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Pharmacology > Injectable Anesthetics > Flashcards

Injectable Anesthetics Flashcards

1
Q

What are the 4 stages in general anesthesia?

A

Analgesia
-> Conscious
-> Reduced pain sensation

Excitement
-> Unconscious
-> Modern anesthesia
–> Designed to shorten / eliminate this stage

Surgical anesthesia

Medullary depression
-> Deep depression of CNS

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2
Q

Why are IA so hydrophobic?

A

Cross BBB

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3
Q

Is the distribution of IA “perfusion - dependent” or “permeability - dependent”?

A

Perfusion - dependent

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4
Q

Is anesthetic effect terminated by “metabolism” or “redistribution”?

A

Redistribution

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5
Q

Is elimination of IA or IH generally faster?

A

IH

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6
Q

Provide 3 example of barbiturates with for ultra short lasting, and 1 for short lasting and long lasting effects

A

Ultra short
- Thiopental
- Thiamylal
- Methohexital

Short acting
- Pentobarbital

Long lasting
- Phenobarbital

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7
Q

Is Thiopental, Thiamylal or Methohexital the fastest acting?

A

Methohexital

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8
Q

What is the post synaptic receptor that Barbiturates binds to?

A

GABA(A)

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9
Q

Which Barbiturate is used for Anticonsulvant?

A

Phenobarbital

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10
Q

Does Barbiturates cause respiratory depression or cardiac depression?

A

Both

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11
Q

What are 4 advantages of ultra short - acting Barbiturates?

A

Cheap
Rapid administration
Minimal equipment required
Rapid induction & recovery
-> After a SINGLE dose

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12
Q

Why happens after repeated injections of Barbiturates?

A

Accumulation in fat tissue
-> Slow metabolism
–> Drug hangover
—> Prolonged recovery

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13
Q

What are 4 adverse effects of Barbiturates?

A

Local irritation
-> Perivascular tissue necrosis
–> Barbiturate ( weak acid ) is mixed w/ NaOH
—> Sodium barbiturate = pH

Low safety margin (<2)
-> Respiratory depression
–> Can cause death
—> Used for euthanasia for lab animals though

Low doses cause excitement
-> Chances : Methohexital > Thiopental

Significant depression
-> CNS
-> Respiratory
-> Cardiovascular

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14
Q

What are the two reasons we would choose Thiobarbiturate induction?

A

Animals w/
-> Seizure history
-> Raised intracranial pressure

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15
Q

What are the two reason we would avoid using thiopental in “greyhounds”?

A

Deficient in oxidative enzymes
-> for drug metabolism
Recovery takes 2 - 4 times compared to other dog breeds

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16
Q

What are the reason we would avoid using thiopental in “sighthounds”?

A

Lean breeds
-> No fat storage
–> No redistribution
–> Prolonged effect

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17
Q

What should we use for greyhounds and sighthounds if thiopental is avoided?

A

Methohexital
-> Rapid distribution
-> Rapid metabolism
-> Quick recovery

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18
Q

What is one example of pre meds used for large animals?

A

Guaifenesin
-> Glyceryl Guaiacolate

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19
Q

What is the 2 reasons to use Guaifenesin w/ Barbiturates for large animals?

A

Reduce Barbiturates doses
Less side effects

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20
Q

Which barbiturate should be avoided for horse and cats anesthesia w/o prior sedation?

A

Thiopental
-> May cause excitation

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21
Q

Which barbiturate is recommended for lean dogs but not for horses?

A

Methohexital

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22
Q

What is the 2 pharmacological effects for Guaifenesin?

A

Skeletal muscle relaxant
-> Central acting
Expectorant
-> Aids in removing mucus

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23
Q

Is Propofol a ( barbiturate / non - barbiturate ) & ( dissociative / non - dissociative ) IA agent?

A

Non - barbiturate
Non - dissociative

24
Q

What is Propofol similar to? Why? ( 4 reasons )

A

Thiobarbiturate
-> GABA
-> Rapid onset
-> [Cardiovascular & Respiratory depression]
-> Large doses induces apnea

25
Q

What are the 7 (= =) advantages for Propofol?

A

Rapid hepatic & lungs metabolism
-> [Used for both induction & maintenance]

Suitable for outpatient procedure

Recovery quality&raquo_space;> Thiopental

No perivascular tissue irritation
-> Though small pain injection causes local pain
–> Large veins recommended

Maintenance of anesthesia
-> When IH is not possible
–> Much movement needed during the procedure

Minimal effects on Babiesssss

Excellent muscle relaxation

26
Q

What are the 7 (= = again?) disadvantages / cautions for Propofol?

A

No analgesia effect

Expensive

Bad for cats
-> Oxidative damage to RBC
–> Repeated use may result in Heinz body
—> Heinz body : Deposition of denatured hemoglobin from RBC

Septicemia
-> If badly stored
–> Ingredients favors bacterial growth

Bad for horse
-> May cause excitement

Cardiovascular & respiratory depression
-> Slow administration is recommended
-> Pre med is recommended
–> Reduce dosage of induction agent

Overdose
-> Treatment is similar to Thiopental

27
Q

Other than Thiobarbiturate, what else is extremely similar to Propofol?

A

Etomidate
( “H”e took my date )

28
Q

What is so similar about Propofol & Etomidate?

A

Non - barbiturate
Non - dissociative
Rapid onset
Respiratory depression & Apnea
No perivascular tissue injection
Rapid hepatic metabolism
No analgesic effect
Expensive
Induction of anesthesia
- Dogs
- Cats
- Humans

29
Q

What is the advantage of Etomidate compared to Propofol & Barbiturates?

A

Less cardiovascular depression

30
Q

What are the disadvantages of Etomidate?

A

[Hemolysis & Hematuria]
-> Dogs
-> Cats
–> Not popular in veterinary medicine
[No analgesic effect]
[May cause serious adrenal suppression]
Pain upon injection
Expensive

31
Q

Is Ketamine & Tiletamine “dissociative” or “non - dissociative”?

A

Dissociative

32
Q

Which receptors does Ketamine binds to?
Is it a (competitive / non-competitive) (agonist / antagonist)?

A

Non - competitive antagonists
-> Glutamate NMDA receptors

33
Q

Does Ketamine stimulate “sympathetic” or “parasympathetic” with clinical doses?

A

Sympathetic
-> Cardiovascular stimulation

34
Q

Does large doses of Ketamine cause cardiovascular depression or stimulation?

A

Cardiovascular depression
-> Hypotension

35
Q

What are two classes of Glutamate receptors?

A

Metabotropic
-> G protein
Ionotropic
-> Ligand - gated ion channel

36
Q

What are two types of Glutamate Ionotropic receptors?
And their functions ( Ion permeability )?

A

AMPA
-> Na+ & K+ permeable
-> Ca++ limited

NMDA
-> Highly Ca++ permeable
–> 20 : 1 : 1 ( Ca++ : Na+ : K+ )

37
Q

Does Ketamine have ‘Fast’ or ‘Slow’ elimination rate?

A

Slow elimination rate
-> Several days

38
Q

List 5 characteristic of Dissociative Anesthesia ( Cataleptic State )

A

Strong analgesia
Unaware of the environment
Eyes open
Increased muscle tone
-> Moves limbs
-> Occasional seizure
Increased salivation & lacrimation

39
Q

Which hepatic enzyme is used for Ketamine metabolism?

A

Cytochrome P450

40
Q

What is norketamine?
Why do we have to be cautious about it?

A

Norketamine
-> Metabolite of Ketamine
–> 10 - 30% of Ketamine effects

Cats always have impaired renal function
-> Slower elimination of Norketamine
–> Prolonged effect

41
Q

What are 2 advantages of Dissociatives?

A

Less respiratory depression
-> compared to Thiopental & Propofol

Can be administered
-> IV
-> IM***
–> Used for intractable animals

42
Q

Why are pre meds used with Ketamine?
What are pre meds used w/ Ketamine
- in Dogs
- in Horses
- in Large animals
What are pre med used w/ Tiletamine?

Choices : Guaifenesin, Diazepam, Xylazine, Detomidine, Medetomidine, Midazolam, Zolazepam

A

To prevent involuntary movement

Dogs
-> Diazepam
-> Midazolam
-> Medetomidine

Horses
-> Xylazine
-> Detomidine

Large animals
-> Guaifenesin

Tiletamine
-> Zolazepam

43
Q

Match the following

Guaifenesin
Diazepam CNS sedative (minor tranquilizer)
Xylazine
Detomidine Alpha2 - agonist (tranquilizer)
Medetomidine
Midazolam CNS sedative + muscle relaxant
Zolazepam

A

CNS sedative (minor tranquilizer)
->Diazepam
-> Midazolam
-> Zolazepam

Alpha2 - agonist (tranquilizer)
-> Medetomidine
-> Xylazine
-> Detomidine

CNS sedative + muscle relaxant
-> Guaifenesin

44
Q

Can Ketamine used in food - producing animals?

A

No

45
Q

Why shouldn’t we use dissociative anesthetics as single agents for horses?

A

Delirium during recovery

46
Q

What is the difference of Thiopental, Propofol, Etomidate & Ketamine? ( Increase, Decrease, Remains the same )
- CBF ( Cerebral blood flow )
- ICP ( Intracranial pressure )
- MAP ( Mean arterial pressure )
- HR ( Heart rate )
- CO ( Cardiac output )
- RR ( Respiratory rate )
- MV ( Minute ventilation )

A

CBF
-> Only Ketamine increases

ICP
-> Only Ketamine increases

MAP
-> Etomidate remains the same
-> Ketamine increases

HR
-> Propofol & Etomidate remains the same
-> Ketamine increases

CO
-> Etomidate remains the same
-> Ketamine increases

RR
-> Only Ketamine remains the same

MV
-> Only ketamine remains the same

47
Q

What is the 2 Steroidal anesthetics?

A

Althesin
Saffan

48
Q

What are the difference between Althesin and Saffan?

A

THEY ARE EXACTLY THE SAME, IDIOT

49
Q

What is the two type of steroids in Althesin / Saffan?

A

Alphaxalone
Alphadolone

50
Q

Which receptor does Althesin acts on?
Is it ‘agonist’ or ‘antagonist’?

A

GABA(A)
-> Agonists

51
Q

Is Althesin short or long acting?

A

Short acting

52
Q

What are the injection methods for Althesin?

A

IV
IM

53
Q

Is Althesin used for anesthetic induction or maintenance?

A

Induction
- Most animals
Maintenance
- Cats

54
Q

Why was the old formulation of steroidal anesthetics withdrawn from the market?

A

Severe anaphylactic reactions
-> caused by vehicle : Cremophor EL
–> causes Histamine release

55
Q

Why is Steroidal anesthetic back on da market?

A

Different vehicle used
-> Cyclodextran

Pharmacology (5 decks)

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