Test 3 Flashcards by Chelsea Furnish

4 characteristics of general anesthesia

Unconsciousness
Immobility
Muscle relaxation
Loss of sensation

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4 classifications of anesthetic agents and adjuncts

Route of administration
Time of administration
Principal effect
Chemistry

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Characteristics of sedation

CNS depression
Drowsiness
Drug induced
Various levels
Unaware of surroundings
Aroused by noxious stimulation
Uses: minor procedure

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Characteristics of tranquilization

Calmness
Reluctant to move
Aware of surroundings but doesn’t care

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Characteristics of hypnosis

Drug induced
Sleep like state
Impaired ability to respond to stimuli
Can be aroused with sufficient stimulation

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Characteristics of narcosis

Drug induced sleep

Not easily aroused

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How opioids work

Prevent nerves from transmitting impulses
Prevent presynaptic release of neurotransmitters, particularly excitatory afferent
Decrease the perception of pain

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Pharmacodynamics of opioid agonists

Bind to mu and kappa receptors

Best for moderate to severe pain

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Pharmacodynamics of opioid partial agonists

For moderate pain

Lower efficacy

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Pharmacodynamics of opioid agonist antagonists

Bind to delta, mu, and kappa receptors–but only stimulate kappa!!
Used as a reversal agent or for mild pain

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Pharmacodynamics of opioid antagonists

Bind to but don’t stimulate mu, delta, and kappa

Used as reversal agents

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Best option for severe pain

Pure opioid agonists

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Only opioid that an cause tachycardia

Meperidine

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Effects of oipiods

CNS: sedation,narcosis, euphoria 
Analgesia
Bradycardia 
Decreased respiratory rate and tidal volume
Cough suppression
Miosis

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Adverse effects of opioids

Salivation and vomiting by stimulation of chemoreceptor trigger zone (CTZ)
Initial diarrhea! Vomiting, and flatulence followed by GI stasis and urine retention
Histamine release
Increased intraocular and intracranial pressure

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Possible opioids and tranquilizers that can be combined to create neuroleptanalgesia

Opioids: morphine, buprenophine, butorphanol, hydromorphone
Tranquilizers: diazepam, midazolam, Thorazine

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State of tranquil dreaming

Neuroleptanalgesia

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MOA of Tramadol (ultram)

Opiate-like
Mu receptor agonist
Blocks serotonin release and reuptake of NE
Prescribed for rheumatoid arthritis and fibromyalgia

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Side effects of Tramadol

Agitation 
Muscle tremors
Sweating
Hyperthermia
Seizures

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3 classes of injectable anesthetics

Barbiturates
Propofol
Etomidate

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Subclasses of barbiturates

Based on duration of action: ultrashort, short, intermediate, long acting
Based on chemical structure: oxybarbiturates, thiobarbiturates

Action of barbiturates

Mimic inhibitory neurotransmitter GABA

Effect of barbiturates on patients with hypoproteinemia

Normal drug dose may produce prolonged unconsciousness or death

Long acting barbiturates

Phenobarbital

Short acting barbiturates

Pentobarbital Secobarbital Amobarbital

Ultra short acting barbiturates

Thiopental

What must you ALWAYS do with barbiturates

Intubate

Adverse affects of barbiturates

Feel like your body is on fire Exaggerated potency in critically ill, hypoproteinemia, or acidodic patients Tissue irritation and sloughs

#1 most used drug for anesthetic induction

Propofol

Primary termination of propofol action

Redistribution

Only legal dissociative anesthetic

Ketamine

MOA of benzodiazepines

Target GABA (gamma amino butyric acid) receptors

What can you never mix Diazepam (Valium) with?

Water soluble drugs

DOC for symptomatic treatment of recreational overdose

Lorazepam (Ativan)

Class of drugs used to cause anesthesia

Benzodiazepines

Most commonly used halogenated organic compound

Isoflurane and sevoflurane

Uptake of halogenated organic compounds depends on....

Concentration gradient Lipid solubility Blood supply Partial pressure of the gas

One of perfusionists most affective tools in changing BO and arterial pressure

Anesthetic vaporizer

Important properties of inhaled anesthetics

``` Vapor pressure Partition coefficient Minimum alveolar concentration Rubber solubility CO dependent ```

Characteristics of volatile agents

High vapor pressure Delivered from precision vaporizer to control delivery concentration Ex: Isoflurane, sevoflurane, desflurane, and halothane

Characteristics of nonvolatile agents

Low vapor pressure Delivered from nonprecision vaporizer Ex: methoxyflurane NO LONGER USED

Blood gas partition coefficient

Measure of solubility of inhalation anesthetic in blood as compared to alveolar/oxygenator gas Indication of speed of induction and recovery for inhalation agent Low blood gas partition coefficient: relatively less soluble in blood than alveolar gas--faster induction and recovery

Minimum alveolar concentration

Concentration of anesthetic vapor in alveoli that is required to prevent a motor response in 50% of patients subjected to surgical pain stimuli

Vaporizer setting of an agent required for surgical anesthesia

1-2x MAC

Archetypical halogenated volatile anesthetic

Halothane

Most commonly used inhalant agent in North America

Isoflurane

Least potent inhalant agent

Desflurane | Called one breath anesthesia

Max N2O that can be mixed with other gas anesthetics

80%

Ranking g of blood gas partition coefficients for anesthetic gases

Halothane>Isoflurane>sevoflurane>nitrous oxide> desflurane

Best and worst gas anesthetics for induction

Best: nitrous oxide Worst: halothane

Best and worst gas anesthetics for recovery

Best: halothane Worst: nitrous oxide