drugs

Question 1

relief of pain w/out intentional production of altered mental state

Answer 1

analgesia

Question 2

decreased apprehension with no change in level of awareness

Answer 2

anxiolysis

Question 3

protective reflexes maintained. independent maintenance of airway/O2 sat/ventilation. REsponse to physical and verbal stimulation

Answer 3

conscious sedation

Question 4

profound effects with loss of one or more of following: protective reflexes maintained. independent maintenace of airway/O2 sat/ventilation. response to verbal stimulation

Answer 4

deep or unconscious sedation

Question 5

sensory, mental, reflex and motor blockade; concurrent loss of ALL protective reflexes

Answer 5

general anesthesia

Question 6

why are INHALATIONAL AND INTRAVENOUS dosing preferred?

Answer 6

b/c they offer more immdeiate control over dose and hence duration of action

Question 7

agenst capable of producing reversible depression of neuronal function, producing loss of ability to perceive pain and/or other sensations

Answer 7

general anesthetics (maintain patent airway–(may require Positive pressure ventilation)

unconsiouscness = loss or protective reflex. need to maintain airway

Question 8

describes what: anesthetic activity = linked to lipid solubility. more lipid soluble = higher anesthetic activity.

what is the execption?

Answer 8

Myer-Overton hypothesis

Exception: can make drug more lipid soluble, but then you lose anestehtic property of drug. NOTE: N20 has really low oil: gas partition coefficient. (greatest to least Isoflurane >sevoflurane>desflurane)

Question 9

concentration of inspired gas needed to render 50% pt unconsicous

Answer 9

minimum alveolar concentration.

Question 10

the lower the MAC the ____

Answer 10

more potent the anesthetic.

Question 11

lipid solubility described by what coeff

Answer 11

oil:gas coefficicent. larger # = more lipid soluble drug

Question 12

inhaled anesthetics MOA:

what do they enforce:

what do they inhibit:

Answer 12

reinforcement of : GABAa and glycine inhibitory signaling, and two pore K+ channel

inhibition of glutamatergic signalling

Question 13

during anesthesia –> decreased parietal response. therefore anesthesia decreases coritcal interactions and decreases integration.

Question 14

note: anesthetic agents distribute throughout body including PERIPHERAL NEURONS : OVERALL effet of drug includes: NOT ONLY direct effect on CNS, but also modulation of ASCENDING NEURAL pathways to the CNS and DESCENDING pathway to peripheral tissue

Question 15

t/f. loss of memory and perceptive awareness can precede production of analgesia

Answer 15

true

Question 16

blood gas partition coefficiecnt

Answer 16

how much anestheic needs to be accumulated in blood to reach equillibrium with avelovlar concentration (partial pressure in admixiure administed = partial pressure in systemic circulation)

Question 17

which new inhalational anesthetics equillbribate most rapidly

Answer 17

sevoflurane

desflurane (much quicker than halothane at 2.3x)

Question 18

why is MAC of nitrous oxide 105%

Answer 18

Nitrous oxide = incomplete anesthetic (would need to increase, increse, hyperbaric pressure for this agent to work ell)

Question 19

do you want a high or low Blood:gas partition coefficient in order to achieve anesthethia the most quickly

Answer 19

very low coefficient.

Question 20

why does nitrous oxide reach saturation in blood rapidly?

Answer 20

b/c it is not lipophilic and does not get stuck in fat

Question 21

t/f. delivery of anesthetic to blood can be hastened by increasing ventilation rate? which drugs affected?

Answer 21

True. increased ventilation leads to the rapid equillibration of NITROUS OXIDE.

Question 22

what are the 4 respiratory effects of inhaled anesthetics?

Answer 22

1. increaesed RR
2. decreased tidal volume
3. regular rhythmic shallow breathing

4. reflex response to PaCO2 blocked by all except N2O

Question 23

which inhaled anesthetic does not have cardio effects unless w/an opioid

Answer 23

Nitrous oxide

Question 24

4 ADE cardio for inhaled anesthetics

Answer 24

1. decreased sympathetic outflow( direct depression)
2. decrease adrenal catecholamine release( peripheral ganglionic blockade)
3. decrease CA2+ flux(baroreceptor decrease)
4. Vagal stimulation

Question 25

why do we use nitrous oxide?

Answer 25

vapor sparing effects

reduced inspired volatile concentration

mild analgesic properties

Question 26

what is a drug combo that produces pain relief and produces analgesia

Answer 26

nuerolept analgesia use fentanyl (short acting opiate. recal fentanyl patch).

droperidol + fentanyl = neurolept-analgesia. combined in preparation. useful for radiology, endoscopy, burn dressings.

Add N20 = nuerolept-anesthesia. Atropine + morphine or mereprinie

Question 27

why would you add atropine to neurolept analgesia regiment?

Answer 27

to dry out secretions

Question 28

for a quick 20 minute procedure, which analgesic which would you use? does it cause N/V?

Answer 28

FENTANYL!!!!

more lipid soluble, onset in <30 seconds, peak effect in 2-3 minutes, and N/V RARE. (COMPARE that to MORPHINE!!!!)

Question 29

for long-lasting analgesia, which drug do you want to use?

Answer 29

MORPHINE!!!

1. poor penetration of BBB

pain relief correlates with CSF drug levels.