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Neuro II: Test 2 > Pharm: Anesthetics > Flashcards

Pharm: Anesthetics Flashcards

1
Q

alveolar concentration

A

depends on Fa (alveolar concentration) / Fi (inspired air concentration)

The faster FA/FI approaches 1, faster anesthesia will occur

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2
Q

blood:gas partition coefficient

A

blood:gas

affinity for blood compared to inspired gas - the smaller the number the lower the blood solubility = fast onset of action

there is an inverse relationship b/w partition coefficient and rate of anesthesia onset!

ex:
- low blood solubility (nitrous oxide, desflurane) = fast onset of action
- high blood solubility (halothane) = slow onset of action

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3
Q

nitrous oxide

A

gaseous anesthetic - low affinity for blood

MAC>100 (would require more than 100% of atmosphere they are inhaling to reach 1 MAC - must use balanced anesthesia)

    • low blood:gas coeff = rapid onset and recovery
  • incomplete anesthetic
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4
Q

desflurane

A

inhaled anesthetic
MAC= 6-7
** blood:gas = 0.42
- low volatility, poor induction agent, rapid recovery

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5
Q

sevoflurane

A

inhaled anesthetic
MAC = 2
** blood gas = .69 - rapid onset and recovery

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6
Q

isoflurane

A

inhaled anesthetic
MAC = 1.4
** medium rate of onset and recovery (1.4)

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7
Q

enflurane

A

inhaled anesthetic
MAC=1.7
** medium rate of onset and recovery (1.8)

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8
Q

halothane

A

inhaled anesthetic - high affinity for blood
MAC=.75
** medium rate of onset and recovery (2.3)

ADR: hepatitis!!!

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9
Q

increased CO

A

↑ pulmonary blood flow
↑ uptake of anesthetic
↓ rate of FA/FI rise
↓ rate of induction

** an increase in CO and pulmonary blood flow will increase the uptake of anesthetic into the blood, but the anesthetic taken up will be distributed in all tissues, no just the CNS; increased CO will thus increase delivery of anesthetics to OTHER tissues and not the brain

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10
Q

recovery from anesthesia?

A
  • lungs are major route for elimination–> can speed up through hyperventilation
  • If relatively insoluble in blood and brain –> eliminated faster
  • Time to recovery depends on elimination from brain
  • some drugs are also eliminated via hepatic metabolism (halothane being the most)
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11
Q

minimum alveolar concentration

A
  1. 0 MAC = partial pressure of inhaled anesthetic, 50% of population remain immobile at skin incision
    - Value expressed as volume %

** Successful anesthesia = 0.5 – 2 MAC

MAC is additive: 0.5 MAC of x + 0.5 MAC of y = 1 MAC

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12
Q

stages of anesthesia?

A

Stage I Analgesia
Analgesia without amnesia; later will experience both

Stage II Excitement
Delirious, completely amnesic; rapid respirations; HR and BP increase

Stage III Surgical Anesthesia
Slowing RR and HR, extends to apnea

Stage IV Medullary Depression
Requires circulatory and respiratory support

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13
Q

propofol

A

IV anesthetic

    • preferred for continuous infusion d/t half time not being affected by infusion duration
    • can cause hypotension

MOA: Potentiation of Cl- current mediated through GABAA receptor complex
- Fast onset, fast clearance

Organ System Effects:
CNS – no analgesia; EEG burst suppression
CV – hypotension
Respiratory – depressant

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14
Q

Thiopental

A

barbituate - IV anesthetic

MOA:
Act on GABAA receptor to increase duration of channel opening

Organ System Effects:

  • CNS – sedation; no analgesia: Decrease electrical activity on EEG (exception methohexital)
  • Respiratory – depressant (apnea)
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15
Q

methohexital

A

barbituate - IV anesthetic

MOA:
Act on GABAA receptor to increase duration of channel opening

Organ System Effects:

  • CNS – sedation; no analgesia: Decrease electrical activity on EEG (exception methohexital)
  • Respiratory – depressant (apnea)
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16
Q

Midazolam

A

IV anesthetic - benzodiazepine

** rapid onset of action ** best for infusion if using benzo d/t shortest context sensitive half time

MOA:
Acts on the GABAA receptor, increases receptor sensitivity to GABA (agonist), enhances inhibitory neurotransmission

Organ System Effects:

  • CNS – potent anticonvulsants
  • Respiratory – depression may occur when given with opioids
17
Q

lorazepam

A

IV anesthetic - benzodiazepine

** rapid onset of action **
MOA:
Acts on the GABAA receptor, increases receptor sensitivity to GABA (agonist), enhances inhibitory neurotransmission

Organ System Effects:

  • CNS – potent anticonvulsants
  • Respiratory – depression may occur when given with opioids
18
Q

diazepam

A

IV anesthetic - benzodiazepine
** rapid onset of action **

MOA:
Acts on the GABAA receptor, increases receptor sensitivity to GABA (agonist), enhances inhibitory neurotransmission

Organ System Effects:

  • CNS – potent anticonvulsants
  • Respiratory – depression may occur when given with opioids
19
Q

etomidate

A

IV anesthetic

MOA:
GABA like effects, potentiation of GABAA mediated Cl- currents

** minimal impact of CV function!!! useful for pts w/ cardiac instability

Organ System Effects:

  • CNS – cerebral vasoconstrictor
  • CV – minimal impact on hemodynamics
  • Endocrine – adrenocortical suppression
20
Q

ketamine

A

IV anesthetic

MOA:
Inhibits NMDA receptor complex
** fast onset of action !

Organ System Effects:

  • CNS – profound analgesia!!! cerebral vasodilator
  • -> Emergence reactions; dissociative anesthesia
    • can have scary dreams and hallucinations!!
  • CV – increase systemic BP, HR, CO; however, is a direct myocardial depressant
21
Q

Dexmedetomidine

A

IV anesthetic

MOA:
Highly selective α2-adrenergic agonist
** causes hypnosis and analgesia - useful in pts. transitioning to extubation

Organ System Effects:

  • CNS – hypnosis, analgesia, activates endogenous sleep pathways
  • CV – decrease in HR and SVR
22
Q

Benzocaine

A

LA - ester

** surface use only!

23
Q

cocaine

A

LA - ester

** low potency, medium DOA

24
Q

procaine

A

LA - ester

** low potency, short DOA

25
Q

tetracaine

A

LA - ester

** high potency, long DOA

26
Q

bupivicaine

A

LA - amide

** highly potent, long acting

27
Q

lidocaine

A

LA - amide

    • lower potency, medium DOA
  • also available as patch
28
Q

ropivacaine

A

LA - amide

** high potency, long DOA

29
Q

laprascopic hernia repair, first time undergoing surgery and is highly anxious?

A

use benzodiaepine - midazolam

30
Q

IV drug that is rapid in onset and recovery w/ antiemetic actions?

A

Propofol

31
Q

chemical w/ which blood:gas partition will reach the highest concentration in brain the fastest?

A

the one with the lowest coeff. b/c that means it isn’t highly bound to blood

32
Q

which agent lacks ability cause CNS depression, or level of consciousness or level to reduce pain

A

pancuronium

33
Q

why can’t NO be used alone for general anesthesia?

A

MAC is greater than 100%

Neuro II: Test 2 (11 decks)

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