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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
toxicity of inhaled anesthetics
nausea and vomiting halothane- hepatitis on multiple exposures renal toxicity malignant hyperthermia
26
propofol MOA
potentiation of Cl curent via GABAaR
27
propofol allergic rxns
has soybean oil glycerol lecithin egg yolk phosphatide
28
advantages of propofol
fast onset fast clearance recovery more complete (less hangover effect) context-sensitive half time small
29
context-sensitive half time
time to elimination after discontinuation of drug | dependent on duration of use
30
propofol CNS effects
general suppression no analgesic properties decreases cerebral blood flow -> decreased ICP and IOP burst suppression in EEG which is neuroprotective in neurosurgical procedures
31
propofol CV effects
most pronounced decrease in systemic BP d/t profound vasodilation in aa and vv hypotensive effects potentiated by impaired baroreflex response
32
propofol respiratory effects
potent respiratory depressant -> apnea | greater reduction in upper airway good for instrumentation of airway
33
propofol uses
``` anesthesia induction continuous infusion maintence of anesthesia sedation in ICU conscious sedation short duration general ```
34
fospropofol MOA
similar to propofol
35
fospropofol PK
onset and recovery are prolonged compared to propofol
36
fospropofol uses
sedation during monitored anesthesia care
37
fospropofol ADRs
less pain on administration then propofol | paresthesia in perianal region
38
barbituates MOA
act on GABAaR to increase action | also inhibits excitatory transmission
39
barbituates PK
methohexital faster and more complete recovery than thiopental
40
CNS effects of barbituates
dose-dependent CNS depression no analgesia anti-convulsant, with the exception of methohexital which can induce seizures
41
benzodiazepines MOA
GABAaR to increase its activity | can be countered with antagonists Flumazenil
42
benzodiazepines PK
midazolam shortest context-sensitive half time and the only one that can be used for continuous infusion
43
benzodiazepines CNS effects
potent anticonvulsants for status epilepticus, alcohol withdrawal, local-anesthetic induced seizures
44
benzodiazepines respiratory effects
severe respiratory depression when administered w/opioids
45
benzodiazepines uses
produces anxiolysis and anterograde amnesia extremely useful as premedication IV sedation and suppression of seizures
46
etomidate MOA
GABA like effects via GABAaR Cl current
47
etomidate PK
minimal effects on hemodynamics and short context-sensitive half-time larger doses or repeated buluses safe
48
etomidate CNS
potent cerebral vasoconstrictor decreased blood flow and ICP
49
etomidate CV
minimal hemodynamic effects
50
etomidate endocrine
adrenocortical suppression -> dose dependent inhibition of 11beta-hyroxylase -> decreased cortisol
51
etomidate uses
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
ketamine MOA
complex | inhibition of NMDA R
53
ketamine CNS
cerebral vasodilator and increases ICP emergence rxns dissociative anesthesia (eyes open w/slow nystagmic gaze)
54
emergence rxns
vivid colorful dreams tactile and auditory sensitivity associated with fear/confusion can also cause euphoric state
55
ketamine CV
can increase BP, HR, CO, via sympathetic stimulation
56
ketamine uses
profound analgesia sympathetic stimulation bronchodilation minimal respiratory depression
57
ketamine other
lacrimation and salvation can occur and premedication with anticholinergic may be indicated
58
dexmedetomidine MOA
highly selective alpha adrenergic agonist may be antagonized by alpha 2 antagonists
59
dexmedetomidine PK
metabolites excreted in urine and bile | significant increase in context-sensitive half time with duration of use
60
dexmedetomidine CNS
hypnosus from stimulation of alpha2 Rs in locus caeruleus and analgesia at level of spinal cord sedative effect resembles physioplogic sleep state
61
dexmedetomidine CV
moderate decrease in HR and systemic vascular resistance -> increased BP bradycardia may require Tx
62
dexmedetomidine uses
short term sedation of intubated and ventilated pts in ICU, operating room anesthesia adjunct, awakening and transition to post-op
63
local anesthetics
most consist of lipophilic grp connected by ester or amide to ionizable grp esters- shorter duration of action
64
local anesthetics metabolism and excretion
excreted in urine | toxicity more likely in those with hepatic disease
65
local anesthetics MOA
block voltage gated NaCh
66
fiber diameter
smaller the diameter the faster complete block will occur
67
myelin
myelinated nn block quicker
68
firing frequency
higher firing frequency blocks faster
69
order of block
temp> pain>light touch >motor
70
benxocaine
pronounced lipophilicyt and poor water solubilty | derm, hemorrhoids, anesthetic lubricant
71
bupivacaine
agent with long duration of action sensory > motor peripheral anesthesia, analgesia post-op, anesthetic infiltration
72
cocaine
blockade of nn impulses and local vasoconstriction | topical anesthetic of upper respiratory tract for intense vasoconstriction
73
lidocaine
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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