Injectible Anesthetics

Question 1

Triad of Anesthesia

Answer 1

muscle relaxation, analgesia, and unconsciousness

Question 2

Recovery of consciousness due to:

Answer 2

redistribution (NOT metabolism). 1st: brain, heart, liver, kidneys. 2nd: skeletal muscle/skin. 3rd: fat, bone, connective tissue

Question 3

Propofol: MOA

Answer 3

GABA-A agonist

Question 4

Propofol: uses

Answer 4

IV only smooth induction, NO proven analgesic effect (debated due to interaction w/ other receptors). muscle relaxation, vasodilation, decrease BP, respiratory depression, decreased cerebral metabolic rate

Question 5

Propofol: adverse effects

Answer 5

propofol infusion syndrome, severe metabolic acidosis

Question 6

alfaxaolone: MOA

Answer 6

GABA-A agonist

Question 7

alfaxalone: uses

Answer 7

IV, IM, SC. premedication in addition to anesthetic induction. NO analgesic effect. Depression (cardiac and respiratory) and hypotension. decreases cerebral metabolic rate

Question 8

etomidate: MOA

Answer 8

GABA-A agonist

Question 9

etomidate: uses

Answer 9

IV only. NO analgesic effect, not smooth induction. (midazolam co-induction). Specifically used for cardiovascular stability (minimal changes in HR, stroke volume, vascular tone)

Question 10

etomidate: adverse effects

Answer 10

decreased adrenocortisol

Question 11

Dissociatives: drugs and MOAs

Answer 11

ketamine and tiletamine. both NMDA antagonists. tiletamine also GABA A agonist (at benzodiazepine site)

Question 12

Dissociatives: uses

Answer 12

IV, IM, SC. good for neuropathic pain, poor visceral analgesic.

Question 13

Dissociatives: effects

Answer 13

increased HR, contractility, vasoconstriction, BP. increases cerebral metabolic rate and intracranial pressure

Question 14

Dissociatives: cautions

Answer 14

causes significant fetal depression during C-sections. emergence delirium and rough recoveries, avoid in renal blocked patients. hepatic or renal dysfunction may result in prolonged anesthetic/recovery times

Question 15

thiopental: MOA

Answer 15

GABA-A agonist at benzodiazepine site

Question 16

thiopental: uses

Answer 16

IV only. ultra-short acting barbiturate. NO analgesic effect. Not available in US.

Question 17

thiopental: effects

Answer 17

induces hepatic microsomal enzymes. causes more fetal depression than propofol. cardiac: vasodilation and drop in blood pressure, compensatory increase in HR. respiratory: dose dependent respiratory depression, suppression of central ventilatory centers. Neurologic: decreases cerebral metabolic rate and intracranial pressure.