Induction Agents and Opioids ☺️ Flashcards

1
Q

What is the definition of

  • analgesia
  • anaesthesia
  • sedative
  • onset
  • offset
A
Analgesia = Pain relief
Anaesthesia = unconsciousness
Sedative = Anxiolytic
Onset = Time taken for drug to start acting
Offset = Time taken for drug to stop being effective
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2
Q

Describe the function and properties of GABA

Describe the function and properties of NMDA

A

GABA

  • reduce neuronal activity
  • sedative, anxiolytic, anticonvulsant, muscle relaxant

NMDA
-increase neuronal activity => cascade leads to sensitization of DH

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3
Q

Propofol

  • positives
  • negatives and SE
  • metabolism and onset/offset
A

GABA agonist => IV induction

  • antiemetic, itch, convulsant
  • BD
  • pleasant dreams
  • low ICP
  • cardiac, resp depression
  • no malignant hyperpyrexia risk

SE

  • anaphylaxis
  • pancreatitis from increased TAG
  • thrombophlebitis

Rapid onset and recovery
Metabolised by liver, kidney

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4
Q

Barbiturates vs benzodiazepines

  • common properties
  • differences
A

GABA agonists

  • anticonvulsants and sedatives
  • low ICP
  • amnesia
  • respiratory depression
  • fall in BP, HR
  • accumulates in fat
  • fast onset, offset
  • liver met => kidney excretion

Barbiturates (-pental, -barbital)

  • CYP interactions
  • v narrow therapeutic index
  • NOT ANALGESIC

Benzodiazepines (-am)

  • Antidote => flumenazil infusion antidote
  • drowsiness, confusion
  • paradoxical reactions
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5
Q

Etomidate

  • positives
  • negatives
  • metabolism and excretion
A

GABA agonist

  • NOT ANALGESIC
  • low ICP
  • no BP, HR fall so can be used in haemodynamic instability
  • resp depression
  • rapid onset, offset
  • liver met => kidney excretion

11b hydroxlyase inhbition => GC, MC adrenal insufficiency

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6
Q

Ketamine

  • positives
  • negatives
  • metabolism and excretion
A

NMDA antagonist

  • analgesic
  • sedative
  • SNS stimulation, suitable for haemodynamically unstable
  • minimal resp depression
  • BD
  • increased ICP
  • liver met => kidney excretion

-nightmares

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7
Q

Morphine

  • positives
  • negatives
  • antidote
A

MOP agonist, long T1/2

  • Liver met => kidney excretion
  • analgesia
  • N+V
  • cough suppression
  • resp, cardiac depression

Naloxone infusion due to short T1/2

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8
Q
Fentanyl properties
Codeine properties
Tramadol properties 
Remifentanyl properties
compared to morphine
A

Fentanyl - MOP, DOP, short T1/2

  • T1/2 increases as infusion time increases
  • more potent than morphine

Codeine - MOP, KOP
-less potent than morphine

Tramadol - MOP, SNRI inh

  • less potent than morphine
  • risk of seretonin syndrome

Remifentanyl - MOP

  • vvv short T1/2
  • metabolised by blood/tissue esterases (enzymes are everywhere)
  • SEDATIVE and ANALGESIA
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9
Q

What is the antidote to opioids

  • what are the pharmacokinetics
  • what are the SE
A

Naloxone
-due to short half life, needs infusion

May cause

  • rebound agonist
  • HTN
  • pulmonary edema
  • arrythmia
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10
Q

TIVA

  • mixture
  • pros and cons
A

Total IV anesthesia
-propofol + remifentanyl

Pros

  • no gas
  • stable CV
  • decreased N+V
  • increased tube tolerance

Cons

  • based on algorithms
  • risk of patient awareness
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