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pharmacology > anesthetics > Flashcards

anesthetics Flashcards

1
Q

5 general benefits/uses of anesthesia drugs?

A 
Sedation and reduced anxiety
Lack of awareness and amnesia
Skeletal muscle relaxation
Suppression of undesirable reflexes
Analgesia
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2
Q

can one drug do all five benefits/uses of anesthesia drugs?

A

NO, generally combine IV and inhaled to maximize effects and avoid ADRs

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3
Q

which is cheaper and easier to use? IV or inhaled anesthetics?

A

IV

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4
Q

what do IV anesthetics do? what are they used for? (used alone, vs adjunct, vs continual infusions)

A

rapid induction of anesthetic effect

  • alone: short procedures, anesthesia
  • continual infusions: longer procedures
  • adjuncts: to inhaled
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5
Q

what is the one IV barbituate anesthetic agent?

A

methohexital (brevital)

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6
Q

what is the MOA of methohexital (brevital)?

A

binds barbiatuate site on GABAa receptor

–> enhance Cl- channel opening to increase GABA inhibitory effect on the receptor.

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7
Q

how long does it take methohexital (brevital) to work?

A

fast, 30 sec. rapid induction of sleep

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8
Q

2 ADRs of methohexital?

A
  1. respiratory depression

2. hypotension (from VasoDilation)

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9
Q

what is the MOA of IV propofol and IV Etomidate, ?

A

binds beta subunit on GABAa receptor

–> enhance GABA inhibitory effect

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10
Q

what is the major benefit of IV propofol over IV methohexital ?

A

kinetics: rapid on, rapid off receptor.

- Recovery is better- less N/V

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11
Q

what are the kinetics of IV propofol?

A

rapid!

onset- 30sec, rapid metabolism, short 1/2 life (30-60min)

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12
Q

3 ADRs of IV propofol? (maybe weeds)

A

Apnea, decrease cardiac output, hypotension

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13
Q

drug of choice for shorter ambulatory procedures in the OR? what is used prior to admin of other anesthesias?

A

short in OR: IV propofol

prior: IV ketamine

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14
Q

when would you choose to use IV etomidate? (over propofol)

A

if BP low before surgery – agent has minimal cardiac and respiratory depression
only Side Effects:
Nausea/vomiting on emergence from anesthesia

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15
Q

what is the 2 part MOA of IV ketamine?

A
  1. blocks NMDA glutamate (excitatory) receptor in CNS = rapid hypnotic state
  2. mu opiod agonist - analgesic effects
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16
Q

which IV drug Produces rapid hypnotic state (dissociative anesthesia) where patient exhibit analgesia, are unresponsive to commands, have amnesia, their eyes may open and limbs move involuntarily?

A

IV ketamine

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17
Q

what are the two major advantages of IV ketamine over other anesthetics?

A

1 . No risk for hypotension or bronchospasm
(increases HR, BP & cardiac output)
2. Pediatric procedures: @ low doses in combo with others (propofol &/or midazolam)

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18
Q

what would you use for a short painful procedure on a kid (like burn dressing change)?

A

IV ketamine

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19
Q

ADRs of IV ketamine?

A

illusions

increases HR, BP and CO

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20
Q

major MOA of inhaled anesthetics?

A

bind beta subunit on GABAa (inhibitory) receptor

same as IV propofol and Etomidate

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21
Q

what are the 3 other MOAs of inhaled anesthetics? what do they all lead to?

A
  1. inhibit NMDA receptors
  2. activates K+ channels
  3. inhibits nicotinic (excitatory) receptor- activated cation channels
    - -> hyperpolarization and reduced membrane excitability
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22
Q

onset and duration of inhaled anesthetics? (maybe weeds)

A

onset: 2-3min
duration: <2hrs

23
Q

5 ADRs of inhaled anesthetics?

A 
shivering
blurry vision 
weak for a few days following after administration 
*Rare: hepatotox
*Rare: malignant hyperthermia
24
Q

two types of inhaled anesthetics

A
  1. inhaled gas - nitrous oxide

2. volatile agents (liquid turns to gas)- “-fluranes”

25
Q

what was “tweaked” to create the volatile inhaled agents “-fluranes”? why? (weeds)

A

Halothane - tweaked b/c ADRs were bad

26
Q

what are the local anesthetics?

A

“-aine” s

*cocaine was the original

27
Q

MOA of local anesthetics? (“-aine”s)

A

reversible inhibition: bind Na+ channel, decrease nerve membrane permeability to Na+

  • -> axn potential can’t propegate
  • -> sensory input lost (pain and temp)
28
Q

what happens with repeated injections of local anesthetics? (“-aine”s)?

A

tachyphylaxis: loses effectiveness

29
Q

what are the 2 groups that the local anesthetics are broken into?

A

esters and amides

30
Q

which drugs are in the ester local anesthetic group?

A

COCAINE
PROcaine
chloroPROcaine
TETRAcaine

31
Q

which drugs are in the amide local anesthetic group?

A

Prilocaine
Lidocaine
“-vacaine”s

32
Q

which are the longest acting local anesthetics?

A 
bupi-vacaine, ropi-vacaine 
("V caine is VERY long lasting ") 
 and 
Tetracaine 
(think "4 times as fast")
33
Q

which are the shortest acting local anesthetics?

A

Procaine and chloroprocaine

“ PROs need to recover QUICK”

34
Q

what is the most important factor for determining DOA and potential for Tox with local anesthetics?

A

local blood flow:

anesthetic cause vasodilation= rapid drug abs and systemic abs. = increased toxicity

35
Q

how can you avoid the short DOA and toxicity risk with local anesthetic? (weeds)

A

give epi with it

Epi vasoconstricts = longer DOA, less systemic abs and less toxicity

36
Q

local anesthetic effect in injured tissue ?

A

injured tissue = inflammation and acidosis
–> lower pH = ionization of local anesthetics
(need to be NON-ionized in order to get into cell and have effect)

OVERALL: doesn’t work as well

37
Q

where can you NOT use local anesthetic w/ epi ?

A

where vasoconstriction could result in permanent tissue destruction
Nose, ear, penis, or ends of digits (fingers and toes), peripheral vascular disease

38
Q

what are the two systemic toxicity complications that come from abs. of too much local anesthetics ?

A

CNS/neuro

Cardiovascular

39
Q

CNS/neuro tox from too much local anesthetic abs?

A

numb tongue + metallic taste
nystagmus + muscle twitch
seizure + CNS depression

40
Q

cardiovascular tox from too much local anesthetic abs?

A

bradycardia, severe hypotension, cardiac arrest

41
Q

what is the one exception from usual cardiovasc. tox progression from too much local anesthetic abs?

A

cocaine: vasoconstriction, HTN, & ventricular arrhythmia

Vasoconstriction= ischemia (why you see ulceration of membranes & damage to septum occur when abused nasally)

42
Q

what drug combo is used to make cream to numb area: apply before venipunture (for putting in port for chemo) ? (weeds)

A

prilocaine/lidocaine (EMLA) cream

43
Q

what drug is used to make lozanges/gels for teeth pain? (weeds)

A

benzocaine

44
Q

what drug is this…
IV/IM drug of choice for preoperative sedation, anxiety and amnesia
Causes high amnesia – often given before entering OR

A

a benzodiazepine (Midazolam aka Versed) injectable

45
Q

when are opiods used with anesthetics?

A

low dose opioids: premedication & adjunct
…as adjunct: decrease pain so don’t need as high a dose to achieve anesthesia
* In high risk surgery to minimize CV depression

46
Q

what two anticholinergics are used with anesthetics? why?

A

atropine and glycopyrolate
- restore cardiac rate (prevent reflex brady) and BP during anesthesia
(stimulates M2)

47
Q

anesthesia adjunct: to relieve anxiety

A

benzodiazepine

48
Q

anesthesia adjunct: to prevent gastric acid secretions

A

H2 blockers

49
Q

anesthesia adjunct: prevent allergic rxns

A

antihistamines

50
Q

anesthesia adjunct: prevent aspiration of gastric acid secretions, post-op N/V

A

antiemetics

51
Q

anesthesia adjunct: to provide analgesia

A

opioids

52
Q

anesthesia adjunct: to prevent bradycardia + secretion of fluids into respiratory tract

A

anticholinergics

53
Q

anesthesia adjunct: to facilitate intubation + relaxation

A

neuromuscular blocking agents

pharmacology (24 decks)

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