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Pharmacology Test 3 > Injectable anesthesia (Shih) > Flashcards

Injectable anesthesia (Shih) Flashcards

1
Q

Therapeutic index

A

(Lethal dose 50)/(Effective dose50)

High therapeutic index

  • safer
  • larger margin of safety
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2
Q

Therapeutic index

  1. Etomidate
  2. Ketamine
  3. Alfaxalone
  4. Propofol
  5. Thiopental
A
  1. Etomidate: 16
  2. Ketamine: High (double digits)
  3. Alfaxalone: >20
  4. Propofol: 3
  5. Thiopental: 5
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3
Q

Compartment theory

A

Redistribution

  • drug leaving brain and going elsewhere
  • doesn’t equal elimination
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4
Q

Time of awakening is dependent on

A

Redistribution rate, not elimination rate

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5
Q

12 bottles of beer adventure (hangover…?) due to

A

Elimination

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6
Q

Continuous infusion

A

Can lead to accumulation of drug

Rate of decay depends on elimination rate not distribution

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7
Q

Context Sensitive half life:

A

Time it takes to wake up once a CRI is discontinued

Time necessary for plasma drug concentration to dec by 50% after d/c ing a continuous infusion of a specific duration

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8
Q

Bolus vs Continuous infusion

(eg propofol vs thiopental)

When will a patient wake up?

A

If given a bolus, patient will wake up at the same time with either drug

  • due to redistribution

If given an infusion, patient given propofol will wake up sooner

  • better elimination
  • Bigger hangover with thiopental
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9
Q

Barbiturate

MOA

A

Lethal injection

Mechanism of action

  • Interaction with Gamma amino butyric acid (GABA) receptor
  • Cl- hyperpolarizes cells, goes in and makes cell sleep

Tiopentol and Diazepam

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10
Q

Thiopental

A

Good at shutting down brown (barbiturate coma)

CNS

  • Dec CBF and CMRO2
  • One of the best drugs to prevent high ICP
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11
Q

Advantage of Tiopental

A

Short lasting barbituric

Awakening due to redistribution

Long half life/long context sensitive half life

  • No recommended repeated bolus
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12
Q

Thiopental

Metabolism

A

Metabolism

  • Liver P450 dependent
  • Careful on patients with low hepatic function (shunt)
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13
Q

Propofol

A

Side effect:

  • Respiratory depression
  • Cardiovascular depression (dec CO)
    • usually short lived
  • Don’t use unless you have a captured airway

Short acting/fast clearance

Bolus

  • Recovery due to redistribution

Smooth induction and recovery

Short context sensitive half life

CRI

  • wakes up from elimination
  • wake up quickly
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14
Q

Propofol

MOA

A

GABA

  • Same as thiopentol
  • Cl in cell, none in blood
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15
Q

Propofol

Advantage

A

Metabolism

  • Fast clearance
  • Extra hepatic metabolism
    • Use on Portosystemic shunt dogs (PSS)
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16
Q

Propofol

Complications

A

Mayonnaise recipe

  • Dont give in pancreatitis patients
    • maybe 1 bolus ok

Vehicle:

  • Soy bean oil, egg lecithin
  • Bacterial growth
  • Fat embolisation
  • High plasma triglyceride
17
Q

Propofol complications

Long-term use

Use in cats

A

Phenolic compound = oxidative injury

Heinz body and methemoglobinemia

Diarrhea/anorexia and malaise in cats

*In cats:

  • 1 bolus probs ok
  • CRI probs not ok
18
Q
  1. Thiopental think:
  2. Propofol think:
  3. Etomidate think:
A
  1. Thiopental: Brain
  2. Propofol: Liver
  3. Etomidate: Heart
19
Q

Etomidate

A

TI (therapeutic index) = 16

Cardiovascular stability: good

  • even in hypovolemia

Minimal respiratory depression

Decreased intracranial pressure

Decreased cerebral oxygen consumption

20
Q

Etomidate

Disadvantage

A

Poorly water soluble

Formulated in 35% propylene glycol

High osmolality

  • may cause phlebitis IV admin
21
Q

Etomidate

adverse events

A

Endocrine

  • shuts down adrenal glands
    • no cortisol
    • no corticosteroids
    • no aldosterone
  • Short term supression NBD
  • Long-term supression = inc mortality
  • Don’t give to stressed patients (ICU)
22
Q

Etomidate best for:

A
  1. Heart murmur patients
  • Yorkie w/ mitral regurge
  • Dobie w/ DCM
  • Cat w/ HCM
23
Q

Ketamine (Relax)

A

Classified as a dissociative anesthetic

  • Not complete anesthesia

Limbic and thalamocortical systems are dissociated: alters awareness

Cortex and medulla don’t communicate

24
Q

Ketamine about

A

Bad recovery

  • Use with xylazine in horses

Schedule III

  • huge abuse potential
25
Q

Ketamine Pharmacokinetics/metabolism

A

Lipid soluble

  • can give IM

Highly protein bound

  • low protein goes straight to brain
26
Q

Ketamine

MOA

A

Non-competitive NMDA receptor antagonist

  • only anesthetic with analgesic properties

Some additional

27
Q

Ketamine

Physiologic effects

A

Direct myocardial depressant

  • In patients with no sympathetic tone

In patients with sympathetic tone

  • inc cardiac output
  • inc blood pressure
  • inc heart rate

Increased muscle tone

  • use with muscle relaxants
    • diazepam
    • dexmetatomadine
28
Q

Ketamine is the ONLY injectible anesthetic that…

A

Provides some analgesia

Give SQ

29
Q

Telazol (Zoletil)

A

Tiletamine + zolazepam (same thing as ketamine + diazepam)

FDA schedule III

Dissociative

Bad recovery

Muscle tension

Inc CO

NMDA receptors

30
Q

Alfaxalone

A

Advertised as ideal anesthetic

  • Therapeutic index low
  • Doesn’t cause histamine release
  • Can give IM
  • No respiratory depression
  • water soluble

Vehicle: cyclodextrin encapsulation

31
Q

Alfaxolone

MOA

A

Gaba

32
Q

Alfaxolone

Physiologic effects

A

High therapuetic index

Inc in Heart rate

  • Good for heart

Decrease in BP

  • Good for BP

Good for lungs

Good muscle relaxation

No analgesia

33
Q

Summary and conclusions

A

Therapuetic index

Distribution vs Elimination

Accumulation vs CRI

Pharmacology Test 3 (12 decks)

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