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Pharmacology > Exam 10: General Anesthetics > Flashcards

Exam 10: General Anesthetics Flashcards

1
Q

purpose of atropine pre-op

A

Prevent bradyarrhythmias that can be caused by general anesthesia

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2
Q

Fast acting IV agent used to induce anesthesia

A

Propofol

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3
Q

Inhaled anesthetics used to maintain anesthesia after propofol

A

N2O plus another inhaled general anesthetic (-flurane)

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4
Q

emergence excitement

A

5-30% of patients experience restlessness, crying, moaning, thrashing when they come out of anesthesia

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5
Q

Drug that can be used to combat shivering due to hypothermia post-up

A

Merperidine

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6
Q

What property of inhaled anesthetics greatly affects how fast they work?

A

Water (blood) solubility
High solubility = slow induction
Low solubility = fast induction

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7
Q

Measurement of water solubility

A

Blood/gas partition coefficient

(concentration in blood)/(concentration in lung) when gas is in equilibrium

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8
Q

how quickly does N2O work? Why?

A

Fast

poorly soluble in blood (low blood/gas partition coefficient

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9
Q

How do we measure potency of inhaled general anesthetics?

A

MAC
Minimum Alveolar Concentration
Inhaled concentration for 50% of patients to not respond to pinprick pain

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10
Q

How does MAC relate to lipid solubility?

A

More lipid soluble = more potent

Less lipid soluble = less potent

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11
Q

What’s weird regarding lipid/water solubility of anesthetics?

A

Poorly water-soluble agents aren’t necessarily highly lipid soluble
Ex. N2O has low lipid and water solubility (fast induction, but low potency)

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12
Q

What’s a really good way to find out how conscious a sleeping patient is?

A

BIS
Bispectral Index
real time computer analysis of patient EEG
Give you a 0-100 scale from deep coma to awake

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13
Q

N2O side effects (3)

A
  1. air pockets (middle ear)
  2. Blood pressure change
  3. Depresses ventillary response to hypoxia
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14
Q

What is one side effect that N2O does NOT have compared to the other inhaled GAs/

A

Malignant hyperthermia

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15
Q

Inhaled anesthetic still used in 3rd world. Side effects?

A

Diethyl ether

Cheap, effective but irritates airway and is flammable

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16
Q

Problem with cyclopropane

A

Spontaneous combustion

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17
Q

Side effect of halothane

A 
decreased BP at 1 MAC
Vasodilation
Decreased cardiac output
bradycardia
Decreased GFR
Decreased ventilation rate
Halothane hepatitis
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18
Q

Pharmacokinetics of halothane

A

Blood:Gas partition = 2.3

Slowest induction, recovery

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19
Q

Rare, 50% fatal side effect of halothane

A

Halothane Hepatitis

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20
Q

Enflurane odor

A

Sweet

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21
Q

Halothane metabolism

A

liver

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22
Q

Enflurane side effects

A

Produces electrical seizure activity, though no

evidence, contraindicated for epileptics

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23
Q

Isoflurane odor

A

Pungent

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24
Q

Where is isoflurane excreted?

A

99% unchanged excreted from lungs

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25
Q

Preferred inhaled GA for neurosurgery? Why?

A

Isoflurane

Modest vasodilation in cerebral vasculature, but metabolic rate of brain is decreased

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26
Q

Desflurane disadvantage

A

Irritating- causes coughing, secretions

you have to induce with IV before giving them this

27
Q

Where is desflurane excreted?

A

99% unchanged excreted from lungs

28
Q

Sevoflurane excretion

A

99% unchanged excreted from lungs

29
Q

Potential danger of sevoflurane

A

Causes CO2 absorber to heat up, could potentially cause a fire

30
Q

Advantage of sevoflurane over desflurane?

A

Non-irritating to airway, so you can use it to induce

31
Q

Preferred inhaled GA for patients prone to myocardial ischemia? why?

A

sevoflurane

does not change cardiac output

32
Q

2 characteristics of IV general anesthetics

A
  1. Act fast (
33
Q

Sodium thiopental mechanism

A

Barbiturate

Enhances effects of GABA at GABAA receptors

34
Q

Sodium thiopental metabolism

A

Liver

35
Q

Sodium thiopental side effects

A

Decreases brain metabolic rate, ICP, and cerebral blood flow
Decreases heart contractility and causes vasodilation
Decreases ventilation

36
Q

Interesting use of Sodium thiopental

A

Lethal injection

37
Q

Propofol constitution

A

Super fatty (white)
Careful with patients with high triglyceride levels
Not water soluble

38
Q

Most common agent of induction of anesthesia in the USA

A

Propofol

39
Q

Advantage of propofol over Sodium thiopental

A

no hangover (faster discharge, better outcomes)

40
Q

propofol mechanism

A

Enhances effects of GABA at GABAA receptors

41
Q

Side effects of propofol

A
  1. Decreased ventilation (even more than Sodium Thiopental)
  2. Major decrease in BP (vasodilation and less heart contractility)
  3. May hurt on injection
42
Q

Advantages of propofol

A

Safe in pregnant women

Anti-emetic properties

43
Q

Who might be good patients with whom to use Etomidate?

A

Those prone to hypotension

44
Q

Mechanism of Etomidate

A

Enhances effects go GABA at GABAA receptors

Also activates GABAA receptors without GABA being present

45
Q

Side effects of etomidate

A

Pain on injection
Myoclonic movements
Nausea/vomiting
Inhibit adrenal gland synthetic enzymes

46
Q

Advantage of Etomidate over propofil

A

It doesnt decrease BP or cardiac output

47
Q

Ketamine advantage

A

Produces profound analgesia

48
Q

Ketamine mechanism

A

NDMA antagonist

Inhibits voltage sensitive Na, K channels

49
Q

Side effects of ketamine

A 
Increased cerebral blood flow
Emergence delerium (1 hr post emergence, hallucinations, vivid dreams)
50
Q

Ketamine effects of ventilation

A

Modest decrease in ventilation

Bronchodilation

51
Q

Ketamine effects of CV system

A

Increases BP, CO and HR

useful for patients at risk of hypotension

52
Q

Ketamine effects of urogenital system

A

Caron abuse leads to severe deterioration of the urinary bladder

53
Q

What is the point of GA adjuncts

A

Decrease the dose of GA needed to reach desired anesthesia

“Balanced anesthesia”

54
Q

Best benzo pre-op sedation (amnesia)

A

Midazolam (versed)
it is water soluble, the others aren’t
also doesn’t irritate blood vessels

55
Q

Role of opioids in anesthesia

A

Minimize vascular reflex to noxious, painful stimuli

Potent analgesics, since only ketamine of the anesthetics has effective analgesic properties

56
Q

Side effects of opioids

A

Nausea, vomiting

Decreased ventilation, HR, BP

57
Q

What opioid has the shortest duration of action?

A

Remifentanil

58
Q

Dexmedetomidine use in anesthesia

A

Alpha 2 agonist
Used for sedation (off label)
Does not decrease ventilation, so it is useful in non-intubated patients

59
Q

How does anesthesia contribute to hypothermia?

A

Vasodilation is a side effect of most of the anesthetics we talked about (convective heat loss)

60
Q

Mechanism of malignant hyperthermia

A

Ryanodine calcium channels do not close, leading to uncontrolled muscle contraction and heat generation

61
Q

How can malignant hyperthermia kill you fast

A

Myocytes eventually lyse, releasing potassium which can cause fatal cardiac effects

62
Q

Treatment for malignant hyperthermia

A

Dantrolene

63
Q

Dantrolene mechanism

A

Ryanodine receptor inhibitor

Pharmacology (34 decks)

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