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Pharmacology > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

What is MAC?

A

minimum alveolar concentration. The alveolar concentration of gas at which 50% of all patients do not respond to a surgical stimulus.

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2
Q

What two structures do general anesthetics exert direct effects on?

A

thalamus

hippocampus

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3
Q

Many neuroscientists believe that the ___ loop is essential to maintaining consciousness.

A

thalamocortical

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4
Q

What system is involved in anesthetic-induced amensia? Why?

A

limbic system is involved in memory

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5
Q

T/F. The pain pathways do NOT involve the spinal cords.

A

False, pain pathways DO involve the spinal cord.

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6
Q

___ of several brain pathways is crucial to achieving general anesthesia.

A

Depression

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7
Q

What are the four sequential stages of general anesthesia?

A
  1. analgesia (induction)
  2. excitement
  3. surgical anesthesia
  4. medullary paralysis
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8
Q

Chloride channels or ___ are the primary inhibitory ion channels targeted by anesthetics.

A

GABA

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9
Q

T/F. Studies on the sympathetic nervous system indicate that synaptic transmission is more sensitive to action potentials than anesthetics.

A

False, Studies on the sympathetic nervous system indicate that synaptic transmission is more sensitive to anesthetics than action potentials.

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10
Q

The ___ ___ ___ receives inputs and is a major center support consciousness and ___. As its activity is ___, its influences decrease and unconsciousness ensues.

A

reticular activating formation; alertness; depressed

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11
Q

Which correlation has dominated thinking on molecular mechanisms for over 100 years?

A

Meyer-Overton correlation

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12
Q

When does anesthesia begin?

A

when it reaches a critical concentration in membrane lipids

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13
Q

T/F. Direct action on lipids leads to indirect action on proteins. Direct action of anesthetics on proteins leads to alterations in protein function.

A

True

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14
Q

The fact that anesthetics interact with ___ sites on proteins and affect their function is more popular theory these days.

A

hydrophobic

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15
Q

What type of proteins are likely targets of general anesthetics?

A

ligand activated ion channels

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16
Q

What are the five primary effects produced by general anesthetics?

A
  1. unconsciousness
  2. amnesia
  3. analgesia (unresponsiveness)
  4. inhibition of autonomic reflexes (autonomic stability)
  5. skeletal muscle relaxation (immobility)
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17
Q

___ ___ is a complete anesthetic but it has a significant draw-back (explosion).

A

Diethyl ether

18
Q

What is an ideal surgical anesthetic treatment?

A
  1. smooth and rapid induction
  2. produce unconsciousness
  3. produce amnesia
  4. maintain essential physiologic functions while blocking undesired reflexes
  5. skeletal muscle relaxation, but not respiratory muscles
  6. block perception of sensory stimuli
  7. smooth, rapid, and uneventful recovery with no lasting adverse effect
19
Q

Match the drug with its explanation.

  1. Antimuscarinics
  2. Various analgesics
  3. Nitrous oxide and/or opiods
  4. Anti-nicotinics
  5. Antiemetics
  6. Additional drugs

A. minimize salivation, laryngospasm (block vagal stimulation), reflex bradycardia
B. preoperative pain relief, sedation, amnesia
C. reduce anesthetic requirement, provide analgesia
D. paralyze skeletal muscle
E. to maintain organ systems

A 
1 - A
2 - B
3 - C
4 - D
5 - nothing
6 - E
20
Q

Why are dental procedures not as traumatic as general surgical procedures?

A
  • not necessary or desirable to render the patient unconscious
  • oral and IV routes are available to provide sedation
21
Q

What is an important determinant of the distribution of volatile anesthetics?

A

the blood gas coefficient - the ratio of the concentration of an anesthetic in the blood phase to the concentration of the anesthetic in the gas phase when the anesthetic is in equilibrium between the two phases
[blood]/[gas]

22
Q

The lower the blood/gas coefficient the ___ the induction and recovery (Nitrous oxide), but the higher the blood/gas coefficient, the ___ the induction and recovery (Halothane).

A

faster; slower

23
Q

T/F. Agents with low solubility (large blood-gas partition coefficients) require large amounts of the anesthetic to dissolve in the blood before the partial pressure in the blood increases enough to effectively deliver them to the brain.

A

False, Agents with HIGH solubility (large blood-gas partition coefficients) require large amounts of the anesthetic to dissolve in the blood before the partial pressure in the blood increases enough to effectively deliver them to the brain.

Agents with LOWer blood solubility (small blood-gas partition coefficients) have more rapid rates of onset of anesthesia and more rapid recovery.

24
Q

Desirable properties for inhalation anesthetic agents include ___ potency (___ MAC) and ___ blood solubility (___ blood/gas coefficient).

A

high; low; low; low

25
Q

The generalized pharamocological effects of volatile anesthetics is decreased in most tissues, except what?

A

liver - alterations produces, but usually reversible and not serious

26
Q

In dentistry, what are the concentrations of Nitrous Oxide used to produce moderate sedation and analgesia (often more of an anti-anxiety medication)?

A

20% - 50%

27
Q

Why is Nitrous Oxide used in conjunction with other (more potent) drugs?

A

to reduce concentration of second drug and achieve a more rapid onset and recovery

28
Q

T/F. Nitrous oxide is a strong cardiac or respiratory depressant that isn’t abused much.

A

False, Nitrous oxide is NOT a strong cardiac or respiratory depressant AND has the possibility of abuse.

29
Q

What drug is an improvement on halothane because it is less toxic (but less potent) and has a low B/G coefficient?

A

Isoflurane - but it smells bad

30
Q

Which general anesthetic has a B/G coefficient similar to nitrous oxide but is contraindicated in patients susceptible to malignant hyperthermia?

A

desflurane

31
Q

___ is more rapid acting than isoflurane.

A

sevoflurane

32
Q

Barbituates act as CNS ___ by potentiating the activity of the ___ receptor.

A

depressants; GABA-A

33
Q

What happens once GABA binds to its receptor?

A

binding of GABA to its receptor activates chloride channels. The influx of negatively charged chloride hyperpolarizes the post synaptic membrane, thus providing an inhibitory influence on synaptic transmission

34
Q

Match the barbituate with its duration of action

  1. Ultra short acting (15-30mins)
  2. Short acting (2-4hrs)
  3. Intermediate acting (4-6hrs)
  4. Long-acting (6-8hrs)
A. Amobarbital
B. Pentobarbital
C. Phenobarbital
D. Secobarbital
E. Thiopental
A

1 - E
2 - B, D
3 - A
4 - C

35
Q

Why has the use of intravenous agents in anesthesia become more popular?

A
  1. Rapid distribution: drug into vein = rapidly gets to brain
  2. Reduced cardiac depression
  3. no risk of malignant hyperthermia
  4. eliminate risk of occupational exposure to volatile anesthetics
36
Q

Intravenous anesthesia can be given in a ___ injection, used as maintenance, but might cause ___ depression.

A

single; respiratory

37
Q

____ (sodium pental) is a ___ ___ acting induction phase barbituate that causes ___ within 1/2 - 1min. At one minute, ___% of total dose is in the brain then it distributes and ___ returns within 5 - 10 minutes. It has been largely replaced by ___.

A

Thiopental; ultra short; unconsciousness; 60; consciousness; propofol

38
Q

What barbituate is 2.5X more potent, faster acting, has a shorter duration of action , has a sleep time of 5-7mins, is cleared 3X faster than Thiopental and favorable in dental practices?

A

Methoxhexital

39
Q

Which barbituate is currently the most popular anesthetic agent with a recovery rapid and ‘clear’ (mental state)?

A

propofol

40
Q

___ produces dissociative anesthesia. What is this?

A

Ketamine

Anesthesia characterized by analgesia and amnesia with minimal effect on respiratory function. The patient does not appear to be anesthetized and can swallow and open eyes but does not process information. It is used to provide anesthesia during brief, superficial operative procedures or diagnostic processes.

41
Q

T/F. Ketamine hydrochloride is a phencyclidine derivative used to induce dissociative anesthesia.

A

True.

42
Q

___ is used for trauma patients with very unstable, low blood pressure or for elderly patients. Emergence may be accompanied by delirium, excitement, disorientation, and confusion.

A

Ketamine

Pharmacology (13 decks)

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