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Neuroscience II > Pharmacology - General and local anesthetics > Flashcards

Pharmacology - General and local anesthetics Flashcards

8
Q

5 primary effects of general anesthetics

A 
Unconsciousness
Amnesia
Analgesia
Inhib of autonomic reflexes
Skeletal muscle relaxation
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9
Q

CNS depression stage 1

A

Analgesia–>analgesia and amnesia

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10
Q

CNS depression stage 2

A

Delirious
Retching and vomiting if stimulated
Irregular–>regular breathing

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11
Q

CNS depression stage 3

A

Regular breathing–>apnea

Loss of response to pain

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12
Q

CNS depression stage 4

A

Deepest
Depression of vasomotor and respiratory centers
Need circulatory and respiratory support

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13
Q

Toxicity of inhaled anesthetics

A

Nausea/vomiting
Halothane–>hepatitis after previous first time exposure
Metab to fluoride ions–>renal toxicity
In combination with succinylcholine–>malignant hyperthermia

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15
Q

Thiopental

A

Barbiturate
GABAa agonist
Sedation to general anesthesia (no analgesia)
Resp depression

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16
Q

Methohexital

A

Barbiturate
GABAa agonist
Sedation to general anesthesia (no analgesia)
Preferred over thiopental for short procedures due to quick elimination

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17
Q

Diazepam

A

Benzodiazepine
GABAa agonist
Used perioperative for anxiolytic and anterograde amnesia properties (terminated by flumazenil)
Anticonvulsant properties

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18
Q

Lorazepam

A

Benzodiazepine
GABAa agonist
Used perioperative for anxiolytic and anterograde amnesia properties (terminated by flumazenil)
Anticonvulsant properties

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19
Q

Midazolam

A

Benzodiazepine
GABAa agonist
Used perioperative for anxiolytic and anterograde amnesia properties (terminated by flumazenil)
Anticonvulsant properties
Water soluble–>good for parenteral administration
IV before operating due to rapid onset, shorter elimination, steeper dose-response curve

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19
Q

IV Anesthetics

A 
Barbiturates
Benzodiazepines
Opioid analgesics
Propofol
Fospropofol
Etomidate
Ketamine
Dexmedetomidine
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20
Q

Fentanyl, sufentanil, remifentanil, morphine

A

Opioid analgesics
Opioid recep agonists
Use in combination with benzodiazepines
Due to adverse effects, used as premedication and adjunct to IV and inhaled

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21
Q

Propofol

A

GABAa agonist
Most common parental anesthetic
Continuous infusions and anesthesia maintenance
Poor water solubility
Formulated with soybean, glycerol, and lecithin–>allergic rxn possible
Rapid onset/recovery/metabolization in liver
No analgesic properties
Decr cerebral flow and metab rate
Decr ICP and IOP
Burst suppression in EEG–>neuroprotective
Decr bp
Inhib baroreflex response–>hypotensive
Depress resp, apnea after induction dose
Reduce upper airway reflex
Painful injection

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22
Q

Fospropofol

A

Prodrug of propofol
Metab by alkaline phosphatase–>propofol, phosphate, formaldehyde
Similar to propofol, but onset and recovery prolonged
Less pain
Adverse effects include paresthesias and pruritis

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23
Q

Etomidate

A 
GABAa agonist
Hypnotic, not analgesic
Minimal CV and resp depression
Rapid LOC
Less rapid recovery
Metab by liver and in plasma
Decr cerebral flow and ICP
Minimal change in HR and CO
Less pronouced resp depression
Inhib 11b-hydroxylase-->adrenocortical suppression
24
Q

Ketamine

A 
NMDA antagonist
Dissociative anesthetic state, catatonia, amnesia, analgesia
With or without LOC
Incr lacrimation and salivation
Incr cerebral flow and CMRO2
Unpleasant emergence
May be euphoric
Incr bp, HR, CO
Direct myocardial depressant, but masked by symp stim
Minimal resp depression
25
Q

Dexmedetomidine

A 
Alpha2 agonist
Hypnosis and analgesic effects
Sedative resembles physiologic sleep
Decr HR, systemic vasc resist, bp
Short term sedation or adjunct to general anesthesia
26
Q

Benzocaine

A

Local anesthetic
Poor solubility in water
Anesthetic lubricant
Topically for dermatologic conditions, hemorrhoids, premature ejaculation

26
Q

Bupivacaine

A

Local anesthetic
Long duration of action
More sensory block than motor

26
Q

Cocaine

A 
Local anesthetic
Blockage of nerve impulses
Inhib NET-->incr NE-->vasoconstriction
Dopamine reuptake inhib-->euphoria
Topical anesthetic for upper resp
26
Q

Dibucaine

A

Local anesthetic
Toxicity assoc with injections
Used as topical cream

26
Q

Lidocaine

A

Local anesthetic
Amide that is an alternative choice for indiv sensitive to esters
Faster, more intense, longer lasting, more extensive than procaine
Antiarrhythmic agent

26
Q

Procaine

A

Local anesthetic
Lower potency, slower onset, shorter duration than newer agents
Metab to para-aminobenzoic acid–>inhib sulfonamide abx

26
Q

Ester-type vs amide-type local anesthetics

A

Ester-type has one “i”

Amide-type has at least two “i”s

Neuroscience II (4 decks)

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