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Pharmacology 825 > general anesthetics > Flashcards

general anesthetics Flashcards

1
Q

are pts less responsive during anesthesia or sleep?

A

pts are less responsive during anesthesia

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2
Q

Halogens like HCCl3 (Chloroform)
di-ethyl ether
CH3CH2OH (ethanol)

how do these structures act ?

A

depress nervous system and prevent action potential (achieved via state of unconsciousness)

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3
Q

What type of experiences are different for anesthesia vs sleep

A

no dreams
perception of the time
“emerging from anesthesia “ aka waking up
PONV: post op n/v caused from anesthesia

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4
Q

How many stages of anesthesia

A

stage 1-4

CNS depression increases as dose and level of sedation increases

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5
Q

stage 1

A

starts as analgesia w/o amnesia
late stage 1 has BOTH

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6
Q

stage 2

A

excitement stage
amnesia occurs, enhanced reflexes, irregular respiration, vomiting, the duration of this stage in limited by increasing anesthetic concentration

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7
Q

stage 3 (something changes here is red flag during surgery)

A

surgical anesthesia
achieved via induction
GOAL stage
regular respiration; patient is unconscious; no pain reflexes, BP is maintained

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8
Q

stage 4

A

medulla depression
COMA
respiratory and cardiac depression requiring respirator and pharm support (not a stage we want)

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9
Q

loss of consciousness

A

thalamic and cortical involved in CNS depression
thalamic injury cause vegetative state
thalamic stimulation improves response
removal or cortex abolishes effect on thalamus

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10
Q

amnesia

A

pt does not remember
common during anesthesia
part of hippocampus response via GABAa receptor

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11
Q

immobility and diminished muscle tone

A
  • do not want the patient to move
  • direct effect on spine
  • activates descending pathways which inhibit spinal reflexes
  • reticulospinal pathways
  • descending pathways from rostral ventromedial medulla
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12
Q

inhaled anesthetics

A
  • aerosolized
  • start in lungs and target CNS
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13
Q

solubility in blood

A
  • important; quicker the drug equalibertaes w/ blood the quicker it passes into brain producing anesthetic affect
  • blood gas partition coefficient (larger=more time spent in blood= longer time to get to the cns=longer onset)

picture: halo thane and n2o respiratory and brain/CNS compartment same size
BLOOD compartment changes size

when drug likes to be in drug compartment like halo thane; it is slower to enter brain meaning onset
of anesthesia would be slower

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14
Q

induction of anesthesia effect

A
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15
Q

elimination of anesthesia

A

anesthesia is terminated of the drug from the BRAIN to the BLOOD and elimination of drug through the LUNGS

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16
Q

Nitrous oxide

A
  • NMDA antagonist (methyl/aspartate)
  • prevents binding of glutamate(stimulate) (excite neurotransmitter)
  • to depress CNS
  • ketamine is similar*** level of anesthesia is not the same as other drugs

causes death via asphyxiation as it displaces oxygen

17
Q

Fluranes

A
  • activate gaba receptors
    gaba: agonist in cl- channel moves Cl- in CNS when active neuron is HYPER-POLARIZED=less activity

⇣opening of nicotinic receptor activated cation channel which

⇣ excite affect of acetylcholine

18
Q

isoflurane

A

K+ channel activity to induce hyper polarization of neurons

19
Q

Iso and Sevo

A

potentiate strychnine sensitive glycine receptor

20
Q

what is MAC?

A
  • min alveolar anesthetic concentration
  • potency of inhaled anesthetics to compare drugs

⇡MAC , ⇣blood gas= ⇡potency (inverse)

21
Q

effects of inhaled anesthetics: CNS

A

CNS: ⇣ cerebral mean arterial pressure

⇡cerebral blood flow

22
Q

effects of inhaled anesthetics: uterine SM

A

uterine SM-relax

useful in OB for c-sec

23
Q

effects of inhaled anesthetics: cardiovascular

A

Cardio:

⇣BP and myocardial function

24
Q

effects of inhaled anesthetics: respiratory

A

ALL are respiratory depressants

25
Q

effects of inhaled anesthetics: toxicity

A

fluoride released from methoxy, en, sevo may cause renal insufficiency as it can enter blood (not ideal)

26
Q

malignant hypothermia

A

triggered by inhaled anesthetics and succs

causes rapid onset of all bad things

muscle biopsy and genetic test can predict

use dantrolene to treat block Ca++ channels released from sarcoplasmic reticulum

rare but causer of anesthetic mortality

27
Q

IV anesthetics

A
  • used for induction of general anesthesia
  • balanced anesthesia: inhaled and IV agents
28
Q

Barbiturates(IV)

A

thiopental: ⇡lipid solubility; ⇡BBB penetration; loss of consciousness achieved <1 min used to induced general anesthesia (skips step 2 the undesired step)

MOA: activates GABA Cl- channels hyper-polarizes cause CNS depression

29
Q

Benzodiazepines

A

MOA: inhibition of GABA receptors

diazepam/lorazepam will help to sedate and decrease anxiety prior to procedure

midazolam (general anesthetic) only benzo that goes straight to anesthesia stage so its used outpatient and induction

flumazenil: benzo antagonist; used to reverse midazolam in emergencies

30
Q

Opioids

A

MOA: mu opioid agonist

⇡opioids dose w/ ⇡ benzo dose will achieve general anesthesia state

good for cardiac surgery where primary goal is to minimize cardiac depression

chest wall rigidity; impair ventilation

abuse

aware/alert after given just opioids

31
Q

propofol

A

MOA: activates GABA receptors

gold standard IV anesthetic

induces anesthesia in <1 min

useful for prolonged surgeries

rapid recovery

anti emetic properties too!!

causes hypotension during induction due to ⇣ peripheral resistance

can cause dose dependent apnea

32
Q

Etomidate

A

MOA: Inhibition of GABA

GI surgeries

minimal effect in cardiac and resp function

ADR: PONV (must also dispense anti emetic)

33
Q

ketamine

A

MOA: NMDA antagonist like nitrous oxide

prevents glutamate binding

produces dissociative anesthesia: conscious but still out of it

cardiovascular stimulant

high doses cause disorientation/hallucination

low dose with other anesthetics used instead of opioids to minimize ventilatory depression

used in vet clinics too

stem from phencyclidine

34
Q

typical anesthesia procedure

A
  1. preop sedation (benzos like diazepam)
  2. induction (IV propofol or IV thiopental); neuromuscular block w/ succs to intubate trachea
  3. maintenance: inhaled anesthetics; IV anesthetics (USUALLY BOTH)
  4. opioids for pain

Pharmacology 825 (8 decks)

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