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Neuro II > general and local anesthetics > Flashcards

general and local anesthetics Flashcards

1
Q

inhaled anesthetics

A 
desflurane
enfluane
halothane
isoflurane
sevofulane
nitrous oxide (gaseous)
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2
Q

IV anesthetics

A 
propofol
fospropfol
barbituates
benzodiazepines
etomidate
ketamine
dexmedetomidine
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3
Q

barbituates

A

thiopental

methohexital

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4
Q

benzodiazepeins

A

midazolam
lorazepam
diazepam

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5
Q

local anesthetics

A

end in ‘caine’

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6
Q

esters

A

only have one i

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7
Q

amides

A

have 2 ‘i’s

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8
Q

desired effects of general anesthesia

A

-unconciousness
-amnesia
-analgesia
-inhibition of autonomic reflexes
-skeletal mm relaxation
to achieve all 5 must mix meds

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9
Q

balanced anesthesia

A

IV and inhaled combo

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10
Q

monitored anesthesia care

A

profound analgesia w/retention of pt ability to maintain a patent airway and respond to commands

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11
Q

volatile anestetics

A

must be administered with vaporizer

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12
Q

driving force for uptake of inhales anesthetics

A

alveolar concentration which is controlled with inspired concentration (partial pressure) and/or alveolar ventilation
the quicker the FA/FI approaches 1 the faster drug onset of action

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13
Q

blood:gas partition coefficient

A

defines relative affinity for blood compared to inspired gas

inverse relationship btwn blood:gas partition coefficient and rate of anesthesia onset

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14
Q

cardiac output

A

greater the CO slower onset of action

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15
Q

alveolar-venous partial pressure differences

A

anesthetic partial pressure differences btwn alveolar and mixed venous blood is dependent on tissue up-take

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16
Q

elimination of inhaled anesthetics

A

primarily by lungs
same as uptake principles, but in reverse
controlled with 2 parameters:
-concentration in inspired air
- alveolar ventilation
concentration cannot be below 0, but can induce hyperventillation

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17
Q

MAC

A

1 MAC is percent of anesthetic needed to sedate 50% of people
additive

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18
Q

stage I of CNS depression

A

Analgesia

initially experiences analgesia w/p amnesia, later both produces

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19
Q

stage II of CNS depression

A

excitement
delirious, may vocalize, but completely amnesiac
respiration, HR, and BP increase

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20
Q

stage III CNS depression

A

surgical anesthesia
begin w/slowing respiratory rate, HR
extends to complete cessation of spontaneous respiration (apnea)
changes in occular mvmts, eye reflexes, and pupil size

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21
Q

stage IV CNS depression

A

medullary depression
vasomotor centrer in medulla dn respiratory center
w/o respiratory and circulatory support death would ensue rapidly

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22
Q

reliable test to indicate stage III

A

loss of responsiveness to pain

trap squeeze

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23
Q

CV effects of inhaled anesthetics

A 
depress normal cardiac contractility 
decrease MAP (dosage dependent)
decrease in arterial BP -> activation of autonomic nervous system -> increased HR
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24
Q

respiratory effects of inhaled anesthetics

A

respiratory depressants -> rapid shallow breathing
ventilation usually required
w/prolonged exposure mucus pooling and plugging -> atelectasis -> post op complications

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25
Q

toxicity of inhaled anesthetics

A

nausea and vomiting
halothane- hepatitis on multiple exposures
renal toxicity
malignant hyperthermia

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26
Q

propofol MOA

A

potentiation of Cl curent via GABAaR

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27
Q

propofol allergic rxns

A

has soybean oil
glycerol
lecithin
egg yolk phosphatide

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28
Q

advantages of propofol

A

fast onset
fast clearance
recovery more complete (less hangover effect)
context-sensitive half time small

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29
Q

context-sensitive half time

A

time to elimination after discontinuation of drug

dependent on duration of use

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30
Q

propofol CNS effects

A

general suppression
no analgesic properties
decreases cerebral blood flow -> decreased ICP and IOP
burst suppression in EEG which is neuroprotective in neurosurgical procedures

31
Q

propofol CV effects

A

most pronounced decrease in systemic BP d/t profound vasodilation in aa and vv
hypotensive effects potentiated by impaired baroreflex response

32
Q

propofol respiratory effects

A

potent respiratory depressant -> apnea

greater reduction in upper airway good for instrumentation of airway

33
Q

propofol uses

A 
anesthesia induction
continuous infusion
maintence of anesthesia
sedation in ICU
conscious sedation
short duration general
34
Q

fospropofol MOA

A

similar to propofol

35
Q

fospropofol PK

A

onset and recovery are prolonged compared to propofol

36
Q

fospropofol uses

A

sedation during monitored anesthesia care

37
Q

fospropofol ADRs

A

less pain on administration then propofol

paresthesia in perianal region

38
Q

barbituates MOA

A

act on GABAaR to increase action

also inhibits excitatory transmission

39
Q

barbituates PK

A

methohexital faster and more complete recovery than thiopental

40
Q

CNS effects of barbituates

A

dose-dependent CNS depression
no analgesia
anti-convulsant, with the exception of methohexital which can induce seizures

41
Q

benzodiazepines MOA

A

GABAaR to increase its activity

can be countered with antagonists Flumazenil

42
Q

benzodiazepines PK

A

midazolam shortest context-sensitive half time and the only one that can be used for continuous infusion

43
Q

benzodiazepines CNS effects

A

potent anticonvulsants for status epilepticus, alcohol withdrawal, local-anesthetic induced seizures

44
Q

benzodiazepines respiratory effects

A

severe respiratory depression when administered w/opioids

45
Q

benzodiazepines uses

A

produces anxiolysis and anterograde amnesia
extremely useful as premedication
IV sedation and suppression of seizures

46
Q

etomidate MOA

A

GABA like effects via GABAaR Cl current

47
Q

etomidate PK

A

minimal effects on hemodynamics and short context-sensitive half-time
larger doses or repeated buluses safe

48
Q

etomidate CNS

A

potent cerebral vasoconstrictor decreased blood flow and ICP

49
Q

etomidate CV

A

minimal hemodynamic effects

50
Q

etomidate endocrine

A

adrenocortical suppression -> dose dependent inhibition of 11beta-hyroxylase -> decreased cortisol

51
Q

etomidate uses

A

alternative to propofol or barbiturates for rapid IV induction of anesthesia especially in those with compromised cardiac fnx
does NOT provide analgesia and post-op nausea and vomiting more common

52
Q

ketamine MOA

A

complex

inhibition of NMDA R

53
Q

ketamine CNS

A

cerebral vasodilator and increases ICP
emergence rxns
dissociative anesthesia (eyes open w/slow nystagmic gaze)

54
Q

emergence rxns

A

vivid colorful dreams
tactile and auditory sensitivity
associated with fear/confusion
can also cause euphoric state

55
Q

ketamine CV

A

can increase BP, HR, CO, via sympathetic stimulation

56
Q

ketamine uses

A

profound analgesia
sympathetic stimulation
bronchodilation
minimal respiratory depression

57
Q

ketamine other

A

lacrimation and salvation can occur and premedication with anticholinergic may be indicated

58
Q

dexmedetomidine MOA

A

highly selective alpha adrenergic agonist may be antagonized by alpha 2 antagonists

59
Q

dexmedetomidine PK

A

metabolites excreted in urine and bile

significant increase in context-sensitive half time with duration of use

60
Q

dexmedetomidine CNS

A

hypnosus from stimulation of alpha2 Rs in locus caeruleus and analgesia at level of spinal cord
sedative effect resembles physioplogic sleep state

61
Q

dexmedetomidine CV

A

moderate decrease in HR and systemic vascular resistance -> increased BP
bradycardia may require Tx

62
Q

dexmedetomidine uses

A

short term sedation of intubated and ventilated pts in ICU, operating room anesthesia adjunct, awakening and transition to post-op

63
Q

local anesthetics

A

most consist of lipophilic grp connected by ester or amide to ionizable grp
esters- shorter duration of action

64
Q

local anesthetics metabolism and excretion

A

excreted in urine

toxicity more likely in those with hepatic disease

65
Q

local anesthetics MOA

A

block voltage gated NaCh

66
Q

fiber diameter

A

smaller the diameter the faster complete block will occur

67
Q

myelin

A

myelinated nn block quicker

68
Q

firing frequency

A

higher firing frequency blocks faster

69
Q

order of block

A

temp> pain>light touch >motor

70
Q

benxocaine

A

pronounced lipophilicyt and poor water solubilty

derm, hemorrhoids, anesthetic lubricant

71
Q

bupivacaine

A

agent with long duration of action
sensory > motor
peripheral anesthesia, analgesia post-op, anesthetic infiltration

72
Q

cocaine

A

blockade of nn impulses and local vasoconstriction

topical anesthetic of upper respiratory tract for intense vasoconstriction

73
Q

lidocaine

A

prototypical amide local anesthetic
faster, more intense, longer lasting, more extensive anesthesia
IV, opthalmic gel, topical, patch

Neuro II (22 decks)

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