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CNS I > IV Anesthetics > Flashcards

IV Anesthetics Flashcards

Compare the contributions of distribution and metabolism to the duration of IV anesthetic effects. Describe organ system effects of IV anesthetics and use this information to make decisions on clinical use of these drugs. Compare IV anesthetics based on general pharmacokinetic properties.

1
Q

Main contributor to termination of effects of most anethstics

A

distribution

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2
Q

Distribution definition

A

initial dispersion of drug into body compartments

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3
Q

affects drug distribution

A

hemodynamics, disease states

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4
Q

terminates the effect of thiopental

A

redistribution

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5
Q

formerly most common used barbituate (no longer available)

A

thiopental

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6
Q

time course of thiopental

A

ultra-short acting, but long elimination

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7
Q

name the drug: rapid unconciousness, good amnesia but poor analgesia, poor muscle relaxation, pleasant induction

A

Thiopental

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8
Q

MOA of thiopental

A

binds to GABAA receptor and stimulates inhibitory neuronal systems

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9
Q

drug that best protects against hypoxic/ischemic injury

A

thiopental

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10
Q

drug that reduces cerebral blood flow, but not perfusion pressure

A

thiopental

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11
Q

CV effects of thiopental

A

hypotension in shock pts, lowers contractility. (HR increases via reflex),

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12
Q

IV drug that can cause massive BP drops in pts with high sympathetic tone

A

Thiopental

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13
Q

IV drug that causes hiccups

A

thiopental

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14
Q

drug that depresses mucocillary reflexes

A

thiopental

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15
Q

drug needed to be added to thiopental to overcome tracheal/laryngeal reflexes

A

muscle relaxants

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16
Q

clinical uses of thiopental

A

general anesthetic induction, brain protection

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17
Q

Best amnestic agents

A

Benzodiazapines

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18
Q

benzodiazepines class examples

A

midazolam and lorazepam

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19
Q

drug to give synergestic sedative effects with opiods

A

benzos

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20
Q

MOA of Benzos

A

bind to GABAA receptor, fires inhibitory neurons

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21
Q

receptor occupancy of benzo giving anxiolysis

A

20%

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22
Q

receptor occupancy of benzo giving sedation

A

30-50%

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23
Q

receptor occupancy of benzo giving hypnosis or unconciousness

A

60%

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24
Q

drug that is pH 3.5 in vial and pH 6.2 in plasma

A

midazolam

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25
Q

CNS effect of midazolam

A

reduction in cerebral metabolism and blood flow.

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26
Q

benzo used for anticonvulsant

A

midazolam

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27
Q

drug causing antegrade, but not retrograde amnesia

A

midazolam

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28
Q

CV effects of midazolam

A

hypotension in hypovolemia

29
Q

Resp effects of midazolam

A

hypnotic dose - apnea.

Amnestic dose gives minimal depression

30
Q

clinical uses of benzos

A

premedication before anesthesia
Conscious or heavy sedation
induction of anesthesia

31
Q

drugs that are not reliable for amnesia

A

opiods

32
Q

clinical use of opiods

A

premedication, maintenance of anesthesia, postop pain control

33
Q

MOA of opiods

A

acts on G-protein linked mu receptors

34
Q

SE of opiods

A

itching, chest wall regidity, “forgetting to breathe”

35
Q

opioid only used for shivering

A

meperidine

36
Q

fentanyl class

A

opoid

37
Q

sufentanil class

A

opioid

38
Q

alfenranil class

A

opioid

39
Q

used as adjunct with inhaled agants for intraoperative analgesia

A

hydromorphone

40
Q

opioid that’s termination of action is due to elimination - not redistribution

A

remifentanil

41
Q

shortest acting opioid

A

remifentanil

42
Q

drug that may result in acute tolerance to other opioids

A

remifentanil

43
Q

MOA of Ketamine

A

NMDA antagonist, inhibits stimulatory systems

44
Q

“dissociatibe anesthetic”

A

ketamine

45
Q

CNS effects of ketamine

A

bad dreams, halluciations, delirium
raises ICP
antidepressent effects

46
Q

treats ketamine “bad trip”

A

benzo, barbiutates, N2O

47
Q

CV effects of ketamine

A

central sympathetic stimulation (higher HR/BP, catchecolamine levels)

48
Q

direct myocardial depressent drug

A

ketamine

49
Q

respiratory effects of ketamine

A

small doses = minimal ventilory depression

bronchodilation from sympathetic effects

50
Q

causes nystagmus

A

ketamine

51
Q

increases salivary and tracheobroncial secretions

A

ketamine

52
Q

Etomidate MOA

A

activates GABAA receptors

53
Q

etomindate CNS effects

A

lowers ICP and cerebral O2 metabolic rate

54
Q

etomindate respiration effects

A

minimal vent depressant

55
Q

good choice for short procedures, due to lower risk of apnea

A

etomidate

56
Q

DOC for pts with CV factors

A

etomidate

57
Q

propofol MOA

A

some action at GABAA complex, may enhance Cl-conduction at glycine receptors

58
Q

CNS effects of propofol

A

reduces cerbral blood flow and metabolism

59
Q

CV effects of propofol

A

decreasd BP, HR, CO, vascular resistance. no change to central venous pressure

60
Q

good drug for CABG pts

A

propofol

61
Q

fast acting drug that burns on injection

A

propofol

62
Q

drug that causes euphoria

A

propofol

63
Q

MOA of dexmedetomidine

A

central a-2 agonist, results in sedation and analgesia

64
Q

excellent sedative for admin by infusion

A

dexmedetomidine

65
Q

hemodynamic effects of dexmedetomidine

A

bradycardia with hypotension to hypertension (dose dependant)

66
Q

very long t 1/2 IV drug (non opioid)

A

thiopental

67
Q

very short t 1/2 IV drug (non opiod)

A

propofol

68
Q

shortest opioid t 1/2 life

A

remifentinil

69
Q

longest opioid t 1/2

A

fentanyl/meperidine

CNS I (36 decks)

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