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Pharm Unit 3 > General Anesthetics I and II > Flashcards

General Anesthetics I and II Flashcards

1
Q

Characteristics of General Anesthesia?

A

Hypnosis, amnesia, analgesia, muscle relaxation, attenuation of autonomic reflexes

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2
Q

Is there one anatomic site responsible for producing general anesthesia?

A

No, but certain anesthetic effects can be attributed to certain locations.

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3
Q

Theory for how unconsciousness is produced?

A

Depression of thalamic neurons and blocking thalamo-cortical communication.

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4
Q

Where is immobility in response to noxious stimuli mediated?

A

Spinal Cord

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5
Q

Likely mechanisms of anesthetic drugs?

A

Inhibit excitatory and enhance inhibitory synaptic transmission.

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6
Q

Volatile anesthetics effects on Glutamate and GABA?

A

Glutamate- inhibit release

GABA- both increased and decreased release

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7
Q

Post-synaptic effects of anesthetics?

A

variable effects on EXCITATORY NTs receptors

enhance receptor response to INHIBITORY NTs

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8
Q

Volatile anesthetic effects on Na+ channels

A

Inhibit activity, reduce nt release at synapse

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9
Q

Neurotransmitters serve as what in ligand-gated ion channels?

A

Ligands, mediate fast excitatory or inhibitory neurotransmission

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10
Q

3 categories of Glutamate ion channels

A

NMDA (modulate long term synaptic response)

AMPA, Kainate (involve fast excitatory transmission)

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11
Q

Drug effects on GABAa receptors at clinical concentrations and high concentrations

A

Clinical: increase Cl current produced by low GABA
High:
1) Direct gating ability to activate receptor w/o GABA
2) Prevention of GABA from initiating Cl current

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12
Q

Barbitiuate, Propofol and Volatile anesthetics effect on GABAa receptor?

A

Create conformational change in GABAa receptor to increase affinity for GABA

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13
Q

Where do anesthetics likely bind?

A

Hydrophobic pockets on proteins

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14
Q

What must be used in conjunction with anesthetics in order to conduct surgery?

A

Opioids or Neuromuscular blocking agents to produce analgesia or muscle relaxation.

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15
Q

How are inhaled anesthetics delivered?

A

By agent specific vaporizers attached to anesthesia machine.

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16
Q

Equilibration implies what for anesthetic gas in twophases (ie alveoli and blood, blood and brain)

A

same partial pressures in both phases (does not mean they have same concentration)

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17
Q

What is MAC?

A

Age dependent concentration of an inhaled anesthetic at which 50% of patients will not move.

Additive when 2 agents given together

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18
Q

What propels anesthetics to brain?

A

partial pressure gradients

P (Alv), Pa, P(brain)

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19
Q

In comparison to the other volatile anesthetics what is different about Desflurane?

A

has a low bp, low potency, least soluble

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20
Q

MOA of Nitrous Oxide?

A

NMDA receptor antagonist

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21
Q

Use of N2O?

A

mask induction in children (no smell, can flavor)

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22
Q

SE of N2O?

A

Post-surgical N/V
adverse effects on embryonic development
accumulates in closed air spaces (bowel, middle ear, pneumothorax, air emboli)

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23
Q

Name three volatile anesthetics

A

Isoflurane, Desflurane, Sevoflurane

24
Q

What is Isoflurane used for?

A

Gold Std of anesthesia maintenance

25
Q

SE of isoflurane, desflurane, and sevoflurane?

A

Dose Dependent CNS depression
Increased cerebral blood flow, ICP
DD decrease in BP, resp fx, relaxes skeletal muscle
Increase in HR, malignant hyperthermia

26
Q

What volatile anesthetic is the most pungent?

A

Desflurane

27
Q

MOA of methohexital?

A

GABAa receptor binding; produce hypnosis/ sedation

NMDA glutamate receptor antagonist

28
Q

MOA of propofol?

A

GABAa receptor agonist, antagonist of NMDA- glutamate receptor

29
Q

Use of propofol?

A

induction/ maintenance of general anesthesia

30
Q

SE of propofol?

A

Propofol infusion syndrome (seen in pts given for several days)
Metabolic acidosis, myocardial failure, rhabodomyolysis, hyperkalemia, renal failure

31
Q

MOA of etomidate?

A

GABAa receptor agonist

32
Q

Use of etomidate?

A

Hypnosis; no analgesia

good for pts w/ minimal cardiac reserve

33
Q

SE of etomidate?

A

involuntary myoclonic movements
post-op N/V
single dose inhibits cortisol synthesis

34
Q

MOA of ketamine?

A

NMDA receptor antagonist
kappa opiate agonist
DD unconsciousness, amnesia, analgesia

35
Q

SE of ketamine?

A

Stim sympathetics
Increased Cerebral blood flow–> ICP
emergence delirium, salivation, lacrimation, nystagmus

36
Q

Ketamine treats?

A

sedative anethestic- children or Developmentally Disbled
Induction agent- Reactive airway disease, trauma patients (hypovalemia), cardiac disease
Adjuvant- to decrease opioid use

37
Q

Name three Acetyl cholinesterase inhibitors used to reverse neuromuscular blockade?

A

Neostigmine, Edrophonium, Pyridostigmine

38
Q

Of Neostigmine, Edrophonium, Pyridostigmine what has the longest duration of action?

A

Pyridostigmine

39
Q

MOA of dexmedetomidine?

A

Binds a2a and a2b in LC and SC–> sedation, sympatholysis, analgesia

40
Q

Use of dexmedetomidine?

A

awake intubations, craniatomies, adjunct to general anesthesia (in pts susceptible to narcotic induced resp depression)

41
Q

Name three amino steroid non-depolarizing NMB.

A

Pancuronium, Vecuronium, Rocuronium

42
Q

MOA of Pancuronium, Vecuronium, Rocuronium?

A

competitive blockade of Ach (no depolarization)

43
Q

What Amino steroid non-depolarizing blocker causes increased HR?

A

Pancuronium

44
Q

Length of action of Pancuronium, Vecuronium, Rocuronium?

A

P- long
V-intermediate
R- intermediate

45
Q

What are Pancuronium, Vecuronium, Rocuronium used for?

A

Skeletal muscle relaxation

46
Q

Name a depolarizing NMB?

A

Succinlycholine

47
Q

MOA of succinylcholine?

A

attaches to Ach receptors and overstimulates

first seen as disorganized contractions then paralysis

48
Q

What is unique about succinylcholine related to its duration of action?

A

Rapid onset, ultra-short Duration of action

CAN NOT be reversed

49
Q

SE of succinylcholine?

A

malignant hyperthermia, cardiac dysrhythmias, hyperkalemia, increased ICP and intraocular pressure
myalgias, masseter spasm

50
Q

Use of succinylcholine

A

skeletal muscle relaxation (intubation)

51
Q

MOA of sugammadex?

A

complexes w/ rocuronium, rendering it inactive

52
Q

SE of sugammadex?

A

decrease in BP, N/V, dry mouth

53
Q

Name two isoquinoline NMBs.

A

Atracurium and Cisatracurium

54
Q

MOA of Atracurium and Cisatracurium?

A

competitive blockade of Ach (no depolarization)

55
Q

Use of isoquinoline NMBs?

A

skeletal muscle relaxant (pts w/ liver or renal dysfunction)

56
Q

SE of Atracurium?

A

histamine release w/ resultant hypotension and tachycardia

Pharm Unit 3 (14 decks)

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