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Pharm 2 - anesthetics Flashcards

1
Q

Analgesia

A

relief of pain w/o intentional production of altered mental state (can be accidental)

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2
Q

Anxiolysis

A

decreased apprehension w/no change in awareness

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3
Q

Conscious sedation

A

dose dependent
protective reflexes maintained
can breathe independently
respond to stimulation

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4
Q

Deep sedation

A

loss of one or more functions maintained in conscious sedation

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5
Q

General anesthesia

A

Sensory/mental/reflex/motor blockade. Loss of all protective reflexes

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6
Q

Impt in anesthetizing pts

A

must maintain pt’s airway

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7
Q

MAC

A

minimal alveolar concentration.
Inversely related to potency
Inversely related to oil:gas partitition coeff

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8
Q

Myer Overton Hypothesis

A

anesthesia is directly proportional to lipophilicity. too simple.

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9
Q

Receptor targets of anesthetics

A

Inc. GABA, Glycine, 2 pore K channels
Dec. NMDA
- ultimately loss of cortical interaction (less fb entropy) and less frontal cortex signaling

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10
Q

Guedel Stages

A

Initiation –> delirium –> plane 1-4

  • pupil constricts in plane 1-2 and dilates in 3-4
  • dec. BP, reflexes, muscle tone
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11
Q

Sequence of events in anesthesia

A

memory goes first, then awareness, ten movement in response to pain, then autonomics

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12
Q

purpose of halogens in anesthesia

A

decerease the volatility of inhalational anesthetics

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13
Q

How does a drug’s blood:gas partition coeff relate to its onset of action?

A

low blood:gas partition coeff will have faster onset of action. also faster decrease in action.

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14
Q

Halothane

A 
inhalational anesthetic
- MAC 0.75
- high blood:gas
highly metabolized
loss of reflexes
arrthymias, hepatotoxic (in women)
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15
Q

Isoflurane

A

Inhalational anesthetic
MAC 1.2
Stinks, muscle relaxation, loss of reflexes

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16
Q

ENflurane

A

inhalational anesthetic
MAC 1.6
stinks, muscle relaxation, loss of reflexes
- can cause seizures!!!

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17
Q

Sevoflurane

A

inhalational anesthetic
- MAC 2
- low blood:gas
stinks, loss of reflexes

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18
Q

Desflurane

A

inhalational anesthetic

  • MAC 6
  • low blood:gas
  • stinks
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19
Q

N20

A

inhalational anesthetic

  • MAC 105 (not a complete anesthetic) high MAC also means it has a high volume in the blood and can cause hypoxia upon termination
  • low blood:gas
  • allows you to use less of the more expensive gases
  • the only one with analgesic properties
  • teratogen, spontaneous abortion, myelodegeneration, inhibits B12 absorption, diffusional hypoxia, pneumothorax (high solubility)
20
Q

Respiratory effects of inhalational anesthetics

A

inc. RR
dec. TV
inc. PaCO2
shallow breathing
loss of response to PaCO2 (except N20)

21
Q

CV effects

A

dec. BP
dec. CO
dec. SNS
Epi release
dec. Ca efflux
vagal stimulation
N20 has no CV effects but will if combined with opiates

22
Q

Balanced anesthesia

A

relax muscles
relieve anxiety
decrease secretions
induce coma

23
Q

Problem with IV anesthesia formulations

A
  • all lipophilic

- can adjust pH or give with a surfactant (which can cause thrombophlebitis if given too fast)

24
Q

What receptors do IV anesthetics work on?

A
  • all potentiate GABA and glycine

- Ketamine and propofol inhibit glutamate NMDA channels

25
What drugs half lives increase with longer infusion times?
Thiopental and diazepam
26
IV anesthetics
``` Barbiturates Benzos Ketamine Opioids Propofol ```
27
Thiopental
- barbiturate used as an IV anesthetic - high potency, high lipophilicity, rapid onset of action, rapid redistribution into tissue, dec. CBF, inc. HR, dec. plum fxn - used for induction anesthesia and short procedures - contra porphyria and CYP interactions
28
Propofol
- IV anesthetic - potentiates GABAa receptors and can act as GABA, also blocks NMDAr - rapid anesthesia induction, for short procedures - antiemetic - dec. CBF, inc. HR, dec. pulm fxn - AE: Propofol infusion syndrome (cardiac arrest, MOSF)
29
Etomidate
- IV anesthetic - dec. CBF, dec. pulm fxn, no CV effect - dec. adrenal steroidogenesis
30
Ketamine
- IV anesthetic - PCP analog that causes a dissociative state (eyes open) - inc. CBF, BP, HR, CO, no plum effect - analgesic - intact reflexes - bronchodilation - hallucinations
31
Benzos for IV anesthesia
Diaze (long acting), Loraza, Midazo (short acting) - dec. BP, no analgesic effect - anticonvulsant - anterograde amnesia - treat OD with flumazenil
32
Opiates for IV anesthesia
- Morphine (long acting) and Fentanyl (short acting) and Remifentanil (rapid acting) - dose dependent respiratory depression - opiate OD triad: coma, pinpoint pupils, dec. RR)
33
Neurolept analgesia
- for awake surgeries: Droperidol Fentanyl N20 Atropine
34
Malignant hyperthermia
- caused by succinylcholine and Isoflurane - male pt w/rapid inc. muscle rigidity/HR/RR/acidosis - caused by widespread Ca release from sarcoplasmic reticulum - tx: Dantrolene
35
Ideal Local anesthetic
reversible blockade that is both lipo and hydrophilic | topical or injected
36
MOA of local anesthetics
- blockade of voltage gated Na channels inside the nerves - preferentially blocks activated/inactivated channels, so in rapidly firing neurons - lipophilic to pass the membrane and and bind to the inside of the channel - hydrophilic to dissolve in the membrane and affect the channel in the membrane
37
Local anesthetics nerve blockade order
``` small myelinated fibers > small unmyelinated > large unmyelinated fibers > large myelinated and fibers in the center of the nerve are anesthetized last ```
38
Local anesthetics cause loss of (in order):
1. pain 2. temperature 3. touch 4. pressure
39
Most local anesthetics are
weak bases with a pKa ~ 8 so at pH of 9, 90% crosses at pH of 7, 10% crosses
40
Inflammation and local anesthetics
areas of inflammation are acidic, so you need more anesthetic to be effective
41
Amides as local anesthetics
``` Lidocaine (fast onset) Mepivicaine Prilocaine (methemoglobinemia) Bupivicaine (cardiotox) Ropivacaine Articaine (both amide and ester) ``` hepatic metabolism, renal elimination
42
Esters as local anesthetics
Procaine Chlorprocaine Tetracaine (slow) Cocaine metabolized by nonspecific esterases (everywhere but CSF)
43
AEs of local anesthetics
``` ringing in ears metallic taste numbing of lips/tongue (too much) seizures maybe allergy (mostly with esters) CNS excitation, HTN, hypotension, arrythmias ```
44
Vasoconstrictors and Local anesthetics
keep the drug where you inject it and stop minor bleeding at wound sites - phentolamine (alpha 1 block) can be used to increase blood flow and reverse anesthesia
45
Topical anesthetics
Benzocaine (methemoglobinemia) Dibucaine (not mucous membranes) Dyclonine (all surfaces) Pramoxine (not mucous membranes)
46
Compounded drugs used as local anesthetics
EMLA: lidocaine + prilocaine LET: lidocaine, epi, tracaine, (peds) Lidocaine+Oxymetazoline for ENT

Neuro 2 (6 decks)

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