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Block 1: Pharmacology > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Drugs Inhaled?

A

-Volatile
-Gas

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2
Q

Voltatile Liquid?

A

-Halothane
-Isoflurane
-Desflurane
-Enflurane
-Sevoflurane

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3
Q

That is Volatile so it HIDES?

A

-Halothane
-Isoflurane
-Desflurane
-Enflurane
-Sevoflurane

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4
Q

Do you pass Gas?

A

NO (Nitrous Oxide)

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5
Q

Fluorine?

A

Volatile

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5
Q

Intravenous?

A

-Thiopental
-Midazolam
-Propofol
-Morphine

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6
Q

“Too Many People Miss” IV?

A

-Thiopental
-Midazolam
-Propofol
-Morphine
(Intravenous)

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7
Q

CAINE?

A

Local Anesthetics

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8
Q

No Pain with?

A

Caine

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9
Q

2 I’s?

A

Amide

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10
Q

Local Anesthetics?

A

-Cocaine
-Procaine
-Tetracaine
-Lidocaine
-Bupivacaine

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11
Q

General Anesthetics?

A

-Inhaled (Volatile liquids)
-Gas (NO)
-Intravenous

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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)

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13
Q

General Anesthetics Administered via?

A

1) Intravenous (very quick to put a patient asleep)
2) Inhalational (Maintain)

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14
Q

Balanced Anesthesia?

A

Anesthesia with a mix of inhaled and intravenous anesthetics

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15
Q

Evaporates at room temperature?

A

Volatile liquid

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16
Q

Barbiturates?

A

(Thiopental) Hypnotic

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17
Q

Benzodiazepines?

A

(Midazolam) Amnesic

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18
Q

Phenols?

A

(Propofol) Very Short Half-Life

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19
Q

Opioids?

A

(Morphine) Analgesic

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20
Q

Intravenous drugs tend to reduce?

A

Blood Pressure

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21
Q

Among the most dangerous drugs approved for general use?

A

Inhalational Anesthetics

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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)

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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

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24
Q

Minimum Alveolar Concentration (MAC)?

A

Concentration that results in immobility in 50% of patients when exposed to noxious stimulus (Surgical Incision)

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25
Q

The larger the MAC?

A

The more concentration needed to have an effect (NO)

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26
Q

The smaller the MAC?

A

The less concentration needed to have effect (Methoxyflurane)

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27
Q

Important factor influencing transfer of an inhaled anesthetic from the lungs to the arterial blood is its?

A

Solubility

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28
Q

Index of Solubility?

A

Affinity of an anesthetic for blood in comparison to air

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29
Q

Lower the solubility?

A

Faster the rate of rise of its tension in the blood and then in the Brain

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30
Q

Pressure is what allows drug to go from?

A

Lungs –> Blood –> Brain

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31
Q

We want low affinity to?

A

Blood, this will allow pressure to build up to go into Brain

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32
Q

PK of Inhalational Anesthetic: Factors affecting uptake?

A

-Solubility in Blood (Blood: Gas Partition Coefficient)
-Concentration of the Anesthetic Agent in the Inspired Gas

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33
Q

Increase in the inspired anesthetic concentration will?

A

Increase the rate of induction

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34
Q

Increase in pulmonary ventilation?

A

Speeds up the uptake of an anesthetic with higher blood:gas partition coefficient

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35
Q

More lipophilic = ?

A

Less drug needed to produce anesthesia

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36
Q

Meyer-Overton Hypothesis?

A

There is a direct correlation between lipid solubility and potency

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37
Q

Anesthetics work by influencing?

A

Synaptic Transmission (Ion-Gated), NOT axonal conduction (Voltage-Gated)

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38
Q

GABAa receptors (ion channels) are?

A

Prime target for most general anesthetics

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39
Q

GABAa channel activity is markedly?

A

Increased in the presence of clinically relevant concentrations of barbiturates, benzodiazepines, propofol, and enflurane

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40
Q

These Anesthetics increase the affinity of the GABAa receptor for GABA?

A

barbiturates, benzodiazepines, propofol, and enflurane

41
Q

Target = GABAa?

A

Increases affinity for GABA

42
Q

General Anesthesia uses?

A

GABA

43
Q

Local Anesthesia uses?

A

Voltage-Gated

44
Q

Practical Approach to Evaluate Depth of Anesthesia?

A

-Eyelid blink
-Swallowing reflex
-Respiration become irregular
(As anesthesia depends all the above responses are reduced)

45
Q

An increase in the depth of anesthesia brings about?

A

Progressive reduction in respiratory tidal volume

46
Q

When potent halogenated agents are used?

A

Arterial blood pressure tends to vary directly with the depth of anesthesia, and hypotension can be used as an approximate index of dosage

47
Q

Dose-Dependent Reduction in Blood Pressure?

A

(Most practical measure of the depth of anesthesia) (Cardiovascular Effects (halogenated general anesthetics))

48
Q

Reduce spontaneous ventilation in a concentration-dependent manner by?

A

(Respiratory Effects (halogenated general anesthetics))
Depressing medullary centers in the brainstem, reducing minute ventilation

49
Q

Halogenated General Anesthetics cause?

A

-Decreased BP due to Vasodilation
-Decreased minute ventilation due to decreased medulla

50
Q

Malignant Hyperthermia?

A

(Adverse Effect) Rapid rise in body temperature (can be lethal)

51
Q

Most common with combined use halothane and succinylcholine?

A

Malignant Hyperthermia

52
Q

Symptoms of Hyperthermia?

A

Tachycardia, Hypertension, Acidosis, and Muscle Rigidity

53
Q

Malignant Hyperthermia results from?

A

Failure to sequester Ca2+, preventing dissociation of actin and myosin filaments of muscle

54
Q

Dantrolene?

A

Muscle relaxer, used for Malignant Hyperthermia

55
Q

Nitrous Oxide?

A

Colorless gas without odor or taste (always have to combine it with something)

56
Q

NO?

A

Nitrous Oxide (Analgesic (NO pain)) (Very low potency)

57
Q

Barbiturates?

A

(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
Q

Poor Analgesics?

A

Not for pain just will knock you out

59
Q

Circulation of Barbiturates?

A

Thiopental decreases arterial pressure due to a reduction in cardiac output

60
Q

Respiration of Barbiturates?

A

Thiopental reduces minute ventilation by lowering the sensitivity of the medullary respiratory center to carbon dioxide

61
Q

Oil at room temperature?

A

Propofol

62
Q

Propofol induces anesthesia as rapidly as?

A

Thiopental but in comparison has a significantly shorter half-life (30-60 minutes)

63
Q

Decreases systemic arterial pressure due to peripheral vasodilation (NOT cardiac output)?

A

Propofol

64
Q

Propofol decreases?

A

Systemic Arterial Pressure due to Peripheral Vasodilation (NOT cardiac output)

65
Q

Which drug will Apnea and pain at the site of injection occur?

A

Propofol

66
Q

“Day Surgery” Drug?

A

Propofol

67
Q

Extremely lipid soluble?

A

Propofol

68
Q

Types of Benzodiazepines?

A

Midazolam and Diazepam

69
Q

Benzodiazepines cause?

A

Sedation, a reduction in anxiety and amnesia

70
Q

Benzodiazepines are NOT?

A

Analgesic (No pain relief)

71
Q

Alone cause only a moderate depression of circulation and respiration?

A

Benzodiazepines

72
Q

Benzodiazepines prolong?

A

Postanesthetic Recovery Period

73
Q

Flumazenil?

A

(Antagonist) Can reverse action of Benzodiazepines

74
Q

Amnesic NOT Analgesic?

A

(Benzodiazepines)
You don’t remember, NOT pain relief

75
Q

Types of Opioid Analgesics?

A

Morphine and Fentanyl

76
Q

Opioid Analgesics are?

A

(Pain Relief) Powerful Analgesic, supplements during general anesthesia, large doses can induce anesthesia on its own

77
Q

Opioid Analgesics can cause?

A

-Mild decrease in BP
-Impair ventilation
-Respiratory depression is severe with a large dose of Opioids
-Increase chest wall rigidity

78
Q

Side Effects of Opioid Analgesics?

A

Nausea or Vomiting, unpleasant postoperative recall and some delay in awakening

79
Q

Naloxone?

A

(Antagonist) (Naltrexone is another Antagonist) Used for Opioid Overdose

80
Q

Will stop breathing on what drugs?

A

Opioid Analgesics

81
Q

Local Anesthetic?

A

Reversibly block impulse conduction along nerve axons, that use sodium channels as their primary means of action potential generation

82
Q

Block pain sensation?

A

Local Anesthetic

83
Q

To achieve the loss of sensation without the loss of consciousness?

A

Local Anesthetic

84
Q

Local Anesthetic Agents consist of?

A

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
Q

Esters?

A

CPT
-Cocaine
-Procaine
-Tetracaine

86
Q

Esters are not intended for?

A

Systemic Circulation

87
Q

(Vasoconstrictor or Vasodilator) Cocaine?

A

Vasoconstrictor

88
Q

(Vasoconstrictor or Vasodilator) Procaine?

A

Vasodilator

89
Q

(Vasoconstrictor or Vasodilator) Tetracaine?

A

Vasodilator

90
Q

Amide?

A

-Lidocaine
-Bupivacaine

91
Q

(Vasoconstrictor or Vasodilator) Lidocaine?

A

Vasodilator

92
Q

(Vasoconstrictor or Vasodilator) Bupivacaine?

A

Vasodilator

93
Q

Local Anesthetics are Weak?

A

Bases (pKa range from 8.0-9.0)

94
Q

Local Anesthetics ionized form of the drug?

A

In the body (occupies sodium channels)

95
Q

Local Anesthetics non-ionized form of the drug?

A

Penetrates the cells

96
Q

CPT has?

A

Short Half-Life

96
Q

Bind selectively to the Intracellular Surface of Voltage-Gated Sodium Channels and block the entry of sodium into the cell?

A

Local Anesthetics

97
Q

Cardiovascular Toxicity is the result partly from?

A

-Direct effect upon cardiac and smooth muscle
-Indirect effect upon autonomic nerves

98
Q

Local Anesthetics all cause Cardiac Contraction except?

A

Cocaine

Block 1: Pharmacology (9 decks)

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