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PBT 3 Exam 2 > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

Can you give sodium channel blockers as general anesthetic

A

NO! Heart has sodium channels -> will block them everywhere

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2
Q

How to suppress CNS

A

activate GABA
NMDA receptor antagonists
glycine inhibition

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3
Q

What drugs get to brain faster: lipophilic or lipophobic

A

lipophilic

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4
Q

What does GA cause

A

muscle relaxation, loss of autonomic reflexes, analgesia, anxiolysis
reversible loss of sensation

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5
Q

what does suppression of amygdala do

A

removes fear, anxiety, emotion, memory

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6
Q

What happens if you suppress activity of medulla

A

medulla is vasomotor center -> will suppress cardiac and respiratory center -> only want to do this to a certain point

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7
Q

Two types of GA

A

inhaled

IV

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8
Q

what is balanced anesthesia

A

both inhaled and IV together

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9
Q

properties of inhaled anesthetics

A

distribute well to all body parts
become concentrated in fatty tissue
CNS primary site of action

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10
Q

At low concentrations, inhaled anesthetics act as

A

GABAa positive allosteric modulators (increase activity of GABA channels)

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11
Q

At high concentrations, inhaled anesthetics act as

A

GABAa receptor agonists

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12
Q

GABA agonist vs modulator

A

agonist increases duration of opening

modulator increases frequency of opening

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13
Q

Four stages of anesthesia

A

stage 1: Analgesia - amnesia, euphora
stage 2: excitement - excitement, delirium, combative behavior
Stage 3: surgical anesthesia - unconsciousness, regular respiration, decreasing eye movement
Stage 4: medullary depression - respiratory arrest, cardiac depression and arrest, no eye movement

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14
Q

primary site of action for GA

A

CNS

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15
Q

What stage of anesthesia is the goal

A

stage 3, avoid stage 4 (in both inhaled and IV)

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16
Q

Minimum alveolar concentration (MAC)

A

alveolar partial pressure (minimum concentration) of anesthetic vapor that is able to prevent motor responses to a surgical incision in 50% of patients (analogous to ED50)

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17
Q

What happens when you increase MAC

A

increase partial pressure

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18
Q

MAC is inversely/proportionately related to potency

A

inversely
LOW MAC = high potency and vice versa
potency = 1/MAC

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19
Q

Wide or narrow TI for inhaled (isoflurane example)

A

narrow TI

TI = lethal pressure 50/MAC

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20
Q

What dictates inhaled anesthetic potency

A

lipophilicity

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21
Q

Greater lipophilicity equals

A

greater potency and greater rate of absorption

22
Q

What dictates rate of anesthetic induction

A

rate of gas absorbed into lungs

23
Q

Lower rate of absorption equals

A

faster anesthesia induction

24
Q

lower rate of absorption allows anesthetic to build up in alveoli, leading to

A

faster onset of anesthesia

25
Q

If gas remains in lungs then you get faster/slower rate of absorption

A

faster

26
Q

highly lipophilic inhaled agents do what

A

penetrate alveoli -> go to capillaries -> distribute to body -> not as much goes to the brain -> slower anesthetic induction

27
Q

low lipophilic inhaled agents do what

A

high concentration builds up in alveoli -> goes to blood -> goes to brain -> faster anesthetic induction

28
Q

Inhaled anesthetic agents

A 
Nitrous oxide 
desflurane
sevoflurane
enflurane
isoflurane
halothane
methoxyflurane
29
Q

Nitrous oxide

A

MAC = 1.01

rapid onset and recovery

30
Q

desflurane

A

MAC = 0.06

poor induction agent, rapid recovery

31
Q

sevoflurane

A

MAC = 0.02

rapid onset and recovery

32
Q

enflurane

A

MAC = 0.0168

medium rate of onset and recovery

33
Q

Isoflurane

A

MAC = 0.0114

medium rate of onset and recovery

34
Q

Halothane

A

MAC = 0.0077

Medium rate of onset and recovery

35
Q

Methoxyflurane

A

MAC = 0.0016

very slow onset and recovery

36
Q

The lower the MAC

A

the more potent the agent

37
Q

The more potent the agent

A

the more lipophilic

38
Q

The more lipophilic the agent

A

the higher rate of absorption

39
Q

The higher the rate of absorption of the agent

A

the SLOWER the onset of anesthesia

40
Q

Balanced anesthesia

A

several anesthetic agents used simultaneously

allows physician to achieve potency and rapid induction/recovery in controlled manner

41
Q

What will mixture of nitrous oxide and isoflurane produce

A

NO = rapid induction
Iso = potent
NO will anesthetize pt quickly and Iso will ensure deep anesthesia
simultaneous removal of the drugs will cause person to wake up (NO = rapid recovery) but be groggy (Iso = medium recovery)

42
Q

IV agents used for

A

rapid induction of anesthesia

administered with inhaled

43
Q

IV agents

A

ultra short acting -> barbiturates (thiopental)

Propofol: ultra-short, rapidly distributed and metabolized

44
Q

Barbiturates

A

ultra short acting
high lipid solubility
Thiopental and Methohexital

45
Q

Benzodizepines

A

-pams and -zolams

given to cause sedation, relaxation, amnesia prior to administration of other GA

46
Q

Do benzo’s have faster or slower onset of action than barbs or propofol

A

Slower, but still adequate for surgical anesthesia

47
Q

What can benzo’s be reversed by

A

flumazenil

48
Q

Propofol

A

powerful GABAa positive allosteric modulator (increases time channel open)
ultra short, but rapidly distributed and metabolized -> faster recovery
most commonly used IV anesthetic

49
Q

Opioid analgesics

A

fentanyl, sufentanil, alfentanil, and remifentanil are used in combo
bind mu receptors in brain and spinal cord -> suppress midbrain/raffe nucleus

50
Q

which two opioids have rapid onset of action and can be used in combo with barbiturates as an anesthetic

A

Alfentanil and remifentanil

PBT 3 Exam 2 (8 decks)

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