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pharmocology > Anesthetics part1 > Flashcards

Anesthetics part1 Flashcards

1
Q

Anesthetic agent:

A

any drug used to induce a
loss of sensation with or without
unconsciousness

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2
Q

Adjunct

A

a drug that is not a true anesthetic,
but that is used during anesthesia to produce
other desired effects such as sedation, muscle
relaxation, analgesia, reversal, neuromuscular
blockade, or parasympathetic blockade

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3
Q

Four (4) Classifications of Anesthetic
Agents
and Adjuncts

A

route of admin. , time of admin, principal effect, chemistry

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4
Q

route of admin. classification

A

 Inhalant
 Injectable
 Oral
 Topical

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5
Q

time of admin classification

A

 Preanesthetic
 Induction
 Maintenance

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6
Q

principal effect classification

A 
 Local vs. general
 Sedatives and tranquilizers vs. analgesics
 Neuromuscular blockers
 Anticholinergic agents
 Reversal agents
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7
Q

chemistry classification

A

(We won’t go into a lot of detail on
this)
*MANY anesthetic agents and adjuncts produce
more than one effec

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8
Q

General Anesthesia

A 
• Reversible
• Produced by administration of one or
more anesthetic drugs
• Characteristics (4)
1) Unconsciousness (SPELL THIS CORRECTLY!)
2) Immobility
3) Muscle relaxation
4) Loss of sensation
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9
Q

Surgical Anesthesia

A

• A stage of general anesthesia
• Analgesia and muscle relaxation
• Eliminate pain and patient movement
during the procedure

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10
Q

sedation

A 
– CNS depression
– Drowsiness
– Drug-induced
– Various levels
– Slightly aware or
unaware of
surroundings
– Aroused by noxious
stimulation
– Uses: minor
procedures
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11
Q

tranquilization

A 
– Calmness
– Patient is
reluctant to move
– Aware of
surroundings but
doesn’t care
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12
Q

hypnosis

A 
– Drug-induced
– Sleeplike state
– Impairs patient’s
ability to respond
to stimuli
– Patient can be
aroused with
sufficient
stimulation
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13
Q

narcosis

A 
– Drug-induced
sleep
– Patient is not
easily aroused
– Associated with
narcotic drugs
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14
Q

Topical Anesthesia

A

 Applied to body surfaces or a wound

 Produces a superficial loss of sensation

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15
Q

Regional Anesthesia

A

 Loss of sensation to a limited area of the
body
 Nerve blocks
epidural anesthesia

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16
Q

Balanced Anesthesia

A

 Using multiple drugs in smaller quantities
 Maximizes benefits
 Minimizes adverse effects
 Gives anesthetist greater control

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17
Q

Agonists

A

Bind to and stimulate target tissue

Most anesthetic agents and adjuncts

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18
Q

Antagonists

A

Bind to target tissue but don’t stimulate

Reversal agents

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19
Q

Partial Agonists and Agonist-Antagonists

A

Opioids
Partial agonists
Agonist-antagonists
Used to block pure agonists

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20
Q

Analgesia

A 
Most general anesthetics are not
analgesics
• Must provide analgesic pre- and
postoperatively
• No pain perception while anesthetized
• True analgesics don’t provide general
anesthesia!
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21
Q

Drug Combinations

A 
• Don’t mix drugs in a single syringe
unless they are compatible
• Don’t administer a drug combination
if a precipitate (what’s this?) develops
when the drugs are mixed
• Most anesthetic agents and adjuncts
are water soluble
• Diazepam (Valium) is not water
soluble!!
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22
Q

opioids

A

 Derivatives of opium
 Produce analgesia and sedation
 Anesthetic induction when combined with
other drugs
 Classified as agonists, partial agonists,
agonist-antagonists, or antagonists

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23
Q

opioids that are not controlled substances and how they are administered

A

antagonists and nalbuphine. Administered IV, IM, SC, oral, rectal,intranasal inhalant, transdermal,
subarachnoid, and epidural
 Wide margin of safety

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24
Q

Opioids—Pharmacodynamics

A 
 Mimic endogenous opioid peptides
 β-Endorphins, dynorphins, enkephalins
(“Runner’s High”)
 Analgesia and sedative effects
 Result of action on the receptors in the brain and
spinal cord
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25
Q

How opioids work:

A 
 They prevent nerves from
transmitting impulses.
 They prevent presynaptic
release of neurotransmitters,
particularly excitatory afferent
neurotransmitters (?)
 Decrease critter’s “perception”
of pain.
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26
Q

opioid agonist bind to and best for

A

mu and kappa receptors

 Best for moderate to severe pain

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27
Q

opioid agonist antagonist bind to and best for

A

delta, mu, and kappa receptors, but
typically stimulate only kappa receptors (Reversal
agent/mild pain)

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28
Q

opioid antagonist bind to

A

Bind to but don’t stimulate delta, mu and kappa

receptors (reversal agents

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29
Q

Effects of Opioids
 CNS
 Effect depends on many factors

A

• Causes sedation
• Narcosis
• Euphoria .
 Analgesia

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30
Q

•Pure opioid agonists are the

BEST things

A

we have for
severe pain!
• Used as a premedication for painful surgery

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31
Q

Effects of Opioids on cardiovascular

A

 Bradycardia except meperidine which has

antimuscarinic effects that can produce tachycardia

32
Q

effects of opioids on respiratory

A

Decreased rate and tidal volume (dose-related)

 Cough suppression (codeine {usually}, morphine)

33
Q

opioids on eyes

A

miosis

34
Q

Adverse Effects of Opioids GI system

A

 Salivation and vomiting by stimulation of the
chemoreceptor trigger zone (CTZ)—(how could this
be beneficial?) it stimulates vomiting before intubation
 Initial diarrhea, vomiting, and flatulence
 GI stasis follows initial GI stimulation

35
Q

opioids cause adverse urine

A

retention

36
Q

affects of opioids on histamine

A

Histamine release
 Allergic rxns are very common with morphine use.
 Avoid in asthmatics.
*Increased intraocular and intracranial pressure
(so what?)

37
Q

opioid cough suppresants

A

(codeine, dextromethorphan)

38
Q

opioid pre anesthetics

A

 Agonists, partial agonists, or agonist-antagonist
 May be used alone or in combination with
• Tranquilizers
• Anticholinergics

39
Q

opioid anlagesia

A

Prevent and treat postoperative pain

 Used with tranquilizer to produce neuroleptanalgesia

40
Q

opioids used to induce Neuroleptanalgesia

A

– Morphine
– Buprenorphine
– Butorphanol
– Hydromorphone

41
Q

tranquilizers used to induce Neuroleptanalgesia

A

– Diazepam
– Midazolam
– Thorazine

42
Q

Neuroleptanalgesia definition

A

A profound state of sedation and analgesia
induced by simultaneous administration of
an opioid and a tranquilizer”
So it’s a state of “tranquil
dreaming”

43
Q

Use of Opioids
 Treatment of Acute Pulmonary Edema, as
in that seen with CHF. it does this by

A

 Vasodilation

 Reduce anxiety of “drowning”

44
Q

Opioid Antagonists

A 
Reverse undesirable effects
– CNS and respiratory depression
• Wake up patient following sedation
• Emergencies
• Overdoses
• Naloxone (Narcan) hydrochloride
– IM or slow IV administration
• Naltrexone: Like Naloxone but longer-acting
and has the potential for liver toxicity
45
Q

Naloxone Hydrochloride (Narcan). administration and doa

A

 IM—5 minutes to reversal
 IV (slowly)—2 minutes to reversal
 Duration of action 30-60 minutes

46
Q

naltrexone methylnaltrexone

A

revia, relistor. Longer duration of action than Narcan
 Usually given orally (one dose of naltrexone lasts
24 hours)
 Methylnaltrexone is a peripherally acting opioid
antagonist; theoretically shouldn’t reverse CNS pain
blockade…
 …but recent evidence finds over half of opioid pain
relief is due to
PERIPHERAL
sensory neuron
blockade!

47
Q

Effects of Opioid Antagonists

A 
 Reversal of effects of opioid
agonists, partial agonists, and
agonists-antagonists
 Reversal can be complete in a
few minutes
 Adverse effects are rare
 Sudden analgesia loss can cause
excitement, anxiety, and
sympathetic nervous system
stimulation
 Prevent by using an agonistantagonist
(why?)
48
Q

tramadol

A 
ultran. • Like an opiate
 but not an opiate
-Usually given P.O.
-Like opioids it is a weak centrally-acting µ-
receptor agonist providing moderately
strong analgesia
49
Q

Tramadol

• Side effects similar to opioids (but generally milder EXCEPT for

A

“Serotonin Syndrome” which can be fatal.

• Agitation • Muscular tremors • Sweating • Hyperthermia • Seizures

50
Q

tramadol dependence can be reversed with

A

partially reversed with opioid antagonists

51
Q

Injectable Anesthetics types and what they do and cant do

A

Can produce unconsciousness • Don’t provide analgesia or muscle
relaxation • Used with other agents • Administered “to effect” IV
• 1) Barbiturates, 2) propofol, and 3) etomidate

52
Q

Barbiturates subclasses

A

– Ultrashort • Thiopental sodium & methohexital • Induce general anesthesia
– Short • Pentobarbital • Induce general anesthesia • Treat epilepsy
– Intermediate – Long-acting

53
Q

Action of Barbiturates

A

Not fully understood  Mimics the inhibitory neurotransmitter GABA
 Causes CNS depression and loss of consciousness

54
Q

termination of barbs

A

Agent leaves brain  Is metabolized, excreted, or redistributed

55
Q 
Pharmacokinetics of Barbiturates
Protein binding (plasma proteins)  Free (unbound) drug
A

enters the brain

56
Q

hypoproteinemia affect in barbs

A

results in more

free drug  Increased drug amounts to brain

57
Q

normal drug dose of barbs may

A

produce prolonged unconsciousness or death in

hypoproteinemia

58
Q

Thiopental

A

ultra–short-acting  Redistributed to muscle and fat and slowly
released  Continuous or repeated dosing may lead to “full”
muscle and fat and prolonged recovery, making it “seem” like a longer-acting drug (first order» zero order kinetics)

59
Q

Methohexital

A

ultra–short-acting  Redistributed to muscle and fat but released
faster  Muscle and fat don’t get “full” (saturated) so
there is no prolonged recovery with continuous or repeated doses (zero order kinetics avoided)`

60
Q

Phenobarbital

A

long acting Sustained effect caused by slow uptake
and release from the brain, therefore
good for seizure disorders. Release is dependent on kidney
excretion, which is slowest

61
Q

Pentobarbital

A

short acting
Brain levels decrease based on liver metabolism
Faster than kidney excretion

62
Q

Use of Barbiturates

A

Rapid anesthetic induction  To allow intubation (thiopental and
methohexital)  Sustain with inhalation anesthetic (thiopental)  Sustain with repeated doses or continuous
infusion (methohexital)  Use alone for short procedures
Always
intubate!

63
Q

Effects of Barbiturates

A

 Dose-Dependent CV and Resp depression

 CNS  Mild sedation to unconsciousness  Possibly excitement at low dose

64
Q

Other Adverse Effects of Barbiturates

A

Exaggerated potency in critically ill,
hypoproteinemic, or acidotic patients (why?)
Tissue irritation and sloughs  Perivascular injection (lawsuit city)  Treat with saline, with or without lidocaine  Use dilute barbiturate solutions

65
Q

Barbiturate-Drug Interactions

Increase hepatic enzyme activity

A

Prolonged use (epileptics)  Shorter duration of activity of drugs metabolized in
the liver
So long-term barbituate users (such as epileptics)
“chew up” drugs that are metabolized by the liver
MUCH faster.

66
Q

propofol primary action of termination

A

Although it is both metabolized by the liver and excreted by the kidneys, the primary way Propofol’s action is terminated is by redistribution.

67
Q

propofol half life (funtional and elimination)

A

This gives Propofol a very short functional half-life (a few minutes) although it’s elimination half-life is 2-4 hours

68
Q

propofol onset/duration of action

A

Onset of action—30-60 seconds  Duration of action—5-10 minutes

69
Q

Effects of Propofol

• CNS

A

– Dose-dependent depression from sedation to

general anesthesia – No analgesia

70
Q

Effects of Propofol cardio system

A

– Cardiac depressant – Transient hypotension

71
Q

Effects of Propofol respiratory system

A

VERY potent respiratory depressant with

possible (frequent) apnea upon induction – Administer slowly to effect – Monitor patient carefully

72
Q

other effects of propofol

A
  • Twitching during induction
  • Muscle relaxation
  • Safe to use in critters with liver disease or kidney disease.
  • Antiemetic
  • Decreases intraocular and intracranial pressure
73
Q

Adverse Effects of Propofol

• CNS

A

Transient excitement and muscle tremors
(induction)
– Thrashing, muscle twitching, nystagmus (what’s this?), opisthotonus (resembles seizures)

74
Q

Adverse Effects of Propofol on cardiorespiratory system

A

– Hypotension—transient
• Respiratorysystem
– Apnea (rapid injection; high dose) • Intubation is usually necessary

75
Q

other adverse effects of propofol

A

Seizure-like signs (induction)  Treat with diazepam
Pain with IV injection  Perivascular injection does not produce tissue
damage (hurts a lot!!)

76
Q

Poor storage characteristics because of

A

Egg lecithin, glycerol, and soybean oil support

bacterial growth – Use aseptic technique

77
Q

In many ways, propofol is like a

A

better short acting barb

pharmocology (20 decks)

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