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Neuro 2 > Pharm 2 - anesthetics > Flashcards

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
Q

What drugs half lives increase with longer infusion times?

A

Thiopental and diazepam

26
Q

IV anesthetics

A 
Barbiturates
Benzos
Ketamine
Opioids
Propofol
27
Q

Thiopental

A
  • 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
Q

Propofol

A
  • 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
Q

Etomidate

A
  • IV anesthetic
  • dec. CBF, dec. pulm fxn, no CV effect
  • dec. adrenal steroidogenesis
30
Q

Ketamine

A
  • 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
Q

Benzos for IV anesthesia

A

Diaze (long acting), Loraza, Midazo (short acting)

  • dec. BP, no analgesic effect
  • anticonvulsant
  • anterograde amnesia
  • treat OD with flumazenil
32
Q

Opiates for IV anesthesia

A
  • Morphine (long acting) and Fentanyl (short acting) and Remifentanil (rapid acting)
  • dose dependent respiratory depression
  • opiate OD triad: coma, pinpoint pupils, dec. RR)
33
Q

Neurolept analgesia

A
  • for awake surgeries: Droperidol
    Fentanyl
    N20
    Atropine
34
Q

Malignant hyperthermia

A
  • 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
Q

Ideal Local anesthetic

A

reversible blockade that is both lipo and hydrophilic

topical or injected

36
Q

MOA of local anesthetics

A
  • 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
Q

Local anesthetics nerve blockade order

A 
small myelinated fibers >
small unmyelinated >
large unmyelinated fibers >
large myelinated
and fibers in the center of the nerve are anesthetized last
38
Q

Local anesthetics cause loss of (in order):

A
  1. pain
  2. temperature
  3. touch
  4. pressure
39
Q

Most local anesthetics are

A

weak bases with a pKa ~ 8
so at pH of 9, 90% crosses
at pH of 7, 10% crosses

40
Q

Inflammation and local anesthetics

A

areas of inflammation are acidic, so you need more anesthetic to be effective

41
Q

Amides as local anesthetics

A 
Lidocaine (fast onset)
Mepivicaine
Prilocaine (methemoglobinemia)
Bupivicaine (cardiotox)
Ropivacaine
Articaine (both amide and ester)

hepatic metabolism, renal elimination

42
Q

Esters as local anesthetics

A

Procaine
Chlorprocaine
Tetracaine (slow)
Cocaine

metabolized by nonspecific esterases (everywhere but CSF)

43
Q

AEs of local anesthetics

A 
ringing in ears
metallic taste
numbing of lips/tongue (too much)
seizures 
maybe allergy (mostly with esters)
CNS excitation, HTN, hypotension, arrythmias
44
Q

Vasoconstrictors and Local anesthetics

A

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
Q

Topical anesthetics

A

Benzocaine (methemoglobinemia)
Dibucaine (not mucous membranes)
Dyclonine (all surfaces)
Pramoxine (not mucous membranes)

46
Q

Compounded drugs used as local anesthetics

A

EMLA: lidocaine + prilocaine
LET: lidocaine, epi, tracaine, (peds)
Lidocaine+Oxymetazoline for ENT

Neuro 2 (6 decks)

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