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SP Pharm > anesthesia > Flashcards

anesthesia Flashcards

1
Q

what does an anesthetic do?

A

depresses the CNS to cause a lack of consciousness, lack of responsiveness to sensory stimuli (like pain), and relaxation of muscles

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2
Q

how are anesthetics administered?

A
  • volatile liquids or gases are vaporized in oxygen and administered by inhalation
  • nonvolatile liquids are injected
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3
Q

an anesthetic is usually what?

A

a mix of several agents that cause the desired effects

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4
Q

what are the 5 things that a general anesthesia involves?

A

1) analgesia (opioids)
2) amnesia (barbiturates)
3) inhibition of reflexes (a variety of drugs)
4) skeletal ms relaxation (NMJ blocking agents)
5) rapid hypnosis (barbiturates and other drugs)

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5
Q

in a general anesthetic, what causes analgesia?

A

opioids

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6
Q

in a general anesthetic, what causes amnesia?

A

barbiturates

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7
Q

in a general anesthetic, what causes skeletal ms relaxation?

A

NMJ blocking agents

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8
Q

in a general anesthetic, what causes rapid hypnosis?

A

barbiturates and other drugs

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9
Q

what are the reasons that general anesthetics are usually a mix? (the benefits)

A
  • no one drug can cause all 5 necessary responses
  • combo can reduce requirement for inhaled anesthetics=reduced side effects, increased safety
  • reduced barbiturates, opioid, NMJ blocking agents means increased safety
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10
Q

how many stages of general anesthesia are there?

A

4

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11
Q

what is stage 1 of general anesthesia?

A

analgesia or loss of pain

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12
Q

what is stage 2 of general anesthesia?

A

excitement and hyperactivity

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13
Q

what is stage 3 of general anesthesia?

A

surgical anesthesia

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14
Q

what is stage 4 of general anesthesia?

A

imminent death or paralysis of the medulla

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15
Q

what stage of general anesthesia is desired for surgery?

A

a plane of stage 3, the plane depends on type of surgery (open heart vs. minor surgery)

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16
Q

what are the adverse side effects of nitrous oxide gas?

A 
dizziness
drowsiness
nausea
euporia
vomiting
malignant hyperthermia
apnea
cyanosis
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17
Q

what are the adverse side effects of volatile liquid general anesthesia?

A 
drowsiness
nausea
vomiting
myocardial depression
hypotension
pulmonary vasoconstriction
hepatotoxicity
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18
Q

what does MAC stand for?

A

minimum alveolar concentration

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19
Q

what is minimum alveolar concentration?

A

concentration at which 50% of the patients do not move during surgery. This is the percent of the gas mixture or percent of 760 mm Hg pressure

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20
Q

Inhaled general anesthetics are administered as _______.

A

gases

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21
Q

the dosage of inhaled general anesthetics are expressed in _________.

A

alveolar concentration

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22
Q

MAC is also and index of what?

A

potency of an inhaled anesthetic

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23
Q

The MAC has a very _______and is inversely proportional to ________.

A

very steep dose-response curve

proportional to anesthetic potency

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24
Q

what is the number one thing that effects MAC (and in what direction?)

A

Age

MAC is lower in the elderly

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25
Q

MAC is not affected by what factors?

A

sex
height
weight

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26
Q

what does ED50 mean?

A

mean effective dose

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27
Q

which anesthetic is more potent?

1MAC=10% or 1MAC=20%

A

1MAC=10%

the higher the required MAC (which is the amount of the drug in the lung air), the less potent.

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28
Q

should stage 2 of general anesthesia be long or short?

A

short

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29
Q

why is a steep dose response curve an issue?

A

need to get the person up to surgical anesthesia quickly so must inject a large volume of agent administered

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30
Q

what is the mechanism of action for general anesthetics?

A

lipophilicity
extreme lipophilicity disrupts plasma membrane
disruption increases threshold needed to fire

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31
Q

The more lipid soluble an agent is, the more or less potent an anesthetic it is?

A

more potent (more disruption to membrane, more increase of threshold)

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32
Q

what is MAC influenced by?

A

pulmonary ventilation
pulmonary blood flow
water solubility (lipophilicity?)

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33
Q

pulmonary ventilation affects what? how

A

speed of induction

the more rapidly air is exchanged, the more rapidly anesthesia will be achieved

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34
Q

what does pulmonary blood flow affect?

A

how quickly an anesthetic leaves the alveolus and enters the blood

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35
Q

The faster blood flows by the alveolus the______it takes to increase blood concentration of anesthetic.

A

longer

converse relationship!

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36
Q

what are 2 reasons that pulmonary blood flow might be low?

A

decreased BP

decreased blood volume

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37
Q

a more water soluble drug will mix with what first?

A

blood reservoir

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38
Q

a more water soluble drug will require _______ to achieve unconsciousness.

A

more because it stays in the watery blood reservoir

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39
Q

how do different drugs work? 5

A

Block flow of sodium into neurons
Enhance the inhibitory action of GABA
Delays impulses and reduces neural activity
Produces unconsciousness
Produces lack of responsiveness to painful stimuli

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40
Q

when are intravenous anesthetics used?

A
  • situations that require short duration anesthesia, like outpatient surgery (think “oscopy”)
  • to supplement inhalation anesthetics
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41
Q

how are intravenous anesthetics primary used?

A

as adjuncts to inhalations agents

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42
Q

are intravenous anesthetics administered before or after inhaled anesthetics?

A

before

43
Q

intravenous anesthetics ________ induce unconsciousness

A

rapidly

44
Q

what are some examples of IV anesthetics?

A 
barbiturate
benzodiazepines
opioids
propofol
ketamine
45
Q

which IV anesthetics has its own category?

A

propofol

46
Q

2 barbiturates

A

Thiopental

Methohexital

47
Q

barbituates have ______onset and are ______, but no _________.

A

rapid onset
potent
no analgesia

48
Q

3 Benzodiazepines

A

Diazepam
Lorazepam
Midazolam

49
Q

Benzodiazepines produce ______and _____ but not _______

A

yes sedation
yes amnesia
no analgesia

50
Q

1 opioid

A

fentanyl

51
Q

opioids are good for _______ for ________

A

analgesia

intra-operative pain

52
Q

propofol is used for what?

A

sedation during procedures or in the ICU

53
Q

how is ketamine used? adverse effects?

A

rarely used in adults
good analgesia for children
produces delusions and can increase ms tone

54
Q

what drug is used prophylactically before surgery and why?

A

atropine prevents bradycardia induced by surgery and for drying of secretions

55
Q

adverse effects of barbiturates

A 
drowsiness
lethargy
hangover
respiratory depression
laryngospasm
56
Q

opioids

A 
sedation
circulatory depression
cardiac arrest
respiratory depression
respiratory arrest
57
Q

anticholinergics

A

salivation
abdominal cramping
sweating
transient complete heart block

58
Q

dopamine blockers

A 
drowsiness
extrapyramidal symptoms
hypotension
tachycardia
laryngospasm
bronchospasm
59
Q

phenothiazine

A

blurred vision
dry mouth
respiratory depression
agranulocytosis

60
Q

NMJ blocker succinylcholine

A

ms fasciculations
bradycardia
respiratory depression
malignant hypothermia

61
Q

NMJ blocker tubocurarine

A 
hypotension
respiratory depression
malignant hypothermia
apnea
circulatory collapse
62
Q

what techniques are used to apply local anesthetics

A 
topical
nerve block
infiltration
spinal
epidural
63
Q

2 types of local anesthetics

A

ester

amide

64
Q

example of ester

A

procaine

65
Q

example of amide

A

lidocaine

66
Q

how do esters and amides work?

A

stop axonal conduction of action potentials by blocking sodium channels

67
Q

what is the effect of esters and amides?

A

rapid loss of sensation in limited part of the body

68
Q

what was the first local anesthetic used?

A

cocaine

69
Q

Local anesthetics may be contraindicated in which patients? why

A

patients with cardiovascular conditions because they have antiarrhythmic properties

70
Q

what is the most commonly used local anesthetics?

A

lidocaine

71
Q

short acting local anesthetic? time frame

A

procaine

1 hour

72
Q

intermediate acting local anesthetic? time frame

A

lidocaine

1 to 2.5 hours

73
Q

long acting local anesthetic? time frame

A

tetracaine

3-9 hours

74
Q

local anesthetics may be administered with what? why

A

Vasoconstrictor substances such as norepinephrine so as to limit absorption and concentrate them at the site of injection

75
Q

how are topical anesthetics administered?

A

directly to skin or mucous membranes

76
Q

what is the major topical anesthetic used?

A

benzocaine

followed by lidocaine and tetracaine

77
Q

why are topical anesthetics used?

A

to relieve or prevent pain from minor burns, irritation, itching or to numb an area before an injection is given

78
Q

what are the adverse effects of topical anesthetics?

A

skin irritation and hypersensitivity reactions (rare)

79
Q

what are ms relaxants?

A

drugs that affect skeletal muscle

80
Q

what are the 2 categories of ms relaxants?

A 
Neuromuscular blockers (NMJ)- used in intensive care units to cause paralysis and as an adjunctive to anesthesia
spasmolytics
81
Q

how are NMJs used?

A

in intensive care units to cause paralysis and as an adjunctive to anesthesia

82
Q

how are spasmolytics used?

A

to reduce spasticity in a variety of neurologic disorders

83
Q

why are ms relaxants used during surgery?

A

to reduce the intensity of muscle spasms in electrically-induced convulsions
to manage patients who are fighting mechanical ventilation

84
Q

how do nondepolarizing NMJ blocking agents work?

A

They block neurotransmitter action of acetylcholine. but do not cross the blood–brain barrier or have any action on the CNS.

85
Q

5 curare alkaloids nondepolarizing NMJ blocking agents

A

tubocurarine
pancuronium bromide
pipecuronium
vecuronium

86
Q

when nondepolarizing NMJ blocking agents are used in surgery, when is anesthesia induced?

A

before neuromuscular blockade is started

87
Q

tubocurarine effects can be reversed with what?

A

anticholinesterases: neostigmine, pyridostigmine, and edrophonium

88
Q

example of depolarizing NMJ blocking agents

A

succinylcholine

89
Q

how do depolarizing NMJ blocking agents work?

A

excessive depolarization which desensitizes muscles and renders them unresponsive

90
Q

where does curare come from?

A

poisonous frogs

91
Q

spasticity causes what?

A

Increase in tonic stretch reflexes
Increased flexor muscle spasm
Muscle weakness

92
Q

what are involved with spasticity?

A

reflex arcs

upper motor neurons (higher centers) affecting descending pathways

93
Q

what drugs are used against spasticity?

A

spasmolytics

94
Q

what do spasmolytics do (therapeutically)?

A

relax skeletal ms, relieve acute musculoskeletal pain, spasm or spasticity

95
Q

what is GABAb?

A

subtype of GABA

96
Q

how do anesthetic drugs work? 5

A

Block flow of sodium into neurons
Enhance the inhibitory action of GABA
Delays impulses and reduces neural activity
Produces unconsciousness
Produces lack of responsiveness to painful stimuli

97
Q

tetrodotoxin, batrachotoxin, and local anesthetics prevent what physiological process?

A

action potential

98
Q

hemicholinuim, botulinus toxin, procaine prevent what physiological process?

A

acetylcholine release

99
Q

curare alkaloids and snake toxins prevent what physiological process?

A

depolarization

100
Q

cholinesterase inhibitors prevent what physiological process?

A

hydrolysis of acetylcholine

101
Q

quinine and tetrodotoxin prevent what physiological process?

A

muscle action potential

102
Q

metabolic poisons, Ca++ deficiency, procaine and dantrolene prevent what physiological process?

A

ms contraction

103
Q

calcium enhances what 2 physiological processes?

A

acetylcholine release and muscle action potentials

104
Q

veratridine enhances what physiological process?

A

muscle action potential

SP Pharm (10 decks)

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