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Neuro-Psych Exam II > Anesthetic Drugs > Flashcards

Anesthetic Drugs Flashcards

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1
Q

Describe 6 goals of “Balanced Anesthesia”?

How is “balanced anesthesia” achieved?

A
  1. Amnesia– avoid PTSD
  2. Analgesia
  3. Produce unconsciousness/ unresponsiveness ( Decrease pain and movement)
  4. Block sensory/ autonomic reflexes
  5. MSK (except resp.) paralysis
  6. Rapid induction / emergence (in and out fast)

*Achieve by giving mult. agents together

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2
Q

General anesthetics: ROA, effect on pt?

A

Usually IV + gas; reversible state of loss of sensation and consciousness

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3
Q

What are the 2 classes of inhalation anesthetics

A

Gases and volatile liquids
Halogenated/non halogenated
Halogenated end in –ane (NOT aine)
Non-halogenated = nitrous oxide

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4
Q

How is potency for inhalation anesthetics expressed and what are 4 factors that effect it?

A

MAC (inspired conc. required to produce anesthesia) = ED50, expressed as % inhaled gas

  1. Age (^ infancy, childhood– need more drugs)
  2. Health status (^hyperthyroid)
  3. Drug interactions (^Amphetamines)
  4. Red Hair* (^ due to genetics)

Reverse = decreased; give less drugs to Elderly etc

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5
Q

Describe the circuit of anesthesia induction: at what point is anesthesia induced?

A

Inspiration–> alveoli –> Arterial circ.–> Brain/ other tissues
–> Venous circ.–> Back to lung
* Induction: PA (alveolar partial pressure)= Pa = PBr
(equilibrium point)

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6
Q

How does the Concentration of anesthetic inhaled affect ROI (rate of induction)

A

^ concentration = FASTER rate of induction

steeper gradient

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7
Q

Alveolar ventilation effect on ROI

A

^ Alveolar ventilation = FASTER rate of induction

rapid turnover in lungs; faster drive

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8
Q

Solubility of anesthetic in blood effect on ROI

A

^ solubile in blood = SLOWER rate of induction

LESS soluble in tissue/ lipophilic, takes longer to move out of blood to brain

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9
Q

CO effect on ROI

A

^ CO = SLOWER rate of induction

Removed volatile anesthetic from lung and lowers PA of gas

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10
Q

How is the concentration of the agent related to the partial pressure of the agent?

A

Directly proportional

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11
Q

Describe the relationship between lipophilicity and MAC

A

linear relationship

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12
Q 
Rate the relative MAC values for the following agents: 
N2O 
Desflurane 
Enflurane 
Isoflurane 
Halothane
A

N2O (105*) > Desflurane > Enflurane > *Isoflurane > Halothane
Nitrous oxide then DUMB ELEPHANTS I HATE (for selling out on cyber Monday)

  • isofurane is most common
  • N2O only effective monotheraputically if in hyperbaric chamber; must use in conjunction with others
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13
Q

Describe the meyer-overton theory

A

inhaled anesthetics are effective because they stiffen membranes and make proteins dysfunctional: INHIBIT GABA breakdown, ^ Cl influx, ^ K efflux, Lower Ca/ Na influx

(basically make you NOT excited)

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14
Q 
Halothane: 
Class of anesthetic 
Effects/ smell?
How is it administered?
Describe one stipulation of use.
A

Halogenated anestetic
Potent anesthetic, weak analgesic smells good
Coadmin. with N2O, opioid, locals
DO NOT USE CONSECUTIVELY WITHIN 2-3 WEEK TIME PERIOD!

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15
Q 
Effects of halothane: 
CV? 
Resp?
Metabolic? 
One other big risk?
A

CV: sensitive to catecholamine and ^ arrhythmia, Decrease CV function
Resp: Decreases response to CO2 MUST VENTILATE PTS
Metabolic: Liberation of Br; hepatotoxic (less in kids)
^^^ risk malignant hyperthermia

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16
Q

Drug drug interaction with halothane anesthetics?

A

HALOTHANE + SUCCINYLCHOLINE

MALIGNANT HYPERPYREXIA; DANTROLENE, YO!?

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17
Q

Enflurane:
Class of anesthetics
How does it compare to halothanes?
Smell?

A

Halogenated anesthetic
Less potent than halothane; rapid induction + recovery
smells good

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18
Q 
Effects of enflurane: 
CV (compare to halothane)? 
Resp?
MSK (compare to halothane)? 
CNS?
A
  • Less risk arrhythmia
  • Resp depression = dose dependent
  • More potentiation of MSK relaxants
    (esp. non-depolarizing NMJ blockers)
  • CNS excitation–> seizures via inhibition of GABA
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19
Q

Isoflurane:
Class of anesthetics
Describe induction and recovery
smell?

A

Halogenated Anestetic
Smooth/ rapid induction and recovery (commonly used)
Pungent odor

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20
Q 
Effects of Isoflurane: 
CV (advantage of use*)? 
Resp? 
MSK? 
Metabolism?
A
  • NO ARRHYTHMIA/ SENSITIZATION TO CATECHOLAMINE/ DECREASE CO (wide margin of safety)
  • Resp depression = dose dependent
  • MSK relaxation: direct + CNS depression; potentates MSK relaxants
  • LOW biotransformation = LOW toxicity
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21
Q

Desflurane:
Drug class
Induction and recovery?
Resp effects?

A

Halogenated anesthetic
VERY rapid induction and recovery
Respiratory irritant* ; Resp depression = dose dependent
(“Des is an irritating kid”)

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22
Q 
Sevoflurane: 
Drug class 
Induction and recovery?
Smell? 
2 stipulations of use*
A

Halogenated anesthetic
Rapid induction and recovery
Low pungency

Stipulations:

  1. Special equipment (reacts with soda lime in breathing apparatus)
  2. TOXIC COMPOUND A*
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23
Q

Nitrous Oxide (N2O):
Drug Class
Therapeutic Use
Induction and recovery?

A

Non-halogenated anesthetic
Weak anesthetic, Potent analgesic
Component in balanced anesthesia
Rapid induction and recovery

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24
Q

N2O Effects:
CV?
Resp?
Malignant Hyperpyrexia?

A
  • Little CV effects
  • Enhances resp depression w/other agents: COADMIN. 30% O2 TO PREVENT THE BENDS
  • NO MALIGNANT HYPERPYREXIA
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25
Q

Describe the “second gas effect”

A

N2O rapidly absorbed and increased the rate of absorption of gases administered after it (it is thus used as a pre-anesthetic)

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26
Q

Major route of elimination of inhalation anesthetics? One secondary route and drug that might be toxic this way?

A

LUNGS (breathe in, breathe back out)

Excess metabolized in liver–halide ions from halogenated anesthetics may cause hepatic and renal toxicity

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27
Q

Which halogenated anesthetic is associated with the production of toxic Compound A

A

Sevoflurane

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28
Q

Why are IV anesthetics used?

When are they administered?

A

Facilitate rapid induction anesthesia that is maintained with inhaled anesthetics

Preanesthetic/ postanesteti, solo for minor procedures (Propofol in kids ear tube surgeries etc.)

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29
Q 
Propofol: 
Drug Class 
MOA
Therapeutic use (2)
2 important metabolic features
A

IV anesthetic
Potentiates GABA
Tx: Same day surgery procedures: induction and maintenance anesthesia, emergent status epilepticus

VERY Quick induction / VERY, VERY rapid recovery* (little hangover)

30
Q

Effects of Propofol:
CV/Resp***?
CNS?
GI?

A
  • VERY STRONG CV (esp. elderly) AND RESPIRATORY DEPRESSION
  • Decrease CBF, ICP, minor neuroexcitatory effects
  • Antiemetic
31
Q 
"Propofol Infusion Syndrome" Clinical manifestations: 
Cardio? 
Metabolic? 
Renal?
CNS?
A

Serious side effect:
1. CV dysfunction (dysrhythmia, heart failure)
2. Hyper: K+, lipidemia, metabolic acidosis, rhabdo,
3. Renal failure
Extreme “CNS depression”- similar to opioid OD

32
Q

Propofol + opioids

A

Increases sedative/ anesthetic effects

33
Q

Propofol + Fentalyl

A

serious bradycardia in pediatric patients

34
Q

Propofol + Alfentanil

A

Seizures in patients w/o Hx. epilepsy

35
Q

Most commonly abused drug by anesthesiology residents

A

propofol

36
Q

For which population are Barbiturates used as anesthetics the most?
Which drug is most commonly used?

A

Pediatric patients; thiopental

37
Q

Describe recovery from thiopental: how does it work?

A

Drug is not metabolized: recovery occurs by means of redistribution from the brain

38
Q

Is there an antagonist to use for treatment of barbiturates OD?

A

NO

39
Q

Describe ADR to barbiturates: CV effects?

In which groups (2) of patients are barbiturates always contraindicated?

A

Transient rise in BP–> HypoTN, CV collapse

PORPHYRIA; PREGGOS

40
Q

BDZs:
Recall MOA
Therapeutic use in anesthesia?

Important ADR?

A
  • Increase frequency of GABA channel opening
  • CNS depressant: therapeutic use limited in anesthesia; largely replaced by propofol
  • ADR: RESPIRATORY DEPRESSION (administered in concert with other depressants)
41
Q

What is the antagonist for BDZ overdose?

A

FLUMAZENIL

42
Q 
Opioids: 
Use in Anesthesia 
Drug drug interactions (2) 
Antagonist for OD? 
Three opioids commonly used during surgery?
A

Analgesic

  • Drug drug interaction with propofol and gaseous anesthetics
  • Tx OD with NALOXONE
  • morphine, fentanyl, sudafenil
43
Q

Anticholinergics:
3 important examples
Use in Anesthesia

A

Atropine, scopolamine, glycoperrolate

Used to combat vagal effects and prevent secretion

44
Q

Which Anticholinergic drug is most effective at preventing salivation?

A

Scopolamine>Glycoperrolate> atropine

45
Q

Which Anticholinergic drug is most effective at preventing reflex bradycardia?

A

Atropine>Glycoperrolate>Scopolamine

46
Q

Glycoperrolate:
Drug Class
Duration of action?
BBB?

A

Anticholinergic
Long acting
DOES NOT CROSS BBB–> peripheral effects

47
Q

Describe dissociative amnesia; which drug is used to administer this effect?

A

Patient is ‘awake’ but not around (dissociation from environment without complete loss of consciousness)

KETAMINE

48
Q

Ketamine:
MOA
Therapeutic uses (2)
What is the primary factor reducing its utility?
Who is more likely to experience these effects?

A

NMDA antagonist: dissociative amnesia + analgesic
*Being used more for pain treatment outpatient

*Causes delirium/ hallucination/ irrational bx. upon recovery; adults> kiddos

49
Q

4 stages of anesthesia

A

Stage I: Analgesia; conscious, conversational pt

Stage II: Excitement; delirium/ violent bx. (limit w/ BDZ, propofol, short acting barb pre-inhalation anesthetic)

Stage III: Surgical anesthesia; regular resp, eye movements fixed, MSK relaxation

Stage IV: Medullary paralysis–> death*

50
Q

How to ID local anesthetics: Ester Type

How are these drugs metabolized? Excreted?

A

1 “i” !!!!!

Esterases, plasma cholinesterases
metabolites excreted renally

51
Q

How to ID local anesthetics: Amide Type

How are these drugs metabolized? Excreted?

A

2 “i’s”!!!!!

Amidases in the liver (metabolites excreted renally)

52
Q

If patient is allergic to ester type local anesthetics, to which metabolite are they allergic?

A

PABA

53
Q

What is the chemical structure of local anesthetics?

Which form predominates at low pH? What are the implications for treatment?

A

Amine (weak base)
Inflammation–> low pH–> ionized form predominates, does not diffuse well to tissue (less effect when injected into inflamed area)

54
Q

MOA for all local anesthetics; which nerve fibers are affected first?

A

ionize within the cell, bind to the Na+ channel to prolong inactivation state

Small unmyelinated (pain) fibers affected first (autonomic/ sensory > motor neurons)

55
Q

3 primary determinants of diffusion rate/ duration of action for local anesthetics? implication for how they are administered?

A
  1. chemical properties
  2. local pH
  3. Blood flow*

Coadmin with vasoconstrictor: prolong effect, decrease likelihood of absorption into systemic circ (bad)

56
Q

Three adverse effects that occur if local anesthetics are absorbed into systemic circ. (CNS? CV? Other?)

A
  1. CNS stimulation seizures–> coma–> death by resp. failure
  2. CV Depression, HypoTN
  3. Hypersensitivity rections***(typically esters, PABA)
57
Q

2 vasoconstrictor commonly administered with local anesthetics

2 reasons why administered

*2 TIMES WHEN/ WHERE NOT TO USE THEM

A

Epinephrine, Phenylephrine

Prolong effect, decrease plasma concentration

DO NOT USE IF:

  1. *End arterial supply–> Gangrene–> peeped falls off
  2. CVD, HTN
58
Q

Topical (local) Anesthesia agents:

  1. Skin
  2. Mucous membrane (3)
  3. 2 mixtures ( LET, EMLA )
A
  1. Benzocaine
  2. Tetracane, epinephrine, cocaine (rare)

LET: lidocaine, epinephrine, tetracaine
EMLA: Epinephrine, Mixture lidocaine + others

59
Q

Infiltration (local) anesthesia:
What is it?
When is it used?
Disadvantage?

A

Anesthetic directly injected into tissue w/ epinephrine usually (2x time effective)

Dental procedures: lots of drug used for small area

60
Q

Iontophoresis local anesthesia:
What is it
When is it used

A

Use electrical current to force anesthetic into tissue

Used in Dental procedures

61
Q

Field Block (local) Anesthesia:
What is it?
Advantages?

A

Series of injections form wall of anesthesia around operative area

Less drug used for larger area

62
Q

Nerve Block (local) Anesthesia:
What is it?
When is it used?

A

Inject into or adjacent to nerve or nerve plexus (i.e. brachial)

Use when need a large area of anesthesia; produced with small mount of drug ( > field block or infiltration )

63
Q

What is spinal (local) anesthesia:

When is it used?

A

Injection into lumbar subarachnoid space around caudal equina–anesthetic is denser than CSF so it hangs out at the base of the spine really well without moving much

Useful in patients who are CI for general anesthesia but need something like knee surgery/ lower body surgery

64
Q

How is an epidural done? Which local anesthetic is administered to preggos for epidural? Why?

A

Local anesthetic injected into lumbar or caudal epidural space an absorbed into general circ.

Bupivacaine*; 300 minute t1/2

65
Q

Which parameters must be monitored in patients with epidural anesthetics (esp preggos)

A

CV parameters of mom and baby–prevent cardiac depression/ neurotox

66
Q

What is the only local anesthetic that causes vasoconstriction?

A

Cocaine!

67
Q

What was the first synthetic local anesthetic
How is it administered?
To what is it metabolized?

A

Procaine
Parenteral administration
Metabolized to PABA (remember i is ester- PABA is the ester metabolite that causes allergy)

68
Q

Benzocaine:

Common therapeutic uses

A

OTC ester

Teething babies/eardrops/pharyngitis/ sunburn*

69
Q

Lidocaine:
Where is it metabolized
Low long does it last
Common therapeutic uses

A

2 i’s–> amide–> metabolized in liver
Intermediate duration of action; 2 hour t1/2
Can administers via all local anesthetic ROA for a number of problems

70
Q

Prilocaine:
What is it?
ADR?
Therapeutic uses?

A

Lidocaine congener
Can cause methemoglobinemia
Limited to topical and infiltration anesthesia

71
Q

Bupivacaine:
Therapeutic use
Half life?
ADR?

A

Obstetrical anesthesia
VERY long t1/2–great for labor which goes long sometimes!
Can be CARDIOTOXIC (lowers threshold for tacky) (monitor CV function)

72
Q

Sudafenil/ alfentanil:

Drug class?

A

Opioids. (Because have ending like –il; think fentanYL derivative)

Neuro-Psych Exam II (11 decks)

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