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Pharmacology > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

Nitrous Oxide (N2O) class?

A

Inorganic gas. Hypnotic, analgesic, NO muscle relaxation

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2
Q

N2O mxn? Is it soluble in blood? What does this mean?

A

NMDA antagonist; relatively insoluble in blood; rapid induction of anasthesia

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3
Q

N2O for?

A

Mask induction in children

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4
Q

N2O side effects?

A

PONV, inactivates B12 (abnormal embryonic development), accumulates in closed air spaces (bowel, middle ear, pneumothoraces, air emboli) because N2O is insoluble in blood

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5
Q

MAC of N2O?

A

104%

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6
Q

Isofluorane class?

A

Volatile anasthetic, will somewhat relax skeletal muscles

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7
Q

Isoflurane for?

A

Gold standard for maintenance of general anasthesia

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8
Q

Isoflurane MAC?

A

1.17% – Most potent of the 3 volatile anesthetics

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9
Q

Isoflurane side effects?

A

Pungent (makes mask induction difficult)

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10
Q

Desflurane class?

A

Volatile anesthetic

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11
Q

Desflurane MAC?

A

6.6% – Least potent, least soluble (allowing for rapid emergence from anesthesia)

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12
Q

Desflurane side effects?

A

Most pungent – will cause airway irritation symptoms (coughing, copious salivation, breath holding, laryngospasm)

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13
Q

Sevoflurane class?

A

Volatile anesthetic

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14
Q

Sevoflurane MAC?

A

1.8% – Middle potency between Isoflurane & Desflurane. Also, middle solubility.

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15
Q

Sevoflurane for? Why?

A

Mask induction in children and adults because it is the least pungent.

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16
Q

Sevoflurane side effects?

A

Produces inorganic Fl- ions; In combination with CO2 forms “compound A” (nephrotoxic in rats); forms CO when exposed to strong bases; exothermic rxns can cause fires

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17
Q

Volatile anesthetics?

A

Isoflurane, Desflurane, Sevoflurane

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18
Q

Effects of volatile anesthetics on CNS?

A

Dose dependent depression of EEG, potentials (↑ latency,↓ amplitude), Cerebral metabolic rate. Dose dependent increase in Cerebral blood flow (CBF) (may be blunted by hypocapnia produced by deliberate hyperventilation), ICP

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19
Q

Effects of volatile anesthetics on cardiovascular system & blood flow?

A

Dose dependent decreases in: vascular resistance, BP
BUT: Minimal effects on myocardial contractility. Isoflurane and desflurane ↑ HR (Likely due to pungency stimulating airway receptors and eliciting reflex tachycardia). Redistribution of blood flow
↑ blood flow to brain, muscle and skin & ↓ blood flow to liver, kidneys, gut.

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20
Q

Effects of volatile anesthetics on respiratory function?

A

Dose dependent decrease in Tidal volume, Ventilatory response to hypoxia and hypercarbia. Dose dependent increase in respiratory rate, Relaxation of airway smooth muscles (bronchodilation)

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21
Q

Effects of volatile anesthetics on NMJ?

A

Direct relaxation of sk muscle; Potentiate the effects of NMJ blockers; Malignant hyperthermia

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22
Q

Methohexital class?

A

Barbiturate

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23
Q

Methohexital mxn?

A

GABAa binding, @ higher concentrations, direct antagonist at the GABAa receptor, inhibit excitatory NTs, antagonise NMDA; hypnosis, sedation, ANTI-analgesic

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24
Q

Methohexital for?

A

Induction of general anesthesia

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25
Q

How is methohexital effect terminated? What is the onset timing?

A

Rapid onset, short duration of action, effects terminated via redistribution away from the brain, metabolized by the liver

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26
Q

How is methohexital dosed?

A

Based on lean body mass?

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27
Q

Methohexital physiologic effects on heart and lungs?

A

Dose dependent decrease in BP due to vasodilation; negative inotropic; Dose dependent respiratory depression

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28
Q

Propofol class?

A

Alkylphenyl (a fatty acid)

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29
Q

Propofol mxn?

A

GABAa receptor agonist; antagonist NMDA; some alpha2 activity; directly depresses spinal cord neurons via GABAa and glycine receptors

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30
Q

Most commonly used IV anasthetic today?

A

Propofol

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31
Q

Propofol for?

A

anti-emetic at low doses; induction and maintenance of general anesthesia; sedation in ICU; procedural sedation

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32
Q

Propofol side effects?

A

Propofol infusion syndrome: metabolic acidosis, rhabdomyolysis, renal failure, BP, bradycardia, death (esp if given >48 hours at high-dose infusion along wtih catecholamine & glucocorticoid use); Pain at injection site; Supports bacterial growth; Allergies to egg and soy; NO malignant hyperthermia

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33
Q

Onset of propofol? How is it metabolized?

A

Rapid onset and offset; Met in liver and lung and mets excreted in kidney

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34
Q

Etomidate class?

A

Carboxylated imidazole

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35
Q

Etomidate mxn?

A

GABAa receptor agonist

36
Q

Etomidate for?

A

Hypnosis – NO analgesic activity

37
Q

Etomidate side effects?

A

Pain on administration (due to its solvent, propylene glycol), involuntary myoclonic movements (not a seizure), PONV, inhibits cortisol synthesis

38
Q

When is etomidate specifically useful & why?

A

MINIMAL cardiorespiratory depression, so this is really good in patients with minimal cardiac reserve

39
Q

Onset and offset of etomidate?

A

Rapid onset and offset

40
Q

Ketamine class?

A

Phencyclidine?

41
Q

Ketamine mxn?

A

NMDA rec antagonist, possibly an opiate agonist in the brain and SC

42
Q

Ketamine for?

A

Dose-dependent unconsciousness, amnesia, analgesia: For pediatric, dev delayed patients, induction in patients with reactive airway disease, hypovolemia, cardiac disease; with propofol for IV procedural sedation; adjuvant during and after surgery to reduce opiod use; pain therapy; depression

43
Q

Ketamine side effects? Contraindications?

A

sympathetic stimulation, including incr. SVR, PVR, HR, cardiac work, and cardiac O2 compensation; increase cerebral flow & ICP; emergence delirium; uncoordinated movements; nystagmus; lacrimation; salivation; dissociative anesthesia; Contraindicated in CAD (but can be used in those with cardiomyopathy, tamponade, restr. pericarditis, congenital heart disease), intracranial lesions

44
Q

Ketamine is metabolized by?

A

P450 – met is norketamine (1/3 - 1/5 as effective)

45
Q

Ketamine can be administered?

A

IV, IM, orally, intranasally, rectally

46
Q

Ketamine is an excellent ____ and can be used in those with ____.

A

Bronchodilator, Reactive airway disease.

47
Q

Dexmedetomidine class?

A

Alpha 2 agonist

48
Q

Dexmedetomidine mxn?

A

Bind a2a/b in LC and SC – sedation, sympatholysis, analgesia

49
Q

Dexmedetomidine for?

A

Awake intubations, craniotomies; Adjunct to general anesthesia in pts susceptible to narcotic-induced post-op respiratory depression; w/drawal/detox

50
Q

Dexmedetomidine side effects?

A

Limitied resp depression – wide safety margin

51
Q

What is unique about dexmedetomidine? What is it’s only approved use?

A

GABA is not hit – sedation is easier to wake from and more similar to non REM sleep. Approved for ventilation of ICU pts < 24 hrs.

52
Q

Succinylcholine class?

A

Depolarizing NMB

53
Q

Succinylcholine mxn?

A

Attach to all AChR and overstimulate then to paralysis (fasciculations –> paralysis)

54
Q

Succinylcholine for?

A

Sk musc relaxant (intubation)

55
Q

Succinylcholine side effects?

A

Malignant hyperthermia; Cardiac dysrhythmias, hyperkalemia, increased intraocular and Intracranial presure, masseter spasm, increased intragastric pressure, myalgias

56
Q

What is the timing of succinylcholine? How is it terminated?

A

Rapid onset and ULTRA-shor duration of action 9-12 min); Blockade cannot be reversed – diffuses away and hydrolyzed by pseudocholinesterase in plasma

57
Q

Pancuronium class?

A

Amino steroid non-depolarizing NMB

58
Q

Pancuronium mxn?

A

Competitive block of ACh, vagolytic

59
Q

Pancuroinium for?

A

Sk muscle relaxant

60
Q

Avoid pancuronium in?

A

Renal insuffic (80% excreted unchanged – low mets in liver)

61
Q

Pancuronium side effects?

A

Increase HR

62
Q

Pancuronium timing?

A

Onset (3-5 min), Only long acting non-dep NMB (60-90 min)

63
Q

Vecuronium class?

A

Amino steroid non-dep NMB

64
Q

Vecuronium mxn? Timing?

A

Comp block of ACh; onset 3-5 min, duration 20-35 min

65
Q

Vecuronium for?

A

Sk musc relaxant

66
Q

Vecuronium side effects?

A

No heart effects

67
Q

Rocuronium class?

A

Amino steroid non-dep NMB

68
Q

Rocuronium mxn? Timing?

A

Com block of ACh; onset 1-2 min, duration 20-35 min

69
Q

Rocuronium for?

A

Sk muscle relaxant (can substitute succinylcholine in rapid sequence intubation)

70
Q

Rocuronium sid effects?

A

No heart effects

71
Q

Sugammedex class?

A

Selective relaxant binding agent?

72
Q

Sugammedex mxn?

A

Complexes with rocuronium, rendering it inactive, no effect on Achesterase (hence no need for anti-muscarinic administration) – Allows for a faster and more complete recovery of rocuronium-induced blockade

73
Q

Sugammedex for?

A

imm reversal of rocuronium

74
Q

Sugammedex side effects?

A

not yet FDA approved – N/V, dry mouth, decrease in BP

75
Q

Cis-atracurium class?

A

isoquinoline non-dep NMP

76
Q

cis-atracurium for?

A

Sk muscle relaxant – used in pts with liver or renal dysfunction

77
Q

cis-atracurium side effects?

A

no hist release or downstream effects

78
Q

atracurium class?

A

isoquinoline non-dep NMB

79
Q

atracurium mxn?

A

comp block of Ach (no depolarization)

80
Q

cis-atracurium mxn?

A

comp block of Ach (no depolarization)

81
Q

atracurium side effects?

A

Hist release (esp if rapid IV bolus), hypotension, tachycardia

82
Q

ACHEIs? Which is most commonly used? Which is shortest acting/fastest onset? Which is longest duration?

A

Edrophonium, Neostigmine, Pyridostigmine. Edro is shortest acting/fastest onset. Neo is most common. Pyrido is longest duration.

83
Q

Glycopyrrolate class?

A

Anti-muscarinic

84
Q

Glycopyrrolate for?

A

Reverse muscarinic effects that may occur with addition of an ACHEI to alleviate muscle relaxation (only want nicotinic synapses to recover!)

85
Q

Elimination of isoquinoline agents? Why is this important?

A

Hoffman elimination (non-enzymmatic degradation) – Useful in pts with liver or renal dysfunction

Pharmacology (46 decks)

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