthetic side effects ?

A

N+V with opioids
hypotension
Post - op cog dysfunction = delirium
chest infection

Pharmocolgy (22 decks)

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