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Neuro > Neuro: Pharm - Anesthetics > Flashcards

Neuro: Pharm - Anesthetics Flashcards

1
Q

Barbiturates:

A

Phenobarbital, pentobarbital, thiopental, secobarbital

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2
Q

Barbiturates: MOA

A

Facilitate GABA A action by increasing duration of Cl- channel opening, thus decreasing neuron firing (barbidurates increases duration). Contraindicated in porphyria.

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3
Q

Barbiturates: Uses

A

Sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)

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4
Q

Induction of anesthesia

A

thiopental

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5
Q

Barbiturates: Toxicity

A

Respiratory and cardiovascular depression (can be fatal); CNS depression (can be exacerbated by EtOH use); dependence; drug interactions (induces cytochrome P-450)

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6
Q

Overdose Tx of barbiturates:

A

supportive –> assist respiration and maintain BP

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7
Q

Benzodiazepines:

A

Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam

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8
Q

Benzos: MOA

A

Facilitate GABA A action by increasing FREQUENCY of Cl- channel opening.
Most have long half lives and active metabolites
“Frenzodiazepines” increase frequency
Benzos, barbs, and EtOH all bind GABA A, which is a ligand-gated Cl- channel

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9
Q

Short acting Benzos:

A

alprazolam, triazolam, oxazepam, midazolam

ATOM

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10
Q

Benzos: uses

A

anxiety, spasticity, status epilepticus (lorazepam and diazepam), detoxification (especially alcohol withdrawal-DTs), night terrors, sleepwalking, general anesthetic (amnesia, muscle relaxation), hypnotic (insomnia)

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11
Q

Benzos: toxicity

A

dependence, additive CNS depression effects with alcohol. Less risk of respiratory depression and coma than with barbiturates

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12
Q

Tx benzo overdose with:

A

Flumazenil (competitive antagonist at GABA benzodiazepine receptor)

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13
Q

Nonbenzodiazepine Hypnotics:

A

Zolpidem (Ambien), Zaleplon, esZopiclone.

“All ZZZs put you to sleep”

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14
Q

Nonbenzo hypnotics: MOA

A

Act via BZ1 subtype of GABA receptor. Effects reversed by flumazenil

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15
Q

Nonbenzo hypnotics: uses

A

Insomnia

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16
Q

Nonbenzo hypnotics: toxicity

A

Ataxia, HA, confusion.
Short duration bc of rapid metabolism by liver enzymes. Unlike older sedative-hypnotics, cause only modest day-after psychomotor depression and few amnestic effects. Decrease dependence risk than benzodiazepines.

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17
Q

Inhaled anesthetics:

A

Halothane, enflurane, isoflurane, sevolfurane, methoxyflurane, nitrous oxide, desflurane

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18
Q

Inhaled anesthetics: MOA

A

unknown

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19
Q

Inhaled anesthetics: Effects

A

myocardial depression, respiratory depression, nausea/emesis, increased cerebral blood flow (decreased cerebral metabolic demand)

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20
Q

Inhaled anesthetics: toxicity

A

Hepatotoxicity (halothane), nephrotoxicity (methoxyflurane), proconvulsant (enflurane), expansion of trapped gas in a body cavity (nitrous oxide.
Can cause MALIGNANT HYPERTHERMIA

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21
Q

Malignant hyperthermia

A

rare, life-threatening hereditary condition in which inhaled anesthetics (except nitrous oxide) and succinylcholine induce fever and severe muscle contractions.
Tx: dantrolene

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22
Q

Dantrolene: MOA and use

A

Tx for malignant hyperthermia

Blocks ryanodine Receptor

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23
Q

IV Anesthetics: mnemonic

A

BBKing on Opioids PROPoses FOOLishly

Barbiturates, Benzos, Ketamine, Opioids, Propofol

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24
Q

Barbiturate for IV anesthetic:

A

Thiopental

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25
Q

Thiopental: MOA

A

high potency, high lipid solubility, rapid entry into brain
effect terminated by rapid redistribution into tissue (skeletal muscle) and fat
Decreases cerebral blood flow
“hangover effect” if injected multiple times

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26
Q

Thiopental: uses

A

Induction of anesthesia and short surgical procedures

27
Q

Benzodiazepines used in anesthesia:

A

Midazolam most common drug used for endoscopy

For pre-op sedation: Midazolam&raquo_space; Diazepam > Lorazepam

28
Q

Most common drug used for endoscopy:

A

Midazolam

29
Q

Benzo uses in anesthesia:

A

used adjunctively with gaseous anesthetics and narcotics.

30
Q

Benzo SE in anesthesia:

A

May cause severe postoperative respiratory depression, decreased BP (tx overdose with flumazenil), and anterograde amnesia

31
Q

Ketamine: MOA

A

Arylcyclohexylamine
Blocks NMDA receptors.
PCP analog that acts as dissociative anesthetic.

32
Q

Ketamine: SE

A

Cardiovascular stimulant. Disorientation, hallucination, bad dreams. Increases cerebral blood flow (useful in pts @ risk for hypotension)
Only modest decrease in ventilation and is potent vasodilator.
Drug of abuse –> problems with urinary bladder

33
Q

Opioids used in anesthesia:

A

Morphine, fentanyl used with other CNS depressants during general anesthesia

34
Q

Propofol: uses

A

sedation in ICU, rapid anesthesia induction, and short procedures
Antiemetic properties - very useful for ppl given opioids
Safe for pregnant women

35
Q

Propofol: SE

A

Less postoperative nausea than thiopental

Caution in pts with high TGs, because very fatty

36
Q

Propofol: MOA

A

Potentiates GABA A

37
Q

Preferred GA for neurosurgery

A

Isoflurane

38
Q

Preferred GA for pts prone to MI

A

Sevoflurane

39
Q

IVGA used for pts at risk for hypotension

A

Etomidate

40
Q

Local anesthetics: esters

A

procaine, cocaine, tetracaine

41
Q

Local anesthetics: amides

A

lidocaine, mepivacaine, bupivacaine (amides have 2 I’s in name)

42
Q

Local anesthetics: MOA

A

block Na+ channels by binding to specific receptors on inner portion of channel. Preferentially bind to ACTIVATED Na+ channels, so most effective in rapidly firing neurons.
Tertiary amine locals penetrate membrane in uncharged form, then bind to ion channels as cahrged form.

43
Q

Local anesthetics: principle

A

Can be given with vasoconstrictors (usually Epinephrine) to enhance local action - decrease bleeding, increase anesthesia by decreasing systemic concentration

44
Q

Need more anesthetic in infected tissue because:

A

infected tissue is acidic, alkaline anesthetics are charged and can’t penetrate membrane effectively

45
Q

Order of nerve block for local anesthetics:

A

small-diameter fibers > large diameter
myelinated fibers > unmyelinated fibers
Size factor predominates over myelination, such that small myelinated fibers > small unmyelnated fibers > large myelinated > large unmyelinated

46
Q

Order of sensation loss:

A
  1. pain 2. temp 3. touch 4. pressure
47
Q

Local anesthetics: uses

A

minor surgical procedures, spinal anesthesia

If allergic to esters, give amides

48
Q

Local anesthetics: toxicity

A

CNS excitation, severe cardiovascular toxciity (bupivicaine), hypertension, hypotension, and arrhythmias (cocaine)

49
Q

Local anesthetic that causes severe cardiovascular toxicity:

A

Bupivicaine

50
Q

Neuromuscular blocking drugs: uses

A

Used for muscle paralysis in surgery on mechanical ventilation. Selective for motor (vs. autonomic) nicotinic receptor

51
Q

Depolarizing NMJ drugs:

A

succinylcholine

52
Q

Succinylcholine: MOA

A

strong ACh R agonist; produces sustained depolarization and prevents muscle contraction

53
Q

Reversal of Succinylcholine blockade:

A 
Phase I (prolonged depolarization) - no antidote. Block potentiated by cholinesterase inhibitors.
Phase II (repolarized but blocked; Ach Rs are available, but desensitized) - antidote consists of cholinesterase inhibitors
54
Q

Complications of Depolarizing NMJ drugs (succinylcholine):

A

hypercalcemia, hyperkalemia, and malignant hyperthermia

55
Q

Nondepolarizing NMJ drugs:

A

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

56
Q

Nondepolarizing NMJ drugs: MOA

A

competitive antagonists - compete for ACh for receptors

57
Q

Reversal of blockade (nondepolarizing NMJ drugs)

A

Neostigmine (must be given with atropine to prevent muscarinic effects such as bradycardia), edrophonium, and other cholinesterase inhibitors

58
Q

Dantrolene MOA

A

Prevents release of Ca2+ from SR of skeletal muscle (Ryanodine receptor inhibitor)

59
Q

Dantrolene Use:

A

Tx malignant hyperthermia and neuroleptic malignant syndrome (toxicity of antipsychotic drugs)

60
Q

Baclofen: MOA

A

Inhibits GABA B Rs in spinal cord, inducing skeletal muscle relaxation

61
Q

Baclofen: use

A

muscle spasms (acute low back pain)

62
Q

Cyclobenzaprine: MOA

A

centrally acting skeletal muscle relaxant. Structurally related to TCAs, similar anticholinergic SEs

63
Q

Cyclobenzaprine: Uses

A

muscle spasms

Neuro (10 decks)

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