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Anesthesiology > Drugs - General Anesthesia > Flashcards

Drugs - General Anesthesia Flashcards

1
Q

4 components of General Anesthesia

A

1 - Analgesia - pain relief
2 - Amnesia - no new memories formed
3 - Areflexia - not moving
4 - Unconsciousness - unaware

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2
Q

General Anesthesia

  • Stages?
  • Solubility in blood?
A

Stage 1 - Analgesia / pain relief
Stage 2 - Delirium ** LARYNGOSPASM RISK
Stage 3 - Surgical Anesthesia ** DESIRED STAGE
Stage 4 - Medullary Paralysis *** OVERDOSE

    • The more soluble the GA agent is in the blood, the MORE YOU NEED to reach critical tension in the brain
    • The LESS SOLUBLE in blood, the FASTER it goes on and off
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3
Q

3 steps of GA

A

1 - Induction
2 - Maintenance
3 - Emergence

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4
Q

Class of drugs used for Anxiolysis/Sedation

A

1 - Benzodiazepines
2 - Barbiturates

*** NOT analgesics, these provide NO pain relief

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5
Q

Benzodiazepines

  • Mechanism of action?
  • Examples (6)
A
  • Binds to GABA receptors –> opens the channel –> increases Cl- (chloride ion) influx –> SLOWS down the CNS
  • Diazepam (Valium)
  • Triazolam (Halcion)
  • Midazolam (Versed)
  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)
  • Lorazepam (Ativan)
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6
Q

Generic Name: Diazepam

Brand Name?

A

Valium

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7
Q

Generic Name: Triazolam

Brand Name?

A

Halcion

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8
Q

Generic Name: Midazolam

Brand Name?

A

Versed

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9
Q

Generic Name: Alprazolam

Brand Name?

A

Xanax

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10
Q

Generic Name: Clonazepam

Brand Name?

A

Klonopin

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11
Q

Generic Name: Lorazepam

Brand Name?

A

Ativan

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12
Q

Barbiturates

  • Mechanism of action?
  • Overdose may lead to what?
  • Contraindication?
  • Examples
A
  • Same as Benzos - - Binds to GABA receptors –> opens the channel –> increases Cl- (chloride ion) influx –> SLOWS down the CNS
  • Overdose may lead to Respiratory Depression
  • Contraindicated in pts with Intermittent Porphyria, aggravates the disease
  • Thiopental (quick onset, short duration of action - undesirable, used for induction)
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13
Q

Midazolam / Versed

  • Class?
  • Effects?
  • When to give?
A
  • Benzodiazepine
  • Anxiolytic, Amnestic
  • Induction period - First medication you give
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14
Q

Fentanyl

  • Class?
  • Effects?
  • When to give?
A
  • Opioid
  • Decrease sympathetic drive - meaning, decrease HR, BP, stress on heart and body
  • Reduces the amount of OTHER anesthetics needed to keep the patient under
  • Induction Period
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15
Q

Lidocaine

  • Class?
  • Effects?
  • When to give?
A
  • Local anesthetic, Class 1B Anti-arrhythmic
  • Reduces pain from Propofol IV injection
  • Reduces post-op pain
  • Reduces amount of anesthetics needed to keep patient under
  • Reduces post-op ileus (painful obstruction of intestines)
  • Induction Period
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16
Q

Propofol

  • Class?
  • Effects?
  • When to give?
A
  • General anesthetic
  • Can be used as the sole anesthetic for MAC (Monitored Anesthesia Care / Twilight anesthesia)
  • Vasodilation - so decreases BP (keep pressors on hand, not good for hemodynamically unstable patients), Anti-emetic
  • Induction and Maintenance Periods
17
Q

Pressors to keep on hand to combat the vasodilatory effects of Propofol:
When to use?

A
  • Phenylephrine (vasopressor)
  • Ephedrine (vasopressor and positive inotrope)
  • Induction Period
18
Q

Paralytics

A
  • Succinylcholine - DEPOLARIZING

- Rocuronium - NON-DEPOLARIZING

19
Q

Dexamethasone

  • Uses?
  • When to give?
A
  • Anti-emetic
  • Anti-inflammatory (steroid)
  • Induction Period
20
Q

Why is Halothane no longer used in the United States?

A

Hepatotoxicity - potential fatal liver toxicity

21
Q

What is MAC (in terms of anesthetic gases) and what does it mean?

A
  • Minimum Alveolar Concentration - alveolar concentration of a gas at 1 atm of steady-state concentration at which 50% of subjects do not respond to surgical incision/painful stimulus
  • Aka = ED50 (effective dose for 50% of the population)
  • MAC values are additive (0.5 MAC isoflurane + 0.5 MAC N2O = 1 MAC)
  • MAC is INVERSELY related to anesthetic POTENCY
  • High MAC –> Less potent
  • 1 MAC of Nitrous Oxide = 104%
  • ED95 is 1.3 MAC
22
Q

What is the MAC of Nitrous Oxide?

A

N2O MAC = 104%

- Meaning, it can NEVER reach 1 MAC alone.

23
Q

Between N2O, isoflurane, desflurane, sevoflurane - list most to least potent

A 
MOST POTENT --
1 - Isoflurane ----- MAC 1.2%
2 - Sevoflurane - MAC 2.0%
3 - Desflurane --- MAC 6.0%
4 - N2O ------------ MAC 104%
-- LEAST POTENT

Anesthesiology (5 decks)

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