pharm of anesthesia

Question 1

principle use of benzos? IV anesthetics? Inhalation agents?

Answer 1

antianxiety and amnesia prior to surgery. Induction of anesthesia. Maintain anesthetic state throughout surgery

Question 2

two features that determine onset and duration of action of these drugs

Answer 2

lipid solubility (faster across BBB so more rapid effect) and redistribution to other tissues (more redistribution curtails duration of action)

Question 3

Barbiturates: examples, which for anesthesia, mechanism, contraindications, onset and duration of anesthesia. Continuous infusion? side effects?

Answer 3

-barbitals, thiopental. increase duration of GABAa Cl channel opening. porphyria. rapid, short. Will accumulate on continuous infusion. CV and resp depression

Question 4

propofol: mechanism, advantages over thiopental, side effects

Answer 4

GABAa; Can be used for long duration (rapidly metabolized in liver), antiemetic, mild bronchodilator. Decreases SVR (severe hypotension)

Question 5

Etomidate: mech, side effects, benefits

Answer 5

GABAa; nausea and adrenocortical suppression; CV stability (little change in BP)

Question 6

Arylcyclohexylamines: other name, what type of anesthetic, mechanism, side effects, two characteristics

Answer 6

ketamine, dissociative (catatonia, amnesia, analgesia), inhibits NMDA, psychic phenomena (hallucination, bad dreams), sympathomimetic (^HR, bronchodilation),^ cerebral blood flow (dont use on patients with high ICP)

Question 7

what would you give to a surgical pt whose HR is high but has low BP due to propofol

Answer 7

phenylephrine

Question 8

Effects of IV anesthetics on CMRO2 and CBF?

Answer 8

decreased cerebral metabolic rate O2 and reduced blood flow.

Question 9

Benzodiazepines: mechanism, examples, OD tx,

Answer 9

GABAa, increase frequency of Cl channel opening. Midazolam, diazepam. Flumazenil

Question 10

MAC: relation to potency and lipid solubility

Answer 10

1/potency. Higher lipid solubility=lower MAC.

Question 11

how does blood solubility change induction and recovery

Answer 11

decreased sol. in blood means rapid induction and recovery times

Question 12

effects of inhaled anesthetics on CMRO2, CBF, ICP

Answer 12

decreased, increased, increased

Question 13

what drives the equilibration process for the volatile agents

Answer 13

the partial pressure of the anesthetic

Question 14

Effects of inhaled anesthetics:

Answer 14

myocardial and resp depression, nausea/emesis

Question 15

organs with high blood flow (fast uptake of anesthetic)? medium flow? low flow?

Answer 15

brain, lung, heart, kidney; skeletal mm; adipose tissue

Question 16

which inhaled anesthetics cause myocardial depression? decreased SVR

Answer 16

halothane; isoflurane, sevoflurane, desflurane

Question 17

toxicity of inhaled anesthetics

Answer 17

hepato (halothane), nephro (methoxyflurane), convulsant (enflurane), malignant hyperthermia (all but NO2),