Lecture 6 Flashcards
1
Q
Drugs Inhaled?
A
-Volatile
-Gas
2
Q
Voltatile Liquid?
A
-Halothane
-Isoflurane
-Desflurane
-Enflurane
-Sevoflurane
3
Q
That is Volatile so it HIDES?
A
-Halothane
-Isoflurane
-Desflurane
-Enflurane
-Sevoflurane
4
Q
Do you pass Gas?
A
NO (Nitrous Oxide)
5
Q
Fluorine?
A
Volatile
5
Q
Intravenous?
A
-Thiopental
-Midazolam
-Propofol
-Morphine
6
Q
“Too Many People Miss” IV?
A
-Thiopental
-Midazolam
-Propofol
-Morphine
(Intravenous)
7
Q
CAINE?
A
Local Anesthetics
8
Q
No Pain with?
A
Caine
9
Q
2 I’s?
A
Amide
10
Q
Local Anesthetics?
A
-Cocaine
-Procaine
-Tetracaine
-Lidocaine
-Bupivacaine
11
Q
General Anesthetics?
A
-Inhaled (Volatile liquids)
-Gas (NO)
-Intravenous
12
Q
General Anesthetics cause?
A
(Surgical Anesthesia)
(Drug-Induced absence of all sensations)
-Unconsciousness (Asleep)
-Analgesia (No Pain)
-Amnesia (No Memory)
-Loss of Reflexes (Don’t move)
13
Q
General Anesthetics Administered via?
A
1) Intravenous (very quick to put a patient asleep)
2) Inhalational (Maintain)
14
Q
Balanced Anesthesia?
A
Anesthesia with a mix of inhaled and intravenous anesthetics
15
Q
Evaporates at room temperature?
A
Volatile liquid
16
Q
Barbiturates?
A
(Thiopental) Hypnotic
17
Q
Benzodiazepines?
A
(Midazolam) Amnesic
18
Q
Phenols?
A
(Propofol) Very Short Half-Life
19
Q
Opioids?
A
(Morphine) Analgesic
20
Q
Intravenous drugs tend to reduce?
A
Blood Pressure
21
Q
Among the most dangerous drugs approved for general use?
A
Inhalational Anesthetics
22
Q
Kinetics of Uptake and Distribution of Anesthetic?
A
1) Rate of entry is controlled by respiration, a cyclic process
2) Elimination occurs in the lungs (except for methoxyflurane and halothane)
23
Q
Rate of entry is controlled by?
A
(Respiration, a cyclic process)
-Tidal Volume: amount of air in lung when you take a breath
-Rate of Respiration: # of breaths per minute
-Minute Ventilation: amount of air going in and out of lungs per minute
24
Minimum Alveolar Concentration (MAC)?
Concentration that results in immobility in 50% of patients when exposed to noxious stimulus (Surgical Incision)
25
The larger the MAC?
The more concentration needed to have an effect (NO)
26
The smaller the MAC?
The less concentration needed to have effect (Methoxyflurane)
27
Important factor influencing transfer of an inhaled anesthetic from the lungs to the arterial blood is its?
Solubility
28
Index of Solubility?
Affinity of an anesthetic for blood in comparison to air
29
Lower the solubility?
Faster the rate of rise of its tension in the blood and then in the Brain
30
Pressure is what allows drug to go from?
Lungs --> Blood --> Brain
31
We want low affinity to?
Blood, this will allow pressure to build up to go into Brain
32
PK of Inhalational Anesthetic: Factors affecting uptake?
-Solubility in Blood (Blood: Gas Partition Coefficient)
-Concentration of the Anesthetic Agent in the Inspired Gas
33
Increase in the inspired anesthetic concentration will?
Increase the rate of induction
34
Increase in pulmonary ventilation?
Speeds up the uptake of an anesthetic with higher blood:gas partition coefficient
35
More lipophilic = ?
Less drug needed to produce anesthesia
36
Meyer-Overton Hypothesis?
There is a direct correlation between lipid solubility and potency
37
Anesthetics work by influencing?
Synaptic Transmission (Ion-Gated), NOT axonal conduction (Voltage-Gated)
38
GABAa receptors (ion channels) are?
Prime target for most general anesthetics
39
GABAa channel activity is markedly?
Increased in the presence of clinically relevant concentrations of barbiturates, benzodiazepines, propofol, and enflurane
40
These Anesthetics increase the affinity of the GABAa receptor for GABA?
barbiturates, benzodiazepines, propofol, and enflurane
41
Target = GABAa?
Increases affinity for GABA
42
General Anesthesia uses?
GABA
43
Local Anesthesia uses?
Voltage-Gated
44
Practical Approach to Evaluate Depth of Anesthesia?
-Eyelid blink
-Swallowing reflex
-Respiration become irregular
(As anesthesia depends all the above responses are reduced)
45
An increase in the depth of anesthesia brings about?
Progressive reduction in respiratory tidal volume
46
When potent halogenated agents are used?
Arterial blood pressure tends to vary directly with the depth of anesthesia, and hypotension can be used as an approximate index of dosage
47
Dose-Dependent Reduction in Blood Pressure?
(Most practical measure of the depth of anesthesia) (Cardiovascular Effects (halogenated general anesthetics))
48
Reduce spontaneous ventilation in a concentration-dependent manner by?
(Respiratory Effects (halogenated general anesthetics))
Depressing medullary centers in the brainstem, reducing minute ventilation
49
Halogenated General Anesthetics cause?
-Decreased BP due to Vasodilation
-Decreased minute ventilation due to decreased medulla
50
Malignant Hyperthermia?
(Adverse Effect) Rapid rise in body temperature (can be lethal)
51
Most common with combined use halothane and succinylcholine?
Malignant Hyperthermia
52
Symptoms of Hyperthermia?
Tachycardia, Hypertension, Acidosis, and Muscle Rigidity
53
Malignant Hyperthermia results from?
Failure to sequester Ca2+, preventing dissociation of actin and myosin filaments of muscle
54
Dantrolene?
Muscle relaxer, used for Malignant Hyperthermia
55
Nitrous Oxide?
Colorless gas without odor or taste (always have to combine it with something)
56
NO?
Nitrous Oxide (Analgesic (NO pain)) (Very low potency)
57
Barbiturates?
(Thiopental) Hypnotic, takes 10-20 seconds for loss of consciousness and 30-40 seconds to loss of eyelash reflexes (1 arm-to-brain circulation)
58
Poor Analgesics?
Not for pain just will knock you out
59
Circulation of Barbiturates?
Thiopental decreases arterial pressure due to a reduction in cardiac output
60
Respiration of Barbiturates?
Thiopental reduces minute ventilation by lowering the sensitivity of the medullary respiratory center to carbon dioxide
61
Oil at room temperature?
Propofol
62
Propofol induces anesthesia as rapidly as?
Thiopental but in comparison has a significantly shorter half-life (30-60 minutes)
63
Decreases systemic arterial pressure due to peripheral vasodilation (NOT cardiac output)?
Propofol
64
Propofol decreases?
Systemic Arterial Pressure due to Peripheral Vasodilation (NOT cardiac output)
65
Which drug will Apnea and pain at the site of injection occur?
Propofol
66
"Day Surgery" Drug?
Propofol
67
Extremely lipid soluble?
Propofol
68
Types of Benzodiazepines?
Midazolam and Diazepam
69
Benzodiazepines cause?
Sedation, a reduction in anxiety and amnesia
70
Benzodiazepines are NOT?
Analgesic (No pain relief)
71
Alone cause only a moderate depression of circulation and respiration?
Benzodiazepines
72
Benzodiazepines prolong?
Postanesthetic Recovery Period
73
Flumazenil?
(Antagonist) Can reverse action of Benzodiazepines
74
Amnesic NOT Analgesic?
(Benzodiazepines)
You don't remember, NOT pain relief
75
Types of Opioid Analgesics?
Morphine and Fentanyl
76
Opioid Analgesics are?
(Pain Relief) Powerful Analgesic, supplements during general anesthesia, large doses can induce anesthesia on its own
77
Opioid Analgesics can cause?
-Mild decrease in BP
-Impair ventilation
-Respiratory depression is severe with a large dose of Opioids
-Increase chest wall rigidity
78
Side Effects of Opioid Analgesics?
Nausea or Vomiting, unpleasant postoperative recall and some delay in awakening
79
Naloxone?
(Antagonist) (Naltrexone is another Antagonist) Used for Opioid Overdose
80
Will stop breathing on what drugs?
Opioid Analgesics
81
Local Anesthetic?
Reversibly block impulse conduction along nerve axons, that use sodium channels as their primary means of action potential generation
82
Block pain sensation?
Local Anesthetic
83
To achieve the loss of sensation without the loss of consciousness?
Local Anesthetic
84
Local Anesthetic Agents consist of?
Lipophilic Group (frequently an aromatic ring) connected by an Intermediate Chain (commonly an ester or amide) to an ionizable group (often a tertiary amine)
85
Esters?
CPT
-Cocaine
-Procaine
-Tetracaine
86
Esters are not intended for?
Systemic Circulation
87
(Vasoconstrictor or Vasodilator) Cocaine?
Vasoconstrictor
88
(Vasoconstrictor or Vasodilator) Procaine?
Vasodilator
89
(Vasoconstrictor or Vasodilator) Tetracaine?
Vasodilator
90
Amide?
-Lidocaine
-Bupivacaine
91
(Vasoconstrictor or Vasodilator) Lidocaine?
Vasodilator
92
(Vasoconstrictor or Vasodilator) Bupivacaine?
Vasodilator
93
Local Anesthetics are Weak?
Bases (pKa range from 8.0-9.0)
94
Local Anesthetics ionized form of the drug?
In the body (occupies sodium channels)
95
Local Anesthetics non-ionized form of the drug?
Penetrates the cells
96
CPT has?
Short Half-Life
96
Bind selectively to the Intracellular Surface of Voltage-Gated Sodium Channels and block the entry of sodium into the cell?
Local Anesthetics
97
Cardiovascular Toxicity is the result partly from?
-Direct effect upon cardiac and smooth muscle
-Indirect effect upon autonomic nerves
98
Local Anesthetics all cause Cardiac Contraction except?
Cocaine
