anaesthetics

Question 1

examples of anaesthetics (to render unconcious)

Answer 1

propofol

etomidate

Question 2

function of propofol

Answer 2

anaesthetic
sedation
anti-emesis (anti-vomit)
v rapid acting - ideal for operation

Question 3

adverse side effect of propofol

Answer 3

cause apnoea - need ventilatory equipment

hyper TG

Question 4

what is etomidate used for

Answer 4

IV induction agent.

not used any more as it causes adrenal suppression (dampens stress response) which is not good for trauma e.g. surgery

Question 5

examples of sedation/anxiolytic drugs

Answer 5

benzodiazepines
barbiturates
dexmeditomidine

Question 6

what are barbiturates used for

Answer 6

anxiolytic (sedation)
seizure suppressants
sleeping aids

Question 7

examples of barbiturates

Answer 7

thiopental - uncontrolled refractory seizures, completely knocks brain out
methohexital - lowers seizure threshold
phenobarbital - suppress seizures
anxiolytics

Question 8

adverse side effect for barbiturates

Answer 8

bronchoconstriction in asthmatics

apnoea (need ventilation nearby)

Question 9

what are benzodiazepines used for

Answer 9

sedative
anxiolytic
amnesic
anticonvulsant

Question 10

examples of benzodiazepines

Answer 10

• midazolam: short acting, rapid onset
• lorazepam and temazepam (intermediate)
• diazepam (long acting)
• flunitrazepam (aka rohypnol)
• remimazolam (new, quick onset and offset)

Question 11

adverse side effect of benzos

Answer 11

• lorazepam and diazepam cause venous irritation and thrombophlebitis
• post-operative delerium
• all can have extended effects

Question 12

respiratory and cardiac side effects of benzos

Answer 12

• reduce muscle tone in upper airway
• lower hypoxic response
• stable CV - BP nd CO maintained

Question 13

what is lorazepam used for

Answer 13

anticonvulsant

Question 14

what are dexmedetomidines used for

Answer 14

sedation
withdrawal (alcohol, drugs)
delerium
analgesia
anxiolytic
[v expensive - nhs don't use)

Question 15

what procedure can dexmedetomidine be used for

Answer 15

awake craniotomy
fibreopticintubation
(sedation without respiratory distress)

Question 16

what is flumazenil and when is it used

Answer 16

• competitive antagonist at GABA-A receptor against benzodiazepines
• used to treat a benzo overdose

Question 17

adverse reaction of flumazenil

Answer 17

too much can cause seizures on patients on chronic benzos (e.g. diazepam for sleep)

Question 18

what is ketamine used for

Answer 18

acute analgesia
sedation in pads (no risk of apnoea)
dissociative anaesthesia (patient is ‘out of body’)
bronchodilation

Question 19

adverse reaction of ketamine

Answer 19

• trigger psychotic episode in schizophrenics
• elderly can react badly
• give Benzos with ket to reduce negative side effects

Question 20

examples of opioids (analgesia)

Answer 20

morphine
codeine
fentanyl
tramadol
ramifentanil

Question 21

what is morphine used for

Answer 21

analgesia
palliation
peri-operative

Question 22

limitations of morphine

Answer 22

• poor bioavailability if taken oral

- takes long to work - slow BBB penetration

Question 23

side effects of morphine

Answer 23

• constriction of pupil (both constricted = opined overdose)
• consipation
• bradycardia
• -vasodilation
• reduce ventilatory response to CO2
• resp suppression

Question 24

what us fentanyl

Answer 24

newer, quick acting.
more potent than morphine
-few CV effects
-transfermal fentanyl for use in cancer

Question 25

how is codeine adminstered and why

Answer 25

oral

pro drug - convert into active metabolite

Question 26

what are some limitations to using codeine

Answer 26

people metabolise at different speeds

Question 27

what is a contraindication to using codeine on a group of patients

Answer 27

-risk to neonate: breast feeding mothers who rapidly metabolise.
codeine spike can go through breast milk to baby.
baby can become apnoeic

Question 28

what is a caution of using tramadol

Answer 28

• in rapid metabolisers

- cause serotonin syndrome - build up of serotonin. (antidepressants also cause build up)

Question 29

what is the action of tramadol (analogue of codeine)

Answer 29

inhibits serotonin reuptake = dampen pain transmossopm

Question 30

benefit of ramifentanil

Answer 30

v short acting and rapid offset

-metabolised by non-specific enzymes in blood and tissue (which is everywhere)

Question 31

what is ramifentanil used for

Answer 31

• ICU sedation
• patient controlled analgesia in obstetrics
• pain relief during surgery
• total intravenous anaesthesia (TIVA)

Question 32

what is TIVA

Answer 32

use of only infusions. patients who are asleep still respond to pain (i.e. raise BP) so we need to give them pain relief

Question 33

what drugs are used mainly in TIVA

Answer 33

propofol and ramifentanil combo infusion

Question 34

benefits of TIVA

Answer 34

• avoid anaesthetic gases
• less nausea and vomiting
• improvement for CV side effects

Question 35

disadvantages of TIVA

Answer 35

based on algorithms - doesn’t take into account the different in people’s tolerance
-risk of awareness

Question 36

which drugs do not have antagonists

Answer 36

barbiturates

propofol

Question 37

which drugs have short acting antagonsits

Answer 37

naloxone

flumazenil