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Pharmacology > !general Anesthetics > Flashcards

!general Anesthetics Flashcards

1
Q

Inhaled general anesthetics

A 
Desflurane
Enflurane
Halothane
Isoflurane
NO
Sevoflurane
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2
Q

IV anesthetics

A 
Dexmedetomidine
Diazepam
Etomidate
Fentanyl
Fospropofol
Ketamine
Lorazepam
Methohexital
Midazolam
Propofol
Thiopental
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3
Q

General anesthesia produce an anesthetic state. What is the anesthetic state

A

Collection of component changes in behavior or perception that include:
Unconsciousness
Amnesia
Analgesia
Attenuation of autonomic reflexes to noxious stimulation
Immobility in response to noxious stimulation (skeletal muscle relaxation)

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4
Q

Can a single drug achieve all 5 effects of anesthetic state

A

No -we use combinations of IV and inhaled drugs to take advantage of the favorable properties of each agent while minimizing their adverse effects (sedatives, neuromuscular blocking agents, local anesthetics, and analgesics may be used in addition to general anesthetics)

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5
Q

Monitored anesthesia care

A

A sedation based anesthetic technique utilized for diagnostic and/or minor therapeutic surgical procedures; typically involves the use of midazolam for premedication (to provide anxiolysis, amnesia, and mild sedation) followed by a titrated propofol infusion (to provide moderate to deep levels of sedation)

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6
Q

Conscious sedation

A

Used primarily by nonanesthesiologists where the patient retains the ability to maintain a patient airway and is responsive to verbal commands; benzodiazepines and opoid analgesics (fentanyl) are usediul bc they are reversible by receptor antagonists (flumazenil and naloxone)

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7
Q

Deep sedation

A

Similar to a light state of general(IV) anesthesia involving decreased consciousness from which the patient is not easily aroused; accompanied by a loss of protective reflexes , and inability to maintain a patient airway, and lack of verbal responsiveness to surgical stimuli; propofol and midazolam are often used, sometimes in combination with potent opoid analgesics or ketamine, depending on the level of pain associated with the surgery or procedure

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8
Q

ICU sedation

A

Patients require mechanical ventilation for prolonged periods

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9
Q

MOA general anesthetic action

A

Most general anesthetics cause CNS depression by facilitating chloride channel activation (GABA and glycine receptors) some reduce activity of excitatory ion channels, AMPA receptors, kainite receptors, and NMDA

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10
Q

Inhaled anesthetics

A

Volatile and gaseous

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11
Q

Volatile anesthetics

A

Halothane, enflurane, isoflurane, desflurane, sevoflurane

Low vapor pressures and thus high boiling points so that they are liquirds at room temperature and sea level ambient pressure

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12
Q

Gaseous anesthetics

A

NO

High vapor pressures and low boiling points and are in gas at room temperature

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13
Q

Inhaled anesthetics are absorbed through gas exchange in __ into the blood where the anesthetic is distributed throughout the body

A

Alveoli

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14
Q

The rate at which an inhaled anesthetic is absorbed is dependent upon the ____ of anesthetic in the inspired air, the ___ rate, and drug ___ in air, blood and CNS

A

Concentration
Ventilation
Solubility

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15
Q

What is the blood gas partition efficient

A

Relative affinity of an anesthetic for the blood compared with that of inspired gas

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16
Q

There is an __ relationship between blood gas partition. Coefficient values and the rate of anesthesia onset

A

Inverse

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17
Q

Agents with __ blood solubility (NO, desflurane) reach high arterial pressure rapidly, which in turn results in rapid equilibration with the brain and fast onset of action

A

Low

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18
Q

Agents with _ blood solubility (halothane) reachhigh arterial pressure slowly, which in turn results sin slow equilibration with the brain and a slow onset of action

A

High

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19
Q

Brain blood partition coefficient values for the inhaled anesthetics are relatively similar and indicate that all agents are more soluble in the brain than in the blood

A

Ok

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20
Q

NO Blood:Gas and Brain:blood

A

.47

1.1

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21
Q

NO MAC

A

> 100%

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22
Q

Metabolism NO

A

Non

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23
Q

Othe NO

A

Incomplete anesthetic; rapid onset and recovery

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24
Q

Desflurane blood:gas and brain:blood

A

.42

1.3

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25
Q

Desflurane MAC

A

6-7%

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26
Q

Desflurane metabolism

A
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27
Q

Other desflurane

A

Low volatility ; poor induction agent ; rapid recovery

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28
Q

Sevoflurane blood:gas and brain:blood

A

.69

1.7

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29
Q

Sevoflurane MAC

A

2%

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30
Q

Metabolism sevoflurane

A

2-5

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31
Q

Comment sevoflurane

A

Rapid onset and recovery

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32
Q

Isoflurane blood gas and brain blood

A

1.4, 2.6

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33
Q

MAC isoflurane

A

1.4%

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34
Q

Metabolism isoflurane

A

<2%

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35
Q

Comment isoflurane

A

Medium rate of onset and recovery

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36
Q

Enflurane blood gas and brain blood

A

1.8 1.4

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37
Q

MAC enflurane

A

1.7

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38
Q

Enflurane metabolism

A

8

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39
Q

Comments enflurane

A

Medium rate of onset and recovery

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40
Q

Halothane blood gas and brain blood

A

2.3 2.9

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41
Q

Halothane MAC

A

.75

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42
Q

Metabolism halothane

A

> 40

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43
Q

Halothane comments

A

Medium rate of onset and recovery

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44
Q

Why is induction of anesthesia slower with more soluble anesthetic agents

A

For a given concentration or partial pressure of the two anesthetic gases in the inspired air, it will take much longer for the blood partial pressure of the more soluble gas (halothane) to rise to the same partial pressure as in the alveoli

Since the concentration of the anesthetic agent in the brain can rise no faster than the concentration in the blood, the onset of anesthesia will be slower with halothane than with NO

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45
Q

The _, _, _, _ and _ _ are highly perfumed and receive over 75% of the resting CO and as a result have higher immediate concentrations of anesthetic

A 
Brain
Heart
Liver
Kidney
Splanchnic bed
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46
Q

Although __ and _- constitute about 50% of the total body mass, anesthetics accumulate more slowly in these tissues than highly perfused tissues because they receive only 1/5 of the resting cardiac output

A

Skin muscle

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47
Q

Inhaled anesthetics that are relatively insoluble in the blood and brain are eliminated at faster rates than more soluble anesthetics; clearance of inhaled anesthetics via the _ is the major route of elimination from the body, although some agents are metabolized by the __ to varying degrees

A

Lungs

Liver

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48
Q

What is MAc

A

Minimal alveolar concentration required to prevent a response to a surgical incision (concentration of inhalation anesthetic that prevents movement in response to surgical stimulation in 50% of subjects (a measure of potency ED50))

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49
Q

How are MAC expressed

A

%, the % of the atmosphere that is anesthetic at the MAc (1 MAC of isoflurane is 1.4volume % while 1 MAC of halothane is .75 volume %)

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50
Q

A dose of 1 MAC of any anesthetic prevents movement in response to surgical incision in _% of patients

A

50%- individual patients may require .5-1.5 MAC

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51
Q

MAC values >100%

A

If 100% of inspired air is in the anesthetic, the MAC value would still be less tan 1 and other agents must be supplemented to achieve full surgical anesthesia (NO)

52
Q

Since NO lacks the potency to produce surgical anesthesia, it is combined with what to produce a state of balanced general anesthesia

A

Volatile or IV anesthetics

53
Q

Using NO to produce 50% MAC in combination with 70% volatile agent’s MA would yield _ % MAC, sufficient for surgical anesthesia in most patients

A

110

54
Q

Inhaled volatile liquid anesthesia __ mean arterial pressure in direct proportion to their alveolar concentration;

A

Decrease

55
Q

All inhaled anesthetics can increase __ atrial pressure in a dose related manner, most likely caused by depression of myocardial function;effects on heart rate are mixed

A

Right

56
Q

Halothane can cause _, desflurane and isoflurane can __ heart rate

A

Bradycardia

Increase

57
Q

Volatile anesthetics are respiratory __ (the body has a reduced response to increased levels of CO2

A

Depressants

58
Q

Common side effects of inhaled anesthetics

A

Nausea and vomiting

59
Q

Halothane may cause __ with or without previous exposure. What are symptoms of this

A

Hepatitis

Anorexia, nausea, myalgia, arthralgias, rash, eosinophilia, hepatomegaly, jaundice 2-3 days after exposure_

60
Q

Enflurane and sevoflurane can cause __ toxicity due to fluoridated metabolites

A

Renal

61
Q

In combination with —-, inhaled volatile anesthetics may cause malignant hyperthermia which consists of rapid onset tachycardia and hypertension, severe muscle rigidity, rhabdomyolysis, hyperthermia, hyperkalemia, and acid base imbalance with acidosis. What is the antidote

A

Succinylcholine

Dantrolene

62
Q

No opoid IV anesthetics are widely used to facilitate rapid induction of anesthesia and have replaced inhalation as the preferred method of anesthesia induction in most settings (except what)

A

Pediatric

63
Q

Balanced anesthesia with multiple drugs (inhaled anesthetics, sedative hypnotics, opoids, neuromuscular blocking drugs) is used to ___ unwanted side efffects

A

Minimize

64
Q

IV anesthetics are highly ___ and preferentially partition into highly perfused lipophilic tissues (brain spinal cord) which accounts for their quick onset of action

A

Lipophillic

65
Q

Etomidate

A

Rapid onset and moderately fast recovery

Provides CV stability, causes decreased steroidogenesis and involuntary muscle movements

66
Q

Ketamine

A

Moderately rapid onset and recovery

CV stimulation, increased cerebral blood flow and emergence reactions that impair recovery

67
Q

Methohexital

A

Rapid onset and rapid recovery

Preferred over thiopental for short ambulatory procedures

68
Q

Midazolam

A

Slow onset and recovery; flumazenil reversal available

Used in balanced anesthesia and conscious sedation; provides CV stability and marked amnesi

69
Q

Propofol

A

Rapid onset and rapid recovery

Used in induction and for maintence ; can cause hypotension ; has useful antiemetic action

70
Q

Thiopental

A

Rapid onset and rapid recovery (bolus dose)-slow recovery following infusion

Standard induction agent; causes CV depression avoid in porphyrias

71
Q

Fentanyl

A

Slow onset and recovery; naloxone reversal available

Opoid used in balanced anesthesia and conscious sedation; produces marked analgesia

72
Q

Propofol MOA

A

Targets GABAA as an agonist and potentials the Cl current (other receptors likely involved)

73
Q

Pharmacokinetics propofol

A

Rapidly metabolized int he liver (phase 1 and II reactions (glucuronide and sulfate conjugates)) with extensiveextrahepatic metabolism (lung tissue may account for elimination of up to 30% of a bolus dose) rapid rate of onset, rapid recovery, and patients are able to ambulated quickly after use (low hangover effect) time of onset is 15-30 seconds as determined by time to unconsciousness

74
Q

PK properties propofol allow for continuous infusions and maintence of anesthesia, sedation in the ICU, conscious sedation and short duration general anesthesia in locations outside te operating room

A

Ok

75
Q

Poor solubility in water and is formulated as an emulsion containing soybean, oil, glycerol, and lecithin (yolk egg), making allergic reactions possible in susceptible patients (solution appears milky white and slightly viscous)

A

Ok

76
Q

What are drug half life’s dependent on

A

Rate of redistribution of drug, amount accumulated in fate and drugs metabolic rate

Called context sensitive half lif e

77
Q

__ ___ and ___ increase only modestly with prolonged infusions

A

Etomidate, propofol, ketamine

78
Q

__ an d___ increase dramatically with prolonged infusion

A

Diazepam

Thiopental

79
Q

CNS effects propofol

A

General suppression of CNS activity even though excitatory effects such as twitching or spontaneous movement are occasionally observed during induction; no analgesic properties; decreases cerebral blood flow and the cerebral metabolic rate for oxygen which decreases intracranial pressure and intraocular pressure

80
Q

Cardiovascular effects:

A

compared with other induction agents produces the most pronounced decres]ase in systemic blood pressure due to profound vasodilation in both arterial and venous circulation leading to reductions in preload and afterload; hypotensive effects are augmented by inhibition of the normal baroreflex response

81
Q

Cardiovascular effects propofol

A

Compared with other induction agents produces the most pronounced decrease in systemic blood pressure due to profound vasodilation in both arterial and venous circulation leading to reductions in preload and afterload; hypotensive effects are augmented by inhibition of the normal baroreflex response

82
Q

Respiratory effects propofol

A

Potent respiratory depressant; generally produces apnea after an induction dose

83
Q

Why premeditate with opoid or coadminister lidocaine before propofol

A

Pain on injection is common

84
Q

Fosprofol

A

Water soluble prodrug of propofol that is rapidly metabolized by alkaline phosphatase, producing propofol, phosphate, and formaldehyde (metabolized by aldehyde dehydrogenase int he liver and in erythrocytes)

85
Q

Effects of fospropofol

A

Similar to propofol, and formaldehyde (metabolized by aldehyde DH in the liver and in erythrocytes)

86
Q

There is __ pain when administer fospropofol than propofol

A

Less

87
Q

Common adverse effects fosopropofol

A

Paresthesia (including perineal discomfort or churning sensation) and pruritus (including genital , perineal, and generalized pruritus) are mostly limited to the first 5 minutes of administration and usually described as mild moderate in intensity (mechanism is unknown; no pretreatment are helpful)

88
Q

Etomidate MOA

A

Enhances the actions GABAA a=on GABA A receptors

89
Q

Effects etomidate

A

Hypnotic but not analgesic effects

90
Q

Causes etomidate on CV and respiratory

A

Minimal CV and respiratory depression useful in patients with impaired CV and respiratory systems

91
Q

Etomidate produces rapid loss of ___ and less rapid recovery rate compared to propofol

A

Consciousness

92
Q

Etomidate metabolism

A

Liver and in plasma

93
Q

CNS effects etomidate

A

Potent cerebral vasoconstrictor; decreases cerebral blood flow and ICP

94
Q

CV effects etomidate

A

CV system stability is maintained even after bolus injections minimal change in heart rate and cardiac output

95
Q

Respiratory depressant effects are less pronounced impaired to barbiturates

A

For etomidate

96
Q

Endocrine effects etomidate

A

Causes adrenocortical suppression by producing a dose dependent inhibition of 11b-hydroxylase (necessary for the conversion of cholesterol to cortisol); suppression lasts 4-8 hours after induction dose; limited use as continuous infusion

97
Q

Ketamine MOA

A

NMDA receptor antagonist

98
Q

What does ketamine cause

A

Dossociative anesthetic state characterized by Catalonia, amnesia, and analgesia with or without loss of consciousness (eyes ramain open with slow nystagmic gaze)

99
Q

Structure ketamine

A

Similar to phencyclidine PCP

100
Q

Why premedication of anticholinergic with ketamine use

A

Lacrimation and salivation are increased upon administration

101
Q

CNS effects ketamine

A

Increases cerebral blood flow and not recommended for use in patients with intracranial pathology, espicially increased ICP; unpleasant emergence reactions after administration are the main factor limiting ketamine use (vivid colorful dreams, hallucinations, out of body experiences, increased and distorted visual, tactile, and auditory sensitivity) may induce a euphoric state, which explains the potential for abuse

102
Q

CV ketamine

A

Can increase systemic blood pressure, heart rate, and cardiac output, presumably by centrally mediated sympathetic stimulation

103
Q

Ketamine is the only IV anesthetic to produce analgesia, stimulation of the sympathetic nervous system, bronchodilator, and minimal respiratoy depression

A

Ok

104
Q

Dexmedetomidine MOA

A

Alpha 2 adrenergic agonist that produces hypnosis presumably from stimulation of alpha 2 receptors in the locus caeruleus and analgesic effects at the level of the spinal cord

105
Q

Effect dexmedetomidine

A

More completely resembles a physiologic sleep state through activation of endogenous sleep pathways

106
Q

Infusion dexmedetomidine

A

Moderate decreases in heart rate and systemic vascular resistance and systemic bp, bradycardia may require treatment

107
Q

What is dexmedetomidine used for

A

Short term sedation of incubated and ventilated patients in an ICU setting or as an adjunct to general anesthesia

108
Q

What are anesthetic adjuncts used for

A

Augment specific components of anesthesia, permitting lower doses of general anesthetics with fewer side effects

109
Q

What have opoid analgesics been used in combination with

A

Large doses of benzodiazepines to achieve a general anesthetic state

110
Q

Common IV opoid analgesics

A

Fentanyl, sufentanil, remifentanil, and morphine

111
Q

MOA opoid analgesics

A

Agonists at opiate receptors

112
Q

Due to adverse effects (what are they?) opiates are often used as premedicationa Nd as an adjunct to both IV and inhaled anesthetics to provide perioperative analgesia

A

Impaired ventilation, tolerance after surgery, awareness during anesthesia

113
Q

Examples of barbiturates

A

Thiopental and methohexital

114
Q

Barbiturates are highly ___ and quick plasma:brain equilibrium

A

Lipophillic

115
Q

Barbiturates cause dose dependent CNS depression ranging from _ to _

A

Sedation to general anesthesia

116
Q

Side effect barbiturates

A

Respiratory depression

117
Q

MOA barbiturates

A

Acts on the GABAA receptor to increase the duration of channel opening (agonist) and enhances inhibitory NT

118
Q

Methohexital may be preferred over thiopental for short ambulatory procedures due to its rapid elimination

A

Over Barbiturates

119
Q

Barbiturates induce ___ enzymes

A

P450

120
Q

Barbiturates are replaces now by ___

A

Propofol induction agents

121
Q

Benzodiazepines examples

A

Diazepam, lorazepam, midazolam

122
Q

MOA benzodiazepines

A

Acts on GABAA receptor to increase receptor sensitivity to GABA (agonist) and enhances inhibitory NT

123
Q

When are benzodiazepines used

A

In the perioperative period bc of their anxiolytics properties and ability to produce anterograde amnesia; actions can be terminated by the antagonist flumazenil

124
Q

Benzodiazepine an be terminated by antagonist

A

Flumazenil

125
Q

__ is water soluble )__ and __ are not and is not considered the drug of choice for parenteral administration

A

Midazolam

Diazepam and lorazepam

126
Q

Midazolam is given IV when

A

Before patients enter the OR bc it has a more rapid onset, shorter elimination half life (2-4hrs) and steeper dose response curve than other benzodiazepines

127
Q

Benzodiazepines have potent __ properties . What can they treat

A

Anticonvulsant

Status epilepticus, alcohol withdrawal, local anesthetic induced seizures

Pharmacology (52 decks)

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