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Psychiatric Pharmacology > General Anaesthetics > Flashcards

General Anaesthetics Flashcards

1
Q

The process of anaesthesia involves: Induction (via gas/IV), Maintenance, Reversal and ________ care.

A

Post-op

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2
Q

GAs are used to produce ___________ and a lack of ___________ to all painful stimuli (inhibition of sensory and autonomic reflexes)

A
  1. unconsciousness

2. responsiveness

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3
Q

The process of anaesthesia involves: ___________ (to discuss potential allergies/comorbidities to look out for), Induction (via gas/IV), _______ management, Maintenance, Reversal and ________ care.

A
  1. Pre-assessment
  2. Airway
  3. Post op
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4
Q

GA involves the triad of _______, amnesia, _______ and provides conditions for interventions i.e. surgery to take place; skeletal muscle relaxation

A
  1. hypnosis (sedation)

2. analgesia

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5
Q

We want to keep patients safe and alive upon __________ and control of _________ (i.e. breathing/blood oxygen levels) during the process is critical.

A
  1. GA reversal

2. physiology

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6
Q 
The ideal anaesthetic should have these properties: 
•unconsciousness
•Analgesia
•Muscle relexation
•A\_\_\_\_\_\_\_\_
•Brief and pleasant
•\_\_\_\_\_\_\_ of anaesthesia can be raised or lowered with ease
•\_\_\_\_\_\_\_\_\_adverse effects
•\_\_\_\_\_\_\_ Margin of safety
A
  1. Amnesia
  2. Depth
  3. Minimal
  4. Large
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7
Q

The 3 key properties we want to control for a balanced GA are: A__________, U_____________ and Inhibition of ______.

A
  1. Analgesia
  2. Unconsciousness
  3. reflex
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8
Q

To ensure a smooth and rapid balanced anaesthesia, a combination of I________ and I__________ anaesthetics are used.

A
  1. inhaled

2. IV

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9
Q

Most commonly used anaesthetics include:

(1) short-acting ___________ (for induction of anaesthesia)
(2) _________ blocking agents (for muscle relaxation)
(3) ______ and N______ (for analgesia)

A
  1. barbiturates
  2. neuromuscular
  3. opioids
  4. nitrous oxide
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10
Q

An important consideration for inhalant GA agents is their _________. The higher the _________, the ______ the onset (lower tendency to distribute to site of action).

A
  1. solubility in blood
  2. blood solubility
  3. slower
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11
Q

________ is not very soluble, quickly travels in blood to the brain and accumulates substantially in a short time due to low solubility (higher tendency to leave blood to enter various organs).

A

Nitrous oxide

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12
Q

________ is more soluble and remains in blood longer compared to nitrous oxide. Accumulates in brain (and other organs) slowly and has a slower onset.

A

Halothane

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13
Q

Most inhalant GAs are volatile liquids (i.e. H_______) except for N_____ O_____ which is a true gas.

A
  1. Halothane

2. Nitrous Oxide

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14
Q

There are 2 proposed MOAs for inhalant GAs:

  1. Enhance neurotransmission at _______ synapses via allosterically increasing ______ receptor sensitivity to GABA.
  2. ________ neurotransmission at excitatory synapses via blocking glutamate neurotransmitter acting on _____ receptor.
A
  1. inhibitory
  2. GABA
  3. Depressing
  4. NMDA
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15
Q

Minimum Alveolar Concentration (MAC) is an index of _____________ ie. low MAC = __________
It is defined as the minimum concentration of drug in the alveolar air that will produce _______ in 50% of patients exposed to a ___________.

A
  1. inhalation anaesthetic potency
  2. high anaesthetic potency
  3. immobility
  4. painful stimulus
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16
Q

MAC values alter with _____, condition, concomitant administration of other drugs etc. We usually use ______x MAC in practice. Since ________ has a MAC of 110%, it cannot induce unconsciousness alone.

A
  1. age
  2. 1.2-1.5x
  3. Nitrous Oxide
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17
Q

We can increase rate of GA uptake into blood by:
• Increasing _______ of anaesthetic in inspired air
• Increased ______ of GA
• Increased blood flow through lungs

A
  1. concentration

2. solubility

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18
Q

GAs preferentially distribute to ___________ tissues and are almost completely eliminated via the ______ with minimal hepatic metabolism.

A
  1. highly perfused

2. lungs

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19
Q

Some GAs produce toxic metabolites. I_______ and E________ have nephrotoxic metabolites while H________ itself is hepatotoxic.

A
  1. Isoflurane
  2. Enflurane
  3. Halothane
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20
Q

Halothane has a potent MAC _____% with a ______rate of onset and recovery. It produces _________ until unconsciousness supervenes.
Halothane relaxes skeletal muscle and potentiates skeletal muscle relaxants.

A
  1. 0.75
  2. Medium
  3. little or no analgesia
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21
Q

Halothane causes ___________ dose-dependently and decreases B.P. due to depression of cardiac output. Bradycardia and arrhythmia may also occur leading to ________ and __________.
•May lead to halothane-associated ________.

A
  1. respiratory depression
  2. hypotension
  3. dysrhythmia
  4. hepatitis
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22
Q

_______ is a Potent GA (MAC 1.4%) with a pungent smell and a Medium rate of onset and recovery.
It decreases B.P. via _____________ and can cause hypotension and arrhythmia (similar to Halothane but milder).

A
  1. Isoflurane

2. decreasing systemic vascular resistance

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23
Q

Sevoflurane is a Potent GA (MAC 2%) with a ______ rate of onset and recovery. It is Metabolized in the ______ to release nephrotoxic inorganic fluoride. Sevoflurane is unstable when exposed to __________ in anaesthetic machines, degrading to a compound that is potentially nephrotoxic.

A
  1. more rapid
  2. liver
  3. carbon dioxide absorbents
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24
Q

Nitrous oxide is an Odourless gas with a _____ onset and recovery. It has a low potency (MAC 105%) and patients undergoing GA receive nitrous oxide to ________________________________.

A
  1. Rapid

2. supplement the analgesic effects of primary anaesthetic

25
Q

Nitrous oxide has analgesia and _______ effects. It can be used alone as an analgesic agent (eg. dentistry, during delivery*). However, Nitrous oxide alone cannot induce ___________ and is frequently used as an adjunct to other anaesthetic agents.

A
  1. amnesiac

2. surgical anaesthesia

26
Q

A major concern of nitrous oxide is postoperative _____________. To prevent this, we should allow patient to recover slowly and rest in bed for at least half an hour until it passes

A

nausea and vomiting

27
Q

Induction agents induce ____________ but does not necessarily keep patients asleep for long. Most agents depress respiration meaning _______ of patients is necessary. They can be used alone or as an adjunct to inhalation agents.

A
  1. unconsciousness

2. ventilation

28
Q

It is advantageous to use a combination of Inhaled and IV GA agents as it __________ required and produces effects that inhalation agents alone cannot achieve (i.e. rapid onset on unconsciousness).

A

lowers the dosage

29
Q

Thiopentone(Sodium thiopental) is a barbiturate with __________ lipid solubility. It can enter the brain easily, resulting in _____ onset of action.

A
  1. extremely high

2. rapid (unconsciousness occurs 10-20 sec after IV)

30
Q

A single Dose of Thiopentone re-distributes to _____ vascularized tissues with an ______ duration of action. It is useful as an induction agent combined with other maintenance agents.

A
  1. less

2. ultra-short (Injected alone w/o inhale agents, patients wake up ~10min)

31
Q

The duration of action for multiple doses/infusions of Thiopentone depends on __________ . Slow elimination, large ___ , an active metabolite (pentobarbital) and __________ can all result in prolongation of clinical action.

A
  1. clearance
  2. Vd
  3. liver cirrhosis
32
Q

Thiopentone is extensively ________________ protein with a small amount of free drug excreted by glomerular filtration + reabsorption in tubules. (< 1% excreted unchanged, mostly metabolized)

A

bound to plasma

33
Q

T__________ causes CNS depression by potentiating the action of the neurotransmitter GABA on the GABA-A receptor-gated chloride ion channels. This hyperpolarizes the cell and reduces neural excitability.

A

Thiopentone

34
Q

________ is the most common IV anaesthetic used in Singapore and is extensively used in “day surgery”.
Compared to thiopentone, it has a _______ Induction rate but more rapid recovery (patients move sooner and feel better).

A
  1. Propofol

2. similar

35
Q

Propofol is used for both induction and maintenance with a _______ onset (unconsciousness develops within ~60sec) and a ______ duration of action (~3-5min following single injection).

A
  1. Rapid

2. Short

36
Q

Due to the rapid redistribution from brain to other tissues, Propofol requires ____________ for extended effects. This makes it easier to overdose if abused (i.e. not used for anaesthesia).

A

continuous, low-dose infusion

37
Q

Compared to nitrous oxide, _______ causes reduced postoperative vomiting (which may be related to an anti-emetic action).

A

Propofol

38
Q

Propofol causes significant _________ during induction (decrease ____ and a negative inotropic) and can lead to hypotension. It should be used with caution in _____ patients, patients with compromised cardiac function, _______ patients.

A
  1. cardiovascular effect
  2. b.p.
  3. elderly
  4. hypovolemic
39
Q

______ exhibits racemic (potency: S-> R+); I/M, oral, rectal routes and produces a state known as dissociative anaesthesia i.e. patient feels dissociated from environment.

A

Ketamine

40
Q

Ketamine can cause _______, immobility, amnesia and has _____ induction with good ______ effect. It is metabolized in the _____ to less active metabolite and excreted in urine and bile.

A
  1. sedation
  2. Rapid
  3. analgesic
  4. liver
41
Q

Due to the _______ and ________, Ketamine is suitable for continuous infusion without lengthening duration of action.

A
  1. large Vd

2. rapid clearance

42
Q

Unpleasant psychologic reactions (hallucination, disturbing dreams, delirium) may occur during recovery from ketamine. These risks of psychologic adverse reactions may be reduced with premedication of d_______ or m________.

A
  1. diazepam

2. midazolam

43
Q

________ is the only IV anaesthetic that possess analgesic property and is very popular in 3rd world country as the only anaesthetic, due to the lack of other anaesthetic agents.

A

Ketamine

44
Q

B__________ can be used as Anxiolytics, induce amnesia and sedation prior to induction of anaesthesia or used for sedation during procedures not requiring GA.

A

Benzodiazepines

45
Q

α2 Adrenergic Agonists can induce ______ prior to and/or during procedures in _________ patients.

A
  1. Sedation

2. non-intubated

46
Q

Analgesics are typically administered with GA to _____________.

A

reduce anaesthetic requirement

47
Q

N______________________ are typically used in the induction of anaesthesia to relax muscles (jaw, neck, airway) to facilitate laryngoscopy and endotracheal intubation. Aids many surgical procedures and provide additional insurance of immobility.

A

Neuromuscular Blocking Agents

48
Q

BZDs have _____ onset when used for induction. They are metabolized in the _____ (elderly tend to be more sensitive, slower recovery).

A
  1. rapid (unconsciousness develops in 80sec; peak ~2min); sedates ~30min when used by itself.
  2. liver
49
Q

Midazolam (BZDs) usually has a high therapeutic index and relatively lesser ____________________ effect compared to other IV anaesthetics.
Adverse effects can be minimized by ______________________________________________. Side effects may be compounded by other concurrent drugs.

A
  1. cardiovascular and respiratory depressing
  2. injecting midazolam slowly (over 2 or more minutes) and by waiting another 2 or more minutes for full effects to develop before dosing again
50
Q

Dexmedetomidine (I/V) is a Highly selective α2 adrenergic receptor agonist with _______ (short term < 24h) and ________ effects. It doesn’t produce ___________ even at maximal doses.

A
  1. Sedation
  2. analgesic
  3. reliable GA
51
Q

Dexmedetomidine (I/V) causes _____ respiratory depression with a ______ decrease in blood pressure and heart rate. Undesirable side effects include n_____, d________, hypotension and bradycardia.

A
  1. little
  2. tolerable
  3. nausea
  4. dry mouth
52
Q

Analgesic choice is based primarily on ________. Coxibs and paracetamol are used for minor surgeries while Opioids are used in the pre-operative period. Most NSAIDs are excreted in urine/bile and metabolized in the liver except R________ (hydrolyzed by tissue and plasma esterases).

A
  1. duration of action

2. Remifentanil

53
Q

Note: _________ will precipitate when mixed with muscle relaxants and should be allowed to clear from the IV line (i..e using saline) prior to injection of muscle relaxant.

A

barbiturates

54
Q

S________ is a Depolarizing NMJ blocker while V________ is a non-depolarizing NMJ blocker. Both are used as an adjunct to GA

A
  1. Succinylcholine

2. Vecuronium

55
Q

Of the 5 major Inhalant Anaesthetics (Halothane, Isoflurane, Enflurane, Sevoflurane and Nitrous Oxide), which of them is/are incompatible with epinephrine?

A

Halothane

56
Q

Of the 5 major Inhalant Anaesthetics (Halothane, Isoflurane, Enflurane, Sevoflurane and Nitrous Oxide), which of them have no significant effect on Blood pressure and Respiration?

A

Nitrous oxide

57
Q

Of the 5 major Inhalant Anaesthetics (Halothane, Isoflurane, Enflurane, Sevoflurane and Nitrous Oxide), what is the order of potency?

A

H > I > E > S > N

58
Q

The 2 Principal adverse effects of GA are depression of ________ and ______ performance.

A
  1. respiratory

2. cardiac

Psychiatric Pharmacology (8 decks)

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