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Basic Pharmacology > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

what does general anesthesia do?

A

renders patient unresponsive to painful stimuli through loss of consciousness

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2
Q

what are the five primary effects of general anesthetics?

A

unconsciousness
amnesia
analgesia
inhibition of autonomic reflexes
skeletal muscle relaxation

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3
Q

what do general anesthetics do to the cardiovascular and respiratory systems?

A

cardiovascular depression
some: cardiac dysrhythmias
depress respiration

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4
Q

why is balanced anesthesia used?

A

to achieve goal of safe, effective anesthesia and analgesia

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5
Q

what are the four stages anesthesia?

A

awake/analgesia
excitement
surgical anesthesia
overdose: medullary paralysis

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6
Q

what are the functional steps in anesthesia?

A

anesthetic induction
anesthetic maintenance
anesthetic recovery

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7
Q

what is the main effect of general anesthetics?

A

inhibit synaptic transmission

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8
Q

what are the main targets of anesthetics?

A

GABAa receptors
glutamate NMDA receptors
glycine receptors
K2P channels

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9
Q

where does general anesthesia act?

A

in the brain

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10
Q

what are the most sensitive regions to anesthesia?

A

thalamic sensory relay nuclei and the deep layer of the cortex to which these nuclei project

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11
Q

what are inhalant anesthetics?

A

volatile anesthetics: gas

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12
Q

what is the mechanism of action for inhalant anesthetics?

A

general disruption of neurotransmission

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13
Q

what do the main differences in agents of inhalant anesthetics relate to?

A

pharmacokinetics and adverse effects

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14
Q

what does it mean for something to be a volatile anesthetic?

A

liquid at room temperature
gas as pressure drops

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15
Q

what are some gas anesthetics?

A

isoflurane
sevoflurane

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16
Q

how do inhalant anesthetics work?

A

augment inhibitory activity (GABA receptors) and depress neurotransmission pathways (glutamate/NMDA and other pathways)

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17
Q

how is the potency of inhaled anesthetics defined quantitatively?

A

minimum alveolar concentration (MAC)

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18
Q

what is the minimum alveolar concentration (MAC)?

A

concentration of anesthetic gas needed to eliminate movement in 50% of patients with a standardized skin incision

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19
Q

what is the blood:gas partition coefficient?

A

how much gas dissolves in blood

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20
Q

what is the tissue:gas partition coefficient?

A

how much gas dissolves in tissues

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21
Q

the _____________ of an individual gas is proportional to its concentration

A

tension

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22
Q

what determines the flow of an anesthetic gas?

A

difference in tension between two sites, or the pressure gradient

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23
Q

where are gas anesthetics absorbed and eliminated?

A

lungs are only quantitatively important route

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24
Q

true/false: anesthetics cross blood-brain barrier quickly, so brain tension follows blood tension

A

true

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25
Q

what determines distribution of an anesthetic?

A

blood flow to tissue
capacity of tissue to absorb anesthetic

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26
Q

what is the main factor in determining rate of induction and recovery?

A

blood:gas partition coefficient

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27
Q

does a lower blood:gas partition coefficient take longer or shorter to induce a response?

A

shorter
drops alveolar gas concentration if higher

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28
Q

agents with _____ blood and tissue solubility have more rapid elimination

A

low

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29
Q

why do high tissue solubility anesthetics take longer to recover from?

A

95% of total amount in body is in fat after a long anesthetic, must come out and does so slowly

30
Q

what are the physiological factors that influence kinetic behavior of inhaled anesthetics?

A

alveolar ventilation rate
cardiac output
distribution of anesthetic in body

31
Q

what is the most commonly used inhalant anesthetic now?

A

isoflurane

32
Q

how soluble is isoflurane?

A

relatively insoluble: relatively rapid induction and recovery

33
Q

does isoflurane put stress on the liver and kidneys?

A

not really

34
Q

does isoflurane impact the cardiovascular system?

A

dose-dependent cardiovascular depression
generally minimal at doses used for surgery
minimal sensitization of heart to catecholamines

35
Q

what is a positive of sevoflurane?

A

very rapid induction and recovery

36
Q

what are the respiratory and cardiovascular impacts of sevoflurane?

A

similar to isoflurane
dose-dependent cardiovascular depression
respiratory depressant

37
Q

what is special about sevoflurane pertaining to toxicity?

A

reacts with carbon dioxide to make compound A, which is potentially nephrotoxic

38
Q

what are the advantages of injectable anesthetics?

A

act more rapidly than inhaled
less menacing than having face mask
rapid induction avoids excitement phase of inhaled

39
Q

what are the disadvantages of injectable anesthetics?

A

more difficult to quickly alter dose delivered
elimination slower than inhaled anesthetics, particularly if body tissues become saturated

40
Q

what are some nonbartituate sedative injectable anesthetic agents?

A

propofol
etomidate
alfaxalone

41
Q

what are some dissociative agent injectable anesthetics?

A

ketamine
tiletamine

42
Q

what receptors do injectable anesthetics act on?

A

GABAa
glutamate-NMDA
glycine
AMPA (glutamate) receptors

43
Q

what drugs act on the GABAa receptor?

A

barbituates
propofol
etomidate
alfaxalone

44
Q

what do the injectable anesthetics that act on GABAa receptor do?

A

enhance inhibitory GABAergic effects
do not bind to GABA binding site

45
Q

what do barbituates generally do?

A

depress the CNS
potentiate GABAa-induced increases in chloride conductance (inhibitory receptors)
bind to specific barbituate receptor sites on GABA-sensitive ion channels

46
Q

are barbituates acidic or basic?

A

weak acids

47
Q

do barbituates have a low or high therapeutic index?

A

low

48
Q

what can underdosing of barbituates lead to?

A

stage 2 excitement

49
Q

is methohexital short acting?

A

ultrashort acting, rapid recovery

50
Q

what are the adverse effects of barbituates?

A

dose dependent depression of all organ systems
respiratory depression
cardiovascular depression

51
Q

how does propofol act?

A

primarily through potentiation of GABA pathways

52
Q

is propofol related to other anesthetics?

A

no
alkoxyphenol derivative

53
Q

true/false: propofol accumulates in the body

A

false: rapidly metabolized so does not

54
Q

does propofol have analgesic effects?

A

no

55
Q

how does propofol affect respiration?

A

significant respiratory depression
can cause period of apnea on induction

56
Q

does proopofol have a rapid recovery after prolonged infusion?

A

yes

57
Q

what animals can you use propofol in?

A

dogs and cats

58
Q

how is propofol metabolized?

A

glucuronidation

59
Q

what can repeated use of propofol cause in cats?

A

heinz body formation
lethargy
malaise
diarrhea

60
Q

where does alfaxalone (neurosteroid) bind?

A

GABAa receptor

61
Q

what is alfaxalone?

A

ultra-short acting anesthetic

62
Q

does accumulation of alfaxalone occur?

A

no

63
Q

what are the adverse effects of alfaxalone?

A

respiratory and CV depression

64
Q

is the NMDA glutamate receptor excitatory or inhibitory?

A

excitatory (depolarization)

65
Q

what are the NMDA glutamate receptor antagonists?

A

ketamine
tiletamine
dissociative anesthetics

66
Q

what do NMDA glutamate receptor antagonists cause?

A

stage I and II anesthesia, no stage III
amnesia and paralysis of movement, but do not cause a true and complete loss of consciousness
significant analgesic

67
Q

what are some body effects of ketamine?

A

minimal cardiopulmonary depressant effects
apneustic breathing
high muscle tone

68
Q

how do you recover from ketamine IV?

A

redistribution

69
Q

what are the practical considerations of ketamine?

A

excellent somatic analgesia
some visceral analgesia
poor muscle relaxation

70
Q

what are some adverse effects of ketamine?

A

increase CSF pressure
+/- increased seizures
should not be used in combination with xylazine in dogs: severe cardiopulmonary depression
cat eyes remain open
painful on IM injection

Basic Pharmacology (37 decks)

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