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Pharm Spring 2014 > Anesthetics > Flashcards

Anesthetics Flashcards

1
Q

What is monitored anesthesia care?

A

Using sedatives and other agents, but the dose is low enough that the patient remains responsive and able to breath without assistance. We use this for simple procedures and minor surgery. MAC generally refers to IV sedation.

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2
Q

What is the main difference between MAC and GA?

A

Patients in GA no longer respond to stimuli

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3
Q

Define minimal, moderate, and deep sedation, and general anesthesia

A

Minimal Sedation (Anxiolysis)- Pt responds normally to verbal commands. Cognitive function and coordination may be impaired. Vent and CV function unaffected.

Moderate Sedation (Conscious sedation)- responds purposefully to verbal commands alone or with light tactile stimulation. Airway and ventilation are fine. CV usually fine.

Deep- Not easily aroused. Responds purposefully to repeated/painful stimuli. Ventilation and airway may be impaired. CV usually fine.

GA- Not arousable even by painful stimuli. Needs assistance with patent airway, may need PPV. CV may be impaired.

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4
Q

Effects of general anesthesia

A

No sensory perception
Loss of consciousness
No recall of events
Immobility

Others include muscle relaxation (although you don’t NEED muscle relaxants), suppression of the ANS, analgesia, and anxiolysis.

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5
Q

What is the only anesthetic that has analgesic properties?

A

Ketamine. Our other anesthetics just cause loss of consciousness.

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6
Q

General induction sequence

A

Pre-op meds (anxiolytic, antibiotic, etc)
Induction agent
Paralytic
Maintenance agent
Opoids
Antiemetics
Reversal agents (reversal of the paralytic)

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7
Q

Why do we need to give antiemetics?

A

Because the opioids and anesthetics can cause nausea

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8
Q

5 effects of benzodiazepines

A

ASAAM

1) Anxiolysis
2) Sedation
3) Antegrade amnesia
4) Anticonvulsant
5) Muscle relaxation (at the spinal level)

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9
Q

Prototype for benzos

A

Diazepam (Valium)

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10
Q

Midazolam (Versed) is an example of this class of drugs)

A

Benzos

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11
Q

How do benzodiazepines work?

A

Potentiating the binding of GABA to GABAa receptors and increases the potency of GABA x 3.
Causes Cl- influx, hyperpolarizing the cell and decreasing its excitability

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12
Q

When would benzos drop your BP?

A

When used in large doses for induction (due to a decrease in SVR), especially with hypovolemia. Also may decrease because the pt was anxious before and is now more relaxed.

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13
Q

When are benzos contraindicated?

A

Pregnancy

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14
Q

What do opioids bind to?

A

On Mu receptors which can be located on either the pre or post-synaptic membranes

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15
Q

At what anatomical locations do opioids work?

A

In the brainstem, spinal cord, and peripheral tissues

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16
Q

Opioids result in decreased release of this NT

A

Substance P

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17
Q

Why should we try to avoid a benzo/opioid cocktail pre-operatively?

A

They have a synergistic effect on ventilation

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18
Q

What is the benefit of using opioids for general anesthesia?

A

It doesn’t drop BP (although it will cause bradycardia!)

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19
Q

How much fentanyl would be needed to induce GA?

A

50-100mcg/kg

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20
Q

This class of drugs are the classic induction agents

A

Barbiturates. Because the end result is depressing the reticular activating system (causing sleep).

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21
Q

Which are more effective as anticonvulsants, benzos or barbiturates?

A

Barbiturates

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22
Q

Which class of medications, when injected arterially, will cause gangrene and nerve damage?

A

Barbiturates

23
Q

What can cause enzyme induction?

A

Smoking, ETOH, and barbiturates.

24
Q

What barbiturate is the most potent enzyme inducer?

A

Phenobarbital

25
Q

What’s the deal with barbiturate allergies?

A

It’s very rare (1:30,000), but highly fatal

26
Q

Barbiturates increase the metabolism of these drugs

A

Oral anticoagulants, phenytoin, TCAs, corticosteroids, and Vitamin K

27
Q

Barbiturates should be avoided in patients with

A

Porphyria.

Barbs cause rapid heme production through the stimulation of the enzyme D-aminolevulinic acid synthetase. People with porphyria have shitty heme. So if you give benzos to these people, they will have a shit ton of shitty heme.

28
Q

Do barbiturates cross the placenta?

A

Yes.

29
Q

Barbiturates stimulate this enzyme responsible for heme production

A

D-aminolevulinic acid synthetase

30
Q

What is included in the base of propofol?

A

Egg, soy, and glycerol

31
Q

Bronchoconstriction is often related to what?

A

Patient not being deep enough. Asthmatics are at an even higher risk of this if they are not deep enough. You want asthmatics to be very deep because they are at high risk of bronchoconstriction when stimulated.

32
Q

Can propofol be given to those with egg allergies?

A

Yes

33
Q

This medication attaches to the B1 subunit of the GABAa receptor

A

Propofol

34
Q

Succinylcholine binds to what type of receptors?

A

Nicotinic ACh receptors

35
Q

Succinylcholine is often replaced with

A

Rocuronium

36
Q

How can we reduce myalgias with succ?

A

Give a small dose of a non-depolarizing agent first, and then give the succ

37
Q

If giving succ to kids, what should you also give them and why?

A

Give atropine. Succ blocks ACh receptors, which can cause profound bradycardia in kids.

38
Q

This medication is a POTENT trigger of malignant hyperthermia

A

Succinylcholine. Isoflurane can also trigger MH.

39
Q

Succ should be avoided in

A

Patients with atypical acetylcholinesterase. Remember this is familial, so if the patient describes a family member not waking up after surgery, etc., then don’t draw this up as an emergency medication.

40
Q

Patients with these diseases are at higher risk for hyperkalemia when given succ

A

Burns, trauma, nerve damage, neuromuscular diseases, and renal failure. `

41
Q

Prototype for the non-depolarizing muscle relaxants

A

Vecuronium

42
Q

Structure of vecuronium

A

Monoquarternary aminosteroid

43
Q

What receptors does vecuronium work on?

A

Pre and post-synaptic nACh receptors

44
Q

For what patients will vecuronium not work?

A

Burn patients

45
Q

Things to look out for with vecuronium

A

Residual NM blockage and increased likelihood of recall

46
Q

How are inhalational anesthetics eliminated?

A

Via the lungs. We can alter elimination by varying the RR. Liver and kidney disease won’t affect metabolism or elimination.

47
Q

What is usually the only inhalational anesthetic used for induction?

A

Sevoflurane

48
Q

Do inhalational anesthetics act as a bronchodilator or constrictor?

A

Bronchodilator

49
Q

What is the MAC of an anesthetic?

A

The alveolar concentration of an inhalational agent at which 50% of patient will not move to a noxious stimulus

50
Q

What is the only inhalational agent we used that will not provide anesthesia by itself?

A

Nitrous oxide (N2O)

51
Q

Local anesthetics will block APs ONLY if the Na channels are in this state

A

Inactivated-closed

52
Q

If your patient starts having signs of local anesthetic toxicity, you should give them this

A

Versed (because the patient will probably have a seizure)

53
Q

Local anesthetic with high risk for cardiac toxicity

A

Bupivicaine (can cause arrythmias, AV blocks, hypotension, and arrest)

54
Q

What class of drug would you want to give to induce anesthesia in a patient with high ICP?

A

Barbiturates

Pharm Spring 2014 (13 decks)

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