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PHAR 300 (Kim) > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Why Diethyl Ether was replace by halothane?

A

bc it is highly flammable

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2
Q

General Anesthesia component:

A 
Lost sensation
Lost consciousness
Amnesia
Relaxation of skeletal muscles
suppression of reflexes.
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3
Q

Inhalation end-name?

A

’‘-ane’’

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4
Q

IV anesthetic agents end-name?

A

’‘-al’’ exept for Barbiturates, benzo ‘‘-am’’ and Propofol

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5
Q

Steps of drugs use in anesthesia

A 
Premedication
Induction agent
Volatile agent and anesthetic gases
Analgesics
Muscle relaxants
Reversal agents
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6
Q

Type of anesthetics often use for induction?

A

Intravenous anesthetics

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7
Q

Structure of IV agent?

A

IV agent have ring structures

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8
Q

Structure of Volatile anesthetics?

A

volatile do not have ring structure, but are small molecules with substitutions on the carbon chain.

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9
Q

Partial pressure =

A

Partial pressure of a gas is the driving force that get the drug from the alveolus into the blood, and then from the bllod into the brain.

Concentration of the drug (%) x the atmospheric pressure (760mmHg)

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10
Q

mix of gases need to include:

A

Oxygen

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11
Q

Most of the removal of general anesthetics is by

A

exhalation

NOT BY METABOLISM

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12
Q

All general anesthetics are lipid- or water-soluble?

A

Lipid soluble!

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13
Q

The Minimal alveolar concentration (MAC) is

A

the Concentration that will produce a surgical level of anesthesia in 50% of humans.

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14
Q

MAC is alter by:

A

Disease

presence of others drugs

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15
Q

Increasing MAC mean increasing ____.

A

Levels of CO2.

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16
Q

Increasing MAC can lead to

A 
Respiratory depression (respiratory minute volume)
Cardiovascular depression (BP)
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17
Q

Nitrous Oxide caracteristic

A 
Is a GAS
Majority are exhaled (NOT METABOLIZE)
Good for pain relief
Low solubility (move quickly in the brain)
Do not decrease BP or respiration rate
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18
Q

Halothane caracteristic

A

Is soluble and dissolve in blood. (less of it immediately available to enter the brain)
Not compatible with epinephrine.
Metabolized 15%
Rare toxic effect

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19
Q

Isoflurane caracteristic

A

No production of toxic metabolites
Good muscles relaxant
Possible to use epinephrine

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20
Q

Avantages of IV anesthetics

A

Less respi and cardiovasc depression
RAPID ONSET with short duration
Wider margin of safety
Recovery of patient less difficult

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21
Q

Most commun inhalation anesthetics:

A

Nitrous Oxide
Halothane
Isoflurane
Sevoflurane

22
Q

Classic barbiturate used for induction:

A

Thiopental

23
Q

Most common IV anesthetics:

A

Thiopental (barbiturates), Midazolam (benzo), Etomidate, Propofol and Ketamine

24
Q

Thiopental caracteristic:

A

Rapid onset and wear off quickly too

half-live longer bc stay in adipose tissue

25
Q

Propofol caracteristics:

A

Rapid onset

Shorter half-life

26
Q

Context-sensitive half-life is

A

how the drug can accumulate in other body tissues (taking more time to get ride off)

27
Q

High half-life for:

A

Benzodiazepam (less for midazolam) and Barbiturates

28
Q

Conscious sedation can be reach with

A

Opioids + midazolam

29
Q

Fentanyl and Remifentanyl(more powerful) use as

A

induction agents for short procedures

30
Q

Neurolept analgesia is

A

Fentanyl + antipsychotic

31
Q

Ketamine

A

STIMULATE cardiovasc system

Psychiatric side effects: Dissociative Dysphoria

32
Q

Major site of action of general anesthesics:

A

Inhibition: GABA A, Glycine
Exitation: Glutamate NMDA, 5HT, Nicotinic

33
Q

Ketamine site of action:

A

Decrease glutamate at the NMDA receptor (blocking excitation)

34
Q

IV anesthetics act primarly on:

A

Ligand-Gated ion channels

35
Q

2 categories of neuromuscular blocking agents:

A

Competitive blocking agents (compete with acetylcholine)

Depolarizing blocking agents (activate the receptor of acetylcholine and DESENSITIZES)

36
Q

Competitive blocking agents usual end-name:

A

’‘-ium’’

37
Q

Succinylcholine is a

A

Depolarizing blocking agents (derivative of acetylcholine)

38
Q

Curare is a

A

Competitive blocking agents

39
Q

Pseudocholinesterase is a

A

plasma enzyme that breakdown succinylcholine

40
Q

Individual with deficite in plasma pseudocholinesterase can lead to

A

stop breathing and not be able to recover quickly as without the deficite.

41
Q

Local anesthesic act by

A

Blocking Voltage-gated Sodium channel.

42
Q

Adrenaline with local anesthesic alter the pharmacokinetics by creating

A

an vasoconstriction –> less blood flow to the region –> slow rate of carrying the local anesthesic away from the site of action AND lest plasma cholinesterase to break down –> INCREASE half-life

43
Q

Local anesthetics structure:

A

Lipid-soluble section, with ester link and an amine portion.

44
Q

Local anesthetics are metabolized by

A

plasma cholinesterase

45
Q

The delivery of the drug to the patient and subsequently to the brain is directly related to:

A

its partial pressure.

46
Q

Factor influencing the rate of induction of anesthesia: (how fast the person will be anesthetized and ready for the surgery)

A
  1. Higher the concentration, faster the induction
  2. Higher/better the alveolar ventilation rate, faster the induction.
  3. Lower solubility of the agent in the blood, faster the induction.
  4. Very high cardiac output = less will go to the brain, less the rate of induction.
47
Q

For most of the situations, we need (xMAC) for a safe amount?

A

1.3x MAC

48
Q

Methoxyflurane % metabolized?

A

50-70%

49
Q

Why is local anesthesia injected in the spinal fluid had a longer effect?

A

bc the spinal fluid is lower in cholinesterase. (take more time to get rid of the anesthetic agent)

50
Q

Eutectic muxture of local anesthesics (EMLA):

A

mixure of local anesthetics in base form that can be absorbed through the skin. (no need to inject, usefull for kids)

PHAR 300 (Kim) (19 decks)

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