pharmacology Flashcards

1
Q

What is Triad of General Anesthesia

A

unconsciousness
analgesia
muscle relaxation

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2
Q

4 stages of anaesthesia

A
Stage I - analgesia
conscious, drowsy, amnesia
Stage 2 - excitement
Loss of consciousness but delirium, irregular cardiorespiration, apnea, spasticity, gagging
Stage 3 - anaesthesia
regular respiration, loss of reflex and muscle tone = operation 
Stage 4 - medullary paralysis
depression of cardiorespiration, death
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3
Q

What sort of compounds are anaesthetic gasses/ vapours?

A

Halogenated ethers or hydrocarbons e.g. halothane (not used), isoflurane (still use)

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4
Q

Inhaled anaesthetics produce effet via what mechanism, describe the process?

A

Breathe vapour into lung, Blood gas exchange (rapid as big SA) into bloodstream.

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5
Q

What are the 3 characterstics of IV anaesthetics?

A

Rapidy onset, short acting, quickly metabolised/excreted

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6
Q

an example of IV anaesthetic?

A

Barbiturates (thiopentone)

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7
Q

What are the two most common methods of giving general anaesthetics?

A

Inhalation and injection

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8
Q

what are the 4 common anaesthetic procedures (using a combined approach)
note: serious surgery is done w combination of all these

A
  1. produce rapid unconsciousness w IV injection e.g. thiopentone
  2. maintain unconsciousness w inhalation agents e.g. N2O, halothan
  3. can be supplemented w IV analgesic agent e.g. IV fentanyl (not in its own right, but give pre-op to ensure initial analgesic phase is stable)
  4. produce muscle paralysis w nicotinic antag e.g. tubocurarine
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9
Q

name commonly used inhalation anaesthetics? there are 7 gasses

A
  1. N2O : rapid, low potency, in combo, obesteric, analgesic
  2. halothane : vet use, developing countries, hepatotoxicity
  3. enflurane: fast on and off, epileptogenic
  4. isoflurane: non-epileptogenic, cardiorespiratory depression
  5. desflurane: v fast on and off, day surgery
  6. sevoflurane: rapid, potent, hepatotoxic
  7. ethers e.g. cyclopropane, chloroform: s/e explosive
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10
Q

what are the 5 commonly used intraveous anaesthetics?

A
  1. thiopentone (barbiturate) : v fast onset (20s), highly soluble, NON-analgesic, resp depression
  2. etomidate : fast metabolism, low CR depression, involuntary muscle jerks
  3. propofol : v fast metab, day surgery
  4. ketamine : slow onset, dissociative, analgesic, hallucinogenic, bradycardia, hypertensive (NMDA anatg, horse tranquiliser)
  5. midazolam, other BZs : pre-op
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11
Q

what is anaesthetic potency relationship said in lipid Theory of Anaesthetic Action

A

the more lipophilic the compound, the higher the potency of the anaesthetic

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12
Q

describe how the lipid theory work?

A
  • normal cell: na influx via VNaC
  • anaesthetic use:
    increased membrane fluidity
    membrane expansion (deform)
    protein expansion
  • A binds to lipid membrane, change conformation of proteins, VNac
  • Unable to operate in normal way
  • no na influx, no ap generation
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13
Q

what does the “luciferase inhibition correlates with anaesthetic potency” suggest the way A works?

A
  • luciferase (luminance) can be isolated to produce pure soluble protein,
  • anaesthetics interact with membrane proteins DIRECTLY eg. receptors and ligand gated ion channel
  • on hydrophobic domain of the protein
  • alter their function
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14
Q

what are A’s effects on inhibitory, excitatory receptors in brain, on NT?

A
  • potentiate inhibitory rec response in brain, GABA
  • inhibit excitatory rec response AMPA, NMDA
  • overall, increase somatic inhibition in brain
  • Potentiate and increase potency of NT,
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15
Q

what are the 2 ion channels A can act upon?

A
  • NA channel blockage (inhibit AP)

- K channel opening

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16
Q

overall desribe the activity of A

A
  • direct, non-specifc, interactions with many many different proteins (glu rec, gaba rec, VNaC, K+ channel, Ach rec)
17
Q

why is lipid theory not as comprehensive?

A
  • anaesthetics can bind protein molecules (e.g. haemoglobin and myoglobin), but the levels required to affect protein conformation are much greater than those required for anaesthesia
  • luciferase can be isolated into protein!
  • correlation of luciferase inhibition and A potency by Franks and libs
18
Q

What are the 4 stages of anaesthesia

A

1 analgesia
2 excitement
3 surgical anaesthesia
4 medullary paralysis

19
Q

How to improve elderly medicine adherence

A
  1. Set reminder on mobile phone
  2. Put medicine with toothbrush or somewhere obvious that can remind them to take med
  3. Write med dairy
  4. Large print label and PIL
  5. Plain tops on bottle not CRC
  6. Médication reminder cards on fridge
  7. Assess use of med: inhaler, eye drops, popping out tab
  8. Dosette box /multicompartment aid MCA (become independent! Hosp/com different!
20
Q

Compliance aid assessment for elderly includes

A
Visual issues
Dexterity 
Knowledge 
Cognition 
Supply. Every 7 days
21
Q

How meds can cause falls

A
  1. Sedation
  2. Confusion
  3. Hypoglycaemia
  4. Hypotension
  5. Vestibular damage
  6. Vision impaired
  7. D induced Parkinsons
  8. Posture instability
  9. Dehydration
  10. Hypothermia
22
Q

Two classes of drugs that her highest propensity to cause falls

A
  1. Cns drugs

2. Heart drugs

23
Q

Who need to go to a fall clinic

A

Recurrent fallers
Undiagnosed dizziness
Poor balance
Syncope

24
Q

What assessment would you do in a fall clinic

A
  1. HISTORY- conscious when fall? Numb feet?
  2. MUR - changes?
  3. Visual assessment
  4. Ostéoporose test