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Neuropharmacology > Nitrous oxide/Propofol - Anaesthetics > Flashcards

Nitrous oxide/Propofol - Anaesthetics Flashcards

1
Q

history of nitrous oxide

A

often used recreationally
1842 - ether was used in surgery
1844 - NO used in dental surgery

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2
Q

is anaesthesia reversible

A

YES

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3
Q

3 main effects of anaesthesia

A

hypnosis
amnesia
immobility

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4
Q

effect of anaesthesia on brain activity

A

slows brain activity (EEG)

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5
Q

hypnosis

A

loss of consciousness/perceptive awareness

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6
Q

amnesia

A

loss of memory formation

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7
Q

immobility

A

no movement in response to painful stimuli

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8
Q

3 good stages of anaesthesia

A

1 - analgesia
2 - excitement, increased muscle tone, HR and BP
3 - anaesthesia

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9
Q

4th bad stage of anaesthesia

A

too much leads to cessation of breathing

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10
Q

in medical practice –> 3 stages of inducing anaesthesia

A

induction
maintenance
recovery

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11
Q

induction stage of anaesthesia in medical practice

A

give patient propofol

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12
Q

maintenance stage of anaesthesia

A

give patient nitrous oxide or a volatile anaesthetic, or O2

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13
Q

recovery stage of anaesthesia in medical practice

A

take mask off patient

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14
Q

characteristics of a good anaesthetic

A 
fast induction, fast recovery
non-flammable
able to adjust length of anaesthesia
regular breathing/HR
cheap
easy to store
no undesired effects
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15
Q

common side effect of anaesthesia

A

nausea

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16
Q

2 classes of anaesthetics

A

intravenous

inhalants

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17
Q

examples of intravenous anaesthetics

A 
barbiturates
ketamine
propofol
benzodiazepine
midazolam
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18
Q

examples of inhalant anaesthetics

A

NO (ether or chloroform)
isoflurane
seroflurane
desflurane

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19
Q

why is propofol good

A

rapid acting and rapid elimination

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20
Q

MAC stands for

A

Minimum Alveolar Concentration

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21
Q

what is the MAC

A

the minimum concentration of the gas in the lungs that is required to cause immobility in 50% of patients in response to a surgical/pain stimulus

22
Q

what is the MAC used for

A

to compare the potency or strength of anaesthetic vapours

23
Q

what two things are tested when measuring the MAC

A

hypnosis –> loss of ‘righting’ reflex (standing up)

immobility –> loss of withdrawal reflex

24
Q

Cp50

A

a measure of anaesthetic potency

the concentration of agent in the blood required to cause immobility in 50% of patietns

25
Q

are you awake in MAC and Cp50 tests

A

yes

26
Q

volatile anaesthetics above 1atm

A

do not initiate immobility in 50% of patients

27
Q

what is the correlation for anaesthetics called

A

meyer-overton (1899)

28
Q

axis for meyer-overton correlation graph

A

MAC on y-axis

olive oil: gas partition coefficient

29
Q

smaller MAC correlates with

A

high potency
high olive oil: gas partition
means it is better at dissolving into lipids

30
Q

what does the MO correlation show

A

that all the anaesthetics have a hydrophobic site of action

31
Q

what is the unitary theory

A

the suggestion that anaesthetics work on the protein hydrophobic site and share common molecular mechanisms

32
Q

what are the assumptions behind the unitary theory

A

that anaesthetics will dissolve in neuronal lipid membranes to affect neuronal activity

33
Q

what are the problems with the unitary theory

A
  • mutations in proteins could impair anaesthetic effects
  • new anaesthetics are less potent than predicted
  • enantiomer pairs of chiral anaesthetic molecules have different properties
34
Q

anaesthetic binding site on GABA A receptors

A

different to GABA site, BZD site and neurosteroid site

35
Q

example of a neurosteroid

A

alphaxolone

36
Q

example of old volatile anaesthetic

A

halothane

37
Q

why was halothane discontinued

A

caused liver problems

38
Q

examples of new anaesthetics

A

isoflurane
desflurane
seroflurane

39
Q

uses of volatile anaesthetics in medicine

A

used in combination with nitrous oxide and O2 during maintenance stage

40
Q

effects of volatile anaesthetics

A

strong immobilisation, amnesic and hypnotic effects

41
Q

which receptors do volatile anaesthics act on

A

GABA

42
Q

other receptor potentiation

A

glycine receptors can also be activated –> contributes to immobility
K2p channels

43
Q

receptor inhibition by anaesthetics

A

Na+ channels

glutamate receptor

44
Q

K2p channels

A

2 pore domain

“leak” potassium channels

45
Q

role of N2O

A

used in maintenance
weak anaesthetic effects
activates K2p channels
inhibits nAchR- channels

46
Q

whats different about ketamine to N2O

A

ketamine can induce anaesthesia by itself

inhibits NMDA receptor channels

47
Q

importance of spinal cord and anaesthetics

A

spinal cord contains targets for the immobilisation effects of anaesthetics

48
Q

if isoflurane is applied to the spinal cord

A

the MAC is lower

49
Q

effect of application of GABA antagonists

A

decrease potency of some anaesthetics e.g. propofol and barbiturates (not ketamine)

50
Q

main phsyiological effects of GABA A receptor potentiation

A

hypnosis

amnesia

51
Q

main physiological effect of glycine receptor potentiation

A

immobilisation

52
Q

main physiological effect of NMDA receptor inhibition

A

analgesia

Neuropharmacology (14 decks)

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