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Block 3 Pharm > General Anesthetics I > Flashcards

General Anesthetics I Flashcards

1
Q

What is anesthesia

A

a state where no movement occurs in response to what should be painful
the patient has lost consiousness

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2
Q

absence of memory during anesthesia

A

amnesia

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3
Q

inability to interepret, respond to and remember pain

A

Analgesia

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4
Q

Analgesia is

A

inable to interpret, respond to and remember pain

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5
Q

During anesthesia you are

A

immobile to respond to noxious stimuli and you do not activate autonomic responses

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6
Q

Potency is usually measured by determination of the concentration of anesthetic that

A

prevents movement in response to pain

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7
Q

The ‘dose’ of anestetic that prevents movement in:

A

in response to pain in 50% of the patients

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8
Q

the dose of a gas is directly related to and determined by :

A

conc in alveolus

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9
Q

What quantifies anesthetic potency in inhaled anesthetics?

A

minimal alveolar concentration (MAC) that prevents movement in 50% of pts

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10
Q

Benefits of MAC as measure of potency

A

Can be continuously monitored by measuring end-tidal anesthetic concentration
Provides a direct correlate to anesthetic concentration at the site of action in CNS
Simple to measure end-point (lack of movement)

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11
Q

How do we measure potency for intravenously administered anesthetics

A

usually use free plasma concentration that produces loss of response to surgical incision in 50% of subjects as an index of potency.

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12
Q

Common effects shared by all anesthetics include

A

membrane hyperpolarization and effects on synaptic function; such that inhibitory neurotransmission is increased and excitatory neurotransmission is reduced.

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13
Q

Likely targets of anesthetics

A

GABAa
NMDA
other channels and membrane proteins

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14
Q 
regulated chloride channel
function is enhanced by most, but not all anesthetics
anesthetics produce allosteric interactions; not a direct effect them
A

GABAA receptors

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15
Q

Glutamate-regulated cation channel

Anesthetics that do not interact with GABA receptors all inhibit these receptors

A

NMDA

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16
Q

Most anesthetics will increase _____ opening via allosteric effects to increase Cl- conductance

A

GABA a

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17
Q

Stages of Genreal anesthesia

A

Premedication
Induction
Maintaine

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18
Q

Keys for induction

A

want it to be non-frightening and non painful and we only induce with inhalational anesthetic in emergency, otherwise via IV

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19
Q

To maintain anesthesia with gaseious anesthetics keep in mind

A

they have short 1/2 lives and need to constantly be administered

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20
Q

All parenterally admin anestetics are

A

hydrophobic and given as single IV bolus

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21
Q

Single iv bolus results in a high concentration in ________within a single circulation time; results in_____ induction of anesthesia

A

brain and spinal cord

RAPID

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22
Q

What happens as blood levels of anesthetics drop after induction

A

As blood levels drop, anesthetic redistributes back into the blood from the brain and winds up in other tissues where it is slowly released and metabolized

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23
Q

the half-life of the anesthetic in the body and the duration of action are

A

not the same

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24
Q

duration of action is _____ than half life thus multiple dosing is _____

A

shorter

complex

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25
Q

typical barbituate anesthetic

A

sodium thiopental

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26
Q

Barbituate used to induce anesthesia; typical induction dose produces unconsciousness in 10 to 30 sec; duration of action of a single dose is about 10 min.

A

sodium thiopental

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27
Q

1/2 life of sodium thiopental

A

Has a long half life (12 hours) so can produce residual effects (hang-over) after anesthesia has worn off

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28
Q

When do we reduce the dose of sodium thiopental we give to patients?

A

Dose should be reduced if patient has been premedicated with other CNS depressants, including opiates, benzodiazepines and alpha2 agonists.

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29
Q

Sodium thiopental works by

A

activating GABAa receptors

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30
Q

Why dont we give intra-arterial injection of sodium thiopental

A

causes necrosis and inflammation

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31
Q

how can we deliver sodium thiopental to peds patients

A

rectally

32
Q

CNS affects of sodium thiopental

A

Reduces cerebral oxygen utilization, and, as a consequence, reduces cerebral blood flow and intracranial pressure
Has been tried as a protective agent for the treatment of cerebral ischemia

33
Q

CV affects of sodium thiopental

A

Vasodialation—espeicially venodialation

**DONT use for pts with reduced pre-load or cardiomyopathy– see severe drop in BP

34
Q

Can we use barbiutates in pts with coronary artery disease?

A

yes because its not arythmogenic

35
Q

Affect on respiration sodium thiopental has

A

respiratory depression— often need to intubate pts bc they stop breathing

36
Q

Propofol:
onset and duration:
uses:

A

Propofol(Diprivan®)

  1. Onset and duration of anesthesia are the same as barbiturates
  2. Is used to maintain and induce anesthesia
37
Q

Is antiemetic, an advantage as many patients are nauseated following surgery

A

Propofol

38
Q

Has a shorter half-life than thiopental; used when a rapid return to normal mental status is desired (out-patient surgery, for example)

A

Propofol

39
Q

Mech of Propofol

A

GABAa

40
Q

Half life of propofol in the body

A

3.5 hours with much less hangover than barbituates.. HUGE for usefullness in outpatient surgeries

41
Q

Unique side effect of propofol

A

pain at injection side thus gven with lidocaine

also causes initial excitaiton upon induciton

42
Q

pain at injection side thus gven with lidocaine

also causes initial excitaiton upon induciton

A

Propofol

43
Q

3.5 hours with much less hangover than barbituates.. HUGE for usefullness in outpatient surgeries

A

Propofol

44
Q

CNS side effects of Propofol

A

CNS: Reduces cerebral oxygen utilization, and, as a consequence, reduces cerebral blood flow and intracranial pressure

45
Q

CV effects with Propofol

A

more sever reduction in BP then thiopental
see vasodialtion and depression of myocardial contractility
blunts baroreflexes

46
Q

What’s the danger in propofol blunting baroreflexes

A

see depression of myocardial contractility but then they’re not opposed by vasoconstriciton and HR will increase

47
Q

What type of patients are intolerant to propofol

A

those intolerant to decreased BP

–contraindicated in pts with hypotension

48
Q

Respiratory effects of propofol

A

more depression then thiopental

49
Q

Primarily used to induce anesthesia in patients at risk for hypotension

A

Etomidate

50
Q

has high incidence of pain on injection and myoclonus

A

etomidate

51
Q

CNS effects of etomidate

A

CNS: Reduces cerebral oxygen utilization, and, as a consequence, reduces cerebral blood flow and intracranial pressure

52
Q

Etomidate has____ respiratory depression than thiopental

A

Less

53
Q

Drawback of etomidate

A

Significantly more nausea and vomiting than thiopental

54
Q

What is concerning about etomidate post-surgery

A

ncreased post-surgical mortality due to suppression of the adrenocortical stress response; primarily when the anesthetic has been given for a prolonged period of time. Therefore, only used to induce anesthesia in patients prone to hemodynamic problems

55
Q

produces dissociative anethesia and profound analgesia

A

Ketamine

56
Q

This anethetic produces dissociative anesthesia, doesn’t affect respiration and is a bronchodilator

A

ketamine

57
Q

Ketamine is charcterized by:

A

1) profound analgesia
2) unresponsiveness to commands, even though eyes can be open
3) amnesia
4) spontaneous respiration

58
Q

Administration of ketamine

A

typically administered iv but can also be used via intramuscular, oral and rectal routes

59
Q

Ketamine mech

A

NMDA receptor anatagonist

60
Q

Advantages of Ketamine

A

Advantages: profound analgesia, very little respiratory depression, bronchodilator

61
Q

Side effects of Ketamine

A

Produces nystagmus, salivation, lacrimation, spontaneous limb movements and increased muscle tone
increased intracranial pressure

62
Q

Produces nystagmus, salivation, lacrimation, spontaneous limb movements and increased muscle tone
increased intracranial pressure

A

Ketamine

63
Q

causes emergence delierium adn increased BP dt sympathomimetic affect

A

Ketamine

64
Q

Ketamine is reserved for pts with

A

broncospasm that can’t be indubated

good for children undergoing short, painful procedures

65
Q

Short acting benszo that is a GABAa activator

A

Midazolam

66
Q

used alone for conscious sedation, anxiolysis and amnesia for short procedures or as an inducing agent

A

MMidazolam

67
Q

Mech of Midazolam

A

Short acting benszo that is a GABAa activator

68
Q

good adjunt for local anestheticsm or pre-op to decrease anxiety

A

midazolam

69
Q

Compared to thiopental, midazolam has ____ duration of action and _____ induction

A

longer duration

slower induction

70
Q

Midazolam must be ______ to it’s active metabolite

A

Metabolized by hydroxylation to an active metabolite

71
Q

a. Has been associated with respiratory depression and respiratory arrest especially when used intravenously to produce conscious sedation

A

Midazolam

72
Q

Pt population to be careful when administering Midazolam

A

Should be used with caution in patients with neuromuscular disease; Parkinson’s disease; bipolar disorder

73
Q

Induction for patient surgery and causes hypotension and hang over

A

Thiopental

74
Q

Used for induction/maintence especially outpatient and cuases hypotension and respiratory depression

A

Propofol

75
Q

Used for induction in pts that have hypotention but causes nausea and adrenal suppression

A

Etomidate

76
Q

Used for pts with broncospasm or in kids for short, painful procedures

A

Ketamine

77
Q

Used for cons sedation and as an anti-anxiety but has slow induction with respiratory depression

A

Midazolam

Block 3 Pharm (19 decks)

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