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AU15 - Pharmacology Test 2 > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

What does a complete anesthetic produce?

A 
Unconsciousness
Unresponsiveness
Amnesia
Immobility
Autonomic stability to the anesthetic state
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2
Q

Why isn’t Diethyl Ether used as a general anesthetic?

A

It is highly flammable

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3
Q

How do modern general anesthetics achieve the best qualities?

A

They’re given as a combination to get the advantages of all the drugs

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4
Q

What are the aspects of Ideal Surgical Anesthetics

A

Smooth and rapid induction
Produce unconsciousness
Produce amnesia
Maintain essential physiological functions, while blocking undesired reflexes
Skeletal muscle relaxation, but not respiratory muscles
Smooth, rapid, and uneventful recovery with no lasting adverse effects

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5
Q

What types of drugs would be in a anesthetic cocktail?

A 
Antimuscarinics
Various analgesics
Nitrous oxide and/or opioids
Antinicotinics
Antiemetics
Additional drugs
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6
Q

What role do antimuscarinics play in anesthetic cocktails?

A

Minimize salivation, larygospasms, and reflex bradycardia

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7
Q

What role do analgesics play in anesthetic cocktails?

A

Proprioceptive pain relief
Sedation
Amnesia

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8
Q

What role do Nitrous oxide and opioids play in anesthetic cocktails?

A

Reduce anesthetic requirement, provide analgesia

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9
Q

What role do antinicotinixs play in anesthetic cocktails?

A

Paralyze skeletal muscle

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10
Q

What role do “additional drugs” play in anesthetic cocktails?

A

Maintain organ stability

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11
Q

Why are general anesthetics not typically used in dental treatment?

A

Dental procedures are not usually as traumatic, so its not necessary or desirable to render the patient unconscious

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12
Q

Membrane Lipid Based Theory

A

The direct action of anesthetics on proteins lead to alterations
aka: Anesthetics interact with hydrophobic sites on proteins and affect their function

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13
Q

What sort of proteins are the likely targets of general anesthetics?

A

GABA receptors
Ligand activated ion receptors
CNS proteins

They interfere with the function of many proteins of neurochemical interest, but there is not a single target

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14
Q

T/F - Anesthetics have been observed to have both pre and postsynaptic effects

A

True

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15
Q

What is the reticular formation important for?

A

Major center supporting consciousness and alertness

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16
Q

Anesthetics that effect the reticular formation do what?

A

By depressing the RF, they induce unconsciousness

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17
Q

Anesthetics that effect the thalamocortical loop does what?

A

Induce unconsciousness

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18
Q

What is the limbic system involved in?

A

Memory

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19
Q

Inhibition of the limbic system would induce what?

A

Anesthetic-induced amnesia

20
Q

Anesthetics that affect the spinal cord will do what?

A

Disrupt pain pathways

21
Q

T/F - Anesthetics only need to depress one brain pathway to achieve anesthesia?

A

False - they need to depress many brain pathways

22
Q

What are the stages of general anesthesia?

A

1) Analgesia (induction)
2) Excitement
3) Surgical anesthesia
4) Medullary paralysis

23
Q

T/F - Modern anesthetic try to skip the steps of general anesthesia by being given in a cocktail

A

True

24
Q

What is the pathway of distribution of volatile anesthetics?

A

Alveoli –> Blood –> Briain

25
Q

What is the pathway of recovery of volatile anesthetics?

A

Brain –> Blood –> Alveoli

26
Q

What does a low blood:gas coefficient mean?

A

Anesthesia has low solubility (prefers the gas stage)
Faster induction and recovery
Ex: nitrous oxide

27
Q

What does a high blood:gas coefficient mean?

A

Anesthesia has a high solubility
Slower induction and recovery
exL Halothane

28
Q

What determines MAC %?

A

Olive oil solubility

29
Q

Drugs with a low MAC% have what?

A

High potency

30
Q

What are desirable properties for inhalation anesthetics?

A

Low MAC

Low blood:gas coefficient

31
Q

What are generalized pharmacological effects of volatile anesthetics?

A

Decrease the activity of cardiovascular system, respiration, kidney, skeletal muscle, and liver

32
Q

Nitrous oxide

A

Volatile Anesthetic with low blood:gas coefficient, and high MAC
Used at concentrations of 20-50% (mostly as an anti-anxiety)
Used in conjunciton with other more potent anesthetics so the other drugs can achieve more rapid onset and recovery

33
Q

Isoflurane

A

Improvement of halothane (less toxic, but less potent - lower B:G coefficient)
MAC = 1.15%
B:G = 1.4
Smells bad, so we want to knock the patient out with something else first

34
Q

Desflurane

A

MAC = 6%
B:G = 0.45
Contraindicated in patients susceptible to malignant hyperthermia

35
Q

Seroflurane

A

MAC = 2%
B:G = 0.65
More rapid acting that isoflurane

36
Q

Barbituates

A

IV anesthetics that act as CNS depressants by potentiating the activity of GABA receptors

37
Q

How do GABA receptors work?

A

When activated, release Cl in the cytoplasm to cause hyperpolarization, thus providing inhibitory influence on synaptic transmission

38
Q

How are Barbituates classified?

A

Based on the duration of action

39
Q

Classification of Barbituates

A 
Ultra-short acting (15-30 min)
Short acting (2-4 hrs)
Intermediate acting (4-6 hrs)
Long acting (6-8 hrs)
40
Q

What are the advantages of IV agents in anesthesia?

A

Rapid distribution (from vein to brain in seconds)
Reduced cardiac depression
No risk of malignant hyothermia
Eliminate the risk of occupational exposure (only patient gets it)

41
Q

What is the major adverse effect of IV anesthetics?

A

Respiratory depression

42
Q

Thiopental

A 
Ultra short acting barbituate
Causes unconsciousness in 0.5-1 min
60% of dose reaches brain in 1 minute
Consciousness returns in 5-10 minutes
Largely has been replaced by Propofol
43
Q

Methoxhexital

A

Similar to thiopental, but 2.5x more potent, faster acting, and a shorter duration
Sleep time is 5-7 minutes
Cleared 3x faster than thiopental
Faster recovery, and more favorable for dentistry

44
Q

Propofol

A

Most popular barbituate
Rapid recovery and clearing
General state is normal after clearing

45
Q

What is the induction dose for Propofol?

A

2-2.5 mg/kg

46
Q

What is the maintenance dose for Propofol?

A

50 ug/kg/min - 200 ug/kg/min

47
Q

Ketamine

A

Produces dissociation anesthesia
Analgesia and amnesia with minimal effect on respiratory function
Patient can blink and swallow, but doesn’t process info (PCP-like drug)

AU15 - Pharmacology Test 2 (10 decks)

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