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PHAR 300 > Lecture #15 - Drugs and Surgery > Flashcards

Lecture #15 - Drugs and Surgery Flashcards

1
Q

First anesthetics?

A

Diethyl ether

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2
Q

Diethyl ether was replaced by? in 1956

A

Halothane, because

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3
Q

General anesthesia induce in patients?

A

Loss of consciousness/sensation
Amnesia
Relaxation of skeletal musc.
Autonomic and endocrine reflexes are then suppressed

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4
Q

Premedication aims at ?

A

reduce anxiety, pain, salivation

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5
Q

2 steps of general anesthesia: Induction goal

Second step?

A

1-Induce unconsciousness very quickly

2-maintains unconsciousness: volatile agent/gases

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6
Q

Inhalation anesthetics all en in?
Barbiturates often end in?
Benzo?

A

ane
al
am

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7
Q

IV tend to have… structure and volatile agents … structure.

A

ring - not ring

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8
Q

Pharmakokinetics of Inhalation Anesthesia two major components and their subcompanents?

A

1-Partial pressure of the gas

2-Blood flow: If high CO, less relative go to brain so reduce induction

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9
Q

If gas dissolved in blood does it still contribute to the gas partial pressure?

A

No

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10
Q

Is nitrous oxide a gas? Why better then all the other?

A

No, volatile liquid.

Because it doesn’t decrease blood pressure/respiration

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11
Q

Factors influencing rate of induction (4)?

A

1-Higher the {} in inspired gas the faster the induction
2-Higher ventilation = faster indution
3-GREATER THE SOLUBILITY OF GAS IN BLOOD, THE SLOWER THE INDUCTION RATE, BECAUSE LESS DRUG ENTERS THE BRAIN AND STAYS IN THE BLOOD.
4-High CO = lower relative {}to brain

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12
Q

MAC?

A

Minimal Alveolar Concentration = ED50. 1.3MAC is the gold standard

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13
Q

Respiratory depression caused by?

A

Increasing CO2 level in blood

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14
Q

Inhalationnal have musc. relaxant effect? Does NO have one?

A

Yes, no.

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15
Q

Metabolization of Inhalationnal?

A

1-2%, the rest is exhaled. Except halothane 15% met.

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16
Q

Halothane compatible with epinephrine?

A

NO

17
Q

Inhalationnal cause vomitting?

A

Yes by triggering CTZ.

18
Q

Can NO cause complete general anes.?

A

No, because would need to be 100%, but you need to give O2 at the same time.

19
Q

Isoflurane/Sevoflurane sensitize the heart?

A

No, compatible with EPI

20
Q

Generally IV have…. cardiovascular/respiratory depressive effects?

A

less

21
Q

IV pharmakokinetics?

A

Lipid soluble, effect is fast with short duration of action

22
Q

Do IV have a wider margin of safety?

A

YES

23
Q

Onset of action of thiopental? Distribution?

A

30 seconds, distributed throughout the body

24
Q

Midazolam advantage over diazepam? Danger?

A

Faster action. Accumulate in the body

25
Q

Conscious sedation?

A

Opioid + MIdazolam

26
Q

Opiod resp. depression caused by?

A

Inability to respond to higher CO2 blood level

27
Q

1-“Neurolept” analgesia? and 2-anesthesia?

A

1-Fentanyl + antipsychotic

2-With NO

28
Q

Only IV that stimulates Cardio?

A

Ketamine

29
Q

Antagonize nausea?

A

Ondansteron - 5HT blocker

30
Q

Pharmakodynamics of general anesthetics?

A

1) Decrease transmitter release at presynaptic terminal
2) Decrease responsivness at post-synaptic
3) Extra-synaptically at pre-synaptic side affecting Ca+ release
4) Extra-synaptically at post-synaptic side affecting tonic inhibition.

31
Q

Except for ketamine and NO all IV?

A

Increase GABA inhibition

32
Q

Ketamine action?

A

decrease glutamate at NMDA receptor, blocking excitation

33
Q

Musc. blocking agents (2)?

A

1- Competitive blocking: Curare derivative, (ium). Compete with acetylcholine
2- Succinylcholine: Activate receptor and keep receptor desensitized.

34
Q

Succinylcholine danger?

A

Indi. deficient in pseudocholinesterase, they cannot breakdown the drug. They will stop breathing.

35
Q

Local analgesia mec. of action?

A

Act on voltage gated Na+ channel. = stop spreading of action-potential

36
Q

Local analgesia often given with adrenaline b/c?

A

Reduce blood flow -> reduce plasma cholinesterase which metabolizes them (also liver meta. them)

37
Q

Derivative of cocaine, sometime used for?

A

Cardiac arrythmias

38
Q

two cat. of local anes.?

A

Ester and amides (amide = longer half-life)

39
Q

EMLA?

A

Eutectic mixture of local anesthetics

PHAR 300 (14 decks)

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