Megan's Guide Flashcards
1
Q
parenteral routes of drugs
A
IV, IM, SC,etc
2
Q
volatile anesthetics: cerebral blood flow
A
increase vasodilation, decrease vasc resistance, increase CBF, increase ICP
3
Q
opioids: metabolism
Fent, Remi, Morphine, Meperidine
A
fentanyl 75% lungs
remi: plasma/tissue
morphine: gluc acid hepatic/renal
meperidine 90% hepatic
4
Q
midazolam: first pass metabolism
A
50% first pass
5
Q
local anesthetics: target channels
A
Na channels
6
Q
volatile anesthetics: coronary blood flow
A
iso is a potent coronary vasodilator
7
Q
desflurane and CO2 absorber
A
carbon monoxide, from dry dessicated absorber
8
Q
bupivicaine toxicity
A
A lower dose of bupivicaine than lidocaine will produce Cardiovascular collapse
Pregnant patients may be more sensitive
Cardiac resuscitation is more difficult after bupivacaine Cardiotoxicity potentiated by acidosis and hypoxia
9
Q
uptake and distribution: alveolar PP
A
uptake = solubility x CO x (PA-PV)
10
Q
opioids: side effects
A
pruritis, N/V, urinary retention, vent despression
11
Q
local anesthetics: metabolism
A
amides: liver CYP450
esters: cholinesterase enzymes
12
Q
opioids:best for neurological assessment post-op
A
remifentanyl
13
Q
desflurane and heart rate
A
increased due to SNS stimulation
14
Q
local anesthetics: nodes of ranvier
A
2-3 blocked will stop the action potential
15
Q
compound A formation
A
sevo interation with CO2 absorbers, higher levels seen in Baralym vs soda lime, nephrotixin in rates, use flows higher than 2
16
Q
EMLA components
A
5% lidocaine, 5% prilocaine
17
Q
Induction drugs: hiccups
A
methohexital (brevitol), etomidate
18
Q
benzodiazepine-ion channel effect
A
hyperpolarization
19
Q
induction drugs: cortisol secretion
A
etomidate
20
Q
inhaled agents: bone marrow suppression
A
nitrous oxide
21
Q
Induction drugs: propofol method of action
A
decrease GABA dissociation
22
Q
opioids: histamine release
A
morphine, meperidine
23
Q
opioids: potency
A
MMHAFRS
24
Q
opioids: remi metabolism
A
plasma cholinesterase
25
opioids: seizure
meperidine or normeperidine with renal failure
26
local anesthetics: cardiotoxicity
circumoral numbness, tinitus
27
dibucaine number
80
28
propofol: additives
glycerol burns, disodium edetate is bacteriostatic
29
opioid: side effects, glucagon
tx biliary coloc 2mg IV
30
ketamine: tx for emergence delirium
benzos
31
thiopental redistribution
effects 5-10 minutes bc of redistribution
32
benzodiazepine: clinical effect
20%: anxiolytic, 30% sedation, amnestic 60% unconscious
33
opioid: dynorphon receptors
kappa
34
inhaled agents: metabolism
exhalation, biotransformation, transcutaneous loss(hal - sevo - iso - des - n20)
35
opioids: renal failure
alfentanyl
36
dose of etomidate
0.2-0.3mg/kg
37
induction drugs: causes analgesia
ketamine
38
duration of naloxone
30-45 minutes
39
local anesthetic: effect of epinephrine
increase duration due to vasoconstriction
40
inhaled anesthetics: MH
don't use
41
local anesthetics: cauda equina syndrome
serious potential complication of spinal anesthesia
42
local anesthetics: methemoglobemia
benzocaine/prilocaine (ortholuidine is the metabolite that causes methemoglobinemia); decreases oxygen carrying capacity of hemoglobin, oxidation of hemoglobin to methemoglobibemia, neonates at higher risk, normal metHbB is less than 1%, pulse ox will read 85, treat with methylene blue 1-2 mg/kg
43
induction drugs: effect of ICP
thio and etom decrease ICP, prop and ketamine increase ICP
44
chloroprocraine: contraindicated in
spinal
45
premedication in children
0.5mg/kg versed PO
46
midazolam: drug interactions
synergistic with opioids
47
induction drugs: myoclonus
etomidate
48
volatile anesthetics: preservatives
halothane has thymol
49
volatile anesthetics: reactive airway
don_t use des, use sevo
50
maximum dose of bupivacaine
225mg with epi, 175 mg w/out epi
51
flumazenil metabolism
quick, doesn_t last = resedation
52
mechanism of action for barbiturates
decrease GABA dissociation
53
propofol CV effects
decrease BP and increase HR
54
alpha 1 glyco protein (protein binding)
basic
55
benzodiazepine: contraindications
PO no grapefruit, pregnancy
56
division of CO
75% VRG (10% of body mass), 19% muscle (50% of body mass) 6% fat (20% body mass) 0% VPG (20% body mass)
57
isoflurane CV effects
decrease SVR, increase HR, no effect of CO, coronary steal
58
desflurane, physical properties
liquid at room temp
59
iso and des
increase heart rate
60
inhaled anethetics: cerebral metabolic rate of oxygen
decrease CMRO2
61
MAC additive properties
MACs are additive
62
thiopental pH
10.5
63
induction drugs: does not interact with GABA
ketamine
64
thiopental concentration
2.50%
65
inhaled anesthetic: analgesic properties
NO only
66
propfol in ICU
3 days then hyper lipidemia
67
routes of administration: onset times
IV, intraosseous, endotracheal, inhalational, sublingual, IM
68
indirect agonist definition
acting receptor agonist _ drug that produces its physiologic response by increasing the concentration of ENDOGENOUS substrate (neurotransmitter or hormone) at receptor site
69
local anesthetics: ion trapping
refers to a phenomenon that occurs when a difference on pH exists in two body compartments. The more acidotic the pH, the greater the fraction of local, which is a basic compound, that ionizes. Ionized compounds are water soluble and cannot easily pass biologic membrands. when a local becomes more ionized and water soluble it becomes less able to leave the body compartment. If a patient who has CNS toxicity due to local overdose, is improperly managed, and becomes hypoxic with accompanying acidosis, the local becomes trapped in the CNS worsening the toxicity. Can also occur in pregnant patients because fetal pH is lower than maternal pH.
70
racemic mixture
50-50 entantiomers
71
CPP=
CPP = MAP - ICP
72
propofol metabolism
hepatic metabolism, glucuronidation is the major pathway
73
propoful IV sedation dose
25-100 mcg/kg/min
74
propofol GA TIVA dose
100-200 mcg/kg/min
75
solubility definition
_Relative affinity of an anesthetic for two phases and therefore the partitioning of that anesthetic between the two phases at equilibrium
76
inhaled anesthetics: what is equilibrium
no difference in partial pressure exists
77
partial pressure
the pressure which is the pressure the gas would have if it alone occcupied the volume
78
two ways to increase initial concentration of gas and the uptake
concentration effect, 2nd gas effect
79
effect of solubility on gas uptake
decreased solubility increases PA/PI so induction is quicker, increased solubility slows induction time
80
inhaled anesthetics: CO effect
increased CO means increased solubility and slower induction
81
what changes pharmacokinetics?
age, lean muscle, body fat, hepatic fxn, pulmonary gas exchange, CO
82
What do we want GA to do?
Minimize deleterious direct and indirect effects of agents, Sustain physiologic homeostasis during procedure, Improve postop outcomes
83
what MAC prevents mvmt in 95%
1.3
84
MAC and hypothermia
For each decrease in core temp 1 degree C_MAC is decreased by 5%
85
MAC and chronic alcohol abuse
MAC unaltered
86
MAC and acute alcohol intox
MAC decreased
87
Agents that decrease myocardial contractility and CO
halothane and enflurane
88
Which agents decrease SVR?
iso, des, sevo
89
Which agents decrease PVR?
all, blunt hypoxic pulmonary vasoconstriction response, (N2O known to increase PVR in pts with hypertension)
90
Inhaled agents and arrythmias
halothane desensitizes the myocardium to catecholamines, exogenous epi can cause vtach and pvc, sinus brady and av rhythms bc of direct depressive effect on SA node / halo, iso, des and sevo prolong QT interval
91
Inhaled agents and MV
increase RR decrease TV, rapid shallow breathing which causes and increase in PaCO2, drugs probably inhibit medullary vent center. Des and Sevo produce apnea around 1.5, 2 mac (decrease in vent response to hypoxemia, decrease in airway resistance, except for des, decrease in FRC)
92
inhaled anesthetics and renal effects
decrease renal blood flow, decrease GFR, decrease urine output, nephrotoxicity
93
inhaled anesthetics and hepatic effects
decrease hepatic blood flow, decrease hepatic clearance, hepatic toxicity
94
inhaled anesthetics in vitro
can cross placenta, baby usually ok until 1 mac
95
inhaled anesthetics and skeletal muscle
ether derived produce more relaxation than halothane, NO does not produce relaxation and may produce rigidity
96
opioid agonist/antagonist
nalbuphine- used for people who are narcotic dependent or weaning off opioids (agonist at kappa, antagonist at mu)
97
opioid: mechanism of action
Bind specific G protein-coupled receptors that are located in brain and spinal cord regions involved in the transmission and modulation of pain
98
opioid receptors: Mu1
analgesia, euphoria, N/V, pruritis, low abuse potential, bradycardia
99
opioid receptors: Mu2
(spinal) hypoventilation, analgesia, euphoria, sdeation, physical dependence, constipation
100
opioid receptors: kappa
(supraspinal, spinal) analgesia, respiratory depression
101
opioid receptors: delta
(supraspinal, spinal) analgesia, resp despression, physical dependence, urinary retention, enkaphalins
102
opioid overdose triad
respiratory depression, CNS depression, pin point pupils
103
opioid miosos
edinger-westphal nucleua of the oculomotor nerve, toolerance does not develop
104
opioid withdrawal
chills, gooseflesh, hyperventialtion, hyperthermia, vomiting, diarrhea, hostility
105
morphine
potency 1, onset 15-30 minutes, 2-10mg, peak effect 45-90 minutes, duration 3-4 hours, metabolized bia conjuction with glucuronic acid, metabolite morphine 6-glucaronide (accumulation in kidney failure pts can lead to prolonged narcosis and vent depression), histamine realease
106
meperidine (demerol)
0.1 potency of morphine, peak effect 5-7 minutes, duration 2-4 hours, local/atropine side effects (block Na channels, tachycardia, dry mouth, mydriasis), 90% hepatic metabolism to normeperidine which is renally eliminated, tx for post-op shivering
107
fentanyl
75-125 more potent than morphine, peak effect 3-5 minutes, duration 30-50, 75% undergoes 1st pass pulmonary uptake, highly lipid soluble and protein bound, hemodynamic stability,
108
induction dose of fentanyl
2-6 mcg/kg with a sedative hypnotic
109
sufentanil
5-10x as potent as fentanyl, 1000x more potent than morphine, greater affinity for opioid receptor, peak 3-5 minutes, duration 30-60 (dosing 0.3-1.omcg/kg 1-3 minutes before DL)
110
alfentanyl
1/5 to 1/10 as potent as fentanyl, duration 10-20 minutes, peak 1.5-2 minutes, renal failure doesn_t alter clearance, rapid on/off, good for RBB, DL, 5-10mcg/kg
111
remifentanyl
similar potency to fentanyl, peak effect 1.5-2 minutes, duration 6-12 minutes, metabolized by plasma and tissure esterases, good for RBB, continuous gtt, MAC vs general, quick recovery cases (0.5-1mcg/kg + propofol for FL then 0.25-.5mcg/kg/min)
112
codeine
antitussive, analgesia for mild to moderate pain
113
methadone
long term relief of chronic pain and opioid withdrawal
114
hydromorphone
8x as potent as morphine but shorter acting
115
pentazocine, butorphanol, nalbuphine
partial agonist and or comp antagonist, produce analgesia with limited resp depression, ceiling effect
116
local anesthetics
bind Na channels in activated state, rate of depolarization is decreased, resting potential and threshold are not altered, blockade of Na channels prevent achievement of the threshold potential; action potential is not progagated
117
lipophilic groups have a
benzene ring
118
hydrophilic groups hav a
tertiary amine
119
what effects potency of local
fiber size, type, myelination, pH, frequency of stimulation
120
metabolites of esters
para-aminobenzoic acid (PABA) **allergies
121
local inj sites and vascularity
IV>tracheal>intercostal>caudal>paracervical>epidural>BP>sciatic>subcutaneous
122
toxicity dosages of locals
bupi is 2.5, lido is 5, lido with epi is 7
123
CV effects of systemic toxicity
hypotension, decreased cardiac conduction, ventricular arrythmias
124
dose of intralipid
1.5mg/kg iv over 10 minutes
125
brain stem anesthesia
Accidental injection into the CSF can occur during the block due to perforation of the meningeal sheaths that surround the optic nerve. The patient may experience disorientation, aphasia, hemiplegia, unconsciousness, convulsions, and respiratory or cardiac arrest. The incidence of this is estimated in studies to be 0.13%. Direct injection intravascularly via the optic nerve sheath or local anesthesia carried by the ophthalmic and internal carotid artery by retrograde flow to the thalamus and midbrain can also present the same way. This situation requires prompt recognition and treatment (including airway control, respiratory support, possible cardiac intervention, etc.)
126
drugs used for topical anesthesia
tetracaine, cocaine, lidocaine (with oxymetazoline)
