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Mandie's Pharm test I > General Anesthesia > Flashcards

General Anesthesia Flashcards

1
Q

wakefulness

A

following fire:

  • noradrenergic neurons in locus ceruleus
  • histaminergic neurons in the tubomammilary nucleus
  • serotonergic neurons in the dorsal and median raphe nuclei
  • dopaminergic neurons in the periqueductal grey matter
  • orexinergic neurons stimulate directly and support monoaminergic neurons
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2
Q

NREM/REM sleep

A

NREM = firing decreases; REM = quiescent

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3
Q

General Anesthesia

A

pharmacologically induced state of:

  • Amnesia
  • unconsciousness-hypnosis
  • skeletal muscle relaxation
  • reduction in autonomic responses
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4
Q

benzodiazepines

A

-sedation, anziolysis, anticonvulsant effects, spinal cord mediated muscle relaxation, anterograde amnesia; at high doses: unconsciousness and resp depression
-NO ANALGESIA
Examples: diazepam (long 1/2 life); madazolam (short 1/2 life); lorazepam
action: BZD facilitates action of GABA at the alpha subunit–> enhanced opening of Cl- channels, hyperpolarization of postsynaptic membrane

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5
Q

propofol

A
  • presumed interaction with GABA, delays dissociation of GABA from receptors (increasing GABA activated opening of chloride ion channels and Na channel blocker)
  • hyperpolarization of cell membranes
  • 95-99% PRO bound
  • T1/2 30-60 min
  • tissue uptake and redistribution are imp factors in term of action
  • met via glucoronidation in liver; excreted by kidneys
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6
Q

fospropofol

A

prodrug of propofol in H20 base s’ln if allergic to solvent in propofol

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7
Q

propofol CV, pulm, CNS effects

A

CV: decreased SBP, MAP, SVR. no change in HR
Pulm- resp depression, dose dependent
CNS: decreased CBF, ICP, CMRO2

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8
Q

propofol induction dose; cont infusion dose

A

induction: 1.5 to 2.5 mg/kg IV, unconscious in 30-60 sec, decreased PONV/PDNV
cont infusion sedation: 25 to 100 mcg/kg/min
anesthesia: 100 to 300 mcg/kg/min

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9
Q

etomidate mech of action; pharmacokinetics

A

MOA: rapid onset of sleep (30-60s), assumed to enhance effects of GABA, rapid awakening
PK: 75% PRO bound, hydrolyzed to inactive metabolites via ester hydrolysis
t1/2 = 75 mins
excretion 85% renal, 15% biliary

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10
Q

etomidate effects (CV, Pulm, CNS)

A

CV: minimal overall; min BP drop, min HR inc, min SVR drop
Pulmonary: min resp depression
CNS: decreased CBF, ICP, CMRO2

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11
Q

etomidate induction dose, SE

A

0.2-0.4 mg/kg; myoclonus, adrenal suppression (not enough to really cause a problem), increased PONV

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12
Q

ketamine MOA/PK

A

MOA: dissociative anesthetic: NMDA/opioid/monoaminergic/muscarinic receptors and VGCa channels
PK: v. lipid soluble, met in liver to norketamine
t1/2 2-3 h
excretion: >90% renal

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13
Q

ketamine effects (CV, Pulm, CNS)

A

CV: incr HR, SBP, SVR
Pulm: no resp depression
CNS: incr CBF, ICP, CMRO2 (not good for neuro pt)

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14
Q

ketamine doses

A

induction: 1-3 mg/kg IV or 4-8 mg/kg IM
adjunctive analgesia
0.2-0.5 mg/kg

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15
Q

ketamine SE

A

emergence delirium

-premed with midazolam seems to help

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16
Q

barbituates MOA/PK

A

MOA: interact with GABA-A receptor, directly activates Cl- ion channels, increase duration open, hyperpolarize membrane), blocks AMPA receptors
PK: 83% PRO bound, highly lipid soluble, achieve CNS uptake in 30 seconds, prompt awakening after 1 dose; hepatic metabolism and renal excretion

17
Q

barbituates SE (CV, CNS, Pulm, Renal)

A

Cv: decreased SBP, SVR, incr HR
Pulm: profound resp depression, apnea, return with slow resp and low TV
CNS: decr CBS, ICP, CMRO2
renal: modes decrease in BP and GFR

18
Q

barbituates induction doses

A

NaP: 3-5 mg/kg
methohexital 1-1.5 mg/kg
rectal methohexital: 20-30 mg/kg (1st pass effect)

19
Q

barbituates SE

A
  • extravasation causes tissue sloughing

- contraindicated in pt with acute intermittent porphyria

20
Q

dexmedetomidine MOA

A

nonselective alpha2 agonist (G Pro)–> casues inhibition of adenylate cyclase and modulation of ion channels
alpha2B and C in brain/SC cause sympatholysis, sedation and antinociception
sedation (locus cereleus)
analgesia (LC and SC)
decreased activity of LC to VLPO, increases GABAergic and galanin release in the TMN which results in a decrease in histamine release in cortical and subcortical areas
-inhib ion conductance via VG calcium activated K channels

21
Q

dexmedetomidine CV, Pulm, CNS effects

A

CV: decreased HR, SV, (CO, SBP/Contractility dec. indirectly)
CNS: not well defined
Pulm: decreased MV, but maintains CO2 response
-similar to natural sleep

22
Q

Dexmedetomidine Anesthetic uses

A

premed: 0.33-0.67 mcg/kg 15 mins before surgery–> decreases MAC, induction agent dose
MAC: 1 mcg/kg over 10 mins (slower than propofol), similar CV effects
0.7 mcg/kg/min keeps BIS 70-80 (40-70 is GA)
Maintenance of GA: reduces MAC of inhaled agent, reduces post of opioid req, not useful as a solo GA

23
Q

volatile anesthetics MOA

A
  • inhibit excitatory NT glutamate

- enhance inhib NT GABA/Glycine

24
Q

volatile anesthetics why fluorinated

A
  • reduces or elim toxicity
  • reduce or elim anesthetic flammability
  • allow increased speed of induction and recovery
25
Q

MAC & MAC levels

A

partial pressure (Vol%) of an agent that must be present in the brain to result in GA
MAC incision: level of anesthesia at which 50% of patients will not move to a surgical stimulus (1 MAC)
MAC awake: is a proportion of MAC at which patients will wake up and respond to commands (0.4 MAC)
MAC BAR: deep anesthesia in which no CV response to BP (1.3 MAC)

26
Q

isoflurane

A

-irritating to breathe
-MAC 1.15
B:G coefficient: 1.4
B:B 2.6
Fat:B 45
Metabolized 0.2%
dose dep hypotension d/t mod peripheral vasodilation
-neg cardiac chronotrop, but may also inc HR 2/2 hypotension

27
Q

desflurane

A 
MAC: 6
B:G 0.4 BB 1.3 F:B 27
v. irritating to breathe
metabolized 0.02%
min myocardiac depression, direct SNS stim: tachy, hypertension (when turn up quickly)
-fast in and out
28
Q

sevoflurane

A 
MAC: 2
B:G 0.69 BB 1.7 F:B 48
non-irritating
metabolized 2-5%
min myocardial depression
-fast in and out 
-incorrectly linked to renal failure
29
Q

nitrous oxide

A

MAC 105
B:G 0.47 BB 1.1 FB 2.3
non-irritating to breathe
min metabolism (

30
Q

pulm effects of inhaled anesthetics

A

-decreased TV (dose dependent)
-decreased residual O2 in lungs at end of expiration
-bronchodilate
-alter pulm vascular resistance
-alter hypoxic pulm vasoconstriction
depress response to hypercapnia at 0.2 MAC
attenuate vent reponse to hypoxia at 0.1 MAC

31
Q

CV effects of inhaled anesthetics

A

dose dep depression of myocardiac contractility

  • dose dep decrease in SBP
  • dose depen decrease in SVR
  • neg chronotropy
  • sometimes tachy response to dec BP
32
Q

Neuro effects of inhaled anesthetics

A

-inc cerebral BP b/c of vasodilation which leads to increased ICP
-decreased CMRO2
centrally mediated muscle relaxant
-can trigger MH

Mandie's Pharm test I (10 decks)

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