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Pharmacology Block 3 > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

Sodium thiopental mechanism of action (3):

A
  • GABAa activator.
  • Decreases cerebral oxygen utilization, blood flow, and intracranial pressure.
  • Drop in BP because of vasodilation (reduction in preload).
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2
Q

Sodium thiopental uses:

A
  • Induces anesthesia.

- Has been tried as a protective agent against cerebral ischemia.

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3
Q

Sodium thiopental side effects:

A
  • *Produces hypotension, hangover effect.

- Respiratory depression

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4
Q

Propofol mechanism of action (3):

A
  • GABAa activator.
  • Results in a decrease in cerebral oxygen utilization, blood flow, and intracranial pressure.
  • Drop in BP because of vasodilation (reduction in preload), AND depression of myocardial contractility.
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5
Q

Propofol uses:

A
  • Induces and maintains anesthesia.
  • Antiemetic.
  • Has a shorter half-life than thiopental; used when a rapid return to normal mental status is desired.
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6
Q

Propofol side effects:

A
  • Hypotension and respiratory depression (more than thiopental).
  • Pain at injection site.
  • Can produce excitation during induction.
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7
Q

Etomidate mechanism of action:

A

Activates GABAa receptors through allosteric effects.

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8
Q

Etomidate use:

A

Primarily used to induce anesthesia in patients at risk for hypotension (less CV effects than thiopental and propofol).

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9
Q

Etomidate side effects:

A
  • Significant nausea and vomiting.

- Increased post-surgical mortality due to suppression of the adrenocortical stress-response.

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10
Q

Ketamine use:

A

-Reserved for patients with bronchospasm, and children undergoing short, painful procedures.

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11
Q

Ketamine mechanism of action:

A
  • NMDA receptor antagonist.
  • Produces a hypnotic state called “dissociative anesthesia”, characterized by profound analgesia, unresponsiveness to commands (even though eyes can be open), amnesia, spontaneous respiration, *bronchodilation.
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12
Q

Ketamine side effects:

A
  • Emergence delirium.
  • Nystagmus, salivation, lacrimation, spontaneous limb movements, and increased muscle tone.
  • Increased BP due to indirect sympathomimetic activity.
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13
Q

Midazolam mechanism of action:

A
  • Short acting benzodiazepine.

- GABAa activator. Metabolized by hydroxylation to an active metabolite.

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14
Q

Midazolam use:

A
  • Used for conscious sedation during minor surgical procedures (wisdom teeth extraction).
  • Slower induction time and longer duration than thiopental.
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15
Q

Midazolam side effects:

A
  • Respiratory arrest.

- Use with caution in patients with movement disorders, bipolar disorder.

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16
Q

Isoflurane mechanism of action:

A

Inhaled GABAa activator with moderate blood:gas partition coefficient.

17
Q

Isoflurane uses:

A
  • Used to induce and maintain anesthesia.

- Co-administration with NO allows for reduction in the dose.

18
Q

Isoflurane side effects:

A
  • Airway irritant.
  • Respiratory depressant, increases PaCO2.
  • Myocardial depression. Arrhythmias (sensitizes the heart to catecholamines).
  • Dilates cerebral blood vessels, increasing intracranial pressure. Dilates coronary vessels.
19
Q

Desflurane mechanism of action:

A
  • Inhaled GABAa activator with low blood:gas partition coefficient (rapid induction and recovery).
  • Produces direct skeletal muscle relaxation.
20
Q

Desflurane uses:

A

-Used for maintenance of general anesthesia in outpatient surgeries.

21
Q

Desflurane side effects:

A
  • Airway irritant - causes coughing and bronchospasms.
  • Respiratory depressant, increases PaCO2.
  • Myocardial depression. Arrhythmias (sensitizes the heart to catecholamines).
  • Dilates cerebral blood vessels, increasing intracranial pressure. Dilates coronary vessels.
22
Q

Sevoflurane mechanism of action:

A

-Inhaled GABAa activator with low blood:gas partition coefficient (rapid induction and recovery).

23
Q

Sevoflurane uses:

A
  • Used for maintenance of general anesthesia in inpatient and outpatient surgeries.
  • Little irritation to airways.
24
Q

Sevoflurane side effects:

A
  • Less irritation to airways, less respiratory depression.

- Myocardial depression.

25
Q

Nitrous oxide uses:

A
  • Often co-administered with other inhalational anesthetics; rapid uptake from the alveolae results in increased concentration of the second anesthetic.
  • Co-administration also allows for a reduction in dosage.
  • Results dilutional hypoxia: place patients on 100% O2.
  • Used in outpatient dentistry.
26
Q

Nitrous oxide contraindication:

A

Contraindicated in pneumothorax: can exchange with nitrogen in any air-containing cavity.

27
Q

Cocaine mechanism of action:

A

-Exhibits local anesthetic activity and also blocks NE uptake into presynaptic adrenergic nerves (potent vasoconstrictor).

28
Q

Cocaine uses:

A
  • Used in ENT surgery to provide anesthesia and limitation of bleeding.
29
Q

Tetracaine use:

A
  • Widely used in spinal anesthesia and in topical ophthalmic preparations.
  • Rarely used for peripheral nerve block (need a large dose).
30
Q

Benzocaine use:

A

-Topical anesthetic.

31
Q

Lidocaine mechanism of action:

A

Produces fast, intense, long-lasting anesthesia. Use with EPI to decrease absorption.

32
Q

Lidocaine use:

A
  • Used in almost any application where a local anesthetic of IM duration is needed.
33
Q

Bupivacaine use:

A
  • Produces long-lasting anesthesia.

- Sensory block (more so than motor block).

34
Q

Bupivacaine side effects:

A

More cardiotoxicity than equal doses of lidocaine (dissociates from Na+ channels slowly, resulting in increased potency for blocking cardiac conduction).

35
Q

Ropivacaine use:

A

-Comparable to the S-enantiomer of Bupivacaine (less cardiotoxic effects). Suitable for epidural and regional anesthesia. Even more motor sparing.

Pharmacology Block 3 (11 decks)

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