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Pharmacology and Therapeutics 2 Y2 > Principles of General Anaesthesia > Flashcards

Principles of General Anaesthesia Flashcards

1
Q

what anaesthetic conc is required for loss of consciousness

A

Low

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2
Q

what anaesthetic conc is required for loss of reflex responses

A

High

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3
Q

2 criteria for general anaesthetics?

A
  • Loss of consciousness

- Suppression of reflex responses

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4
Q

4 examples of inhalational GA?

A
  • Nitrous oxide
  • Diethyl Ether
  • Halothane
  • Enflurane
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5
Q

2 examples of IV GA?

A
  • Propofol

- Etomidate

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6
Q

What is peculiar about the structures of GA

A

They are all different

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7
Q

How was the lipid solubility theory of GA proven wrong? (2)

A
  1. At relevant concentrations (clinical doses), the change in the lipid bilayer was minute
  2. How would this change impact membrane proteins?
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8
Q

MOA of IV GA?

A
  • They alter synaptic function primarily though GABAA receptors (they potentiate and enhance GABA)
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9
Q

Suppression of reflexes MOA of IV GA?

A
  • The ability of I.V. agents to suppress reflex responses seems to be due to their effect on GABA receptors that contain the beta3 subunit
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10
Q

The effect on GABA receptors that contain the beta3 subunit by IV GA causes…?

A

Suppression of reflex responses

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11
Q

Amnesia MOA of IV GA?

A
  • The ability of I.V. agents to cause amnesia seems to be due to their effect on GABA receptors that contain the alpha5 subunit (lots of these in the hippocampus)
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12
Q

What do IV GA promote regarding polarisation of cells (think receptor they act on)

A

Hyperpolarisation

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13
Q

The effect on GABA receptors that contain the alpha5 subunit by IV GA causes …

A

Amnesia

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14
Q

MOA of inhalational GA (receptors they target, (5))

A
  • They can have an effect on GABAA receptors
  • glycine receptors Particularly important in spinal cord and lower brainstem – these contain alpha1 subunits – these are linked to suppression of reflexes
  • nitrous oxide block NMDA-type glutamate receptors
  • can also inhibit nicotinic ACh receptors
  • Can also activate TREK K+ channels Important for consciousness
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15
Q

what receptor is important for consciousness (2)

A

TREK K+ channels

GABAa

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16
Q

TREK K+ channels are important for?

A

Consciousness

17
Q

what receptor is important for suppression of reflexes

A

glycine receptors and GABAreceptors

18
Q

what receptor is important for analgesia

A

nAchR and GABAa with the alpha5 subunit

19
Q

nAchR are important for (regarding GA)?

A

Analgesia

20
Q

glycine receptors are important for?

A

suppression of reflexes

21
Q

Which is more selective, IV or gaseous GA

A

IV

22
Q

Which 2 neurons are important for loss of consciousness

A

reticular activating neurons OR depression of excitability of thalamocortical neurons

23
Q

How is an IV GA excreted?

A

Via metabolism in the liver/kidney etc

24
Q

How is an inhalational GA excreted?

A

Out the lungs

25
Q

What does rate of inhalational GA excretion depend on

A

blood/gas partition coefficient

26
Q

Explain the blood/gas partition coefficient

A
  • If the agent dissolves poorly in the blood (low partition coefficient), lots of it remains gaseous in the blood – this diffuses easily into the brain (this is good)
  • If the agent dissolves well in the blood (high coefficient), it doesn’t easily enter the brain due to the BBB
  • It is also easier to clear an agent with a low partition coefficient because it can diffuse out as easily as it moved in
    Basically agents with a low blood:gas partition coefficient are favourable as it gives you more control over anaesthesia
27
Q

Low blood:gas partition coefficient impact on entry to brain?

A
  • If the agent dissolves poorly in the blood (low partition coefficient), lots of it remains gaseous in the blood – this diffuses easily into the brain (this is good)
28
Q

Low blood:gas partition coefficient means how much dissolves?

A

Not much dissolves

29
Q

High blood:gas partition coefficient impact on entry to brain?

A

If the agent dissolves well in the blood (high coefficient), it doesn’t easily enter the brain due to the BBB

30
Q

High or low blood:gas partition coefficient is favourable for anaesthesia?

A

Low as it gives you more control over anaesthesia

31
Q

Thinking control of the rates of excretion, what type of general anaesthetics are administered when during an op

A

an IV agent is used to induce anaesthesia, and then an inhalational agent to control the anaesthesia

32
Q

Speed of elimination of inhalational general anaesthetics?

A

Quick

33
Q

Speed of elimination of IV general anaesthetics?

A

Slow

34
Q

Speed of effect of inhalational general anaesthetics?

A

Slow

35
Q

Speed of effect of IV general anaesthetics?

A

Quick

36
Q

Why do some people only use IV anaesthetics

A

because less coughing and inhalational can cause seizures

37
Q

What type of GA do you want for suppression of reflexes and why

A

, you want an easy drug to control i.e. an inhalational anaesthetic

38
Q

What needs to be taken into account when dealing with obese people and GA

A

Anaesthetics are extremely lipid soluble and so will sit in your adipose tissue, this can leak back into your blood as well. This needs to be taken into account when dealing with fatty boom battys.

Pharmacology and Therapeutics 2 Y2 (24 decks)

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