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Neuro Block 5 > Drugs > Flashcards

Drugs Flashcards

1
Q

General anesthesia

A

a state of CNS depression

a complete absence of sensations and is unconscious

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2
Q

Stage I of anesthesia

A

analgesia and amnesia

good stage

less pain, and loss of consciousness

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3
Q

Stage II of anesthesia

A

Delirium

patient may be agitated or combative

breath-holding, vomiting

ideally, patient should move through this stage as fast as possible

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4
Q

Stage III of anesthesia

A

surgical anesthesia

good stage

respiration becomes regular

four substages based on eye movement, depth of respiration and muscular relaxation

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5
Q

Stage IV of anesthesia

A

Medullary depression

bad stage

stage of relative overdose

may result in cardiovascular suppression

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6
Q

Halothane

A

CNS effects

  • Decrease brain metabolic rate
  • Increase cerebral blood flow
  • Increase intracranial pressure

CV effects

  • Decreased myocardial contractility and stroke volume leading to lower arterial blood pressure
  • Sensitizes myocardium to catecholamines
  • ↑ automaticity
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7
Q

Isoflurane

A

Advantages

  • Potent
  • Induction in less than 10 minutes
  • Doesn’t sensitize the myocardium to catecholamines
  • Less hepatotoxicity and renal toxicity than halothane (may be related to lower rate of metabolism)

Disadvantages

  • Rarely arrhythmias
  • Pungent odor
  • Potential for malignant hyperthermia
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8
Q

Desflurane

A

Halogenated Hydrocarbon Inhalation Anesthetic

CNS effects: Increase intracranial pressure

CV effects:

  • Decreased myocardial contractility and stroke volume leading to lower arterial blood pressure
  • Sensitizes myocardium to catecholamines
  • ↑ automaticity

Watch for malignant hyperthermia!

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9
Q

Sevoflurane

A
  • Newest approved inhalation agent for use in North America (1996)
  • High potency (low % of inspired gas)
  • Low blood solubility
  • Rapid onset – 5-10 min
  • Rapid recovery – same day surgery
  • Almost perfect inhalation anesthetic
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10
Q

Nitrous oxide

A

Advantages

  • Low blood solubility (rapid onset)
  • Second gas effect

Disadvantages

  • MAC = 104% - can’t use as sole anesthetic agent
  • No muscle relaxing effect
  • Diffusion hypoxia if rapidly discontinued
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11
Q

Thiopental

A

Barbiturate

  • Facilitates GABA induced Cl- entry into neurons, leading to CNS depression
  • Rapid onset (sec) after iv administration and short action (min) allows quick recovery
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12
Q

Propofol

A
  • Rapid induction (50 seconds) and recovery (4-8 minutes) from anesthesia
  • May be given alone to maintain anesthesia or used for induction as part of balanced anesthesia technique
  • May result in injection site pain
  • Causes Apnia (22-45%) –> don’t leave the room!
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13
Q

Midazolam

A

Benzodiazepine

  • Facilitates GABA induced Cl- entry into neurons, leading to CNS depression
  • Most important characteristic is amnestic action
  • Insufficient for anesthesia when given alone
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14
Q

Ketamine

A
  • Dissociative anesthetic (Patient appears to be awake - eyes open; Unaware of environment and doesn’t feel pain)
  • Principal drawback is the occurrence of emergence reactions (delirium and hallucinations)
  • Abuse - currently abused in the US
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15
Q

Fentanyl

A

Opioid

  • Hemodynamic stability - good for patients with compromised myocardial function
  • Respiration must be maintained artificially and may be depressed into the postoperative period
  • Usually supplemented with inhalation anesthetic, benzodiazepine or propofol
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16
Q

Sufentanil

A

opioid

  • Hemodynamic stability - good for patients with compromised myocardial function
  • Respiration must be maintained artificially and may be depressed into the postoperative period
  • Usually supplemented with inhalation anesthetic, benzodiazepine or propofol
17
Q

Why is the partial pressure of an inhalation anesthetic is a more important variable in producing anesthesia than blood concentrations of the agent?

A
  • Remember Dalton’s Law?
  • (Pt = P1 + P2 + P3 …)
  • Always have 21% O2!!
  • So the remaining 79% is available
  • Amount of undissolved drug in blood is related to the clinical effect
  • Drugs dissolved in fluid do not raise the Panesthetic in that fluid
18
Q

3 Factors affecting Parterial

A
  1. Concentration of anesthetic in inspired air
      Higher = faster onset
  2. Pulmonary ventilation
      Higher = faster onset
  3. Transfer of anesthetic from alveoli to blood
      Solubility of anesthetic in blood
19
Q

Really important number used in anesthesia: Minimum Alveolar Concentration (MAC)

ED50

What are the usual MACs for surgical anesthesia and deep anesthesia?

A

Surgical anesthesia is usually attained at 1.3 - 1.5 MACs

Deep anesthesia ensures at about 2 MACs

20
Q

Potency in Anesthesia

A

DEF: Amount of drug necessary to produce effect of specified intensity

Function of lipid solubility

Conclusion: The more lipid soluble the anesthetic, the greater is its potency

21
Q

Blood:Gas Partition Coefficient

A

Reflects solubility of an inhalation anesthetic in blood

Conclusion: **the more soluble a drug is in blood, the longer it takes to raise its partial pressure in blood (Pblood) **

Longer period of time for anesthesia

22
Q

Halogenated Hydrocarbon Inhalation Anesthetics:

halothane, isoflurane, methoxyflurane (vet), sevoflurane

What are the CV effects?

A
  • Decreased myocardial contractility and stroke volume leading to lower arterial blood pressure
  • Sensitizes myocardium to catecholamines
  • ↑ automaticity
  • Halothane > isoflurane, desflurane, sevoflurane > nitrous oxide
23
Q

Malignant hyperthermia may occur with all inhalation anesthetics…

Whis is MH?

Potential for MH with all inhalation anesthetics except what?

Antedote = ???

A

rapid increase in body temp due to hypermetabolic reaction in skeletal muscle (cool patient!!)

All except N2O

Dantroline – blocks Ca release from sarcoplasmic reticulum

24
Q

Intravenous Anesthetics

A
  • Act faster
  • Best suited for induction of anesthesia
  • Useful for short operative procedures
  • Unsuitable as a single drug anesthetic for many surgical procedures (inhalation anesthetics maintain anesthesia for longer procedures)

Neuro Block 5 (12 decks)

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