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Pharmacology > Anesthetics and Local Anesthetics > Flashcards

Anesthetics and Local Anesthetics Flashcards

1
Q

Anesthetic action is terminated how in general?

A

Redistribution from the site of anesthesia

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2
Q

General anesthetics terminate how?

A

Leave brain

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3
Q

Local anesthetics terminate how?

A

Leave site of action

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4
Q

8 associated anesthesia effects

A 
Relieve anxiety
Sedation
Prevent allergic response
Prevent aspiration of stomach contents or emesis
Analgesia
Prevent bradycardia 
Prevent pulmonary fluid secretions
Facilitation of incubation and relaxation
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5
Q 
Ideal anesthetic:
Timing of analgesia
Consciousness
Skeletal muscle
Reflexes
Memory
Safety
A

Analgesia that persists after procedure itself
Rapidly reversible depression of consciousness
Relaxation of skeletal muscle
Reduction in reflexes
Amnesia
Safety in operating room

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6
Q

Is any drug perfect?

A

No

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7
Q

What drug comes close to perfect?

What’s wrong?

A

Ether

Not safe for the operating room staff

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8
Q

Four stages of anesthesia?
Which is target?
Which do you want to pass quickly?
Which do you want to avoid

A

Analgesia
Disinhibition: Pass through quickly
Surgical anesthesia: Target
Medullary depression: Avoid

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9
Q 
Disinhibition stage
Mental status
Reflex change
Respiration change
GI change
A

Delirium and excitation
Reflexes enhanced
Respiration irregular
Nausea and vomiting

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10
Q 
Surgical anesthesia:
Consciousness
Reflexes
Heart changes
Temperature change
Respiratory rate
A 
Unconscious
No pain reflexes
Stable BP and rate
Temp stable
Normal respiratory rate
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11
Q

How to get respiratory rate lower in surgical anesthesia safely

A

Oxygen supplementation

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12
Q

2 severe aspects of medullary depression

A

Severe respiratory and CV depression

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13
Q

3 parts of surgical anesthesia?

A

Induction
Maintenance
Recovery

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14
Q

Goal of induction

A

Quick into anesthesia and to bypass disinhibition/excitatory phase

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15
Q

Goal of maintenance

A

Maintain surgical anesthesia and vital functions

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16
Q

Goal of recovery

A

Rapid emergence from anesthesia with short disinhibition

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17
Q

Recovery is complete when the patient is? 3

A

Conscious
Alert
Responsive

18
Q

Two theories of how anesthetics work

A

Membrane expansion by 0.4% disrupts sodium channel function –> Decrease excitability

Anesthetic receptor that when activated interferes with sodium or chloride function.

19
Q

Most likely common anesthetic receptor target?

A

GABA

20
Q

Primary site of inhaled anesthetics

A

Brain/CNS

21
Q

Minimum Alveolar Concentration is what type of measurement?

Define

A

Dosage

Level needed to get 1/2 patients anesthetized in order to do a surgical incision 3 inches long in abdomen through all layers of muscle

22
Q

Rapid induction needs a MAC of what?

A

1.3/1.5

23
Q

Why is nitrous oxide never used solo?

A

MAC > 100.0

24
Q

Explain the relationship of solubility, induction and emergence and equilibrium.

A

Less soluble the gas –> Faster it reaches equilibrium –> Faster the induction and emergence

25
Q

Effect of inspired concentration on equilibrium

A

Higher the concentration –> Faster the equilibrium

26
Q

Deeper or faster inspiration effect on equilibrium?

A

Deeper or faster inspirations mean faster equilibrium

27
Q

Cardiac output effect on equilibrium

A

Faster CO –> Faster delivery

28
Q

What is the second gas effect?

A

Two gases put together actually gives a faster effect (increases concentration gradient)

29
Q

Why do you want a scavenger with a anesthetic apparatus?

A

Want what the patient is breathing out to not go into the surrounding room.

30
Q

What is an active scavenger?

A

Draws gas back out

31
Q

What is a passive scavenger?

A

Anesthetic is trapped in a chemical trap as patient breathes

32
Q

What happens when you turn off NO anesthetic?

A

NO rushes back into the alveolar space –> Displaces oxygen –> Diffusion hypoxia

33
Q

How to offset diffusion hypoxia? (2)

A

100% O2 administration

Maintaining normal ventilation

34
Q

Malignant hyperthermia is most common with what?

What is it related to?

A

Halogenated anesthetic or succinylcholine

Increased myoplasmic calcium levels and increased coupling –> Leaving calcium causes contractions to continue

35
Q

How to treat malignant hyperthermia (3)

A

Withdraw drug
Cool patient
Treat with dantrolene

36
Q 
Halothane
2 uses
Effect on CV
Effect on Respiratory
Effect on SNS
Effect on myocardium
1 toxic side effect
A 
Uses: Weak analgesic + muscle relaxant
CV: Depress
Resp: Depress
SNS: Block SNS reflexes
Myocardium: More sensitive to catecholamines (arrhythmia)
Toxicity: Hepato
37
Q 
Enflurane
Use:
CV:
SNS effect: 
Myocardium effect:
Toxicity
And why: 
Adverse effect
Contraindication
A 
Same as halothane
CV depressant
No SNS effect
Sensitizes myocardium to catecholamines
Renal
Biotransformation product has fluoride
Lowers seizure threshold
Contraindicated in labor
38
Q

Isoflurane and Desflurane
Respiratory effect
CV effect:
Myocardium effect

A

Resp: Stimulation of reflex and secretions
CV: None
Myocardium: None

39
Q 
Desflurane
Advantage: 
Reacts with what
To form what:
Causes what:
How to alleviate
A 
Ad: Fast induction sand rapid adjustments
Dry absorbents
Carbon monoxide
Carboxyhemoglobinemia
Use appropriate scavenger
40
Q 
Nitrous Oxide
MAC
Use solo:
Use overall:
What effect to watch: 
Respiratory effect: 
CV effect
A 
MAC: Over 100%
Solo use: Do NOT
Use overall: Analgesic
Effect to watch: 2nd gas effect
Resp: Potentiate depression of other drugs
CV effect: Depressant
41
Q

Sevoflurane
Who likes it the most:
Induction/Emergence speed
Adverse effect:

A

Kids like it the most –> Sweet scent
Fast induction and emergence
Adverse

Pharmacology (6 decks)

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