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General Anesthetics Flashcards

1
Q

Inhalaled Anesthetics

A

Volatile anesthetics (liquid at room temp; high boiling point)

  1. Desflurane
  2. Enflurane
  3. Halothane
  4. Isoflurane
  5. Sevoflurane

Gaseous anesthetics (gas at room temp; low BP)

  1. Nitrous oxide
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2
Q

Volatile anesthetics end in which suffix?

A
  • -ane
  • Halothane, enflurane, isoflurane, desflurane, and sevoflurane
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3
Q

IV anesthetics (6)

A
  1. Diazepam
  2. Etomidate
  3. Fentanyl
  4. Ketamine
  5. Midazolam
  6. Propofol
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4
Q

What effects do General Anesthetics produce?

A

Anesthetic state

  1. Unconsciousness
  2. Amnesia
  3. Analgesia
  4. Attenuation of autonomic reflexes
  5. Immobility
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5
Q

What general anesthetics produces a anesthetic state?

A

No single drug acheives all 5 sates; must use combo of IV + inhalaled drugs (balanced anesthetia)

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6
Q

How do inhaled anesthetics distributed T/O the body?

A

Absorbed via gas exchange into alveoli => blood => body

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7
Q

MOA of general anesthetics

A
  1. Facilitate Cl- channels via GABA-A or glyceine
  2. DEC + of excitatory channels => nAChR/mAChR, AMPA, Kainate, NMDA
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8
Q

Rate at which an inhaled anesthetic is absorbed depends on what?

A
  1. Concentration of anesthetic in inspired air

1. Ventilation rate

3. Solubility in air, blood and CNS

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9
Q

Induction of anesthetia is slower with ______ soluble anesthetic gases

A

More soluble inhaled anesthetic = SLOWER onset

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10
Q

What is the Blood:gas partition coefficient and how does it relate to an anesthetics onset of action?

A
  • Defines relative affinity of an anesthetic for the blood compared to inspired gas (i.e., blood solubility)

- Inverse relationship btw blood:gas partition coefficient values and rate of onset of drug

  • Drugs w/ ↓ blood : gas coefficient =>
  • less soluble in blood (NO, desflurane) =>
  • rapid rise in arterial pressure
  • => rapidly equilibriate with brain
  • => fast onset of action
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11
Q

How does the value of minimum alveolar concentration (MAC) relate to potency?

A

↓↓↓ MAC = ↑↑↑ potent

*Inverse relationship

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12
Q

Drugs with high blood:gas coefficient => _____ blood solubility => ____ increase in arterial partial pressure => ____ equilbriation with brain => ____ onset of action

A
  • more soluble in blood
  • slow
  • slow
  • slow
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13
Q

What is the brain: blood parittion coeffcient for inhaled anesthetics?

A

Relatively similar for all inhaled anesthetcs => _more soluble in brain t_han blood.

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14
Q

Why is the induction of anesthesia slower in more soluble gases?

A
  1. Takes longer for the blood partial pressure of the moer soluble gas to rise to the same partial pressure as in the alveoli
  2. Bc concentration of the anesthetia in the brain CANT rise faster than in the blood =>slower onset
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15
Q

What parts of the body do inhaled anesthetics MOST go to and why?

A

Brain, heart, liver, kidney and splanchnic bed: bc get 75% of CO.

*accumulate slowly in skin and muscle bc only get 1/2 of CO

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16
Q

which inhaled anesthetics are eliminated from the body the fastest?

A

Those relatively insoluble in blood and brain.

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17
Q

How are inhaled anesthetics elimated from the body?

A

Lungs; but some are metabolized by liver

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18
Q

What does the MAC correspond to on the drug-dose effect curve?

A

ED50

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19
Q

Which inhaled anesthetic may have a toxic side effect of hepatitis (hepatomegaly, jaundice, and liver tenderness) which can present 2 days to 3 weeks after exposure?

A

Halothane

‘H’ for Hepatoxicity

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20
Q

Which toxicity is associated with the inhaled anesthetics, Enflurane and Sevoflurane?

A

Renal toxicity due to fluorinated metabolites

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21
Q

In combination with succinylcholine, inhaled VOLATILE anesthetics may cause what serious adverse reaction?

What is seen with this reaction?

A

- Malignant hyperthermia

  • - Rapid onset tachycardia and HTN
    • Severe muscle rigidity
  • rhabdomyolysis,
  • hyperthermia,
  • hyperkalemia,
  • acid-base imbalance w/ acidosis
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22
Q

What is the antidote for malignant hyperthermia?

A

Dantrolene

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23
Q

What is meant by the term “balanced anesthesia?”

A
  • Modern anesthesia relies on the use of combos of IV and inhaled drugs to take advantage of the favorable properties of each drug, while minimizing adverse effects
  • No single available drug can achieve all 5 desired effects of the anesthetic state
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24
Q

Define minimum alveolar concentration (MAC)?

A
  • Concentration of inhaled anesthetic that prevents movement during surgery in 50% of ppl (meausre of potency; ED50)
  • This is equal to 1 MAC
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25
1 MAC =
**50% of population** will not move to skin stimulation during surgery
26
Which inhaled anesthetic has a **MAC (vol %) \>100** and what does this mean for use in surgery?
**_Nitrous oxide_** - \>100% indicates that if 100% of inspired air is the anesthetic, the MAC value would still be \<1 and other agents must be given to achieve full surgical anesthesia - You can't achieve \>100% nitrous oxide; you couldn't achieve 80% either w/o killing the patient!
27
What is the MAC of: **Desflurane**, **Sevoflurane**, **Isoflurane**, **Enflurane**, and **Halothane**? Which is the least and most potent?
* - **Desflurane** = 6-7% (least potent) * - **Sevoflurane** = 2% * - **Isoflurane** = 1.4% * - **Enflurane** = 1.7% * - **Halothane** = 0.75% (most potent)
28
How do ***inhaled volatile anesthetics*** affect CV system? ## Footnote Specific effects related to _halothane_, _desflurane and isoflurane?_
1. **- ↓↓↓ MAP** in direct proportion to their alveolar concentration 2. - **↑↑↑ right atrial pressure,** due to depression of myocardial function 3. - **Halothane** can cause bradycardia 4. - **Desflurane** and **Isoflurane** can ↑↑↑ HR
29
Which property of **IV anesthetics** accounts for their quick onset of action?
**_Highly lipophilic_** and preferentially **partition** **into highly perfused lipophilic tissues (brain, spinal cord)**
30
**Inhaled volatile anesthetics** affect respiration how?
**Respiratory depression**
31
What is the most likely MOA of **Propofol**?
**GABA-A R AGO :** potentiates the Cl- current
32
Describe the pharmacokinetics of **Propofol** (i.e., _metabolism_, _rate of onset_ and _recovery_)
- Rapidly metabolized in **liver** (phase I and II rxns) w/ extensive extrahepatic metabolism (i.e., **lung** may account for elimination of up to 30% of a bolus dose) - **Rapid** rate of onset= **15-30 seconds** - **Rapid** recovery, patients able to **ambulate quickly (low hangover effect)**
33
What is **Propofol** mainly used for based on its PK?
1. **Induce** and **maintain anesthesia**; can be _continously infused_ 2. **Sedation in ICU** 3. **Conscious sedation** 4. **Short-duration general anesthesia outside OR** (i.e., interventional rads., ED, and dental offices)
34
Which IV anesthetic has **poor solubility in water** and is an emulsion that contains **soy bean oil, glycerol,** and **lecithin**; making **allergic reactions** a possibility in susceptible patients?
**Propofol**
35
What is **context-sensitive 1/2 life?** Which drugs have dramatic increases in **1/2 life (context-sensitive 1/2 life)** with prolonged infusions?
**After prolonged infusion,** the drugs 1/2 life depends on: 1. Rate of re-distrubition on the frug 2. Amount of drug that accumalted in fat 3. Drugs metabolic rate. 1. **- Diazepam** 2. **- Thiopental**
36
Compared to other **IV anesthetics** which drug produces the **most pronounced decrease in systemic BP (HYPOTENSION)** due to _profound vasodilation_ in both arterial and venous circulation leading to r_eductions in preload and afterload?_
**Propofol**
37
What are the **respiratory effects** of Propofol?
Profound **respiratory depression**
38
What are the CNS effects of **Propofol**?
1. **Supress CNS,** but can cause _twitching_ and _spontaneous movement_ when inducing. 2. **↓ ICP/IOP** because ↓ cerebral blood flow and metabolic rate for O2. 3. **NO** **analgesic** properties
39
Common AE for **Propofol**? How do we avoid?
**Pain when injecting;** give opioid or lidocaine before
40
What is **Fospropofol** and how is it metabolized?
**_Water-soluble_ PROdrug** of propofol that is **rapdily metabolized** by alkaline phosphatase (**ALP**)
41
What are common adverse effects of **Fospropofol**?
1. - **Paresthesias** (including perineal discomfort or burning sensation) 2. - **Pruitis/itching** (including genital, perineal, and generalized pruritus)
42
What are the **differences** and **advantages** of using **_Fospropofol_**?
1. - Effects are **similar** to Propofol, but **onset** and **recovery** are **prolonged**, since prodrug **needs to be metabolized** 2. **- Water soluble** 3. **- Less pain on administration**
43
What is the MOA of the IV anesthetic, **Etomidate**?
Enhances the actions of **GABA** on **GABA-A R =\>** **Hypnotic,** but _NOT_ analgesic effects
44
Which patients would it be useful to use ***Etomidate*** in, why?
- Those with **impaired** _CV_ and _respiratory_ systems - Causes **minimal CV and respiratory depression**
45
What are the CNS effects of **Etomidate**?
Potent **cerebral vasoconstictor;** _↓↓↓ cerebral blood flow_ and _ICP_
46
What is significant about the CV effects of the IV anesthetic, **Etomidate**?
**CV system stability;** minimal change in HR and CO
47
Which IV anesthetic causes **adrenocortical suppression** by producing dose dependent **inhibition of 11β-hydroxylase** (necessary to convert of cholesterol =\> cortisol)?
**E**tomidate \*Think **E**tomidate = **E**ndocrine **E**ffects!
48
What is the **MOA** of Ketamine?
**NMDA- R ANT =\>** * **Dissociative anesthetic state** (catatonia + amnesia + analgesia) **with or w/o LOC** (eyes stay open with slow nystagmic gaze)
49
What are the MAIN limiting factor for use of Ketamine?
* **Unpleasant emergent reactions** after administration: vivid colorful dreams, hallucinations, etc); can * Can also cause euphoria =\> **abusive**
50
What is the **only IV anesthetic** to produce 1. **profound analgesia**, 2. **stimulation of the sympathetic nervous systm,** 3. **bronchodilation**, 4. **minimal respiratory depression?**
Ketamine
51
What are the effects on the CV system by **Ketamine**?
**+ sympathetic NS** =\> Increase systemic BP, heart rate, and CO;
52
**Ketamine** is not recommended in patients with which pathology, due to what effects?
**- Intracranial pathologies** bc **- ↑↑↑ cerebral blood flow** and **ICP**
53
Which **inhaled anesthetic** has thw loest and highest blood:gas partition coefficient?
1. **NO** = 0.47 = less soluble in blood = rapid onset 2. **Halothane** = 2.3 = more soluble in blood = medium onset and reovery
54
Which **inhaled anesthetic** is a _incomplete anesthetic_ with _rapid onset + recover?_
**Nitrous oxide**
55
Which anesthetic has **low volatility**, **poor induction agent** but has **RAPID recovery?**
1. **Desflurane**
56
Which inhaled anesthetic has rapid onset + recovery?
**Sevoflurane**
57
Which **inhaled anesthetics** have _MEDIUM rate of onset + recovery?_
1. **Isoflurane** 2. **Enflurane** 3. **Halothane**
58
1. 4 common **IV opioid analgesics** used as anesthetic adjuncts: augments specific components of anesthesia =\> lower doses of general anesthesia 2. MOA?
**Fentanyl**, Sufen**tanil,** **Remifentanil**, **Morphine** ## Footnote **- Opioid-R AGO**
59
What are the **2 IV Barbituate anesthetics** used as adjuncts?
**- Thiopental (prototype)** **- Methohexital**
60
Which IV Barbituate is preferred for **short ambulatory procedures** due to its **rapid elimination**?
**Methohexital**
61
Which anesthetic adjuncts **induce CYP450 enzymes?**
**Barbituates** ---\> _Thiopental_ and _Methohexital_
62
What are the **3 common IV Benzodiazepines** used as anesthetic adjuncts?
1. **Diazepamn** 2. **Lorazepam** 3. **Midazolam**
63
What is the **MOA** of **IV Benzodiazepines** used as anesthetic adjuncts
Act on **GABAA receptor allosteric modulators** =\> increase sensitivity to GABA (agonist) and **enhances inhibitory neuotransmission**
64
**IV Benzodiazepines** used as anesthetic adjuncts are commonly used when and why? Actions can be terminated by which antagonist?
**- Perioperative period:** _anxiolytic_ and cause _anterograde amnesia_ - Can be terminated by the **antagonist, flumazenil**
65
Which **IV Benzodiazepine** used as an anesthetic adjunct is _water-soluble_ and considered the _drug of choice for parenteral administration_? What else is unique about this specific benzo?
- **Midazolam =** water soluble (others are not) **_- Given IV before entering OR bc;_** 1. **More rapid onset** 2. **Shorter 1/2 life (2-4 hrs)** 3. **Steeper dose-response curve**
66
**Benzodiazepines** have potent __________ properties; used in the Tx of status epilepticus, alcohol withdrawl, and local anesthetic-induced seizures
Anticonvulsant
67
Which IV anesthetic provides **CV stability;** causes **decreased steroidogenesis** and **involuntary muscle movements**?
**Etomidate**
68
Which IV anesthetic is used as a standard induction agent, but must be avoided in **porphyrias**?
**Thiopental**

NMSK Exam 3 (17 decks)

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