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Pharmacy Year 3 > General Anaesthetics > Flashcards

General Anaesthetics Flashcards

1
Q

Describe the structure of a nerve

A

Bundle of neurone axons surrounded by epineurium

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2
Q

What is anaesthesia?

A

Reversible loss of awareness of pain

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3
Q

What is the difference between local, regional and general anaesthesia?

A

Local - Remains conscious, cheaper and safer
Regional - Larger area involved than local
General - Central effects, loss of consciousness

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4
Q

What is stage 1 of anaesthesia?

A

Induction/analgesia
Conscious but drowsy
Reduced pain response

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5
Q

What is stage 2 of anaesthesia?

A

Excitement
Loss of response to non-pain stimuli
Gag reflex, coughing

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6
Q

Why does stage 2 anaesthesia have to be limited?

A 
Choking
Breath holding
Talking
Vomiting
Movement
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7
Q

What is stage 3 of anaesthesia?

A 
Ideal stage for surgery
Regular respiration
Some reflexes
No movement
Shallow breathing
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8
Q

What is stage 4 of anaesthesia?

A

Overdose
Medullary paralysis
Respiratory and vasomotor control ceases
Death

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9
Q

What are the ideal anaesthetic pharmacokinetics?

A

Rapid induction and recovery
Avoid phase 2 and not reach stage 4
Avoid side effects

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10
Q

Why are drugs used in combination for anaesthetics?

A

Stages become less apparent

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11
Q

What is the advantage of fast induction and recovery?

A

Reduces stage 2
Maintains homeostatic reflexes
Patient usually amnesic

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12
Q

What is the lipid theory for GA MoA?

A

Changing membrane protein conformation by changing environment they are dissolved in

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13
Q

What are the protein theories for GA MoA?

A

Potentiated GABAa receptor function
Inhibition of NMDA receptor function
Potentiated two-pore potassium channel function

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14
Q

What are the pros and cons of inhaled anaesthetics?

A

Easy to maintain degree of anaesthesia, rapid emergence

Complicated and expensive equipment, administered via mask, atmospheric pollution

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15
Q

Why are scavenger systems required?

A

Fluranes generate fluoride which cause renal toxicity

Halothanes are converted to bromide and TFA which cause hepatotoxicity

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16
Q

What is the blood-gas partition coefficient?

A

Measure of how well drug dissolves in blood
Determine rate of induction and recovery
Low blood solubility = faster recovery

17
Q

What is the oil-gas partition coefficient?

A

How well drug dissolves in fat, higher coefficient means more potent drug but more will dissolve in fat

18
Q

What is the disadvantage of a high oil-gas partition coefficient?

A

Anaesthetic takes long time to leave fat

Slow recovery - patient likely to be groggy

19
Q

What is likely to make the “hangover” phase of anaesthetics worse?

A

Higher body fat percentage

More fat soluble drug

20
Q

What are the most commonly used anaesthetics?

A

N2O and isoflurane

21
Q

Why are ethers not widely used?

A

Explosive, irritant and cause nausea

22
Q

What are the positives of isoflurane?

A

No metabolism
Little toxicity
Not proconvulsive

23
Q

What are the negatives of isoflurane?

A

Twice the price of halothane
Causes hypotension
Coronary vasodilator - may divert blood away from narrowed arteries
Worries surrounding neurodegeneration

24
Q

What are the positives of sevoflurane?

A

Rapid induction and recovery

Little metabolism

25
Q

What are the negatives of sevoflurane?

A

5x cost of halothane
Neurodegeneration concerns
Post-op analgesia required

26
Q

What are the positives of nitrous oxide?

A

Quick induction and recovery

Doesn’t cause loss of consciousness - low potency

27
Q

What are the negatives of nitrous oxide?

A

Transient hypoxia due to dilution of oxygen in lungs

Extra O2 required at end of anaesthesia

28
Q

When is nitrous oxide contraindicated?

A

Early pregnancy
Pernicious anaemia
Scuba diving

29
Q

What are the advantages and disadvantages of IV anaesthetics?

A

Rapid induction, no stage 2, simple apparatus, pleasant induction, no atmospheric pollution
Difficult to control levels of anaesthesia, slow recovery, finite duration but can give infusion, vein damage

30
Q

Describe the pharmacokinetics of thiopental

A

Lipophilic
Induction perfusion rate limited
Rapid distribution
Slow distribution into fat

31
Q

What are the negatives of thiopental?

A

Long hangover
Increases HR and cardiac oxygen demand
Hypotension in hypovolaemic patients
Can cause respiratory depression

32
Q

What are the advantages of propofol?

A

Rapidly metabolised so rapid recovery

Can be continually infused to maintain anaesthesia without inhaled agent

33
Q

How does propofol cause anaesthesia?

A

Potentiates GABAa receptors

34
Q

Describe the anaesthetic effect of ketamine

A

Causes analgesia and amnesia but patient is still partly conscious

35
Q

How does ketamine cause anaesthesia?

A

Non-competitive antagonist at NMDA receptors

36
Q

What are the positives of ketamine?

A

Safe for emergency situations

Little effect on respiration and BP

37
Q

What are the negatives of ketamine?

A

High abuse potential
Increases HR
Olney’s lesions - neurotoxicity from NMDA receptor antagonist

Pharmacy Year 3 (15 decks)

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