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Pharm Fall > General Anesthesia > Flashcards

General Anesthesia Flashcards

1
Q

Physiological affect of General Anesthesia

A

Decreases systemic arterial BP

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2
Q

IV Anesthetic Agents

A
  • Barbiturates
  • Propofol
  • Etomidate
  • Ketamine
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3
Q

Barbiturates

A
  • Sodium thiopental (most common)
  • Thiamylal (veterinarian use only)
  • Methohexital
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4
Q

Standard Practice of Barbiturates

A

Delay administration of other drugs until the barbiturate has cleared the IV tubing

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5
Q

Barbiturate Side Effects

A
  • Suppression/burst suppression of EEG
  • Reduce cerebral metabolic rate
  • BP reduction
  • Respiratory depression
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6
Q

Propofol MOA

A

Agonist actions on GABA A receptors

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7
Q

Propofol Adverse Effects

A
  • Pain at the injection site

- Hyperlipidemia

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8
Q

How should propofol be administered?

A

Within in 4 hours of its removal from sterile packaging o/w throw it out

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9
Q

Fospropofol

A
  • Prodrug of propofol
  • Does not have the adverse effects propofol does
  • Indicated for sedation in patients undergoing diagnostic procedres
  • new aqueous form of propofol
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10
Q

Propofol Metabolism

A
  • Metabolized in the liver
  • Excreted from the kidneys
  • Some may also be excreted through the lungs
  • Clearance is reduced in elderly and neonates
  • Clearance is faster in bigger people (more central volume)
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11
Q

Propofol Side Effects

A
  • Increased Chloride conduction
  • Hyperpolarization of neurons
  • Suppressed EEG
  • Burst suppression EEG
  • Provokes anaphalactoid reactions
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12
Q

Does propofol have clinically significant effects on the hepatic, renal, or endocrine organ systems?

A

NO

it does have anti-emetic actions though

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13
Q

What is Etomidate primarily used for?

A

Anesthetic induction of patients who are at risk for hypotension

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14
Q

What is Etomidate a/w?

A
  • Pain on injection (use lidocaine)

- Myoclonic movements (pre medicate with benzos or opiates)

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15
Q

Etomidate Side Effects

A
  • May induce hiccups
  • May reduce cortisol levels
  • Can cause vomiting
  • Can lower the seizure threshold
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16
Q

What is an advantage of Etomidate over barbiturates and propofol?

A

Cardiovascular stability after induction

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17
Q

What is ketamine used for?

A

Anesthetizing patients at risk for hypotension and bronchospasms and good for certain pediatric procedures

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18
Q

How do you administer ketamine?

A
  • Mainly IV
  • IM
  • Oral
  • Rectal
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19
Q

Ketamine Side Effects

A
  • Rapidly produces a hypnotic state
  • Hallucinations
  • Emergence delirium
  • Increased ICP
  • Increased CO
  • HTN
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20
Q

What is the only inhalation anesthetic that does cause malignant hyperthermia?

A

NO

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21
Q

What happens with incr lipid solubility?

A

slower induction, longer maintenance and longer recovery

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22
Q

What happens with decreased lipid solubility?

A

quicker induction, less maintenance, and shorter recovery

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23
Q

How are inhaled anesthetics eliminated?

A

Reverse process of uptake

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24
Q

Halothane

A
  • Incr Lipid solubility

- Used mostly in children (diminished side effects)

25
Q

Halothane SE

A
  • Inhibits hypoxic pulmonary perfusion
  • Relaxation of skeletal muscle
  • May cause malignant hyperthermia
26
Q

Is Isoflurane as lipid soluble as Halothane?

A

No.

27
Q

Does Isoflurane have analgesic effect?

A

No

28
Q

Is Isoflurane commonly used?

A

Yes

29
Q

What is Isoflurane mostly used for?

A

Maintenance after induction

30
Q

What reduces concentration of Isoflurane?

A

Opioids (they are needed for analgesia)

31
Q

Isoflurane SE

A
  • Concentration dependent depression of ventilation
  • Incr ICP
  • W/ incr dose Splanchnic and hepatic blood flows are reduced along with systemic arterial pressure
32
Q

Is cardiac output well maintained with Isoflurane?

A

Yes

33
Q

What is Enflurane mainly used for?

A
  • Maintenance

- Can achieve anethesia

34
Q

Enflurane SE

A
  • Hypotension
  • Greater ventilator depression
  • Increase cerebral pressure (cerebral vasodilator)
  • Mild to moderate liver injury (rare)
35
Q

How fat soluble is Desflurane?

A

Not very

36
Q

How does does it take alveolar concentration to reach 80% with Desflurane?

A

5 mins (quick induction and recovery)

37
Q

When is Desflurane mostly used for?

A

Out pt surgury

38
Q

Is Desflurane used for induction?

A

Hell no! Strong airway irritant (coughing, breath holding and so on)

39
Q

Desflurane cardiac effect

A

Cardiac output is well preserved

40
Q

Sevoflurane Lipid Solubility?

A

Low (Rapid induction)

41
Q

What is Sevoflurane inidcated for?

A
  • Induction and maintenance

- Out pt due to rapid recovery

42
Q

Sevoflurane SE

A
  • Reduction of tidal volume
43
Q

Nitrous Oxide

A
  • Weak anesthetic

- Significant Analgesic effect

44
Q

NO SE

A

When administered alone it can significantly incr cerebral blood flow and intracranial pressure

45
Q

Why are Benzos used?

A
  • anxiolysis
  • amnesia
  • sedation
46
Q

What are the most frequently use Benzos perioperative? (In order of whats used most first)

A
  1. Midazolam
  2. Diazapam (valium)
  3. Lorazapam (Ativan)
47
Q

What is an example of an Alpha Adrenergic Agonis?

A

Dexmedetomidine (Precedex)

48
Q

What is Dexmedetomidine indicated for?

A

Short term (<24hrs) sedation of critically ill or sedation in non intubated pts

49
Q

What does Dexmedetomidine provide?

A

Provides analgesia with little respiratory effects

50
Q

Dexmedetomidine SE

A
  • Hypotension
  • bradycardia
  • n/v
51
Q

What is the only effective analgesic?

A

Katamine

52
Q

What is the only opioid NOT metabolized in the liver?

A

Remifentanil (Ultilva)

53
Q

Name one depolarizing neuromuscluar blocking agent

A

Succinylcholine

54
Q

Succinylcholine SE

A
  • ***Incr Serum K
  • ***Malignant Hyperthermia
  • Incr intra-ocular pressure
  • Incr Intragastric Pressure
  • Prolonged paralysis
55
Q

How does succinylcholine work?

A

Directly blocks the nicotinic receptors with an initial activation

56
Q

Name one non-depolarizing neuromuscluar blocking agent

A

Vecuronium

57
Q

How does Vecuronium work?

A

Directly blocks the postsynaptic nicotinic receptors with no activation

58
Q

How can you stop the effects (muscle paralysis is no longer desired) of Vecuronium?

A

Give anticholinesterase inhibitor

  • neostigmine or endrophonium

Pharm Fall (12 decks)

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