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pharm II > Injectable Anesthetics > Flashcards

Injectable Anesthetics Flashcards

1
Q

List dissociative anesthetics

A
  1. Ketamine
  2. Tiletamine
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2
Q

List the barbiturates

A
  1. Thiobarbiturates
    -Thiopental
  2. Oxybarbiturates
    -Phenobarbital
    -Pentobarbital (Euthasol)
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3
Q

List the non-barbiturates

A
  1. Propofol
  2. Alfaxalone
  3. Etomidate
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4
Q

What stages are involved in inducing anesthesia?

A

Stage 1 + 2

  1. Analgesia - no pain still conscious
  2. Excitement phase - Loss of consciousness and voluntary control
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5
Q

MOA for dissociative anesthetics?

A

Non-competitive NMDA antagonists

-Binds irreversibly! (No reversal)

(Ketamine, Tiletamine)

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6
Q

Where do dissociative anesthetics work on the pain pathway?

A

Modulation

(Ketamine, Tiletamine)

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7
Q

Amantadine, Ketamine, and Tiletamine all have the MOA. Why is amantadine not in the class of dissociative anesthetics?

A
  • Amantadine is given PO and does not cross BBB
  • Ketamine and Tiletamine are injectable anesthetics that cross BBB causing dissociation

Similarities: All are NMDA antagonists and have analgesic properties (neuropathic pain)

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8
Q

What route of administration can Ketamine and Tiletamine be given?

A

Usually IV, can be given IM

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9
Q

What is false about Ketamine and Tiletamine?

A. Decent transmucosal bioavailability

B. Caution with pre-existing renal disease

C. Has a long duration of action

D. Blocks glutamate by irreversibly binding to NMDA receptors

A

C. Has a long duration of action

Only has anesthetic effects for ~30 mins

Recovery is long

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10
Q

Main effects of Ketamine and Tiletamine on the CNS?

A
  • Depression of thalamocortical system (sensory perception)
  • Activation of limbic system (dissociation)
  • Anesthesia and amnesia through CNS stimulation and catalepsy
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11
Q

What level of anesthesia can be reached when using Ketamine alone?

A

Only Stage 1 + 2

consciousness not completely lost when used alone

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12
Q

What drugs are used to counteract the catalepsy that occurs when using Ketamine?

A

Used with a muscle relaxant (Benzos)

  1. Diazepam
  2. Midazolam
  3. Alprazolam
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13
Q

What is catalepsy?

A

CNS stimulation, seen with ketamine use

  1. Muscle tone maintained to hypertonic
  2. Pharyngeal and laryngeal reflexes maintained
  3. Eyes open, mydriasis
  4. Light and sound sensitivity
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14
Q

Ketamine at subanesthetic doses has analgesic properties which work better for ___________ (visceral/somatic) pain

A

Somatic

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15
Q

Main effects of ketamine on the CV system?

A
  • Cardiovascular stimulation
  • Increased sympathetic tone (Positive inotropic)
  • Increased CO, HR, CVP
  • Increased cerebral blood flow
  • Increased intracranial and intraocular pressure (ICP and IOP)
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16
Q

Main effects of Ketamine on the respiratory system?

A
  • Safe respiratory profile
  • Bronchodilation (good for asthmatic patients)
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17
Q

What body systems are most at risk when using ketamine?

A
  1. Cardiovascular system
  2. CNS

can cause CV and CNS stimulation

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18
Q

What drugs are in kitty magic?

A

Ketamine + Dexdom + Buprenorphine

  • Ketamine for dissociation/unconsciousness
  • Dex for sedation and pain
  • Bup for pain
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19
Q

When would ketamine be used alone?

A

Rarely

  1. Chemical restraint and anesthesia for minor procedures
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20
Q

Ketamine and Tiletamine are the only induction agents for anesthesia with _______ properties

A

Analgesic

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21
Q

Which injectable anesthetics are GABA receptor agonists?

A

Barbiturates and non-barbiturates

Barbiturates
1. Thiopental
2. Pentobarbital
3. Phenobarbital

Non-Barbiturates
4. Propofol
5. Alfaxalone
6. Etomidate

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22
Q

Barbituates and non-barbituates main clinical uses?

A
  1. Anesthetic induction (stage 1 + 2)
  2. Sedation
  3. Emergency anticonvulsant (anti-seizure)
  4. Total IV anesthesia (TIVA)
23
Q

How are barbituates most commonly administered?

A

IV

24
Q

What needs to be considered when using barbituates over time rather than just a single dose?

A

Enzyme Inducers

Esp Phenobarbital

over time will lead to quicker metabolism of the drug, also drug/drug interactions

25
Q

How is recovery time of barbituates effected from patient to patient?

A

Thin/emaciated animals recover slowly, sleepier/sedated for longer

26
Q

Thiopental can be inactivated by the ___________

A

Brain and kidney

27
Q

What adverse effects are seen with barbiturates?

A
  1. Respiratory depression, apnea Most common cause of death
  2. CNS depression
  3. Hypotension, which may cause reflex tachycardia
28
Q

Should barbiturates be used adjunct therapy for cases of head trauma?

A

Yes, decreases ICP and decreases brain metabolism

29
Q

Which animal is most sensitive to respiratory depression when given barbiturates and non-barbiturates?

A

Cats

30
Q

What is the most common cause of death when using a barbiturate/non-barbiturate?

A

Respiratory depression

31
Q

____________ is an ultra short acting GABA receptor agonist

A

Thiopental

32
Q

Which of the following injectable anesthetics is not available in the USA or Canada?

A

Thiopental

33
Q

What is thiopental used for?

A

Anesthetic induction

34
Q

Which injectable anesthetic is used for humane euthanasia?

A

Pentobarbital (oxybarbiturate)

35
Q

What drug should be used in adjunct to a barbiturate in a euthanasia procedure?

A

Pentobarbital + neuroleptic/sedative

Pentobarbital + Propofol

allows for a smooth euthanasia and limits the effects of excitement during stage 2 of anesthesia

36
Q

MOA of propofol?

A

GABA agonist

37
Q

How is propofol administered?

A

IV only

38
Q

Onset of action and duration of action for propofol?

A

Fast onset, short duration

39
Q

Why is propofol part of a euthanasia procedure?

A

Rapid, smooth, excitement-free anesthetic induction prior to admin of pentobarbital

40
Q

Propofol given repeatedly over 5 days can have adverse effects in ________

A

Cats - Heinz body anemia

41
Q

Effects of propofol on the muscle?

A
  1. Decreased laryngeal reflexes
  2. Myoclonic movements during induction, good muscle relaxation after induction
42
Q

Which barbiturate is prohibited for use in food animals?

A

Pentobarbital

43
Q

Which of the following barbiturates/non-barbiturates are labeled for use in dogs only?

A

Propofol

heinz body anemia in cats

44
Q

Extravasation of propofol after IV induction can cause ________

A

Abscesses/ tissue damage

45
Q

Which of the following GABA agonistscan be administered IV or IM?

A

Alfaxalone

46
Q

_________ is classified as a neurosteroid, although it has no clinical steroidal effects

A

Alfaxalone

47
Q

Propofol has similar adverse side effects as _________

A

Alfaxalone

48
Q

Which of the following injectable anesthetics is indicated for use in patients with cardiac disease?

A

Etomidate

Minimal CV effects

49
Q

What is the main contraindication when using Etomidate?

A

Contraindicated in hypoadrenocorticism (Addisons dz)

Inhibits cortisol synthesis

50
Q

True or False, unlike propofol and alfaxalone, Etomidate has analgesic effects when used alone

A

FALSE

all have no analgesic effects when used alone

51
Q

Which of the following non-barbiturates have the most to least CV side effects?

A

Propofol > Alfaxalone > Etomidate

52
Q

Why is pre-oxygenation important when planning to use barbiturates/non-barbiturates?

A

Reduce risk of respiratory depression and apnea on induction

53
Q

Which injectable anesthetics can be used as an anticonvulsant?

A

Propofol and Alfaxalone (non-barbiturates)

Phenobarbital (oxybarbiturate)

pharm II (23 decks)

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