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Pharm 2 > Lecture 2 - GA > Flashcards

Lecture 2 - GA Flashcards

1
Q

What was the first anesthetic?

A

ether

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2
Q

What is the theory behind how anesthetics work?

A

produced by changes in the physical properties of cell membranes

fails to explain how the proposed disturbance of the lipid bilayer would result in a dysfunctional membrane protein

how they actually work: make the receptors more sensitive to GABA so they activate at a lower threshold

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3
Q

How do barbituates differ from benzodiazepines in regard to anesthetic mechanism?

A

Both enhance GABA function

Barbiutates do so by increasing the lenght of time that chloride channels remain open

Benzos do so by increasing affinity of GABA to GABAa receptor

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4
Q

Ketamine and NO do what to the GABAa receptor and what to the NMDA receptor?

A

Ketamine and NO don’t do anything to the GABAa receptors but they do inhibit NMDA receptors

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5
Q

Etomidate, propofol, barbiutates, isoflurane, and secoflurance are anesthetics because they all do what?

A

enhance the GABAa receptor

increasing Cl- conductance

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6
Q

1 MAC

A

alveolar concentration that renders 50% of subjects exposed to noxious stimuli (such as surgical incision) immobile

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7
Q

___MAC is mild anesthesia

A

0.3

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8
Q

___MAC is amnesia

A

0.5

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9
Q

____% of pts fail to respond to a noxious stimulus at ____ MAC, and ___MAC the sympathetic responses to surgery are blunted and ____% of subjects are immobile

A

95% at 1.3 MAC

99% at 1.5 MAC

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10
Q

What MAC is often used for induction?

A

2.0

any higher than this dose can be fatal

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11
Q

MAC

A

minimal alveoli concentration

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12
Q

Which drug is more potent, MAC of 90 or MAC of 0.01?

A

MAC of 0.01

that means % of air needed to get to 1 MAC is much smaller

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13
Q

Go back through the examples in the slides/notes

A

do it

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14
Q

When are inhalation anesthetics used?

A

primarily used for maintenance

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15
Q

What does the blood:gas partition coefficient tell us about the drug?

A

solubility
the lower the solubility the quicker on/off (induction)

speed of induction is inversely proportional to the solubility of the agent in blood (blood:gas partition)

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16
Q

NO has a low solubility, what does this mean in regards to induction time?

A

fast

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17
Q

Methoxyflurane is highly soluble, what does this mean in regards to induction time?

A

slow

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18
Q

What is the order of drugs from fastest induction to slowest?

A 
NO
Isoflurane 
Enflurane
Halothane
Methoxyflurane

fastest to equilibrium

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19
Q

What does Fat:blood partition coefficient mean?

A

distribution of the anesthetic in different tissues

if the agent is more soluble in fat, equilibrium may take a long time (hours)

takes a long time to accumulate in fat, thus takes a long time to leave fat (d/t low blood flow of fat)

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20
Q

Where in the body does NO reach equilibrium first?

A

Lung and blood
then
brain, heart, kidney

then much later muscle
then even later fat

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21
Q

What makes an ideal anesthetic?

A

Low blood:gas coefficient
Low fat:blood partition coefficient
MAC –??
no metabolism

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22
Q

What properties does Halothane have?

A

high blood:gas (slow induction)

high fat:blood (there will be a difference between fat people and skinny people

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23
Q

What are the disadvantages of halothane?

A

halothane hepatitis - immune response evoking hepatitic necrosis, fever, nausea, rash and vomiting

malignant hyperthermia (volatile anesthetics)

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24
Q

What are the characteristics of enflurane?

A

blood:gas relatively high –slow induction

25
Q

What are the disadvantages of enflurane?

A

CV depression d/t decrease in contractility

seizures - no permanent damage

uterine muscle relxant

26
Q

What is the most commonly used inhalation anesthetic in the US?

A

isoflurane

27
Q

What are the characteristics of Isoflurane?

A

blood:gas relatively low - somewhat fast induction

1MAC = 1.4%

28
Q

What are the advantages of isolflurane?

A

CO maintained
systemic vessels dilate causing small decrease in BP
arrhythmias uncommon
potent coronary vasodilator

29
Q

What are the disadvantages of isoflurane?

A

more pungent than halothane

progressive respiratory depression

30
Q

What are the characteristics of sevoflurane?

A

low blood:gas - fastest induction

31
Q

What are the advantages of sevoflurane?

A

can be used for outpatient anesthesia because of its rapid recovery profile

32
Q

What are the disadvantages of sevoflurane?

A

some reports of toxicity

33
Q

What are the characteristics of desoflurane?

A

very low blood:gas
very fast induction
very fast emergence (5-10 min)

34
Q

What are the advantages of desoflurane?

A

use for outpatient surgery - rapid onset, rapid recovery

not very soluble in fat

35
Q

What are the disadvantages of desoflurane?

A

more irritating to airway
can provoke coughing, salivation, and bronchospasm

low volatitily - requires use of specially heated vaporizer

may evoke tachycarida

36
Q

What are the characteristics of methoxyflurane?

A

very high blood:Gas

highly soluble in RUBBER (means you need more specialized equipment)

37
Q

What are the advantages of methoxyflurane?

A

very potent

38
Q

What are the disadvantages of methoxyflurane?

A

extensive metabolism

may produce renal failure and nephrotoxicity (rarely ever used)

39
Q

What are the characteristics of NO?

A

1 MAC = 105%

blood:Gas low –rapid induction and emergence

analgesic (not anesthesia)

70-80% in O2 is typical usage

40
Q

What are the advantages of NO?

A

powerful analgesic
rapid induction/recovery
little toxicity
analgesia before anesthesia

41
Q

What are the disadvantages of NO?

A

weak agent
hypoxia –may occur upon d/c –give 100% o2
closed air spaces may expand since NO exhanges with N2 –not to be used in pts with bowel obstructions or middle ear obstructions

42
Q

Malignant hyperthermia

A

a rare heritable disorder triggered by volatile anesthetics (halothane) and by some nueromuscular blockers (succinlycholine)
caused by an inability of sarcoplasmic retiuculm to sequester a2+
the triggering agents cuase a sustained and prolonged release of Ca2+ and massive muscle contraction, lactate production and increased body temperature

treat with dantrolene to reduce intracellular Ca2+ release

43
Q

What is the treatment for malignant hyperthermia?

A

dantrolene

to reduce intracellular Ca2+ release

44
Q

Which IV anesthetics are primarily used for INDUCTION?

A

barbiturates
propofol
etomidate
ketamine

45
Q

What are the characteristics of IV anesthetics?

A

rapid onset (seconds)
rapid awakening (minutes)
danger of OD due to irrevocability of IV injection
redistribution determines duration of action

46
Q

Which barbiturate is used in anesthesia?

A

sodium thiopental

47
Q

What are the advantages of sodium thiopental?

A 
little post-anesthetic excitement or vomiting 
water soluble (makes it easier to use)
48
Q

What are the disadvantages of sodium thiopental?

A

respiratory and CV depression
no antagonist
slow recovery
no analgesia

49
Q

What are the advantages of propofol?

A

rapid metabolism and recovery
little accumulation
“milk of amnesia: as it produces a hypnotic and forgetful rest

50
Q

What are the disadvantages of propofol?

A 
not water soluble 
no antagonist 
no analgesia 
cardiorespiratory depression 
can elicit pain upon initial injection
51
Q

Ketamine advantages

A

analgesia
no respiratory depression –may increase BP
produces hypnotic state - dissociative anesthesia

this is more commonly used in kids than adults

52
Q

What are the disadvantages of ketamine?

A

increased muscle tone and incidence of involuntary movements
hallucination
adverse effects are less common in children

53
Q

What are the advantages of etomidate?

A

antagonist available
anterograde amnesia
CV stability –primarily used for pts at risk for hypotension

54
Q

What are the disadvantages of etomidate?

A

accumulates - slow recovery
no analgesia
pain on injection

55
Q

What preanesthetic medications are used?

A 
Benzos 
Antihistamines
Antiemetics
Opioids
Antimuscarinics
Muscle relaxants
56
Q

Why are benzos used preanesthetically?

A

to reduce anxiety
induce amnesia

ex. medazolam, diazepam (valium)

57
Q

Which anesthetic would you use for a pt at risk for hypotension?

A

etomidate

58
Q

Why are antimuscarinics given?

A

amnesia
prevent bradycardia and fluid secretion
ex. scopolamine, atropine

Pharm 2 (6 decks)

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