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SBM neurology > PHARM - anesthetics > Flashcards

PHARM - anesthetics Flashcards

1
Q

five major effects of general anesthesia

A

1) unconsciousness
2) amnesia
3) analgesia
4) inhibition of autonomic reflexes
5) skeletal muscle relaxation

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2
Q

describe the anesthesia induction process

A
  • IV anesthetic until unconscious
  • management with inhaled or IV
  • muscle relaxant if intubation required
  • anti-anxiety at the beginning if needed
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3
Q

describe maintenance of anesthesia

A
  • inhaled or IV drugs
  • monitoring of vitals
  • use of opioid for pain, such as fentanyl
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4
Q

example of a reversal agent for muscle relaxants

A

neostygmine

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5
Q

how does general anesthesia work?

A 
reduce excitatory stimulation
- ACh (nicotinic/muscarinic)
- excitatory amino acids (NMDA, Kainate, AMPA)
- serotonin (5-HT)
increase inhibitory stimulation
- GABA, glycine
- potassium channels
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6
Q

list these inhaled anesthetics in terms of solubility and discuss onset and recovery: nitrous oxide, halothane, isoflurane, sevoflurane

A

least soluble - nitrous oxide - rapid, rapid (incomplete)
low solubility - sevoflurane - rapid, rapid
mid range solubility - isoflurane - middle, middle
most soluble - halothane - middle, middle

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7
Q

relate opioids to inhaled anesthetics

A

can depress respiration and make induction take longer

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8
Q

what is anesthetic potency?

A

minimal alveolar concentration needed to prevent response to a surgical incision in 50% of cases

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9
Q

alveolar concentration formula that should work for 95% of patients

A

1.3xMAC

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10
Q

4 stages of anesthesia depth

A

1) analgesia - awake to drowsy
2) excitement - delirium, proposal can eliminate this
3) surgical anesthesia - muscles relaxed, breathing regular, no more spontaneous movement, careful monitoring
4) death

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11
Q

physiological effects of anesthesia on brain

A
  • decrease metabolic activity
  • decrease blood flow
  • vasodilation
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12
Q

physiological effects on cardiovascular system of anesthesia

A
  • contractility down
  • ## MAP down
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13
Q

resp effects of anesthesia

A
  • decrease tidal volume

- increase RR

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14
Q

why does propofol go strait to the CNS quickly?

A

lipid solubility

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15
Q

how is propofol administered?

A

IV

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16
Q

local anesthetics can be divided into two categories…

A

esters

amides

17
Q

what are the local esters and how are they used?

A
  • benzocaine, cocaine - surface action
  • procaine - short acting
  • tetracaine - long acting
18
Q

what are the local amides and how are they used?

A
  • lidocaine - medium acting

- bupivicaine - long acting

19
Q

contrast metabolism and half life of amides and esters

A

esters - minutes, broken down by pseudocholinesterases

amides - 1.5-3.5 hours, broken down by P450 enzymes

20
Q

how do local anesthetics work?

A

block voltage gated sodium channels preventing action potentials

21
Q

characteristics of nerves better suited for local anesthetics

A
  • narrower
  • heavily myelinated
  • peripheral
  • rapidly firing
22
Q

which inhaled anesthetic can lead to megoblastic anemia?

A

NO2

23
Q

isoflurane - type, PD, PK

A
  • inhaled general
  • PD - unknown, lipid soluble, potentiates GABA, opens K+
  • PK - lungs 95%
24
Q

sevoflurane - type, PD, PK

A
  • inhaled general
  • PD - unknown, GABA and K+
  • PK - lungs primarily, 5% liver
25
Q

NO2 - type, PD, PK

A
  • inhaled
  • PD - close NMDA, open K+
  • PK - 100% lungs
26
Q

ketamine - type, PD, PK

A
  • IV, IM general anesthetic
  • PD - close NMDA, potentiates NO2
  • PK - liver, kidney
27
Q

propofol - type, PD, PK

A
  • short acting IV for induction
  • PD - GABA
  • PK - minutes, liver
28
Q

midozolam - type, PD, PK

A
  • adjunct, sedative
  • PD - enhances GABA
  • PK - 15-20mins, liver
29
Q

ketamine caution

A

can cause emergence reactions with psychologic manifestations

30
Q

propofol caution

A
  • aseptic technique required, susceptible to contamination
31
Q

midolozam caution

A
  • respiratory arrest

- use only in hospital/ambulatory setting

32
Q

etomidate type, PD, PK

A
  • general anesthetic and adjunct
  • hypnotic
  • not analgesic
  • PD - GABA
  • PK - liver, half life 75 minutes
33
Q

remefentanil

A
  • opioid
  • very short acting
  • analgesia/sedation
34
Q

bupivicaine

A
  • long acting local

SBM neurology (22 decks)

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