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Cology 2 Exam 1 > Anesthetics > Flashcards

Anesthetics Flashcards

1
Q

Amnesia is mediated through what loci?

A

Hippocampus

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2
Q

Immobility is mediated through what loci?

A

Thalamus

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3
Q

Unconsciousness is mediated through what loci?

A

RAS (reticular activating system)

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4
Q

What do we use to induce analgesia before maintaining it with gas?

A

Propofol, thiopental (both IV)

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5
Q

What drug is used as an anti-emetic before surgery?

A

Promethazine po

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6
Q

What drug is used to decrease secretions before surgery?

A

Antihistamines po

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7
Q

What oral drugs are used for analgesia/sedation before surgery?

A

Clonidine, dexmetetomidine

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8
Q

What IV anxiolytic/amnestic is used prior to surgery?

A

Midazolam

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9
Q

What IV analgesic is used during surgery?

A

Fentanyl

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10
Q

What muscle relaxant is used during surgery?

A

Atracurarium

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11
Q

What drugs are used for maintenance of anesthesia?

A

N2O and isoflurane

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12
Q

What indicates need for more fentanyl or gas during surgery?

A

Increases in HR or BP

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13
Q

What is used after surgery to reverse blockade?

A

Neostigmine and atropine

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14
Q

What are the inhalation anesthetics?

A

Ether
Nitrous oxide (N2O)
Halothane

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15
Q

What are the IV anesthetics?

A

Barbiturates
Ketamine
Propofol

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16
Q

What are the molecular targets of general anesthetics? (6)

A
  1. Enhance Gaba-A receptor sensitivity (enhance affinity for GABA, prolong channel opening time and increase frequency of opening)
  2. Enhance glycine-gated Cl- channels (Increase receptor’s affinity for glycine)
  3. Inhibit neuronal nicotinic ACh receptors, inhibiting excitation (produce analgesia and amnesia; does not affect neuromuscular junction)
  4. Inhibit NMDA receptors (Inhibit long-term potentiation, produce unconsciousness)
  5. Activate two-pore domain K+ channels (Hyperpolarization causes inhibition of action potentials, produces unconsciousness)
  6. Neurotransmitter release (inhibit NT release in hippocampus, contributes to amnesia)
17
Q

What kind of therapeutic index do anesthetics have?

A

Very low

18
Q

What CNS effects do anesthetics have? (5)

A

Increase cerebral blood flow
Stimulate CTZ (nausea and vomiting)
Decrease or eliminate ventilatory drive
Decrease ventilatory reflexes (ie response to high CO2)
Lower temperature setpoint –> Hypothermia (worse with cold iv fluids, exposed organs, vasodilation)

19
Q

What CV effects to anesthetics have? (6)

A 
Decrease sympathetic tone
Increase vasodilation
Myocardial depression
Blunt baroreceptors
Decreased blood pressure
Decreased cardiac output (Worse with volume depletion and worsened myocardial dysfunction)
20
Q

Besides CNS and CV effects, what other 3 effects do anesthetics have?

A

Decrease renal blood flow and filtration
Muscle relaxation
Decrease esophageal sphincter tone

21
Q

What is MAC?

A

Mean Alveolar Concentration: concentration (%) at 1 atm required to prevent reflex responses to skin incision of 1 cm in 50% of patients

22
Q

What is MAC-WAKE?

A

concentration (%) at 1 atm where 50% of patients will respond to verbal commands

Lower MAC value – more potent the agent
MAC over 100 means hyperbaric condition is needed

23
Q

Which anesthetic has the highest MAC? Lowest MAC?

A

Lowest MAC: Halothane (0.75%)

Highest MAC: Nitrous oxide (105%)

24
Q

What does a low partition coefficient mean?

A

Less in the blood, more in the brain

25
Q

What determines induction rate?

A

B/GPC

26
Q

What anesthetic has the highest Blood/Gas Partition Coefficient? Lowest?

A

Lowest: Desflurane (0.42)

Highest: Halothane (2.30)

Lowest = fastest into the brain (fastest induction)

27
Q

Fat/blood ratio affects what?

A

Recovery time and residual effects

28
Q

Which anesthetic has the fastest recovery time?

A

Nitric oxide

Cology 2 Exam 1 (14 decks)

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