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NMSP 2 > General And Local Anesthetics Dr. Kruse > Flashcards

General And Local Anesthetics Dr. Kruse Flashcards

1
Q

Inhaled anesthetics ending and 6 of them

A 
Desflurane
Enflurane
Halothane
Isoflurane
Sevoflurane 
Nitrous Oxide
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2
Q

IV Anesthetics 6

A
  1. Diazepam
  2. Etomidate
  3. Fentanyl
  4. Ketamine
  5. Midazolam
  6. Propofol
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3
Q

Local Anesthetics 6 and ending

A 
Benzocaine 
Bupivacaine 
Cocaine 
Dibucaine 
Lidocaine
Procaine
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4
Q

5 desired effects from an anesthetic

A
  1. unconsciousness
  2. Amnesia
  3. Analgesia
  4. Attenuation of autonomic reflex to noxious stimulation
  5. immobility in response to noxious stimulation (skeletal muscle relaxer)

= need more the 1 to achieve all 5

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5
Q

inhibitory channels of anesthetics

exictatory channels of anesthetics

A
  1. GABA (Cl- channels) , K+ channels

2. NMDA, AchR, 5HT, AMPA

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6
Q

key to how quickly an inhaled anesthetic gets into CNS and causes changes

A

the SLOWER the rate of absorption into BLOOD + concentration making it into the alveoli

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7
Q

blood:gas partition

A

a drugs affinity for blood over inspired gas (higher the higher blood solubility and the lower concentration makes it to cns)

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8
Q

SMALL blood:gas

what happens and 2 drugs

A 
gas reaches a HIGH arterial P in alveoli Fast
= Fast acting and Fast leaving 
= A lot makes it to brain 
1. NO
2. Desflurane
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9
Q

BIG blood:gas

what happens and 1 drug

A

high arterial P in alveoli is reached slowly
= Slow to get to CNS and slow to leave
1. Halothane

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10
Q

MAC (Minilam Alveolar Concentration)

A

amount that a drug is needed to be inhaled that works in 50% of subjects during surgery
(most are over 100% = you need to combine more then 1 drug for good surgery anesthesia)

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11
Q

Toxicity of inhaled anesthesia

  1. common
  2. Halothane
  3. in combination with succinylcholine , and how to fix
  4. drugs giving F ions
A
  1. N, V
  2. Hepatitis, (2days to 3 weeks later)
  3. Malignant Hyperthermia (htn, tachy, muscle rigid + rhabdo, acidosis, hyperthermia) = TREAT WITH DANTROLENE
  4. kidney problems
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12
Q

how to reverse malignant hyperthermia

A

DANTROLENE

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13
Q

IV anesthetics are different how 3 things (biochema and R is likes)

A

PREFERRED MOST
lipophilic = QUICK ONSET

(most act on GABA)

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14
Q

Midazolam effects can be reversed with

A

Flumazenil

(slow onset slow recovery)

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15
Q

Fentanyl effects can be reversed with

A

Naloxone

slow onset slow recovery

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16
Q

Propofol

A

GABA
FAST onset + SHORT acting (3-10min)
(continuous infusion can last more hours = in ICU or operating room)

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17
Q

Propofol side effects

A

hypotension

respiratory depressant

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18
Q

Fospropofol

A

water soluble so similar to propofol only LONGER recovery and SLOWER onset (less pain when administrating it)

19
Q

Etomidate

A

GABA
FAST and longer then propofol recovery (continuous infusion only works before 4-8hours)
= minimal cardiovascular and respiratory depression so good for CV or Pulmonary PATIENTS**

20
Q

Etomidate adverse effects

A

inhibits cholesterol ā€“> cortisol (11B-hydroxylase)

21
Q

Ketamine

A 
NMDA agonist (PCP structure)
can cause upleasant emergence reactions (vivid colorful dreams, hallucinations, out-of-body experiences)
22
Q

Dexmedetomidine

A

A2 adrenergic agonist = hypnosis (SLEEP LIKE STATE) by binding to A2 R at locus ceruleus
(SHORT time for ICU intubated or ventilated patients, or added to adjunct)

23
Q

2 anesthesia ADJUNCTS

A
  1. Opioids : Fentanyl, Sufentanil, Remifentanil, Morphine
  2. Barbiturates : increase GABA, Thiopental, Methohexital
  3. Benzodiazepines : increase GABA, Diazepam, Lorazepam, Midazolam
24
Q

how to reverse Benzodiazepines overdose

A

Flumazenil

25
Q

Local Anesthetics 2 classes

A

AMIDE : have 2 iā€™s in the name (Lidocine)

ESTER : only have 1 i in the name (cocaine)

26
Q

ESTER vs AMIDE

A

ESTER Groups have higher risk of allergy causing compounds in them (hives, rash, itching, breathing difficulty)

27
Q

how to administer local anesthetics

A

injections , IV

28
Q

local anesthetics are usually given how and where

A 
with Vasoconstrictor (unless cocaine)
= give Epinephrine usually to vasoconstrict (DONT inject into end arteries like fingrs, toes, ear, nose....)****
29
Q

local anesthetics adverse effects

A

high dose : nystagmus, muscular twitching, convulsions
lower CV output , hypotension (except cocaine)
ALLERGY (esp ESTERS)

30
Q

USE of

  1. Lidocaine
  2. Cocaine
  3. Benzocaine
  4. Dibucaine
  5. Procaine
A
  1. antirrhythmic agent
  2. upper respiratory tract topical agent
  3. only topical agent
  4. skin cream due to toxic when injected
  5. inject to nerve ending directly (infiltration ansesthetic)
31
Q

examples of organophosphates

A

echothiophate, parathion, malathion, sarin, soman

32
Q

Organophosphates interact with what

A

AcheE (depleted) = replenish with PRALIDOXIME

33
Q

reverse AchE inhibition

A

PRALIDOXIME

34
Q

when to use a drug that stimulates AChR

A
  1. Glaucoma

2. NMJ (Myasthenia Gravis)

35
Q

drugs used for Myasthenia Gravis 3

A
  1. Pyridostigmine
  2. Neostigmine
  3. Ambenonium
    (AchE inhibitors)**
36
Q

testing if someone has Myasthenia Gravis

A

Edrophonium Test, ice pack test, Ig testing

37
Q

how to reverse NM blocking drug induced paralysis

A
  1. AchE (paralytic ilieus)

2. Neostigmine*

38
Q

TX toxicity to AchE inhibitors intoxication and SX

A

SX : miosis, salvation, sweating, bronchial constriction, V, D
TX : Atropine

39
Q

2 drugs used for Spasmolytics and side effects

A
  1. Carisoprodol (dizzy and drowsy)= anxiety

2. Cyclobenzaprine (sedation, confusion, hallucination, drowsy, dizzy, xerostomia) = antidepressant like TCA

40
Q

5 other drugs for Spasmolytics besides cyclobenzapine and carisoprodol

A
  1. Baclofen
  2. Diazepam
  3. Tizanidine
  4. Dantrolene (non Central acting)
  5. Botulinum toxin (non central acting)
41
Q

drugs for MS 4

A
  1. Glucocorticoids
  2. Glatiramer Acetate
  3. Interferons (INF-B1a, INF-B1b)
  4. Mitoxantrone
42
Q

when to use NMBDs

A
  1. tracheal intubation
  2. surgery
  3. ventilation control
  4. convulsion tx
43
Q

BEST NMBD

A

Succinylcholine BLOCKS DEPOLARIZATION*(Sochuronium, Vecuronium) = intubation and quick things

44
Q

NMBD used for used as adjunct to general anesthesia for longer time

A

Pancuronium (Atracurium, Cisatracurium)

NMSP 2 (3 decks)

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