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Anesthesia > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

what are the inter related processes of pharmacokinetics (4)

A
  1. absorption
  2. distribution
  3. metabolism
  4. excretion
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2
Q

what are the interrelated processes of pharmacodynamics (4)

A
  1. receptors
  2. ion channels
  3. enzymes
  4. immune system
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3
Q

what is pharmacokinetics

A

the relationship between drug dose, concentration in bodily fluids and tissues, and time

Simply: what the body will do with a given drug

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4
Q

what is absorption

A

The processes by which a drug moves from the site of administration to the bloodstream.

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5
Q

what are possible routes of administration (7)

A
  1. Oral
  2. inhalational
  3. transdermal
  4. transmucosal- ( sublingual/ buccal, rectal/ suppositories, nasal spray)
  5. subcutaneous
  6. intramuscular
  7. intravenous.
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6
Q

what factors affect absorption (3)

A
  1. Physical properties of drug
    - Solubility
    - Diluent
    - Binders
    - Formulations
  2. Dose
  3. Site/Route.
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7
Q

what is volume of distribution

A

Apparent volume into which a drug is distributed throughout the body’s compartments (tissues. fat, muscle) relative to its concentration in the plasma

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8
Q

what factors affect volume of distribution (4)

A
  1. Lipid solubility
  2. Protein binding
  3. Ion binding- electrical charge
  4. Molecular weight- smaller easy to cross membrane
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9
Q

what is the formula for Vd

A

total quantity of drug/ plasma concentration in steady state

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10
Q

what is bioavailability

A

its the fractional dose of a drug that is actually able to reach the systemic circulation

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11
Q

what is phase 1 metabolism

A

is metabolism that results in the loss of pharmacologic activity through cleavage or formation of a new or modified functional group ( oxidation, reduction, hydrolysis)

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12
Q

what is phase 2 metabolism

A

is metabolism that involves conjugation of the parent drug or phase 1 metabolite with endogenous compounds ( glucuronidation, sulfation. acetylation)

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13
Q

what is hepatic clearance

A

it is the volume of blood/plasma that is completely cleared of drug by the liver per unit of time

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14
Q

what is terminal half life

A

Time required for the plasma concentration to decrease by 50% during the terminal phase of decline

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15
Q

what is clearance

A

Represents the volume of blood or plasma from which the drug is completely eliminated in unit time (ml/min)

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16
Q

which organs are primarily responsible for drug clearance (2)

A
  • liver
  • kidneys
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17
Q

what is pharmacodynamics

A

Relationship between a drug’s mechanism of action and the biochemical and physiologic response produced in the body.

Simply put: What does the drug do to the body.

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18
Q

how do drugs exert their effect

A

by interactions with receptors, or cellular macromolecules, located throughout the body.

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19
Q

what is the therapeutic index

A

Ratio of LD50 to ED50.

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20
Q

what is the minimal alveolar concentration (MAC Value)

A

its the concentration of an anesthetic gas that when inhaled prevents 50% of subjects from responding to noxious stimulus

( it helps quantify the potency of inhaled anesthetic agents)

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21
Q

what are pharmacodynamic interactions (6)

A
  1. Agonism- stimulation of receptor.
  2. Antagonism- inhibition of receptor.
  3. Synergism- enhanced effect.
  4. Additivity- combined effect.
  5. Partial agonism- partial stimulation
  6. Inverse agonism- reversal of receptor activity.
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22
Q

what is the general anesthesia triad

A
  1. hypnosis (unconsciousness)
  2. analgesia
  3. paralysis
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23
Q

hypnosis can be achieved via by what routes (2)

A
  1. intravenous
  2. volatiles
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24
Q

paralysis can be achieved by what methods (2)

A
  1. depolarizing
  2. non depolarizing
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25
Q

what are intravenous anesthetics used for(2)

A
  1. during induction and maintenance of hypnosis
  2. amnesia- to reduce anxiety, stress and improve patient comfort
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26
Q

what are the types of amnesia (2)

A
  1. Anterograde-inability to form new memories
  2. Retrograde-loss of existing memory
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27
Q

what is an ideal intravenous anesthetic (6)

A
  1. Rapid onset + rapid recovery
  2. Storability: Long shelf-life at room temperature
  3. Pleasant effect during the induction phase
  4. Safety following extravasation or inadvertent intra-arterial injection
  5. Analgesic at sub-anesthetic concentrations
  6. Minimal cardiovascular and respiratory depression
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28
Q

what effects dont you want from an intravenous anesthetic (7)

A

1.toxic effects
2. emetic effects
3. pain on injection
4. histamine release or hypersensitivity reaction
5. interference with other drugs
6. stimulation of porphyria
7. unpleasant experiences in the peri-operative phase

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29
Q

what makes IV anesthetics have rapid onset (2)

A
  1. iv administration leads to fast delivery into well vascularized tissue
  2. rapid diffusion across the blood brain barrier due to
    - lipid solubility
    - protein binding (low?)
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30
Q

what causes IV anesthetics to have rapid recovery (3)

A
  • rapid redistribution
  • rapid elimination
  • metabolism
31
Q

what are examples of IV anesthetics (2)

A
  1. Barbiturates
    - thiopental
    - methohexitone
  2. Non-barbiturates
    - propofol
    - ketamine
    - etomidate
32
Q

what IV anesthetics are commonly used in malawi (3)

A
  • Thiopentone
  • Ketamine
  • Propofol
33
Q

what is the MOA of thiopentone (3)

A
  1. Prolonged GABA dependent Cl- channel opening
  2. Rapid onset (one arm-brain-circulation time)
  3. Short duration of action
34
Q

what are effects of thiopentone (4)

A
  1. Antiepileptic activity
  2. Minor degree of muscle relaxation
  3. Hypotension
  4. Histamine release
35
Q

thiopentone is unsafe in what

A

porphyria

36
Q

what happens with repeated administration/ infusion of thiopentone

A

has long half time

37
Q

what is the MOA of ketamine

A

NMDA receptor antagonist

38
Q

how is ketamine metabolized

A

Ketamine is demethylated to the active metabolite norketamine by hepatic P450 enzymes

39
Q

what are the effects of ketamine (8)

A
  1. Produces sympathetic nervous system stimulation, increasing circulating levels of adrenaline and noradrenaline- increased blood pressure
  2. causes a dissociative anesthesia
  3. Analgesia (acute, chronic, Complex reginal pain syndrome)
  4. Anesthesia
  5. Hallucinations
  6. Bronchodilatation
  7. Anti-depressive
  8. Airway reflexes are maintained
40
Q

how can ketamine be given (5)

A
  1. IV
  2. IM
  3. rectally
  4. orally
  5. inhalational
41
Q

what are ways of taking ketamine recreationally (2)

A
  • orally
  • inhalational
42
Q

what happens during the dissociative state of ketamine (5)

A
  1. Detachment from one’s body & external world (depersonalization & derealization)
  2. Mimics schizophrenia
  3. Unaware of own identity
  4. Sensation of floating, euphoria
  5. Loss of time perception
43
Q

in adults you give ketamine with what

A

benzodiazepine

44
Q

what is the MOA of propofol

A

Affects GABA Chloride channels

45
Q

what are the properties of propofol (2)

A
  • Highly lipid soluble
  • Oil-in-water emulsion
46
Q

what additives are found in propofol (3)

A
  • soybean oil
  • glycerol
  • egg lecithin
47
Q

where can propofol be used (3)

A
  1. Induction & maintenance of general anaesthesia
  2. Sedation in ICU
  3. Sedation for other procedures
48
Q

who should give propofol

A

persons trained in its use because it has a narrow therapeutic range

49
Q

what needs to be readily available when giving propofol

A

advanced airway management

50
Q

what are the effects of propofol (4)

A
  1. Rapid onset of anaesthesia (one arm-brain circulation time).
  2. Rapid recovery.
  3. Little accumulation
  4. Reduces laryngeal reflexes (ideal for use with LMA)
51
Q

propofol is safe to use in what (2)

A
  • porphyria
  • malignant hyperthermia
52
Q

what are side effects of propofol (6)

A
  1. Reduces laryngeal reflexes
  2. Dose dependent_ fall in SVR, no reflex tachycardia, slight fall in CO
  3. Considerable fall in BP
  4. Pain on injection
  5. Spontaneous excitatory movements (misinterpretation can happen)
  6. Crosses placenta (not used in obstetrics)
53
Q

what are the inhalational anesthetics ( volatiles) (6)

A
  1. Halothane
  2. Isoflurane
  3. Enflurane
  4. Sevoflurane (standard in rich countries)
  5. Desflurane
  6. Xenon
54
Q

how does a lipid soluble anesthetic affect the MAC

A

the MAC will be lower and the greater the potency

55
Q

when mixing gases MAC values are what

A

additive

56
Q

what is oil:gas partition coefficient

A

Measure of the lipid solubility
therefore has a close relationship to MAC and therefore potency

57
Q

what is the meyer overton hypothesis

A

is the theory of anesthetic action which proposes that the potency of an anesthetic agent is related to its lipid solubility- the hypothesis hypothesis proposed that once a sufficient number of anesthetic molecules were dissolved in the lipid membranes of cells within the central nervous system, anesthesia would result by a mechanism of membrane disruption.

58
Q

what is the blood: gas coefficient

A

Expresses the solubility of a gas in blood
e.g. Low coefficient = low solubility = rapid onset

59
Q

what are effects of halothane (8)

A
  1. 20-25% metabolized in the liver (hepatotoxic)
  2. Cardiac dysrhythmias
  3. Increased cerebral blood flow and ICP
  4. Reduced myocardial contractility, HR, CO, BP
  5. Reduced TV
  6. increased RR & PaCO2
  7. reduced laryngeal reflexes & airway resistance
  8. Uterine relaxation (cave obstetrics)
60
Q

what is halothane like (2)

A
  • colourless liquid
  • pleasant smell
61
Q

what is isoflurane like (2)

A
  • Colourless volatile liquid
  • has an irritant smell
62
Q

comparing isoflurane to halothane what is the difference (2)

A
  1. Isoflurane has a Lower blood gas solubility than Halothane and therefore provides rapid onset of and recovery from anesthesia
  2. isoflurane increases cerebral blood flow and ICP less than halothane
63
Q

what are the effects of isoflurane (8)

A
  1. Lower blood gas solubility that Halothane and therefore provides rapid onset of and recovery from anesthesia
  2. Low toxicity to liver and kidneys
  3. Increases cerebral blood flow and ICP( less than Hal)
  4. Does not cause arrhythmias(does not increase myocardial sensitivity to adrenaline)
  5. Little effect on myocardial contractility.
  6. Dose dependent fall in blood pressure due to decrease in SVR
  7. Reduced TV
  8. increased RR
64
Q

what are the types of muscle relaxants (2)

A
  1. depolarizing
    - suxamethonium
  2. non-depolarizing
    i) Steroids
    - vecuronium
    - rocuronium
    - pancuronium
    ii) Esters
    - atracurium
65
Q

how does suxamethonium work (3)

A
  1. mimics action of acetylcholine, binding to nicotinic receptors on the muscle causing depolarization
  2. rapid onset of action- 1min
  3. it is short acting 4-6 mins after observable muscle fasciculation
66
Q

what are the undesirable effects of suxamethonium (7)

A
  1. Mild to severe muscle fasciculation which can lead to increased CO, BP, ICP
  2. Myalgia
  3. Hyperkalemia (burns, neurological conditions, peripheral nerve injuries, renal failure, acidosis) which can lead to cardiac arrest
  4. Dual block
  5. Increased intraocular pressure
  6. Malignant hyperpyrexia
  7. Parasympathetic effects
67
Q

what is the most widely used non depolarizing agent

A

vecuronium (its cheap)

68
Q

how does vecuronium work (4)

A
  1. Little CVS effects
  2. Moderately short onset of action – 2min
  3. Moderate duration of action – 20min
  4. Rare Histamine release
69
Q

how does rocuronium work (3)

A
  1. Fast onset of action (60 sec) – similar to Suxamethonium
  2. Longer duration of action than Vecuronium
  3. Less potent but otherwise similar to Vecuronium
70
Q

what metabolizes atracurium

A

Hofmann degradation into Laudanosine and ester hydrolysis

71
Q

atracurium is the drug of choice in what condition (2)

A
  • renal failure
  • hepatic failure
72
Q

what are side effects of atracurium (2)

A
  1. severe Histamine release
  2. profound hypotension
73
Q

where do you store atracurium

A

fridge because its unstable

Anesthesia (12 decks)

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