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Block7 > PDA Anesthetics nad introductions > Flashcards

PDA Anesthetics nad introductions Flashcards

1
Q

What are the unique side effects of propofol?

A

pain on injection, and often given with lidocaine

can cause initial excitation on induction

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2
Q

What do you do for patients who are at risk for hypotension for anesthesia?

A

utilize Etomidate

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3
Q

What are the unique side effects of Etomidate?

A

high incidence of pain on ijection, myoclonus
significant nausea
suppresion of adrenocorticol response to stress; can cause increased death

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4
Q

What type of anesthesia does ketamine produce??

A

Dissociative anesthesia

  • profound analgesia
  • eyes open but pts unresponsive
  • amnesia
  • bronchodilator
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5
Q

What are some of the unique side effects of ketamine?

A 
emergence delilrium
nystagmus, salvitation, spontaneous movement
lacrimation
increased ICP
hypertension
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6
Q

What is ketamine reseved for?

A

ppatients with bronchospasm

children undergoing short painful procedures

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7
Q

What is midazolam used for?

A

short acting benzo; GABAa activator

used alone for concious sedation

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8
Q

What are midazolam side effects?

A

respiratory depression; arrests
caution in pts with neuromusc diseases
hypotension

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9
Q

What are some commonalities of inhalation general anesthetics?

A

very low therapeutic indices; LD50/ED50 very low;

vaporized or gas; uniqeu and important pharmokinetics

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10
Q

What are the role of partition coefficients used for?

A

determine relative amount of anasthetics in different compartments

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11
Q

How are anesthesia eliminated?

A

gas moves from blood into inspired air; fat and high solubility into fat changes recovery

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12
Q

Why isn’t Isoflurane used to induce anesthesia?

A

Coughing, and respiratory irritant

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13
Q

What is the risk of toxicity with MAO inhibitors related to food intake?

A

Tyramine build up due to MAO inhibition leads to hypertensive crisis due to Tyramine causing NE release

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14
Q

What are the therapeutic uses of MAO inhibitors

A

second line depressive disorder treatment

Narcolepsy

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15
Q

What are the central criteria of Schizophrenia?

A

two symptoms at least one must be postiive

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16
Q

What are the positive symtpoms of schizophrenia?

A

Delusions, hallucination, disorganized speech

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17
Q

What are the negative symptoms of schizophrenia?

A

groslly disorganized or catatonic behavior, blunted affect, lack of spontaneity, poor abstract htinking, poverty of thought, social withdrawal

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18
Q

What is the dopamine hypothesis of schizophrenia?

A

schiz results from hyperactivity of dopaminergic neruons or their receptors; based on the fact that all effective antipsychotics interact with dopamine systems

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19
Q

What antipsychotic has cardiac effects?

A

Thioridazine

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20
Q

What was the first drug of anti-psychotics to go onto the market?

A

Clozapine

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21
Q

What are the negative side effects of clozapine?

A

lowers seizure thresholds and can cause agranuloctyosis

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22
Q

What atypical antipsychotic has a shorter half life and is sued for augmentation of depression?

A

Quetiapine

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23
Q

What are the uses of the antipsychotic drugs?

A 
actue psychotic episodes
chronic schizophrenia
manic episodes, bipolar
schizoaffective disorder
augmentation in depression
Tourette's, antiemisis
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24
Q

What antipsychotic is not sued to treat emesis?

A

thioridazine

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25
Q

What was the first drug used to treat bipolar?

A

lithium blocks manic behavior; has no behavior change in normals

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26
Q

What is the mechanism of aciton of bipolar disorder?

A

Inhibitis pohosphatase conversion of IP2 to IP1

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27
Q

Pharmokinetics of liuthium?

A

complete abs in 6 to 8 hous serum half life 18–24 hours, unboundt o plasma protein, CSF concentration half of plasma concentration renal eliminated

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28
Q

What is the difference between half life of lithium in elderly vs young?

A

Lithium half life is much longer in elderly 30-36 h;ours compared to 18-24 hours

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29
Q

What can raise Lithium levels?

A

increase Na excretion such as by loop diuretic

also ACE inhibitors lead to increase Lithium levels

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30
Q

Side effects?

A

fatigue, muscle weakness, tremor, Gi symptoms, slurred speech. Coma and dangerous side effects at 2-3x tx levels

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31
Q

Alternates to lithium?

A

Carbamazepine and Valproic acid, Olanzapine and fluoxetine combined, initial control is with haloperidol in ER of manic episodes

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32
Q

What is mechanism of action of Carbamazepine?

A

blocks sodium channels

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33
Q

What is mechanism of Valproic acid?

A

blcoks repetitive neuronal firing
reduce T-type C++ current
increase GABA concentration

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34
Q

Characteristics of Generalized anxiety disorder?

A

persistent anxiety for at least 1 month duration, absence of specific symptoms of other disorders

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35
Q

What are teh treatments for anxiety and insomnia?

A 
Benzodiazepines
SSRIs
BUSPIRONE
Antihistamines 1st gen H1 blocker
Alcohol, cannabis, opiatees
Barbiturates
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36
Q

Where is GABA localized?

A

Substantia Nigra, globus pallidus, hippocampus, limbic structures, hypothalamus, spinal cord

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37
Q

What does bendoiazepines do?

A

enhance the effects of GABA on Cl- channels

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38
Q

What are the agonists of benzodiazepine receptor?

A

Diazepam, clinically useful

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39
Q

What is the antagonisnt of benzodiazepine?

A

Flumazenil

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40
Q

Why do we use benzodiazepines as opposed to barbituates?

A

benzodiazepines are much safer

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41
Q

How lipid soluble is diazepam?

A

very fast onset, because high lipid solubility and has rapideredistribution

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42
Q

HOw lipid soluble is lorazepam?

A

less lipophilic than diazepam. Absorption and onset of action are slower

43
Q

What are the CNS effects of benzodiazepines?

A

decreased anxiety, sedation, hypnosis, muscle relaxation, anterograde amnesia, anticonvulsant action, minimal cv and respiratory actions

44
Q

What benzo is used for alcohol withdrawal?

A

chlordiazepoxide

45
Q

What benzo is used to treat actue manic episodes?

A

clonazepam

46
Q

What benzo is used as a muscle relaxant?

A

diazepam

47
Q

what is the only benzo used for both sleep and anxiety?

A

lorazapam

48
Q

What are the adverse effects of benzos?

A

daytime sedation, ataxia, rebound insomnia, tolerancee and dependence, occasional idiosyncratic excitement and stimulation, increased death rate associated with use

49
Q

Zolpidem is waht?

A

anti-insomnia, binds to BDZ receptor on GABA receptor, non-benzo chemically
preserves REM and non REM sleep

50
Q

What is the mechanism of action of Barbiturates?

A

Act at GABA Cl ion channel complex; enhance action of GABA and increase inhibition

51
Q

Baclofen is a muscle relaxant that acts through what mechanism?

A

alpha GABA receptor agonist

52
Q

What are the four general componenets of general anesthetic state?

A

amnesia
unconsciousness (not always necessary)
analgesia (inability to interpret, repond to and remember pain(
Noxious painful stimuli don’t evoke movment or ANS

53
Q

What is the dose of a gas directly related to?

A

It’s concentration at the alveolus

54
Q

What is MAC?

A

minimal alveolar concentration that prevents movemnt in 50% of patients

55
Q

How is potency for IV anesthetics determined?

A

free plasma concentration that produces loss of response to surgical incision in 50% of pts

56
Q

What is the GABAa receptor?

A

GABA-regulated chloride channel; most anesthetics increase GABAa opening, results in hyperpolarization

57
Q

Inhibition of NMDA receptors is used in what drug group?

A

some general anesthetics; results in hyperpolarization and reduced sodium and calcium influx

58
Q

What are the stages of general anesthesia?

A

premedicaiton
induction
-usually by IV only by gas in emergent situations
Maintenaince
-gaseous usually have short half life and needed to be admin continuously

59
Q

What is the mechanism of Sodium thiopental?

A

activate GABAa receptors

60
Q

What is the role and class of sodium thiopental?

A

used to induce anesthesia; occurs 10-30 seconds after IV injection; barbiturates

61
Q

Why are intra-arterial injections contraindicated in barbituate use?

A

results in inflammation and necrosis

62
Q

What are the side effects of barbituates?

A

CNS depression, CV, respiratory depression

63
Q

What is the most commonly used barbituate for anesthesia?

A

sodium thiopental

64
Q

What is the most commonly used parenteral general anesthetic in US?

A

propofol

65
Q

What is the mechanism of action of propofol?

A

GABAa mechanism

66
Q

What is propofol used for during anesthesia?

A

both to induce and maintain anesthesia

67
Q

What is the advantages of propofol?

A

antiemetic, quick onset of action, half life in body is 3.5 hours resulting in much less of a hangover

68
Q

What are the unique side effects of propofol?

A

pain on injection, and often given with lidocaine, excitation on inducion

69
Q

Why is propofol dangerous to administer?

A

more severe BP reduction than with thiopental
vasodilation and depression of myocardial cotnractility
blunts baroreflexes
respiratory more depression than thiopental

70
Q

What drug is used in patients at risk for hypotension?

A

Etmoidate

71
Q

What are the unique side effects of Etomidate?

A

high incidence of pain on injection and myoclonus
problems with nausea and vomiting
suppression of hte adrenocortical response; can result in higher mortality

72
Q

What are the side effects of Etomidate non-unique?

A

CNS is the same as thiopental
CV is far less than thiopental
Respiratory less than thiopental

73
Q

What type of anesthetic is ketamine?

A

dissociative anesthestic

  • profound analgesia
  • eyes open but unresponsive to commands
  • amnesia
  • bronchodilator no respiratory suppresion
74
Q

What is the mechanism of action of ketamine?

A

NMDA receptor antagonist

75
Q

What are the side effects of ketamine?

A 
increased ICP
Emergence delirium
nystagmus, salivation, lacrimation, increase muscle tone
spontaneous movment
hypertension
76
Q

What indicates ketamine use for patients?

A

children undergoing short, painful procedures

reserved for pateients iwth bronchospasms–bronchodilator

77
Q

What are the properties of midazolam?

A

short acting benzo, GABAa activator
used alone for conscoius sedation or as an induction adgent
adjunct during local anesthesia
pre-op med for anxiety

78
Q

What are the side effects of midazolam?

A

respiratory depression and arrest
caution in pts with parkinsons, bipolar and neuromusc disease
CV effects similar to thiopental

79
Q

What is does blood:gas Ppartion coefficient indicate

A

if low need more inspired air, quick induction, recovery quick
high means less in inspired air, both induction and recovery are slow

80
Q

What are important when induction occurs with gaseous anesthetic?

A

pulmonary ventilation (more important for gases with moderate to high blood gas PC)
anesthetic conc in inspired air
pulmonary blood flow
arteriovenous concentration gradient

81
Q

What are the clinical uses of isoflurane?

A

most commonly used inhalational anesthetic in US and worldwide

82
Q

What are the side effects of isoflurane?

A

airway irritant, coughing, decrease tidal volume, increase respiratory rate
anesthetic depress respiration
myocardial depression, arrythmias and ICP increase

83
Q

What is the pharmacokinetics of desflurane?

A

very volatile at room temperatures, very low solubility in blood, rapid inductiona dn recovery
excreted unchanged in expired air

84
Q

What are hte clinical uses of desflurane?

A

outpatient surgeries/maintenaince
not used to induce bc of resp irrtation
skeletal muscle relaxation

85
Q

What are the side effects of desflurane

A

similar to isoflurane but a worse respiratory irritant

86
Q

What are hte pharmokinetics of sevoflurane?

A

very low blood:gas PC
about 5% metabolized to fluoride ion
nephrotoxic effects

87
Q

What is the clinical use of sevoflurane?

A

very popular for inpatient and outpatient to induce and maintain; not a respiratory irritant

88
Q

What are the clinical use of Nitrous oxide?

A

weak anesthetic, cannot get enough into air to prodduce MAC

Good for sedation and alagesia, used together to reduce dose of other anaesthetics

89
Q

What are the side effects of nitrous oxide?

A

contraindicated in pneumothorax
negative ionotrope but also sympathomimetic
respiratory effects are minimal
abuse liability

90
Q

What are the mechanisms of local anesthetics?

A

bind reversibly to a site within the pore of voltage gated Na+ channels; blocking sodium entry when channel is openned
Bc of the role of these channels in AP initiation and generation
cause sensory loss and motor paralysis

91
Q

In what order to local anesthetics have for sodium channesl?

A

lowest to highest affinity?
unactivated->activated->inactive
resting nerves less sensitive to block
nerves with positive membrane potential more sensitive to block

92
Q

What are the sensitivity of neuron types to local anesthetics?

A

autonomic fibers, small non-myelinated C fibers, and small Adelta fibers, are blocked before larger myelinated Adelta, Abeta and Aalpha fibers

93
Q

What is the order to the block of local anesthetics?

A

in order pain, cold, warmth, touch, deep pressure, motor and recover in reverse

94
Q

What are the toxicity and side effects of local anesthetics?

A

interfere with function of all organs or transmission of impulses (CNS, ganglia, NMJ, Muscle)
systemic toxic reactions
intraneuronal injection can produce irreversible damage
S-enantiomer is less toxic than R-enantiomer in local anesthetics

95
Q

What is the CNS toxicity of local anesthetics?

A

stim is seen first, depressiona t higher doses, death associated with sever toxicity usually caused by respiratory depression

96
Q

What is the CV toxicity of local anesthetics?

A

general depression of CV system, down myocardial contractility
develop hypotension and arrythmias

97
Q

How are local anesthetics metabolized?

A

ester local anesthetics inactivated by plasma esterases

amide local anesthetics metabolized in liver

98
Q

What is the role of cocaine clinically?

A

local anesthetic, but also blocks uptake of norepi, potent vasoconstrictor, used for topical anesthesia of upper resp tract

99
Q

What is tetracaine?

A

long acting ester local anesthetic
more potent and longer duration of action than procaine
used in spinal anesthesia and in topical and opthalmic preparations

100
Q

What is benzocaine?

A

anesthetic with low water solubility, therefore too slowly abosrbed when applied topically
applied to wounds and ulcerated surfaces for pain relief

101
Q

What is lidocaine?

A

intermediated duration of action, produce faster more intesnse and long lasting compared to prococaine
wide range of clinical uses

102
Q

What is role of Bupivicaine?

A

long acting amide local anesthetic
capable of producing prologned anesthesia
provide more sensory than motor block
more cardiotoxic than equi-effective dose of lidocaine

103
Q

What is ropivacaine?

A

long acting amide, anesthetic actions similar to bupivicaine with less toxicity
used for epidural and regional anesthesia
even more motor-sparing

104
Q

Difference between amide and ester local anesthetics?

A

amides metabolized by liver with no allergic reaction

esters metabolizedd by plasma cholinesterases with rare allergic reactiosn

Block7 (10 decks)

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