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neurology FA > anesthetic drugs > Flashcards

anesthetic drugs Flashcards

1
Q

CNS drugs must ….(according to structure_

A
  1. be lipid soluble (cross BBB)

or 2. be actively transported

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2
Q

anesthetic drugs - solubility in blood / lipids

A

low solubility in blood –> rapid induction and recovery times
increased solubility in lipids –> increased potency

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3
Q

inhaled anesthetics - MAC? (definition)

A

minimal alveolar concentration (of inhaled anesthetic) required to prevent 50% of subjects from moving in response to noxious stimulus (e.g. skin incision)

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4
Q

potency vs minimal alveolar concentration (EQUATION)

A

potency = 1 / MAC

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5
Q

example of inhaled anesthetic with low blood and lipid solubility

A

nitrous oxide

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6
Q

example of inhaled anesthetic with increased blood and lipid solubility

A

halothane

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7
Q

inhaled anesthetic with increased blood and lipid solubility –> …. (potency and induction)

A

high potency

low induction

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8
Q

inhaled anesthetic with low blood and lipid solubility –> …. (potency and induction)

A

low potency

high induction

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9
Q

inhaled anesthetics - drugs

A

(HALOTHANE, -FLURANE, N20)

  1. halothane 2. enflurane 3. isoflurane
  2. sevoflurane 5. methoxyflurane
  3. nitrous oxide (N2O) 7. desflurane
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10
Q

inhaled anesthetics - mechanism of action

A

unknown

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11
Q

inhaled anesthetics - side effects (and which drug) and other effects

A
  1. fulminant hepatic necrosis (halothane)
  2. nephrotoxicity (methoxyflurane)
  3. proconvulsant (enflurane)
  4. expansion of trapped gas in body cavity (N20)
  5. malignant hyperthermia (all)
  6. Myocardial and resp depression
  7. nausea/emesis
  8. increased cerrebral blood flow (decreased metabolic demands)
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12
Q

malignant hyperthermia - definition/causes/manifestation ….

A

rare, life threatening condition in which inhaled anesthetics or succinylcholine induce fever and severe muscle contraction

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13
Q

malignant hyperthermia - manifestations / susceptibility

A

fever and severe muscle contraction
Susceptibility is AD with variable expression –> mutation in voltage-sensitive ryanodine receptor cause increase Ca+ release from sarcoplasmic reticulum

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14
Q

malignant hyperthermia - treatment

A

dantrolene

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15
Q

Intravenous anesthetics - groups/drugs?

A
  1. barbiturates - thiopental
  2. benzodiazepines - midazolam
  3. arylcyclohexylamines - ketamine
  4. opioids - morphine, fentanyl
  5. propofol
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16
Q

Intravenous anesthetics - thiopental - properties

A

high potency, high lipid solubility, rapid entry BBB

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17
Q

Intravenous anesthetics - thiopental - clinical uses

A

induction of anesthesia and and short surgical procedures

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18
Q

Intravenous anesthetics - thiopental’s effect terminated by

A

rapid redistribution into tissue and fat

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19
Q

Intravenous anesthetics - thiopental - side effects

A

decreases cerebral flow

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20
Q

Intravenous anesthetics - benzodiazepines - drugs?

A

midazolam

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21
Q

Intravenous anesthetics - midazolam - clinical uses

A
  1. MC drug used for endoscopy

2. adjunctively with gaseous anesthetics and narcotics

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22
Q

Intravenous anesthetics - midazolam - side effects

A
  1. severe postoperative respiratory depression
  2. low BP
  3. anterograde amnesia
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23
Q

Intravenous anesthetics - treat midazolam overdose with

A

flumazenil

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24
Q

Intravenous anesthetics - arylcyclohexylamines - drugs

A

ketamine

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25
Intravenous anesthetics - ketamine - mechanism of action
PCP analog that act as a dissociative anesthetics Block NMDA receptors cardiovascular stimulant
26
Intravenous anesthetics - ketamine - side effects
1. hallucination 2. bad dreams 3. disorientation
27
Intravenous anesthetics - ketamine - except its action an anesthetic is also a
cardivascular stimulant --> useful for patients in cardiogenic of septic shock
28
Intravenous anesthetics - ketamine effect on cerebral arteries
increase cerebral blood flow
29
Intravenous anesthetics - opioids - drugs
1. morphine | 2. fentanyl
30
Intravenous anesthetics - opioids - clinical use
uses with other CNS depressants during general anesthesia
31
Intravenous anesthetics - propofol - mechanism of action
potentiates GABA-A
32
Intravenous anesthetics - propofol - side effects
1. low BP | 2. chemical pancreatitis
33
Intravenous anesthetics - propofol vs thiopental according side effects
propofol --> less postoperative nausea
34
Intravenous anesthetics - propofol clinical use
1. used for sedation in ICU 2. rapid anesthesia induction 3. short procedures
35
malignant hyperthermia - treatment
dantrolene
36
Intravenous anesthetics - groups/drugs?
1. barbiturates - thiopental 2. benzodiazepines - midazolam 3. arylcyclohexylamines - ketamine 4. opioids - morphine, fentanyl 5. propofol
37
local anesthetics - groups
1. esters | 2. amides
38
local anesthetics - groups/drugs
- CAINE 1. esters --> procaine, cocaine, trtracaine, benzocaine 2. amides --> lidocaine, mepivacaine, bupvacaine (AMIDES HAVE 2 Is in name)
39
local anesthetics - mechanism of action
- block Na+ channels by binding to specific receptors on inner portion of channel. Preferentially bind to activated Na+ channels, so must effective in rapidly firing neurons. - They penetrate membrane in uncharged form, then bind to ion channels as charged form (3ry amines)
40
local anesthetics - clinical use
1. minor surgical procedure | 2. spinal anesthesia
41
local anesthetics - toxicity (and which drugs)
1. CNS excitation 2. severe cardiovascular toxicity (bupivacaine) 3. hypertension 4. hypotension 5. arrhythmias (cocaine) 6. methemoglobinemia (benzocaine) IF ALLERGIC TO TO ESTERS --> GIVE AMIDES
42
local anesthetics can be given with ... (why)
vasoconstrictors (usually epinephrine) to enchance local action - decrease bleeding, increase anesthesia by decrease systemic concentration
43
local anesthetics in infected (acidic) tissue
alkaline anesthetics are charged and cannot penetrate membrane effectively --> need more anesthetic
44
local anesthetics - order of nerve predominates
small myelinated fibers > small unmyelinated fibers > large myelinated fibers > large unmyelinated fibers
45
local anesthetics - order sensation loss
1. pain 2. temperature 3. touch 4. pressure
46
local anesthetics - groups/drugs
- CAINE 1. esters --> procaine, cocaine, trtracaine, benzocaine 2. amides --> lidocaine, mepivacaine, bupvacaine
47
neuromuscular blocking drugs - purpose
muscle paralysis in surgery or mechanical ventilation
48
neuromuscular blocking drugs - muscle paralysis in
surgery or mechanical ventilation
49
neuromuscular blocking drugs - selective for
motor (vs autonomic) nicotinic receptors
50
neuromuscular blocking drugs - receptors
motor nicotinic receptors | - selective for motor (vs autonomic) nicotinic receptors
51
neuromuscular blocking drugs are divided to (and drugs)
1. depolarizing --> succinylcholine 2. nondepolarizing --> (-CURARINE, -CURIUM, -CURONIUM) 1. Tubocurarine 2. Atracurium 3. Mivacurium 4. Pancurorium 5. Vecuronium 6.Rocuronium
52
neuromuscular blocking drugs - depolarizing - drugs
succinylcholine
53
succinylcholine - mechanism of action
strong ACh receptor agonist --> produce sustained depolarization and prevents muscle contraction
54
succinylcholine - complications
1. hypercalcemia 2. hyperkalemia 3. malignant hyperthermia
55
depolarizing neuromuscular blockage - phases and characteristic
phase I - prolonged depolarization | phase II - repolarized but blocked. ACh receptros are available but desensitized
56
depolarizing neuromuscular blockage - phase II - receptor's condition
ACh receptros are available but desensitized
57
depolarizing neuromuscular blockage - reversal of blockage by ... (antidote?)
phase I --> no antidote | phase II --> cholinestarase inhibitor
58
depolarizing neuromuscular blockage - action of cholinestarase inhibitor
phase I --> potentiates the block | pase II --> antidote
59
nondepolarizing neuromuscular blockage - drugs?
(-CURARINE, -CURIUM, -CURONIUM) 1. Tubocurarine 2. Atracurium 3. Mivacurium 4. Pancurorium 5. Vecuronium 6.Rocuronium
60
nondepolarizing neuromuscular blockage - mechanism of action
competitive antagonists - compete with ACh for receptors
61
nondepolarizing neuromuscular blockage - reversal of blockage?
cholinesterase inhibitors 1. edrophonium 2. neostigmine (with atropine) 3. other cholinesterase inhibitors drugs
62
nondepolarizing neuromuscular blockage - reversal of blockage - neostigmine featrues
must be given with atropine to prevent muscarinic effects such as bradycardia
63
dantrolene - mechanism of action
prevents release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle
64
dantrolene - clinical use
1. malignant hyperthermia | 2. neuroleptic malignant syndrome (a toxicity of antipsychotic drugs)
65
Baclofen - mechanism of action
Activate GABA -B receptors at spinal cord level --> induces skeletal muscle relaxation
66
Baclofen - clinical use
muscle spasms (eg. acute low back pain)
67
cyclobenzaprine - mechanism of action
centrally acting skeletal muscle relaxant | structural related to TCAs
68
cyclobenzaprine - clinical use
muscle spasm
69
cyclobenzaprine is stractural related to
TCAs
70
cyclobenzaprine - side effects
similar to anticholinergic side effects
71
neuroleptic malignant syndrome is a toxicity of
antipsychotic drugs
72
Intravenous anesthetics - groups/drugs?
1. barbiturates - thiopental 2. benzodiazepines - midazolam 3. arylcyclohexylamines - ketamine 4. opioids - morphine, fentanyl 5. propofol
73
local anesthetics - groups/drugs
- CAINE 1. esters --> procaine, cocaine, trtracaine, benzocaine 2. amides --> lidocaine, mepivacaine, bupvacaine
74
inhaled anesthetics - drugs
(HALOTHANE, -FLURANE, N20) 1. halothane 2. enflurane 3. isoflurane 4. sevoflurane 5. methoxyflurane 6. nitrous oxide (N2O) 7. desflurane

neurology FA (31 decks)

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