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Spring Pharm Exam 1 > General Anesthesia > Flashcards

General Anesthesia Flashcards

1
Q

Primary MOA for anesthetics

A

Facilitate inhibitory GABAergic neurotransmission

GABA potentiators

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2
Q

MOA for NO

A

NMDA glutamate receptor inhibitor

Inhibits kainate receptors too

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3
Q

MOA for ketamine

A

NMDA glutamate receptor inhibitor

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4
Q

Blood:gas partition coefficient

A

measures solubility of the drug getting from lungs into blood
Low value means less molecules needed to rise partial pressure therefore faster induction

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5
Q

Fat:blood coefficient

A

Higher value means that its more soluble in fat - be aware in obese patients

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6
Q

Halothane

A

2.3 - slow induction, soluble in fat

Disad: halothane hepatitis (necrosis, fever, rash, N/V)

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7
Q

Enflurane

A

Blood:gas 1.8 slow induction
Disad: CV depression d/t dec contractility
Seizures, uterine muscle relaxant

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8
Q

Isoflurane

A

1.4 somewhat fast induction
Most commonly used inhalant
Adv: maintain CO, dilation of systemic and coronary vessels
Disad:pungent, progressive respiratory depression w/ prolonged use

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9
Q

Sevoflurane

A

0.69 - fast induction
Can be used in outpatient d/t fast recovery
Disad: reports of toxicity

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10
Q

Desflurane

A 
0.42 - very fast induction
Good for outpatient, not very fat soluble
Disad: irritating to airway
Need special vaporizer (low volatility)
Tachycardia
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11
Q

Methoxyflurane

A

Not really used anymore, blood gas 12, highly metabolized in body can produce renal failure and nephrotoxicity

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12
Q

Nitrous oxide

A 
0.47, rapid induction
Analgesic, not anesthetic 
Adv: little toxicity
Disad: weak, hypoxia, cold air expansion
Avoid in pts w/ pneumo, middle ear obstruction, air embolus, obstruction of bowel o intracranial air
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13
Q

Tx for malignant hyperthermia

A

Dantrolene to reduce intracellular Ca release

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14
Q

Barbiturates: sodium thiopental

A

Adv: little post n/v, water soluble
Disadv: resp/CV depression, no antagonist, slow recovery, no analgesia

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15
Q

Propofol

A

Adv: rapid recovery, little accum, “milk of amnesia”
Disad: not water soluble, no antag, no analgesia, cardioresp depression, can elicit pain on injection

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16
Q

Ketamine

A

Adv: analgesia, no resp depression, hypnotic state
Disad: inc muscle tone, invol mvmts, halluc
AE less common in children

17
Q

Etomidate

A

Adv: antag available, anterograde amnesia, CV stability
Disad: accumulates which slows recovery, no analgesia, pain on injection

18
Q

Benzodiazepines

A

Midazolam and diazepam

Reduces anxiety and induces amnesia

19
Q

Antihistamines

A

Diphenhydramine

Prevention of allergic rxns, some sedation

20
Q

Antiemetics

A

Ondansetron

Prevents vomiting and post surg n/v

21
Q

Opioids

A

Fentanyl, morphine

Provides analgesia

22
Q

Antimuscarinics

A

Scopolamine, atropine
Amnesia
Prevent bradycardia
Prevent fluid secretion in trachea

23
Q

Muscle relaxants

A

Pancuronium

Facilitation of intubation

24
Q

How do barbiturates act?

A

Increase length of time that Cl channels are open

25
Q

How do benzodiazepines act?

A

Increase GABA efficacy by increasing GABA’s affinity for its binding site

26
Q

What is MAC?

A

Minimum alveolar concentration
1 MAC renders 50% of subjects exposed to noxious stimuli as immobile
0.3 MAC = mild anesthesia
0.5 MAC = amnesia

27
Q

Equilibrium rates for tissues

A

Lung/blood
Brain, heart, kidney
Muscle
Fat

28
Q

Low blood:gas partition coefficient drugs

A

NO
Desflurane
Sevoflurane

29
Q

High:blood gas partition coefficient agents

A

Isoflurane
Enflurane
Halothane
Methoxyflurane

30
Q

What is the most commonly used inhalant anesthetic?

A

Isoflurane

31
Q

Malignant hyperthermia

A 
Heritable d/o triggered by anesthetics and neuromuscular blockers 
SR cannot sequester Ca
Muscle contractions
Lactate production
Inc body temp
32
Q

Which patients should you avoid giving NO to?

A 
Pneumothorax
Middle ear obstruction 
Air embolus 
SBO
Intracranial/ocular air
33
Q

Which IV should be used for patients at risk for hypotension?

A

Etomidate

34
Q

Which IV agent is the only one to provide analgesia?

A

Ketamine

Spring Pharm Exam 1 (6 decks)

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