Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Unit 3 Pharm > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

General anesthesia is a reversible drug-induced coma featuring what 5 affects?

A

Hypnosis, amnesia, analgesia, muscle relaxation, attenuation of autonomic reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Briefly describe the Meyer-Overton Rule and what firefly luciferase expts showed about how anesthetics likely bind to hydrophobic pockets on proteins.

A

Potency of inhibition of the water soluble protein correlated with potency of the anesthetic, and the Rule states that the more potent an anesthetic the more soluble in olive oil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The ratio of solubilities of a gas betw two compartments at eqb; describes how inhaled anesthetics distribute themselves (based on their solubility) betw diff tissues at eqb

A

Partition coefficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Partial pressure in the alveolus (PA) is the driver for uptake and distribution of anesthetic. What 2 general factors determine it? What factors increase PA?

A

Delivery to alveoli minus uptake into the blood.
To inc deilvery to alveoli: inc partial pressure of agent inhaled, inc alveolar ventilation, dec FRC.
To dec uptake by blood: dec blood solubility of agent, dec cardiac output, dec gradient alveolus to capillary.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The conc of an inhaled agent at which 50% of patients will not move in response to a surgical incision, a common measure of potency

A

Min Alveolar Conc (MAC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MAC is increased by

A

Hyperthermia, red hair, inc CNS catecholamine levels, cyclosporine, hypernatremia, inc central nt’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MAC is decreased by

A

Hyponatremia, age, dec CNS catecholamine levels, opioids anxiolytics a2 agonists lidocaine, hypothermia, pregnancy and post partum period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Inhaled analgesic that doesn’t relax muscle
Assoc’d with PONV, inactivates B12
Accum’s in close air spaces
AEs on embryonic development
Used freq for mask induction in children
Used with volatile agents for maintenance

A

N2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Potent, kinda pungent, difficult mask induction

Inhaled gold std for maintenance of general anesthesia

A

Isoflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Inhaled, lower potency anesthetic
Decreased solubility allows for rapid induction/emergence
Most pungent, with mask induction can cause coughing, drooling, laryngospasm

A

Desflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nonpungent bronchodilator inhaled anesthetic

Medium solubility, medium potency

A

Sevoflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Physiologic effects of volatile agents: CNS effects

  • Dose-dependent depression (DDD) of…
  • Dose-dependent increase (DDI) in…
A
  • DDD of EEG, sensory and motor evoked potentials, cerebral metabolic rate
  • DDI in CBF and thus ICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Physiologic effects of volatile agents: CV function

  • DDD in…
  • Minimal effects on…
  • Isoflurane and desflurane do what to HR likely due to pungency stimulation of airway receptors and reflex tachy
  • Redistribution of blood flow (inc to where, dec to where?_
A
  • DDD in SVR and thus dec arterial BP
  • Myocardial contractility
  • Inc HR 5-10%
  • Inc flow to brain, muscle and skin
  • Dec flow to liver, gut and kidneys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Physiologic effects of volatile agents: Respiratory function

  • DDD in…
  • DDI in…
  • Relaxation of…
  • Neuromuscular function (directly relaxes what, potentiates effects of what drugs, can trigger what in susceptible patients?)
A
  • DDD in TV and ventilatory response to hypoxia and hypercarbia
  • DDI in respiratory rate
  • Airway sm muscles (bronchodilation)
  • Directly relaxes skel muscle, potentiates fx of NMBs, triggers MH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Barbs, propofol, etomidate, phencyclidines, and a2-agonists are all what type of administered anesthetics?

A

Intravenous anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Barbiturates (methohexital and thiopental) provide ONLY what effect?

A

Hypnosis/sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Barbs produce hypnosis by enhancing actions of inhibitory nt’s by binding to what receptors, and inhibiting actions of excitatory nt’s by antagonizing what receptors?

A

GABA-A to enhance Cl- conductance, Antagonize NMDA-Glu receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Unlike propofol, barbs adversely impact what?

A

Cardiac contractility because they are negative inotropes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Barbs and propofol produce DDD in what two vitals?

A

DDD in BP due to vasodilation, and respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Propofol effects:

  • Hypnosis due to what agonist activity?
  • Sedation also may be contributed by what receptor activity?
  • Inhibits what receptors?
  • Direct depression of what neurons via action of GABA-A and glycine receptors?
A
  • GABA induced Cl- currents
  • a2 receptor
  • NMDA-glu
  • Spinal cord neurons
21
Q

Be aware of allergic reactions to soybean oil and egg

A

Propofol

22
Q

Unique property of propofol. Also, what does it not trigger?

A

Anti-emetic properties at sub-hypnotic doses. MH

23
Q

Used for induction of maintenance of general anesthesia and for sedation in ICU and during procedures

A

Propofol

24
Q

Admin of propofol with catechols and glucocort’s that causes MA, myocardial failure, rhabdo, hyperkalemia, renal failure possibly due to fatty acid oxidation is called what?

A

Propofol infusion syndrome

25
Q

MINIMAL cardiorespiratory depression IV agent of choice in patients with minimal cardiac reserve who can’t take a drop in bp

A

Etomidate

26
Q

What things should you expect after administering etomidate?

A

Involuntary myoclonic mvmts, PONV, single dose inhibits cortisol synthesis (can’t use continuous)

27
Q

Primary CNS action of etomidate. Name receptor agonized or antagonized. What activity does it not have?

A

Hypnosis. GABA-A agonist. NO analgesia

28
Q

IV drug that produces unconsciousness, amnesia, and ANALGESIA

A

Ketamine

29
Q

Undesirable effects of ketamine

A

Nystagmus, lacrimation, salivation, increased muscle tone with uncoordinated mvmt

30
Q

Primary site of action may be what for ketamine? What does this cause? What receptor action does it have?

A

Thalamoneocortical projection system causing functional disorganization. May occupy opiate receptors in brain and spinal cord. NMDA-glu receptor antagonist

31
Q

Unique effects of ketamine on CV system:

  • Directly stim’s SNS to cause…(3)
  • Increases CBF and ICP so can’t be used in patients with what?
A
  • Inc systemic and pulm vascular resistance and thus increases pressures, HR increase, increase cardiac work and O2 consumption (not used in CAD patients)
  • Intracranial mass lesions
32
Q

Property of ketamine making it a useful induction agent in patients with reactive airways

A

Excellent bronchodilator

33
Q

Ketamine is used as an induction agent in patients with…

And in what patient population?

A

Hypovolemia and cardiomyopathy, and used IM for sedation for children procedures and for analgesia to decrease opioid use

34
Q

IV drug which binds to a2A and a2B receptors in LC and spinal cord to produce sedation, sympatholysis and analgesia. Quality of sedation is more like natural sleep

A

Dexmedetomidine

35
Q

What type of surgery is dexmedetomidine used as an adjunct in?

A

Bariatric surgery

36
Q

What IV drug has limited resp depression and wide margin of safety

A

Dexmedetomidine

37
Q

Name the two chemical classes of non-depolarizing NMBs

A

Benzilisoquinolinium compounds (curium’s) and amino steroid cpds (curonium’s)

38
Q

Depolarizing agent

A

Succinylcholine

39
Q

Besides action at nicotinic ACh receptors at the NMJ, succinylcholine acts at what other receptors?

A

Muscarinic and nicotinic receptors of the ANS (stim’s all cholinergic autonomic receptors)

40
Q

Side effects of succinylcholine

A

Cardiac dysrhythmias, hyperkalemia, increases in intraocular intracrania and intragastric pressures, myalgias

41
Q

Neuromuscular blockade (by non-depolarizing agents) can be antagonized by administration of what type of drugs?

A

Anti-cholinesterases (ex: neostigmine)

42
Q

In reversing NMBs, we don’t want the muscarinic effects so we administer an antimuscarinic like atropine or best yet…

A

Glycopyrrolate

43
Q

Avoid use of this long acting NMB in patients with?

Causes modest in what due to its vagolytic effect?

A

Pancuronium
renal insufficiency
HR

44
Q

NMBs devoid of CV effects

A

Vecuronium and Rocuronium

45
Q

Rapid reversal of rocuronium blockade achieved with what new drug?

A

Sugammadex

46
Q

Atracurium and Cisatracurium undergo Hoffman Elimination and thus are advantageous in patients with…

A

Renal or liver dysfunction

47
Q

Isoquinoline NMB that causes histamine release with brisk injection, thus causing a transient increase in HR and BP

A

Atracurium

48
Q

Isoquinoline NMB that does not cause histamine release and is devoid of CV effects

A

Cisatracurium

49
Q

Henry’s Law Equation:

A

Partial pressure = Conc/solubility

Unit 3 Pharm (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions