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D&T2 Exam 2 > Anesthetics: general and local - Egleton > Flashcards

Anesthetics: general and local - Egleton Flashcards

1
Q

what are two categories of inhalational anesthetics

A

halogenated

non-halogenated

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2
Q

name a non-halogenated anesthetics

A

nitrous oxide

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3
Q

what is balanced anestheisa

A

making sure the patient stays alive

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4
Q

MAC

A

inspired concentration of anesthetic required to produce anesthesia in 1/2 of subjects

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5
Q

Name 4 factors that affect MAC

A

age
health status
drug interactions
red hair

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6
Q

MAC is measured for what age range? how do you adjust MAC for an infant/child and old age

A

35-40 yrs
increase for infant/child
decrease for old age

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7
Q

how would you adjust MAC for someone who has hyperthyroidism and hypothyroidism

A

hyer: increase
hypo: decrease

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8
Q

How is potency expressed

A

expressed as minimum alveolar concentration MAC

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9
Q

if someone is on sedatives how does one change the dose of MAC

A

decreases

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10
Q

if someone is on Amphetamines how does one change the dose of MAC

A

increase

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11
Q

how does inhaled anesthesia leave the body

A

lungs

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12
Q

how much of the inhaled anesthesia is metabolised

A

minimum

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13
Q

what is rate of induction

A

how quickly the gas will induce anesthesia

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14
Q

how does increasing concentration of anesthetic in inspired-gas mixture impact rate of induction

A

increase

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15
Q

how does increasing alveolar ventilation impact rate of induction

A

increase

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16
Q

how does increasing solubility of anesthetic in blood ( blood; gas partition coefficient) impact rate of induction? how?

A

decrease

since its soluble it takes longer for it to distribute

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17
Q

how does increasing cardiac output impact rate of induction? explain?

A

decrease

  • drugs leave alveolar to bloodstream faster
  • respiration rate must match this
  • partial pressure in arterial blood becomes lower
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18
Q

concentration of agent is directly proportional to what

A

partial pressure

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19
Q

anesthetic induction occurs faster with what type of agent

A

agents which are less soluble in blood

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20
Q

what is the relationship between lipid solubility and MAC

A

linear

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21
Q

what is a special characteristic of nitrous oxide

A

would need a LOT of it to induce complete anesthesia

which is impossible

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22
Q

What is the Meyer-Overton Theory

A

anesthetic dissolves in the membrane and “affects” the function of membrane proteins - no specific receptor, no specific antagonist

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23
Q

for the Meyer-Overton Theory may impede the breakdown of what and how

A

GABA

  • potentiating GABA-increased Cl-influx
  • increase K+ efflux; Reduce Na, Ca influx
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24
Q

what halogen do you not repeat at intervals less than 2-3 weeks

A

Halothane

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25
Q

what are cardiovascular effects of Halothane

A

Sensitizes heart to catecholamines –> increases risk of arrhythmias

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26
Q

what can metabolism of Halothane cause

A

liberation of hydrocarbons, bromide ion which can result in hypersensitivity reaction and hepatitis

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27
Q

Halothane and Succinylcholine increases the risk of what? how do you treat this

A

malignant hyperthermia: sustained contraction of skeletal muscles; dramatic increase in O2 consumption
- Dantrolene

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28
Q

what is the cardiovascular effects of Enflurane

A

less sensitization of heart to catecholamines and Halothane

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29
Q

what is respiratory effects of Enflurane

A

respiratory depression in dose-dependent manner

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30
Q

what are CNS effects of Enlflurane

A

CNS excitation –> Seizures

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31
Q

what are muscular effects of Enflurane

A

Block ACh effects at NMJ

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32
Q

what are cardiovascular effects of Isoflurane

A

-does not induce arrhythmias
- does not sensitize heart to catecholamines
- does not decrease cardiac output
leads to wide margin cardiac safety

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33
Q

what is a respiratory effect of Desflurane

A

respiratory irritant

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34
Q

what is a disadvantage of Sevoflurane

A

leads to production of toxic compound A

-Fl- released during metabolism

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35
Q

what are two properties of nitrous oxide

A

potent analgesic

balances anesthesia

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36
Q

what are respiratory effects of Nitrous oxide

A

at least 30% oxygen should be used with N2O ( limited to 70%; usually less due to other agents.

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37
Q

what are cardiovascular effects of nitrous oxide

A

decreases circulatory effects of halogenated anesthetics

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38
Q

what can nitrous oxide cause to the blood

A

oxidizes cobolt of vitamin B12 –> inhibits methylation of macromolecules –> chronic exposure can cause megaloblastic anemia

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39
Q

Nitrous oxide does not cause what

A

malignant hyperthermia

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40
Q

what is the second gas effect

A

a rapidly absorbed gas increases the rate of uptake of a second anesthetic gas

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41
Q

what is the major elimination of inhalation anesthetics

A

lungs

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42
Q

when are intravenous anesthetic agents used and inhalation

A

IV: rapid induction of anesthesia

maintained by inhalation agent

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43
Q

how well do people recover from Propofol

A

rapid recovery

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44
Q

what are cardiovascular effects of using Propofol? who is prone to them

A

hypotension

elderly

45
Q

what is PRIS propofol-related infusion syndrome

A 
serious side effect of 
dysrhythmia
heart failure
hyperkalemia
lipemia
metabolic acidosis 
renal failure
46
Q

what happens when propofol is used with opioid

A

increased sedative or anesthetic effects

decrease systolic, diastolic and mean arterial pressure and cardiac output

47
Q

what happens when propofol is used with opioid fentanyl

A

serious bradycardia in pediatric patients

48
Q

what happens when propofol is used with alfentanil

A

seizure activity in patients without any history of epilespy

49
Q

what are advantages of using Etomidate

A
  • minimal cardiovascular effects

- decreases cerebrovascular blood flow to brain–> use for brain/neural type surgeries

50
Q

what is a drug example of a barbiturate

A

Thiopental

51
Q

what are properties of Barbiturates

A

short acting
used for induction, sedative effects
no analgesia or muscle relaxation

52
Q

How does one recover from Thiopental

A

redistribution from brain into less vascular regions

53
Q

how do you treat over dose of Barbiturates

A

you don’t

no antagonists in case of overdose

54
Q

what are 2 contraindications of Barbiturates

A

Variegate porphyria

acute intermittent porphyria

55
Q

Porphyria

A

a rare hereditary disease in which the blood pigment hemoglobin is abnormally metabolized

56
Q

Diazepam, Iorazepam, Midazolam are what type of drugs

A

Benzodiazepines

57
Q

What do Benzaodiazepines cause

A

reduce anxiety
facilitates amnesia while causing sedation
prevent convulsions
may depress respiration

58
Q

how might Benzodiazepines depress respiration

A

increase frequency of channel opening

59
Q

what is a Benzodiazepine antagonist

A

Flumazenil

60
Q

Fentanyl, Morphine, Sulfentanil are what type of drugs

A

opioids

61
Q

what type of surgery are opioids used in? what is perseved

A

cardiac surgery as cardiac output and myocardial contractility are perserved

62
Q

what are some side of effects of opioids

A

hypotension, respiratory depression, muscle rigidity, prostanesthetic nausea/vomiting

63
Q

Opioids can potentially interact with what other drugs

A

propofol

gaseous anesthetics

64
Q

what is an opioid antagonist

A

naloxone

65
Q

Atropine, Scopolamine, glycopyrrolate are what type of drugs

A

anticholinergic

66
Q

what anticholinergics used for

A

combat secretions, prevent vagal effects

67
Q

compare/contrast Scopolamine and Atropine with salivation and heart

A

Scopolamine better prevents salivation

Atropine is better preventing bradycardia

68
Q

which anticholingeric does not cross the BBB

A

Glycopyrrolate

69
Q

mental state where individual appears to be dissociated from environment without complete loss of consciousness

A

Dissociateive Anesthesia

70
Q

name a dissociative anesthesia drug

A

Katamine

71
Q

MOA of ketamine

A

NMDA receptor

72
Q

Ketamine reduces what effects of recovery? who usually gets these

A

delirium, hallucination, irrational behavior

in adults, less likely in children

73
Q

what are the 4 stages of Anesthesia

A

analgesia
Excitement
surgical anesthesia
medullary paralysis

74
Q

Analgesia phase of anesthesia

A

patient is conscious and conversational

75
Q

what happens in excitement phase? do we want to be in this phase

A

delirium
tachycardia
violent behavior
NO

76
Q

how can an anesthesiologist prevent stage II

A

give short acting Barbiturate IV before inhalation anesthesia to avoid Stage II

77
Q

what happens in surgical anesthesia

A

regular respiration

relaxation

78
Q

what happens in medullary paralysis

A

severe depression of respiratory and vasomotor centers

death

79
Q

what zone do you want to be in for anesthia

A

surgical anesthesia

80
Q

ketamine is related to what other drug

A

phencyclidine

81
Q

as you progress through the stages of anesthesia what happens to the brain

A

increased CNS depression

accumulation of anesthetic in brain

82
Q

to create loss of sensation without loss of consciousness or impairment of central control of vital function

A

local anesthetics

83
Q

what are two types of Anesthetic drugs? how do you differentiate between the 2

A

ester : i

amide: ii

84
Q

MOA of local anesthetics

A

bind to Na channel ( internal site)

reversible inhibition of axonal nerve conduction

85
Q

what types of cells are easier to put under local anesthetics

A

unmyelinated fibers

automatic and sensory nerves

86
Q

what metabolizes ester type drugs

A

esterases, plasma cholinesterases

87
Q

what metabolizes amide type drugs

A

amidases, liver

88
Q

what are some adverse CNS effects of local anesthesia

A 
CNS stimulation ( restlessness) followed by CNS inhibition ( sedation)
headache
89
Q

what are some adverse CV effects of local anesthesia

A

hypotension

cardiac depression

90
Q

what are some hypersensitivity reactions of local anesthesia? why?

A

allergic dermatitis or asthamatic attack

due to ester anesthetics to metabolism ro PABA

91
Q

Epinephrine and Phenylephrine do what as anesthetics

A

vasoconstrictors

92
Q

properties of vasoconstrictors

A

slows rate of absorption
decreases drug plasma concentration
less likehood of side effects

93
Q

where should vasoconstrictor not be used

A

end arteries

fingers, toes, ears, nose, penis

94
Q

what kind of patients should be receiving epinephrine and Phenylephrine

A

whom adrenergic stimulation may have adverse effect ( hypertension, ventricular arrhythmias)

95
Q

name a skin topical anesthisa

A

Benzocaine

96
Q

name a mucous membraine and cornea anesthisa

A

tetracaine
lidocaine
cocaine

97
Q

what is special about epinephrine and mucous membrane

A

can penetrate mucous membrane, but not good local anesthetic

98
Q

Iontophoresis

A

small electrical current forces anesthetic into tissue

99
Q

what is the effect of Epinephrine on infiltration anesthesia

A

doubles duration of anesthesia

100
Q

what is infiltration anesthesia

A

anesthetic injected directly into tissues

101
Q

Administered in a series of injections to form a wall of anesthesia encircling operative fields

A

field block anesthesia

102
Q

what is an advantage of field block anesthesia

A

less drug for greater area of anesthesia than infiltration

103
Q

what is the effect of nerve block anesthesia

A

produces large ares of anesthesia with small amount of drug

104
Q

when is spinal anesthesia used

A

people contraindicated for general lower body surgery

105
Q

what drug is used for Epidural anesthesia

A

Bupivacaine

106
Q

what is the only anesthetic that causes vasoconstriction

A

cocaine

107
Q

what is procaine metabolized to

A

PABA

108
Q

Benzocaine is used to treat what

A

teething/gum pain

109
Q

where is Lidocaine metabolized

A

liver

D&T2 Exam 2 (14 decks)

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