GENERAL ANESTHETICS Flashcards
1
Q
A state of decreased awareness of pain, sometimes with amnesia
A
Analgesia
2
Q
Is a state characterized by unconsciousness, analgesia, amnesia, skeletal muscle relaxation and loss of reflexes
A
General Anesthesia
3
Q
The stages of Anesthesia
A
- Analgesia
- Excitement
- Surgical Anesthesia
- Medullary Depression
4
Q
Depression of vasomotor and respiratory centers-coma & dealth
A
Medullary Depression
5
Q
sleep, normal respiration and blood pressure
A
Surgical Anesthesia
6
Q
Amnesia, hyperreactivity, irregular respiration
A
Excitement
7
Q
Analgesia without amnesia
A
Analgesia
8
Q
The mechanism of action of Inhalation Anesthetics
A
-Depress electrical activity of neurons
-Interaction of anesthetic with lipid cell membrane (Meyer-Overton principle) with increased fluidity and a reduction of “orderliness” of the lipid structure
-Act on specific receptors (GABAa receptor)
9
Q
What are the uptake & distribution of INHALED ANESTHETICS
A
-Solubility
-Anesthetic concentration in the Inspired Air
-Pulmonary Ventilation
-Pulmonary blood flow
-Arteriovenous Concentration gradient
10
Q
One of the most important factors influencing the transfer
of an anesthetic from the lungs to the arterial blood is its
A
Solubility Characteristics
11
Q
It is a useful index of solubility and defines the relative affinity of an anesthetic for the blood compared with that of inspired gas.
A
blood:gas partition coefficient
12
Q
The partition coefficients for desflurane and nitrous oxide are
A
relatively insoluble in blood, are extremely low
13
Q
possesses low solubility in
blood, reaches high arterial tensions rapidly, and
in rapid equilibration with the brain and fast
onset of action.
A
Nitrous Oxide
14
Q
A rapid onset of anesthetic action is also characterized as
A
desflurane and, to a lesser
extent, with sevoflurane.
15
Q
The anesthetic concentration gradient between
arterial and mixed venous blood is dependent
mainly on uptake of the anesthetic by the
tissues, including nonneural tissues.
A
ArterioVenous concentration gradien
16
Q
the tissues that exert greatest
influence on the arteriovenous
anesthetic concentration gradient are
those that are highly perfused
A
Brain, Heart, Liver, Kidney, and splanchnic bed
17
Q
Muscle and skin constitute of
A
50%
18
Q
These tissues accumulate more slowly than in highly perfused tissues
A
Brain
19
Q
Are relatively insoluble in
blood and brain are eliminated at faster rates than the
more soluble anesthetics.
A
Inhaled Anesthetics
20
Q
Is twice as soluble in brain tissue and five
times more soluble in blood than nitrous oxide and
desflurane
A
Halothane
21
Q
The major route of elimination from the body.
A
Lungs
22
Q
May also contribute to
the elimination of some volatile anesthetics
A
Hepatic
23
Q
Metabolism of halothane results in the formation
of trifluoroacetic acid and release of bromide and chloride
ions
A
Oxidative metabolism
24
Q
The least metabolized of the
fluorinated anesthetics.
A
Isoflurane and desflurane
25
is degraded by contact with the carbon dioxide
absorbent in anesthesia machines, yielding a vinyl ether called
"compound A*," which can cause renal damage if high
concentrations are absorbed.
Sevoflurane
26
70% of the absorbed methoxyflurane is
metabolized by the
Liver
27
In terms of the extent of hepatic metabolism, rank order for the inhaled anesthetic is
1. Methoxyflurane
2.Halothane
3. Enflurane
4. Sevoflurane
5. Isoflurane
6. Desflurane
7. Nitrous Oxide
28
Not metabolized by human
tissues.
Nitrous Oxide
29
General Anesthetics Effects in CNS
-motor and autonomic systems are inhibited
-respiratory function depressed via CNS
-cerebral blood flow increased
30
General Anesthetics Effects in Cardiovascular
-blood pressure may decrease (inhibition of sympathetic tone) or increase (vagal inhibition)
-adrenal medullary secretion of catecholamines (Counteract myocardial depression)
31
Decreases mean arterial pressure in direct
proportion to their alveolar concentration.
-Halothane
-Desflurane
-Enflurane
-Sevoflurane
-Isoflurane
32
Have a depressant
effect on arterial pressure as a result of a decrease in
systemic vascular resistance with minimal effect on cardiac
output.
-Isoflurane
-Desflurane
-Sevoflurane
33
Can be seen with halothane, probably because of
direct vagal stimulation
Bradycardia
34
Desflurane and Isoflurane increases
Heart Rate
35
Causes transient sympathetic activation with
elevations in catecholamine levels can lead to marked
increases in HR and BP
Desflurane
36
Have greater myocardial
depressant effects than isoflurane and the newer, less soluble
halogenated anesthetics.
Enflurane and Halothane
37
Found to depress the myocardium in a
concentration-dependent manner
Nitrous Oxide
38
Are less likely to produce
arrhythmias
Sevoflurane and Desflurane
39
General Anesthetic Effects in Salivary and bronchial secretions
-inhalation anesthetics irritate mucosal cells
-Results in coughing and laryngeal spasms
40
General Anesthetics Effects in Skeletal Muscles
-Depression of reflexes
-via effect of reflexes
- by inhibiting activity at neuromuscular junction
41
Have little effect on uterine
musculature
Nitrous Oxide
42
Potent uterine
muscle relaxants.
Halogenated anesthetics
43
This pharmacologic effect can be used to
advantage when profound uterine relaxation is
required for an intrauterine fetal manipulation or
manual extraction of a retained placenta during
delivery.
Effects on Uterine Smooth Muscle
44
What stages is the induction of anesthesia
Stages 1 and 2
45
What stages is the maintenance of anesthesia?
Stages 3
46
Pre-operative medication for sedation and analgesia
Balanced Anesthesia
47
Combination of inhales and IV anesthetics generally used
Balanced Anesthesia
48
What are the 3 toxicity?
-Hepatotoxicity (Halothane)
-Nephrotoxicity
-Malignant Hyperthermia
49
The 4 chronic toxicity
-Mutagenicity
-Carcinogenicity
-Effects on Reproductive Organs
-Hematotoxicity
50
under normal conditions, inhaled anesthetics are neither mutagens nor carcinogens in patients
Mutagenicity
51
Increase in the cancer rate in OR personnel
Carcinogenicity
52
Higher incidence of miscarriages, abortions
Effects on reproductive organs
53
Prolonged exposure to nitrous oxide
decreases methionine synthase activity
and theoretically can cause megaloblastic
anemia.
Hematotoxicity
54
commonly used for induction of
general anesthesia.
Intravenous agents
55
is a barbiturate commonly used for induction
of anesthesia.
Thiopental
56
is structurally almost identical to thiopental and
has the same pharmacokinetic and pharmacodynamic
profile.
Thiamylal
57
After an IV bolus injection, thiopental rapidly crosses the
B-B-B
58
This can cause central excitatory activity
Methohexital
59
These benzodiazepines drugs are used for
preanesthetic medication and as adjuvants during surgical
procedures performed under local anesthesia.
-Diazepam
-Lorazepam
-Midazolam
60
Considered to be the drugs of choice for
premedication
Benzodiazepines drugs
61
are not water-soluble, and their
intravenous use necessitates nonaqueous vehicles, which
cause pain and local irritation
Diazepam and Lorazepam
62
Water-soluble and is the benzodiazepine of
choice for parenteral administration.
Midazolam
63
is frequently
administered intravenously before patients
enter the operating room
Midazolam
64
Unpleasant sensation that is acute
or chronic and is a consequence of
complex neurochemical processes
in the peripheral and central
nervous system
Pain
65
Produce morphine-like effects
Opiod Analgesics
66
Types of opioid Analgesics
-Synthetic
-Semi-synthetic
-Natural
67
Opioid Analgesics Receptors
-Mu
-Kappa
-Delta
68
Morphine Actions of Analgesia
-Raise the pain threshold, alter brain perception
69
Disinhibition of dopamine-containing neurons
Morphine Actions of Euphoria
70
Therapeutic uses of Morphine
-Analgesia
-Treat Diarrhea
-Relief of cough
-Treat acute pulmonary edema
71
Binds to Mu & Kappa receptors
Meperidine
72
Therapeutic Uses of Meperidine
-Analgesic
-Not effective for diarrhea & cough
73
Binds to Mu receptors, antagonist of
the N-methyl-D-aspartate (NMDA)
receptor
Methadone
74
Therapeutic Uses of Methadone
-Analgesic in nociception and neurogenic pain
-Treatment by controlled withdrawal of heroin and morphine dependency
75
Induce anesthesia and analgesia postoperatively
Epidural
76
Transmucosal preparation for patients with cancer who are tolerant to other opiods
Fentanyl
77
Are less potent, shorter acting
Alfentanil, Remifentanil
78
Is more potent than fentanyl
Sufentanil
79
A potent and extremely short-acting opioid has
been used to minimize residual
ventilatory depression
Remifentanil
80
These 2 drugs are administered together to produce analgesia and amnesia and combined with
nitrous oxide provide a state referred to as
neuroleptanesthesia
Fentanyl and Droperidol
81
Heroin
-Diacetylmorphine
-Crossess BBB
-Converted to Morphine in the body
82
It is a treatment for moderate to severe pain and twice the analgesic effect to morphine
Oxycodone & Oxymorphone
83
8-10x more potent than morphine
Hydromorphone
84
Weaker than hydromorphone
Hydrocodone
85
Only 30% analgesic activity compared to morphine and is used for cough
Codeine
86
Agonist on the kappa receptors, relieves moderate pain and can precipitate a withdrawal syndrome for morphine abuser
Pentazocine
87
A partial agonist, Mu receptor and Precipitate withdrawal with morphine addicts
Buprenorphine
88
Treatment for chronic pain, mimics the symptoms of psychosis and ceiling effect of respiratory depression
Nalbuphine & Butorphanol
88
Treatment for chronic pain, mimics the symptoms of psychosis and ceiling effect of respiratory depression
Nalbuphine & Butorphanol
89
Binds to mu receptors, lesser respiratory depression to morphine and causes CNS excitation seizure
Tramadol
90
Binds to mu receptors, norepinephrine reuptake blocker and for the management of moderate to severe pain, both chronic and acute
Tapentadol
91
Reverse coma and respiratory depression in opioid overdose and a competitive antagonist at the mu, kappa and delta receptors
Naloxone
92
Has become the most popular IV anesthetic and is used for both induction and maintenance of anesthesia as part of total IV or balanced anesthesia techniques
Propofol
93
Agent of choice for ambulatory surgery
Propofol
94
Is excreted in the urine as
glucoronide and sulfate conjugates.
Propofol
95
It causes a marked decrease in blood
pressure during induction of anesthesia
through decreased peripheral arterial
resistance and venodilation.
Propofol
96
A water-soluble prodrug of
propofol, has recently been approved
Fospropofol
97
A carboxylated imidazole
and for induction of anesthesia in patients with limited cardiovascular reserve
Etomidate
98
It produces a dissociative anesthetic
state characterized by catatonia,
amnesia, analgesia, with or without
loss of consciousness (hypnosis)
Ketamine
99
The only IV anesthetic that possesses
both analgesic properties and the
ability to produce dose-related CV
stimulation.
Ketamine
100
Is a potentially dangerous drug when
intracranial pressure is elevated.
Ketamine
101
Adverse effect of etomidate
-Pain on injection, myoclonic activity, postoperative nausea and vomiting
102
Adverse effect of Ketamine
-posoperative disorientation
-sensory and perceptual illusions
-vivid dreams
103
Is the condition that results when sensory
transmission from a local area of the body to
the CNS is blocked.
Local Anesthesia
104
In the body, they exist either as the uncharged base
or as a cation.
Local Anesthesia
105
Systemic absorption of injected local anesthetic from the
site of administration is determined by several factors
-Dosage
-Site of injection
-Drug-tissue binding
-Local tissue blood flow
-Use of vasoconstrictors
-The physiochemical properties of the drug itself
106
The local anesthetics are converted in the liver (amide
type) or in plasma (ester type) to more water-soluble
metabolites, which are excreted in the urine.
Metabolism and Excretion
107
Promotes ionization of the tertiary
amine base to the more water-soluble charged form,
leading to more rapid elimination
Acidification of urine
108
Isolated by Niemann in 1860 and introduced into
practice by Koller in 1884 as a topical ophthalmic
anesthetic
Cocaine
109
The first local anesthetic introduced into medical
practice
Cocaine
110
It was the only local
anesthetic drug available for 30 years
Cocaine
111
In 1905 he synthesized procaine, which became
the dominant local anesthetic for the next 50 years.
In an attempt to improve the clinical properties
of cocaine
Einhorn
112
was synthesized in 1943 by Löfgren
Lidocaine
113
Repeated injection of Lidocaine can result in
Loss of effectiveness
114
Are commonly used as
adjuvants to the combination of a tricyclic
antidepressant (eg, Amitriptyline) and an
anticonvulsant (eg, Carbamazepine) in
patients who fail to respond to the
combination of antidepressant and
anticonvulsant
Systemic LA drugs
115
Toxcicity in CNS
-Sleepines
-Light-headedness or sedation
-Visual and auditory disturbances
-Circumoral & tongue numbness
-metallic taste
-restlessness
-nystagmus & muscular twitching
-tonic-clonic convulsions
116
May produce severe CV
toxicity, including arrhythmias and hypotension, if
given intravenously
Bupivacaine
117
Cocaine cardiovascular toxicity includes
-severe hypertension with cerebral hemorrhage
-cardiac arryhtmias
-MI
118
Is metabolized to products that include
an agent capable of causing methemoglobinemia
(patient may appear cyanotic and the blood
ʺchocolate-colored
Prilocaine
