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Phar300 > lect 16 drugs and surgery > Flashcards

lect 16 drugs and surgery Flashcards

1
Q

first used anesthetic

A

diethyl ether

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2
Q

non flammable anesthetic later developped

A

halothane

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3
Q

in addition to general anesthetic other drugs used to suppress what

A

ANS, endocrine reflexes, somatic reflexes

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4
Q

mixture of other drugs to anesthetic increase both what

A

effectiveness of anesthesia and safety of anesthesia

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5
Q

how to suppress pain reflexes in surgery

A

anelgesics or muscle relaxants

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6
Q

drugs that reverse muscle relaxation so no paralyzation

A

reversal agents

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7
Q

inhalational aanesthtics examples (5)

A

diethyl ester prototype. halothane, isoflurane, nitrous oxide, sevoflurane

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8
Q

anesthesia used for short procedures

A

intravenous anesthetics

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9
Q

types of intravenous anesthetics

A

benzo, barbiturates, opoids. propofol

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10
Q

most commonly used IV anesthetic worldwide to induce anesthesia

A

propofol

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11
Q

rate of drug delivery is determined by what

A

partial pressure of anesthetic in gas

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12
Q

partial pressure of gas is proportional to what

A

its concentration

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13
Q

induction of drug gas pathway

A

alveoli–>blood vessels–>main arterial blood–>brain due to high flow

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14
Q

metabolism of inhalation anesthetic

A

not much so most is unchanged and breathed out

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15
Q

if anesthetic soluble in blood than what happens to brain

A

not much availability going into brain and takes longer to leave the blood

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16
Q

effective anesthetic that get quick to brain and less amount than halothane

A

nitrous oxide (lipid soluble)

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17
Q

does blood flow affect rate of anesthetic uptake in different locations

A

yes greater blood flow in brain even if its a very small proportion to the total of the body

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18
Q

two factors increasing affecting rate of induction

A

increased concentration of anesthetic and increased alveolar ventilation

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19
Q

two factors decreasing affecting rate of induction

A

increased solubility

increased cardiac output

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20
Q

elimination of inhalation anesthetic

A

via exhalation

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21
Q

minimal alveolor concentration meaning

A

amount of drug that produces anesthesia in 50% of patients

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22
Q

how to calculate total MAC

A

take each gas component in mixture since it is additive to get 1 MAC

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23
Q

anesthetic effect on respriration

A

depresse respiration, pCO2 high and minute ventilation decreases

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24
Q

anesthetic effect on cardiovascular

A

cardiovascular depression, blood pressure declines. cardiac output variable differentiates between drugs

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25
Q

inhalation anesthetic that is less powerful at depressing blood pressure

A

sevoflurane

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26
Q

anesthetic that does not cause pCO2 buildup and CO not badly affected. most often the choice of drug

A

isoflurane

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27
Q

has huge MAC and used as adjuvant

A

nitrous oxide

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28
Q

why was halothane replaced

A

unwanted effects like nausia vomiting and sensitization of CV system

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29
Q

why is isoflurane widely used (3)

A

no cardiac sensitization, good muscle relaxant, no toxic metabolites

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30
Q

anesthetic barbiturate that cant be used because build up in tissue and has long half life

A

thiopental

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31
Q

rapid onset and short half life intravenous anesthetic

A

propofol

32
Q

why is diazepam not good for anesthetic

A

slow induction and super long half life when administered for longer

33
Q

midazolam produces amnesia so mix it with what to get what phenomenon?

A

mix with opioid to get conscious sedation

34
Q

opioids as analgesics effect on respiration and brainstem

A

depressed respiration, lower ventilation. more or less nausia

35
Q

opioids benefits for surgery

A

relief of pain and anxiety reduction

36
Q

total intravenous anesthesia

A

propofol for induction + opioid such as remifentanil + drug for amnesia such as midazolam + short acting muscle relaxant

37
Q

neurolept analgesia

A

fentanyl opioid + droperidol (antipsychotic) for minor surgery to relieve stress but not unconsciousness

38
Q

neurolept anesthesia

A

add also nitrous oxide

39
Q

ketamine

A

only intravenous anesthetic that stimulates cardiovascular system

40
Q

side effects of ketamine

A

dissociative anesthesia or dysphoria (intense hallucinations, anxiety and memories of surgery) so not favorite drug

41
Q

use of ketamine

A

burn patients, short term procedures for kids with cardiovascular concerns

42
Q

drugs that can treat nausea

A

ondanseron, 5HT blockers

43
Q

treat cough

A

dextromethorphan

44
Q

treat bradycardia (CV depression)

A

stimulants

45
Q

muscle relaxation treatment and reverse by what

A

anticholinergics

muscarinic agonists

46
Q

revrse msucle relaxation drug

A

muscarinic agonists

47
Q

main site of action of anesthetics

A

synapses

48
Q

presynaptic anesthetics and example

A

decrease transmitters release by blocking Ca channels. interfere with vescile docking/release (ex. isoflurane)

49
Q

postsynaptic anesthetics

A

effects on ligand gated ion channels increasing inhibition (GABA) snd decreasing excitation (glutamatergic transmission NMDA, cholinergic receptors)

50
Q

all anesthetics show power to increase inhibition by acting on gaba a receptors except

A

ketamine

51
Q

ketamine mostly has effects on what and blocks what

A

effect on spinal cord and blocks NMDARs

52
Q

neuromuscular blocking agents

A

blocks various reflexes and allow endotracheal intubation and ventilation so patient not fighting respirator. permit lower levels of aanesthetics

53
Q

neuromuscular blocking agent permit lower levels of what

A

anesthetics

54
Q

competitive nondepolarizing blocking agent

A

reversible and competitive, compete with acetylcholine for binding. can be short intermediate or long acting

55
Q

metabolism of nondepolarizing agents

A

plasma cholinesterase inactiavtes some of them when diffused from synapse to plasma. broken down in liver, excreted in kidneys

56
Q

depolarizing non competitive agents

A

short half life, rapid onset. binds to cholinergic receptor such that channel stays open for a long time. receptor becomes desensitized

57
Q

depolarizing non competitive agent example

A

succinylcholine

58
Q

both depolarizing and nondepolarizing neuromuscular agents dont cross BBB

A

TRUE

59
Q

rare genetic defect that blocks inactivation succinylcholine

A

genetic defect in plamsa pseudocholinesterase

60
Q

defect in plasma pseudocholinesterase use to inactivate succinylcholine does one

A

trouble breathing (apnea) increase as succinylcholine keeps getting administered

61
Q

local anesthetics

A

smaller fibers like a delta and c fibers carrying pain so more sensitive to local anesthetics

62
Q

local anesthetics target what channels

A

voltage gated sodium channels along the axon

63
Q

local anesthetics effects on sodium

A

block sodium influx, blocking propagation of action potential

64
Q

local anesthetics act better on which type of nerves and why

A

unmyelinated nerves because larger surface area of plasma membrane so easy access of anesthetic inside cell

65
Q

local anesthetic is often injected with what in order to prolong their action aand why

A

adrenaline because it causes vasoconstriction, reduce in blood flow so longer for anesthetic to reach systemic circulation. (altered pharmacokinetics)

66
Q

example of local anesthetic

A

lidocaine

67
Q

local anesthetics are weak acids or bases

A

weak bases

68
Q

what happens to local anesthetics if tissues ph lowered.

A

decrease in amount of lipid soluble drug that can enter neuron–>decrease effect of local anesthetic

69
Q

two categories of local anesthetics

A

ester (procaine) and amides (lidocaine)

70
Q

standard structure of local anesthetic

A

ring, linker region and amine group

71
Q

local anesthetics with ester links are metabolized by what

A

metabolized by plasma cholinesterase and shorter half lives

72
Q

local anesthetic duration with ester links in spinal fluid

A

longer duration because spinal fluid is low in esterase

73
Q

metabolism of local anesthetic amides

A

metabolized in liver and longer half life so more potency

74
Q

side effects of local anesthetic

A

large amounts can cause respiratory and cv arrest because interfering with neuronal activity.
loss of sensation of cold, heat, pain, touch, deep pressure

75
Q

EMILA cream and used for what

A

mixture of local anesthetics in cream form to increase absorption across skin as it changes solubility

used to relieve pain associated with vaccinations so that kids dont feel anything

Phar300 (18 decks)

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