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Pharm 3 Test 5 > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

What severly limited surgery before general anesthetics?

A

Pain and shock

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2
Q

What do general anesthetics induce?

A

Generalized, reversible depression of the CNS

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3
Q

What are the broad purposes for general anesthetic use?

A

Analgesia, amnesia, immobility, unconsciousness, skeletal muscle relaxation

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4
Q

Where is the immobilizing effect of inhaled anesthetics taking place in the body?

A

Spinal cord

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5
Q

Where does the sedative effects of inhaled anesthetics work in the body?

A

Supraspinal (amygdala, hippocampus, cortex)

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6
Q

What is the lipid theory for GA?

A

Lipid portions of the neuronal membrane are affected by the GA, causing ion channel structures to change

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7
Q

What is the Mayer and Overton theory?

A

Anesthetic action is correlated with oil/gas partition coefficiency. So, more lipid a drug is, the greater its anesthetic property

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8
Q

What is the membrane expansion theory?

A

Molecules penetrate into hydrophobic regions of the cell membrane and cause its expansion

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9
Q

What is the protein based theory?

A

Anesthetics bind to amphipathic sites on proteins, induce/prevent conformational change, alter kinetics, compete with ligands

Or

Specific protein acts with hydrophobic pockets on certain membrane proteins to produce anesthetic effect

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10
Q

What are the primary inhibitory channels?

A

Chloride channels (GABA and glycine), and potassium channels

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11
Q

What are the primary exhitatory channels?

A

Those activated by ach, so muscarinic, nicotinic

Also glutamate, AMPA, NMDA, and serotonin

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12
Q

How many molecules of GABA are needed to activate GABA receptors?

A

2

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13
Q

What is the hormonal theory?

A

GA induce unconsciousness by activating a cluster of cells at the base of the brain called supraoptic nucleus

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14
Q

What factors increase anesthetic requirements?

A

Chronic ETOH, infant, red hair, hypernatremia, hyperthermia, robustness of health

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15
Q

What factors decrease anesthetic requirements?

A

Acute ETOH, elderly patients, hyponatremia, hypothermia, anemia, hypercarbia, hypoxia, pregnancy

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16
Q

What are the three stages of GA?

A

Induction, maintenance, and recovery

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17
Q

Progressive deepening of anesthesia as the concentration increases in the ____

A

brain

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18
Q

Surgical anesthesia is reached ____ the body water and fat stores reach equillibrium

A

before

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19
Q

What is each stage of anesthesia characterized by?

A

Increased CNS depression

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20
Q

What are the four stages of anesthesia?

A

Analgesia, excitement, surgical anesthesia, medullary depression

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21
Q

What patients are at risk for delirium post op?

A

Elderly

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22
Q

In regards to delirium and altered transmission post op, what is the only neurotransmitter released?

A

Cholinergic transmission

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23
Q

What specific receptors do inhaled anesthetics work on?

A

None really, they are non-specific

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24
Q

Lipid solubility is proportional to ____

A

Potency

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25
What are the two things anesthesia personal can control in regards to the alveolar concentrations of inhaled anesthetics?
Inspired concentration | Alveolar ventilation
26
What is the first compartment anesthetic gas encounters?
Blood
27
Inverse of MAC is an index of ____
Potency Low MAC means high potency
28
Low MAC number infers ____ onset of action
slower
29
High MAC number infers ____ onset of action
rapid
30
What type of anesthetic is nitrous oxide considered?
Dissociative evidently....
31
What are the things to remember about nitrous oxide?
Not a full anesthetic Low potency High MACC POSSESES GOOD ANALGESIC PROPERTIES
32
What are the toxic side effects of nitrous oxide?
Megoblastic anemia, tinnitus, numbness peripheral neuropathy
33
What is the prototype inhaled anesthetic that other agents are compared to?
Halothane
34
Is halothane an analgesic, hypnotic, or both?
Hypnotic
35
What are the side effects of halothane?
Toxic metabolites-leading to hepatotoxicity | MH
36
What do you treat MH with?
Dantrolene, muscle relaxant that blocks Ca release
37
What are halothanes disadvantages?
Hypotension, bradycardia Respiratory depression Increased ICP and CBF
38
What are the characteristics of isoflurane?
Potent agent and rapid induction/recovery
39
Isoflurane does not ____ cardiac tissue for arrythmias?
sensitize
40
What are the disadvantages of isoflurane?
Pungent smell and respiratory irritation
41
What are the characteristics of enflurane?
Potent agent and rapid induction/recovery (Like iso)
42
What are the side effects of enflurane on the heart? in general?
Little effect on the heart | Can cause respiratory depression, decreased bp, increased CBF and ICP, MH
43
What does enflurane produce that is unique for its class?
Produces some level of muscle relaxation alone KNOW THIS!!!!!!!!!!!!!!
44
What are the characteristics of desflurane?
Fastest onset of action/recovery of the halogenated ethers
45
What agent supposedly has the fastest onset of action?
Sevo
46
What are the characteristics of sevo?
Decrease in BP
47
What are the toxic side effects of sevo?
MH, hypotension, mild increase in CBF and ICP, potentially nephrotoxic
48
How fast are thiopental and methohexital?
FFASSTT
49
What do receptors do thiopental and methohexital act on?
GABAa, activating the inhibitory pathway through Cl influx
50
What are the side effects of thipoental and methohexital?
Reduced CBF and ICP, dose dependent decrease in BP
51
What is etomidate used for specifically?
Hypnotic
52
What does etomidate have an increased level of compared to the barbs?
Higher margin of safety
53
What are the side effects of etomidate?
Decreased ICP and CBF, respiratory depression, N/V with long term use
54
What is the benefit of Fospropofol?
No pain on injection as compared to propofol
55
What makes ketamine unique?
Its the only non opiate IV anesthetic with analgesic properties
56
What is ketamine good for?
Children, poor risk geriatric patients, and in unstable patients
57
What does NMDA receptors allow?
Sodium and calcium to flow INTO the cell, letting K flow out
58
What receptors do benzos act on?
GABAa
59
What are the side effects of benzos?
Respiratory depression and hypotension
60
What is Innovar a combo of?
Droperidol and fentanyl
61
What broad category is droperidol classified as?
Neuroleptic
62
What is the use of Innovar?
Short procedures

Pharm 3 Test 5 (4 decks)

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