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Year 2 neuro exam 2 > Pharm Anesthetics, Kinder II > Flashcards

Pharm Anesthetics, Kinder II Flashcards

1
Q

what barbituates are used for IV anesthetic

A

thiopental and methohexital

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2
Q

MOA thiopental and methohexital

A

GABAa R increase channel opening duration

inhibit excitatory too

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3
Q

which barbituate has shorter elimination

A

methohexital

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4
Q

CNS effects thiopental and methohexital

A

dose dependent CNS depression

no analgesia

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5
Q

which barbituate anesthetic cannot be used for anticonvulsant

A

methohexital

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6
Q

respiratory effects thiopental and methohexital

A

depressors

transient apnea

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7
Q

use of thiopental and methohexital

A

induction anesthesia

propofol used more

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8
Q

what benzos are used perioperatively

A

midazolam
lorazepam
diazepam

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9
Q

MOA benzos

A

GABAa increase sensitibity to GABA and enhance inhibitory NT

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10
Q

benzos can be terminated by administration of what

A

flumazenil

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11
Q

what benzo is suitable for coninuous infusion

A

midolazam

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12
Q

CNS effects benzos

A

anticonvulsants- status epilepticus, alcohol withdrawal, local anesthetic induced seizure

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13
Q

resp effects benzos

A

severe resp depression if given with opioid

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14
Q

therapeutic use benzos

A

produce anxiolysis and anterograde amnesia

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15
Q

MOA etomidate

A

GABA like effects thorugh GABAa and Cl channels

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16
Q

metabolism etomidate

A

urine excretion and bile

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17
Q

CNS effects etomidate

A

cerebral vasoconstrictor

dec blood flow and ICP

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18
Q

CV effects etomidate

A

minimal hemodynamic effects! good for those with compromised cardiac contractility prior to anesthesia

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19
Q

endo effects etomidate

A

adrenocortical suppression

inhibits 11bhydroxylase for cholesterol –>cortisol

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20
Q

use of etomidate

A

alternative to propofol or barbituates for those with conmprmised cardiac contractility

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21
Q

MOA ketamine

A

inhibition of NMDA R

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22
Q

CNS ketamine

A

cerebral dilator and inc blood flow
can have emergence reactions :vivid color dreams hallucinations etc
“dissociative anesthesia” eyes open with slow nystagmic gaze

23
Q

CV ketamine

A

can increase BP HR and CO

direct myocardial depressant( mainly critically ill patients)

24
Q

therapeutic use ketamine

A

profound analgesia, SAN stimulation
bronchodilation
minimal respiratory depression

25
side effect ketamine
lacrimation and salivation increased | so give anticholindergic before administration
26
MOA dexmedetomidine
selective a2 agonist
27
CNS dexmedetomidine
hypnosis from activation a2 in locus ceruleus | analgesia at level spinal cord
28
CV effects dexmedetomidine
mod dec HR and systemic vascular R | bradycardia
29
therapeutic use of dexmedetomidine
short term sedation of intubated and ventilated patients in ICU setting
30
which IV anesthesia does not affect respirattion
dexemedetomidine
31
local anesthesia
loss of sensation in limited region of body
32
role of systemic circulation in local anesthesia
diminish or terminate its effect
33
structure most local anesthetics
lipophilic ring and ionizable group | aromatic ring and tertiary amine
34
what are the amide local anesthetics
bupivacaine lidocaine ropivacaine
35
what are the ester local anesthetics
benzocaine cocaine procaine tetracaine
36
what are the long acting local anesthetics
bupivacaine ropivacaine tetracaine (more lipophilic)
37
how are local anesthetics excreted
converted to water soluble by liver (amide) or plasma (ester) and excreted in urine
38
careful using amide type local anesthetics in what patients
those with hepatic disease since need hepatic metabolism
39
excretion uncharged local anesthetic
diffuse readily across lipid membrane so no excretion of neutral form occurs
40
how do local anesthetics work
block vNaCh
41
Potency local anesthetics
lipid solubility | so tetracaine, bupivacaine and ropivacaine are more potent
42
what are the intrinsic factors of susceptibility of nerve fibers
fiber diameter firing frequency anatomic arrangement
43
which nerve fibers are blocked first
smallest diameter | myelinated before unmyelinated
44
how does firing frequency affect nerve blocks
higher freq= more block | so sensory nn>motor nn
45
which pain fibers affected quickly by nerve block
A delta and C fibers because have high freq pain transmission
46
usual route of administration for local anesthetics
topical- nasal mucosa, wound, margins | injection
47
evolution of nerve block
sympathetic then temp then pain then light touch then motor
48
how do we prolong local anesthesia
add vasoconstrictor
49
processes of local anesthetic toxicity
systemic effects from intravasc injection by accident or absorption from site neurotoxicity from local effects with direct contact with neural elements
50
CNS toxicity local anesthetic
sedation, light headedness, visiaul and auditory disturbances restlessness nystagmus, musc twitching, tonic-clonic convulsions
51
what do we give to prevent CNS toxicity local anesthetic
give benzo before
52
CV effects local anesthetics
arrhythmia and cardiac arrest | block Na Ch on heart so dec electrical excitability, conduction rate force and arteriolar dilation causing hypotension
53
cocaine CV effects
inhibits NE reuptake and results in vasoconstriction leading to ischemia, also have HTN and cardiac arrhythmias

Year 2 neuro exam 2 (23 decks)

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