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Pharmacology > Pharm 16- Anesthetic Agents I > Flashcards

Pharm 16- Anesthetic Agents I Flashcards

1
Q

Anesthetic agent

A

any drug used to induce a loss of sensation without or without unconsciousness

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2
Q

Adjunct

A

a drug that is not a true anesthetic, but htat is used during anesthesia to produce other desired effects such as sedation, muscle relatxation analgesia reversal neuromuscular blockage or parasympathethic blocker

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3
Q

4 Classifications of Anesthetic Agents and Adjuncts

A

Route of administration
Time of administration
Principal effect
Chemistry

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4
Q

Route of administration classificiations

A

Inhalant
Injectable
Oral
Topical

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5
Q

time of administration classifications

A

preanesthetic
induction
maintenance

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6
Q

Principle effect classificaitons

A 
local vs. general
sedatives and tranquilizers vs analgesics
neuromuscule blockers
anticholinergic agents
reversal agents
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7
Q

Describe general anesthesia

A

Reversible

produced by administration of one or more anesthetic drugs

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8
Q

4 characteristics of general anesthesia

A

Unconsciousness
Immobility
Muscle relaxation
loss of sensation

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9
Q

Describe surgical anesthesia

A

A stage of general anesthesia
Analgesia and muscle relaxation
eliminate pain and patient movement during the proceudre

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10
Q

Sedation

A 
CNS depression
drowsiness
drug-induced
various levels
 slightly aware or unaware of surroundings
aroused by noxious stimulation
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11
Q

What are the uses for sedation

A

minor proceudres

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12
Q

Tranquilization

A

calmness
patient is reluctant to move
aware of surroundings but doesn’t care

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13
Q

hyponosis

A

drug-induced
sleeplike state
impairs patient’s ability to respond to stimuli
patient can be arroused with sufficient stimulation

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14
Q

Narcosis

A

drug-induced sleep
patient is not easily aroused
associated with narcotic drugs

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15
Q

Local anesthesia targets what?

A

Small, specific area of the body

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16
Q

Local anesthesia produces what effect?

A

Loss of sensation to a specific area

Drug is infiltrated into the desired area

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17
Q

Where is topical anesthesia applied?

A

Body surfaces or a wound

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18
Q

What does topical anesthesia produce?

A

Superficial loss of sensation

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19
Q

What does regional anesthesia produce

A

Loss of sensation to a limited area of the body

Ex. nerve blocks, epidural

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20
Q

Balanced Anesthesia

A

Multiple drugs in smaller quantities
Maximizes benefits
Minimizes adverse risks
Gives anesthetist greater control

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21
Q

Agonists

A

bind to and stimulate target tissue; most anesthetic agents and adjuncts

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22
Q

Antagonists

A

Bind to target tissue but don’t stimulate reversal agents

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23
Q

Partial Agonists and Agonist-Antagonists

A

Opioids
Partial agonists
Agonist-antagonists
used to block pure agonists

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24
Q

Analgesia

A

most general anesthetics are not analgesics
Must provide analgesic pre- and post operatively
no pain perception while anesthetizes

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25
Q

Do true analgesics provide general anesthesia?

A

NO

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26
Q

Why shouldn’t you mix drugs in a single syringe?

A

They may not be compatible

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27
Q

What should you look for when mixing two drugs?

A

A precipitate

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28
Q

Most anesthetic agents and adjuncts are soluble in what?

A

Water

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29
Q

What is an example of a drug that is not water soluble?

A

Diazepam (Valium)

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30
Q

Opioids are derivatives of what?

A

Opium

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31
Q

Opioids produce what?

A

Analgesia and sedation; result of action on receptors in the brain and spinal cord

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32
Q

What can be used for anesthesia induction when combined with other drugs?

A

Opioids

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33
Q

How are opioids classified?

A

Agonists, partial agonists, agonist-antagonists, or antagonists

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34
Q

Common Opioid Agonists

A 
Morphine (Contin)
Oxymorphone (Oxycontin)
Hydromorphone (Dilaudid)
Fentanyl (Actiq, Duragesic)
Meperidine (Demerol)
Remifentanil (Ultiva)
Hydrocodone (Vicodin)
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35
Q

Common Opioid Partial Agonist

A

Buprenorphine (Buprenex)

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36
Q

Common Opioid Agonist-Antagonists

A

Butorphanol (Stadol)
Nalbuphine (Nubain)
Pentazocine (Talwin)

37
Q

Common Opioid Antagonists

A

Naloxone (Narcan)
Naltrexone (Depade, Revia)
Methynaltrexone (Relistor)

38
Q

Which opioids are not controlled substances?

A

Antagonists and Nalbuphine

39
Q

How are opioids administered?

A

IV, IM, SC, Oral, Rectal, Intranasal inhalant, transdermal, subarachnoid, and epidural

40
Q

Describe the margin to safety for opioids

A

Wide; reversal agents

41
Q

What are class C1 drugs used for?

A

Just for research

42
Q

How do opioids work?

A

Mimic endogenous opioid peptides
-B-Endorphins, dynorphins, enkephalins “Runner’s High”

Prevent nerves from transmitting impulses; prevent presynaptic release of neurotransmitters, particularly excitatory afferent neurotransmitter; decrease perception of pain

43
Q

Agonists MOA

A

Bind to and stimulate mu and kappa receptors

Best for moderate to severe pain

44
Q

Partial Agonists MOA

A

For moderate pain- they have lower efficacy

45
Q

Agonist-Antagonists

A

Typically bind to delta, mu, and kappa receptors but typically stimulate only kappa receptors (reversal agent/mild pain)

46
Q

Antagonists MOA

A

Bind to but don’t stimulate delta, mu and kappa receptors (reversal agents)

47
Q

What are the best things we have for severe pain?

A

Pure opioid agonists; used as a premedication for painful surgery

48
Q

Effects of Opioids: CV Effects

A

Bradycardia, except meperidine which has antimuscarinic effects that can produce tachycardia

49
Q

Effects of Opioids: Respiratory Effects

A

Decreased rate and tidal volume (dose-related)

50
Q

Effects of Opioids: Cough Suppression

A

codeine (usually), morphine

51
Q

Effects of Opioids: Miosis

A

Small pupil size

52
Q

Effects of Opioids: GI

A

Salivation, vomiting by stimulation of the chemoreceptor trigger zone (CTZ)
Initial diarrhea, vomiting, flatulence
GI stasis follows initial GI stimulation

53
Q

Effects of Opioid: Urinary Retention

A

Deaden ability to respond to a full bladder

54
Q

Effects of Opioid: Histamine Release

A

Allergic rxns very common with morphine use

Avoid in asthmatics

55
Q

Effects of Opioids: Intraoccular pressure and intracranial pressure

A

(in red)

56
Q

What are opioids used for?

A

Cough Suppressants (codeine, dextromethorphan)
Preanesthetic
Analgesia
Acute pulmonary Edema (CHF)- vasodilation, reduce anxiety and “drowning”

57
Q

Opioids as a preanesthetic

A

Agonists, partial agonists, agonist-antagonist
May be used along or in combination with:
Tranquilizers
Anticholinergics

58
Q

Opioids as analgesia

A

prevent and tx postop pain

used with tranquilizer to produce neuroleptanalgesia

59
Q

Neuroleptanalgesia

A

a state of quiescence, altered awareness, and analgesia produced by a combination of an opioid analgesic and a neuroleptic. “Tranquil dreaming”

60
Q

What two types of drugs are used to create a neuroleptanalgesia?

A

Opioids

Tranquilizers

61
Q

Opioids

A

Morphine
Buprenorphine
Butorphanol
Hydromorphone

62
Q

Tranquilizers

A

Diazepam
Midazolam
Thorazine

63
Q

Opioid Antagonists

A

Reversible undesirable effects (CNS/Respiratory depression)
Wake up the patient following sedation
Emergensices/overdoses

64
Q

What are two examples of opioid antagonists?

A

Naloxone (Narcan) Hydrochloride

Naltrexone

65
Q

Naloxone (Narcan) hydrochloride

A

IM- 5 minutes to reversal
or slow IV administration- 2 min to reversal
Duration of action 30-60 minutes

66
Q

Naltrexone

A

Like naloxone but longer-acting and has the potential for liver toxicity

67
Q

Tramadol (Ultram)

A

Like an opiate but not one
Usually give P.O.
Like opioids it is a weak centrally acting u receptor agonist providing moderately strong analgeisa

68
Q

How does Tramadol (Ultram) work?

A

Blocks serotonin release and reuptake of norepinephrine

69
Q

What is Tramadol (Ultram) prescribed for?

A

Rheumatoid arthritis

Fibromyalgia

70
Q

Tramadol (Ultram) Side Effects

A

Similar to opioids but geerally milder (Except serotonin syndrome which can be fatal)

  • Agitation
  • Muscular tremors
  • Sweating
  • Hyperthermia
  • Seizures
71
Q

What type of problems are seen with tramadol (Ultram)

A

dependence and withdrawal problems with long-term use similar to opioids

72
Q

How can tramadol (ultram) be partially reversed?

A

Opioid antagonists

73
Q

Injectable Anesthetics

A

Can produce unconsciousness
Don’t provide analgesia or muscle relaxation
Used with other agents
Administered “to effect” IV

74
Q

Name 3 injectable anesthetics

A
  1. Barbiturates
  2. Propofol
  3. Etomidate
75
Q

Subclasses of barbiturates are based on what?

A

Duration of action OR chemical structure

76
Q

Types of Barbiturates

A

Ultrashort
Short
Intermediate
Long-acting

OR: Oxybarbiturates vs Thiobarbiturates

77
Q

Ultrashort Barbiturates

A

Thiopental Sodium & Methohexital

Induce general anesthesia

78
Q

Short Barbiturates

A

Pentobarbital
Induce general anesthesia
Tx epilepsy

79
Q

Oxybarbiturates

A

Penobarbitol
Pentobarbital
Methohexital

80
Q

Thiobarbiturates

A

Thiopental and thiamylal

81
Q

Action of Barbiturates

A

Not fully understood
Mimics inhibitory neurotransmitter GABA
Causes CNS depression and loss of consciousness
Termination effect: agent leaves brain; is metabolized, excreted, or redistributed

82
Q

A “Normal” dose of barbiturates could produce what

A

Prolonged unconsciousness or death in hypoproteinemia

83
Q

Protein Binding- Barbiturates

A

Free (unbound) drug enters the brain
Hypoproteinemia results in more free drug
Increased drug amounts to brain

84
Q

Thiopental

A

Ultra short-acting
Redistributed to muscle and fat slowly released
Continuous or repeated dosing may lead to full muscle nad fat and prolonged recovery, amking it “seem” like a longer-acting drug (first order&raquo_space; zero order kinetics)

85
Q

Methohexital

A

Ultra short acting
Redistributed to muscle nad fat but released faster
Muscle and fat don’t get “full” saturate so there is no prolonged recovery with continuous or repeated doses (zero order kinetics avoided)

86
Q

Phenobarbital

A

Long acting
Sustained effect caused by slow uptake and rleease from the brain, therefore good for seizure disorders.
Release is dependent on kidney excretion which is slowest

87
Q

Pentobarbital

A

Short acting
Brain levels decresae based on liver metabolism
Faster than kidney excretion

88
Q

What is the #1 drug for anesthetic induction in most of hte owrld?

A

Propofol (PropoFlo, Diprivan)

89
Q

How is propofol’s action terminated?

A

Both metabolized by liver and excreted by the kidneys, the primary way Propofol’s action is terminiated is by redistribution

Pharmacology (23 decks)

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