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RUSVM Anesthesiology 2016 > Premedication > Flashcards

Premedication Flashcards

1
Q

Sedation

A

induction of CNS depression and drowsiness by the use of drugs

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2
Q

Tranquillization

A

used somewhat synonymously to sedate

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3
Q

Analgesia

A

(antinociception) loss of reduction of pain sensation

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4
Q

General Anesthesia

A

controlled and reversible loss of consciousness, nociception, and mobility
Hypnosis and narcosis are sometimes used as synonyms

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5
Q

Balanced anesthesia

A

using multiple drugs to achieve the goals of general anesthesia with less side effects than using a single agent

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6
Q

Dissociative Anesthesia

A

a form of general anesthesia characterized by a catatonic state. These drugs dissociate the function of different parts of the brain; therefore, neural information is processed without proper coordination in space and time

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7
Q

Neuroleptanalgesia

A

a state similar to general anesthesia produced by sedative and an analgesia agent

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8
Q

Inhalational Anesthesia

A

general anesthesia using inhalational drugs

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9
Q

Total Intravenous Anesthesia (TIVA)

A

Achieved solely by injectable drugs

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10
Q

Partial Intravenous Anesthesia (PIVA)

A

a combination of injectable drugs and a lower concentration of inhaled anesthetic agent

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11
Q

Local Anesthesia

A

loss of sensation in a smaller, circumscribed body area

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12
Q

Regional Anesthesia

A

loss of sensation in larger but limited body area

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13
Q

What are the parts of the anesthetic procedure?

A

Premedication
Induction
Maintenance
Recovery

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14
Q

Anticholinergics

A

inhibit the parasympathetic nervous system

Antagonists on muscarinic acetylcholine receptors

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15
Q

Atropine

A

Lipid Soluble
Absorbs well IM, SC, PO
Crosses the BBB and placental barrier

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16
Q

Glycopyrrolate

A

Water soluble
Absorbs slowly IM, SC, PO
Does NOT cross the BBB or placental barrier

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17
Q

What are the indications of Atropine and Glycopyrrolate?

A

Increasing heart rate
Treatment of opioid induced bradycardia
decreasing salivation and bronchial secretion

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18
Q

What are the contraindications of Atropine and Glycopyrrolate?

A

Tachycardia
Hyperthyroidism
Heart Disease
Narrow angle glaucoma

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19
Q

What are the cardiovascular side effects of Atropine and Glycopyrrolate?

A 
2 degree AV block
bradycardia 
cardiac arrest
Tachycardia 
hypertension
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20
Q

Medetomidine + Atropine

A

Vasoconstriction
Tachycardia
Hypertension
DO NOT COMBINE THESE DRUGS ROUTINELY

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21
Q

What are other side effects of anticholinergics?

A 
Relaxes lower esophageal sphincter 
Mydriasis
Bronchodilation 
Dries airway secretion 
Intestinal paralysis 
CNS toxicity
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22
Q

Why is it contraindicated for Atropine to be used in Rabbits?

A

They have high levels of Atropinase enzyme that break down atropine

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23
Q

What is the preferred anticholinergic for Rabbits?

A

Glycopyrrolate

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24
Q

What drugs are Alpha 2 agonists?

A

Xylazine
Dexmedetomidine
Medetomidine
Detomidine

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25
Q

What drugs are alpha 2 antagonists?

A

Atipamezole

Yohimbine

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26
Q

What are the strongest sedatives?

A

Alpha 2 agonists

27
Q

What are the effects of alpha 2 agonists?

A

Sedation
Analgesia
Reduction sympathetic outflow from the brain
Reduction of stress response

28
Q

Where are alpha 2 receptors located?

A

Wall of arteries and veins
causing vasoconstriction
Inhibition of lipolysis
inhibition of insulin release: hyperglycemia

29
Q

What are the CNS effects of alpha 2 agonists?

A

Sedative effects : weak in pigs
some analgesic effect
Muscle relaxation

30
Q

Cardiovascular effects of alpha 2 agonists?

A

Strong vasoconstriction
Leads to high SVR and BP
Reflex bradycardia develops due to high SVR and BP
Resulting in low CO and tissue perfusion

31
Q

Respiratory effects of alpha 2 agonists

A 
mild respiratory depression 
RR decreases but tidal volume increases 
Upper airway resistance increases 
V/Q mismatch in horses
Bronchoconstriction 
lung edema
hypoxemia
32
Q

GI effects of alpha 2 agonists

A

Salivation decreases
Lower esophageal sphincter tone decreases
GI motility decreases
vomiting

33
Q

Xylazine effects in cattle

A

uterine contractions and abortion

34
Q

Alpha 2 agonist indications

A

Sedation of aggressive animals sedation in the ICU
Sedation to manage post operative airway
Prevention/treatment of seizures

35
Q

Phenothiazines

A

acts as an antagonist on dopamine, seratonin, alpha 1, and histamine receptors

36
Q

Phenothiazine CNS effects

A

Actions on dopamine and serotonin receptors
weaker sedative effects
no analgesia
Antiemetic effect

37
Q

Phenothiazine Cardiovascular Effects

A

Antagonist on alpha 1 receptors

causing vasodilation and hypotension

38
Q

Other Phenothiazine effects

A

Antihistamine
Antiarrhythmogenic
Inhibit platelet function
Penile prolapse

39
Q

Phenothiazine indications

A

Mild sedation
prevention/treatment of opioid dysphoria
Prevention of emesis caused by morphine
sedation for dogs with laryngeal paralysis

40
Q

Benzodiazepines

A 
GABA receptor agonists
Sedative 
Anticonvulsants
muscle relaxant effects
Minimal CV and respiratory effects
No analgesia
41
Q

GABA

A

inhibitory neurotransmitter in the CNS

42
Q

Benzodiazepine agonists

A

Diazepam
Midazolam
Zolazepam

43
Q

Benzodiazepine antagonists

A

Flumazenil

Sarmazenil

44
Q

Benzodiazepine indications

A

Premedication : combined with opioids, alpha 2 agonist, or both
Induction: combine with dissociative anesthetics or Barbiturates or propofol
Treatment of seizures

45
Q

What are the 3 Opioid receptors?

A

Mu
Kappa
Delta

46
Q

What are the classifications of opioids?

A

Full agonists
Partial Agonists
Antagonists
Mixed agonist antagonist

47
Q

Full agonists

A

activate receptors and trigger full tissue response

48
Q

Partial agonists

A

activate receptors but do not trigger full tissue response even at high dose

49
Q

Antagonists

A

bind to receptors but do not activate them

50
Q

Mixed agonist antagonist

A

activate one receptor type and inhibit another one

51
Q

Potency

A

tells you the dose

52
Q

Efficacy

A

tells you the strength of the effect

53
Q

Pharmacokinetics

A

onset, duration of effect, administration strategy

54
Q

Opioid CNS effects

A

Analgesia

Decreasing the MAC of inhalants

55
Q

Opioid GI effects

A

Defecation

Obstipation

56
Q

Other effects of Opioids

A

Hypothermia
Myosis or mydriasis
Inhibition of urination
Noise sensitivity

57
Q

Opioid Indication

A

Premedication
Preoperative analgesia
Treatment of acute and chronic pain

58
Q

Morphine

A

Strong analgesic

May cause histamine release

59
Q

Hydromorphone, oxymorphone

A

Strong analgesic

No histamine release

60
Q

Fentanyl

A

Strong Analgesic
Fast onset short duration
No histamine release

61
Q

Butorphanol

A

Weak and short acting analgesic
Antagonist on mu and agonist on kappa
Used for premedication in combo with benzodiazepine or alpha 2 agonists

62
Q

Buprenorphine

A

Partial mu agonist

Strong analgesic than butorphanol but weaker than full mu agonist

63
Q

Tramadol

A

Weak analgesic

inhibits NE and serotonin reuptake

RUSVM Anesthesiology 2016 (38 decks)

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