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Quarter 3 > Anesthesia Pharm II > Flashcards

Anesthesia Pharm II Flashcards

1
Q

Opioid receptors

A

mu, delta, and kappa

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2
Q

Opioid mechanism of action

A
  • opioid binds receptor
  • Ca2+ channels close
  • K+ channels open
  • cells hyperpolarize
  • transmission blocked

primary effect is a decrease in neurotransmission

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3
Q

Where are opioid receptors located

A

brain, spinal cord, and peripheral nerves

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4
Q

Common clinical effects of Opioids (8)

A
  • impairs sympathetic compensatory responses
  • itching
  • depression of ventilation
  • increased CO2 increases ICP
  • sedation
  • biliary spasm
  • nausea/vomiting
  • urinary retention
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5
Q

Meperidine

(Demerol)

A
  • antispasmodic effect
  • renal excretion
  • CNS stimulant
  • shivering
  • serotonin syndrome
  • demethylation to normeperidine in the liver
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6
Q

Fentanyl

A
  • renal excretion
  • stable hemodynamics
  • no amnestic effect
  • depression of ventilation
  • skeletal muscle rigidity possible
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7
Q

Sufentanil

A
  • renal and biliary excretion
  • bradycardia
  • skeletal muscle rigidity
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8
Q

Rank in order of duration

morphine, meperidone, fentanyl

A

fentanyl < meperidone < morphine

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9
Q

Remifentanil

A
  • ester linkage susceptible to hydrolysis
  • rapidly titratable
  • respiratory depression
  • no change in ICP

*must add a longer acting agent to cover post-op pain

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10
Q

Context-Sensitive half-time of Remifentanil

A

4 minutes

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11
Q
A

Sufentanil

Fentanyl

Alfentanil

Remifentanil

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12
Q

Rank in order of increasing context-sensitive half time:

Sufentanil, Fentanyl, Alfentanil, Remifentanil

A

Remifentanil

Sufentanil

Alfentanil

Fentanyl

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13
Q

Codeine

A
  • interindividual variability
  • cough supressant
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14
Q

Hydromorphone

(Dilaudid)

A
  • 5x more potent than morphine
  • faster onset
  • oral dose every 4 hours
  • agitiation/restlessness
  • dangerous when combind with other sedatives
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15
Q

Oxycodone

A

moderate to severe pain

high abuse potential

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16
Q

Hydrocodone

A

high abuse potential

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17
Q

Methadone

A
  • used for chronic pain
  • prolonged duration of action
  • overdose possible
  • used to control withdrawal symptoms
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18
Q

Opioid Agonist-Antagonist

A
  • binds to mu receptors, but produce limited effects
  • may antagonize effects of other narcotics
  • may produce dysphoric effects
  • low abuse potential
  • limited respiratory depression
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19
Q

Pentazocine

(Talwin)

A

combined with naloxone to prevent “powdering”

can develop phyiscal dependence

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20
Q

Suboxone

A

treats opioid addiction

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21
Q

Naloxone

A
  • nonselective antagonist of all 3 opioid receptors
  • treats depression of ventilation
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22
Q

Naltrexone

A

treats alcoholism

Q24 hour dosing

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23
Q

PCA pumps

A

(patient-controlled anesthesia)

  • Settings
    • drug concentration
    • loading dose
    • lockout interval
    • basal rate
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24
Q

Which opioid has a cephalad movement?

A

Morphine

less lipid soluble compared to fentanyl/sufent

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25
Q

Side effects of Neuraxial Opioids

A
  • itiching
  • urinary retention
  • nausea/vomiting
  • depression of ventilation

*does not appear in breast milk

*may be reversed by naloxone

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26
Q

Masimo Acoustic Monitor

A

alarm that triggers when patient stops breathing

  • 81% sensitive
  • do not give to a person at risk of hypoventilation
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27
Q

Withdrawal symptoms

A
  • yawning
  • diaphoresis
  • lacrimation
  • coryza (stuffy nose)
  • insomnia
  • abdominal cramps
  • nausea/vomiting
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28
Q

What can cause an increase of NMB activity?

A

CO2 retention

  • patient can hypoventilate in PACU and become “recurarized”
  • Treatment
    • increase FIO2
    • sit patient up
    • assist ventilation
    • additional reversal
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29
Q

What can reverse a spasm of the sphincter of Oddi?

A

naloxone or glucagon (2mg IV)

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30
Q

4 Parts in a Nociceptive system

A
  • transduction
  • transmission
  • modulation
  • perception
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31
Q

What accounts for perception of sensory-discriminative component of peripheral pain stimuli?

A

forebrain somatosensory cortex

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32
Q

What accounts for the perception of motivational affective components of pain?

A

Limbic cortex and Thalamus

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33
Q

(3) Primary afferent nocicpetors

A

A-beta, A-delta, and C fibers

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34
Q

A-alpha fibers

A

proprioception

myelinated

wide diameter

fastest conduction speed

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35
Q

A-beta Fiber

A

touch

myelinated

wide diameter

fast conduction speed

36
Q

A-delta fiber

A

pain (mechanical and thermal)

myelinated

narrow diameter

slow conduction speed

37
Q

C fiber

A

pain (mechanical, thermal, and chemical)

non-myelinated

narrowest diameter

slowest conduction speed

38
Q

sensory nerves travel to what part of the spine?

A

dorsal root (posterior)

also dorsal root ganglion

39
Q

Gate Theory of Pain

A

painful stimuli can only be reached when “gate” is open

  • can be closed by inhibitory impulses
    • rubbing painful area
    • A-beta fibers faster than C fibers
40
Q

“wind up” sensitization

A

repeated peripheral noxious stimuli where the pain increases with each stimulus, but the intensity of that stimulus remains the same

41
Q

Heterosynaptic activity-dependent plasticity

A

a brief intense stimulus increases the efficiency of the dorsal horn synapses causing subsequent subthreshold inputs to result in pain

42
Q

(4) ascending pathways of pain perception

A

–spinothalamic tracts (STT)

–spinomedullary projections

–spinobulbar projections

–spinohypothalamic tract (SHT)

43
Q

Spinothalamic Tract (STT)

A
  • originates in dorsal horn
  • travel up contralateral side
44
Q

Spinobulbar projections

A

the integration of nociceptive activity with processes that serve homeostasis and behavior

45
Q

Spinohypothalamic Tract (SHT)

A

important for autonomic, neuroendocrine, and emotional aspects of pain

46
Q

Neurotransmitters involved in Pain

A

glutamine

enkephalin

norepinephrine

GABA

47
Q

Somatic Stimuli

A

easily localized and a distinct sensation

48
Q

Visceral pain

A

diffuse and poorly localized

49
Q

Complex Regional Pain Syndrome (CRPS)

A

reflex sympathetic dystrophy

  • Type I - absence of major nerve injury
  • Type II - specific nerve injury
  • hyperalgesic
50
Q

Perfusion pressure

A

MAP - CVP

51
Q

Transmural pressure

A

pressure outside the tube minus pressure inside the tube

52
Q

GABA mechanism of action

A

increases Cl- conductance

hyperpolarizes and inhibits postsynaptic neuron

53
Q

(6) GABA agonists

A
  • propofol
  • etomidate
  • benzodiazepines
  • nonbenzodiazepines and benzodiazepines
  • barbituates
  • alcohol
54
Q

Diprivan pH

A

7 - 8.5

uses disodium edetate and sodium hydroxide

55
Q

Generic Propofol pH

A

4.5 - 6.4

uses sodium metabisulfite

56
Q
A

propofol’s context sensitive half-time with 8 hour infusion is less than 40 minutes

57
Q

6 effects of Propofol

A
  • decreases cerebral metabolic rate
  • decreases cerebral blood flow
  • decreases ICP
  • autoregulation maintained
  • does NOT modify evoked potentials
  • tolerance does not develop
58
Q

6 Cardiovascular effects of Propofol

A
  • decreases:
    • BP
    • SVR
    • contractility
  • does not alter SA or AV node function
  • does NOT prolong QTc interval
59
Q

Propofol infusion syndrome

A

lactic acidosis with infusions over 24 hours

60
Q

Etomidate

A
  • GABAA receptor
  • rapid in onset
  • hydrolyzed in the liver and plasma esterases
  • involuntary myoclonic movements
  • NO analgesic properties
61
Q

Effects of Etomidate

A
  • lowers ICP and CMRO2
  • minimal effects on contractility
  • nausea
  • adrenocortical supression
62
Q

What occurs after a decrease in SVR?

A

lower blood pressure

reduced filling of the LV secondary to increased pericardial pressure prevents a compensation in stroke volume to maintain BP

63
Q

Midazolam

A
  • water soluble
  • metabolized by P450 and excreted by kidneys
  • anticonvulsant
64
Q

Effects of Midazolam

A
  • decreases CMRO2
  • decreases cerebral blood flow
  • decreases hypoxic drive
    • especially with fentanyl
65
Q

Lorazepam

A

slow onset and long duration

  • delays emergence
  • suitable for withdrawal symptoms
66
Q

Flumazenil

A

competitive antagonist of benzodiazepines

  • may result in seizures
  • no negative cardiovascular side effects
67
Q

(3) Nonbenzodiazepine Benzodiazepine drugs

A

Zaleplon (sonata)

Zolpidem (ambien)

eszopiclone (lunesta)

68
Q

what classification do the “sleeping agents” fall under?

A

nonbenzodiazepine benzodiazepine

69
Q

Ketamine Characteristics

A
  • intense analgesia at “sub-anesthetic” doses
  • emergence delirium
  • hemodynamically stable
  • not a respiratory depressant
70
Q

What receptor does Ketamine bind?

A

NMDA

(N-methyl-D-aspartate)

* Glutamate is the neurotransmitter and glycine is the co-agonist

71
Q

Which sedative is useful in patients who are unable to be monitored or have a maintained airway?

A

Ketamine

72
Q

Ketamine cautions

A
  • aspiration risk
    • hypersensitive reflexes
  • delirium
73
Q

Dexmedetomidine

(Precedex)

A
  • potent alpha2 agonist
    • mainly on pontine locus ceruleus
  • inhibitory
  • decreases plasma catecholamines
  • decreases MAC
74
Q

spasm of the muscles causing backward arching of the head, neck, and spine, as in severe tetanus, some kinds of meningitis, and strychnine poisoning

A

opisthotonos

75
Q

Artery of Adamkieqicz

A

provides the major blood supply of the lumbar and sacral cord

  1. located between T8 and L1
76
Q

Ideal anesthetic for aortic insufficiency

A
  • decreased SVR
  • preserved or increased HR
77
Q

Ideal anesthetic for aortic stenosis

A
  • preserved SVR
  • prevent tachycardia
78
Q

Aortic Stenosis concerns

A
  • left ventricular hypertrophy
  • vasodilators are hard to recover from
    • CPR is ineffective
    • easy to kill someone
  • avoid spinals
79
Q

Ideal anesthetic for Mitral Regurge

A

decreased SVR and preserved HR

80
Q

Ideal anesthetic for Mitral Stenosis

A

preserved SVR and decreased HR

81
Q

Causes of QT prolongation

A
  • Sevo and Iso
  • Type 1A and III antiarrhythmic agents
  • hypokalemia
  • hypocalcemia
  • Droperidol
82
Q

Normal QTc interval

A

< 430 in male and < 450 in females

83
Q

Equation for QTc

A

QTc = QT / sqrt(RR)

84
Q

Which is the best inhalational agent for a cardiac ablation?

A

Sevo

(TIVA even better)

85
Q

Which inhalational agent causes “steal”

A

Isoflurane

86
Q

does minute ventilation increase/decrease with inhalational agents?

A

decrease

87
Q
A

Quarter 3 (12 decks)

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