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Pharmacology > Unit 3 Anesthetic Agents > Flashcards

Unit 3 Anesthetic Agents Flashcards

1
Q

Anesthesia

A

loss of sensation or state without feeling

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2
Q

General anesthesia

A

Clinical state where there is an induced loss of consciousness or total insensibility (no pain) in a reversible manner
Full body, can cause decreased respiration, decreased blood pressure

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3
Q

Local anesthesia

A

limited to small area; minimal system disturbances

Commonly not adequate for many different procedures

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4
Q

Triad of anesthesia

A

Asleep, pain-free, still

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5
Q

Ideal anesthetic agent

A

Unconsciousness, amnesia, analgesia (no pain), skeletal muscle relaxation, areflexia, good minute-to-minute control

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6
Q

Is there any one drug considered to be an ideal anesthetic?

A

No

Use adjuvant drugs prior to anesthesia to make more safe & comfortable

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7
Q

Preanesthetic Medication uses

A

Relieve anxiety (benzodiazepines), Prevent allergic rxn (antihistaminics), prevent nausea/vomiting (antiemetics), analgesia (opiods), prevent bradycardia & secretion (atropine, glycopyrrolate)

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8
Q

4 phases of general anesthesia

A

Induction, Maintenance, Emergence, & Recovery

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9
Q

Induction phase

A

Initial administration until desired level is achieved

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10
Q

Maintenance phase

A

Desired level of anesthesia is maintained

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11
Q

Emergence phase

A

From sub-optimal concentration of anesthetic until it reaches zero

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12
Q

Recovery phase

A

From discontinuance of anesthetic agent until full restoration of function

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13
Q

4 Stages of Anesthesia

A

Analgesia, Excitement, Surgical Anesthesia, Medullary Depression

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14
Q

Analgesia Stage

A

1st stage

No pain, amnesia, euphoria; start to fall asleep

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15
Q

Excitement Stage

A

2nd stage Excitement, delirium, combative behavior
More asleep than stage 1
Want to get through this phase as fast as possible

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16
Q

Surgical Anesthesia Stage

A

Stage 3
Unconsciousness, regular respiration, decreasing eye movement
Want in this stage for surgery

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17
Q

Medullary Depression Stage

A

Stage 4
Do not want to enter this stage
Respiratory arrest, cardiac depression & arrest, no eye movement

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18
Q

Inhalable general anesthetics

A

Gasses/vapors
Usually used for maintenance of anesthesia
Can be used for induction in pediatrics

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19
Q

I.V. or fixed anesthetics

A

Used for induction & short surgical procedures

More common for maintentance

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20
Q

Anesthetic MOA

A

Depress spontaneous & evoked neuronal activity
Induce hyperpolarization, increase firing threshold (lesser activity), inhibit synaptic transmission & response to NT

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21
Q

Anesthetics may alter ion channels by

A

Increasing GABAa receptor Cl channel activity (enhance inhibitory NT), activate VG K channels (hyperpolarization & reduce activation), & inhibit glutamate NMDA receptors (decreased excitatory)

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22
Q

Advantages of inhalable anesthetic agents

A

Easy to control depth

Readily reversible, minute-to-minute control

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23
Q

Disadvantages of inhalable agents

A

Induction not as fast or smooth as fixed agents

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24
Q

Factors that affect rate of onset & recovery of inhalable agents

A

Anesthetic concentration in inspired air, pulmonary ventilation rate, solubility in blood & lipid, pulmonary blood flow, arteriovenous concentration gradient, elimination

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25
Q

Higher concentration of anesthetic in inspired air =

A

Higher partial pressure in lungs & Faster onset of anesthesia

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26
Q

Increase alveolar ventilation =

A

more gas molecules into blood/time & faster anesthesia onset

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27
Q

Less soluble in blood =

A

more rapid rise in partial pressure in blood & faster induction
However, also faster elimination from brain

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28
Q

More soluble in lipid =

A

more potent

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29
Q

high blood flow =

A

slower onset

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30
Q

Slower rate of uptake in alveolar/arterial =

A

fast induction

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31
Q

Minimum alveolar concentration (MAC)

A

concentration of anesthetic in inspired air at equilibrium when there is no response to noxious stimulus in 50% of patients

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32
Q

Lower MAC =

A

more potent anesthetic

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33
Q

Higher lipid solubility =

A

more potent anesthetic (lower MAC)

34
Q

Anesthesia is produced when anesthetic px in brain is _____ MAC value

A

greater

35
Q

Nitrous Oxide

A 
Gaseous inhalation (laughing gas)
Rapid onset & recovery (low blood/gas coefficient = poor solubility)
36
Q

Nitrous Oxide advantages

A

Good analgesia
Relatively safe, nontoxic
Rapid onset/recovery
2nd Gas effect (reduces induction time for primary agent, which reduces required concentration & toxicity)

37
Q

Nitrous Oxide limitation

A

Incomplete anesthetic
Low potency (insufficient for surgical anesthesia)
Diffusion hypoxia, increased risk of abortion & decreased conception probability

38
Q

Nitrous Oxide Uses

A

Complimentary agent to other more toxic agents
Cannot be SOLE anesthetic
Minor procedures (dentistry) or EMS

39
Q

Halothane

A

halogenated agent
Today not used often (poor analgesia & muscle relaxation), slower recovery, caused decreased cardiac output & hypotension, high incidence of post-op hepatitis

40
Q

Enflurane

A

Halogenated

Not used often today - CNS stimulation effects (EEG convulsive pattern, jerking, twitching)

41
Q

Isoflurane

A 
Halogenated
Used for maintenance
Pungency limits mask induction
Very long duration 
Lower toxicity
42
Q

Desflurane

A

Halogenated
Fastest onset & recover, excellent minute-to-minute control
2nd most commonly used inhalable
More irritating to respiratory passages than others - bronchial irritation with cough & laryngeal spasm

43
Q

Sevoflurane

A

Halogenated most commonly used
Mask induction, rapid onset & recovery, very potent, controllable (low solubility & high potency)
Low airway irritation

44
Q

IV drug use

A

Induction (most commonly) & maintenance

45
Q

IV drug advantages

A

Quick induction, rapid & complete recovery

46
Q

IV drug disadvantages

A

Can’t reverse effects, slow elimination, CV & respiratory effects

47
Q

Thiopental

A

Barbiturate
Commonly used induction agent
Rapidly diffuse out of brain & redistributes to other tissues (longer duration of action)
Highly soluble

48
Q

Propofol

A

IV anesthetic
99.9% of all inductions, can be used as continuous IV drip
Good quality of recovery (awake, clear head)

49
Q

Keatmine

A

IV anesthetic
Dissociative anesthesia - intense analgesia, catalepsy, & amnesia (can appear to be awake)
Non-competitive glutamate NMDA receptor antagonist
Emergence phenomenon - unpleasant dreams & hallucinations
Good for pts with
compromised cardiac status
Do NOT give to pts with psychiatric hx

50
Q

Midazolam

A

Benzo

Good for sedation, amnesia, & anxiolytic properties (potentiate GABAa recepetors)

51
Q

Local anesthesia

A

loss of sensation limited to a local area or region of body

Blocks generation & propagation of nerve impulse in a reversible, regional loss of function

52
Q

Topical (surface) local anesthesia

A

To skin, wounds, burns, mucous membranes

Skin penetration is critical factor

53
Q

Perineural Infiltration

A

injection of agent around specific area where anesthesia is desired
Easy to deliver to specific area
However increases potential for systemic absorption & toxicity

54
Q

Nerve Block

A

Injection of agent around specific nerve to block conduction of sensory & motor fibers distal to block
Less drug required to block larger areas distal to injection site
However requires more skill/knowledge

55
Q

Spinal Block

A

Injection of agent into CSF in lumbar subarachnoid space to reach roots of spinal nerve that supply specific region
More reliable block, return of CSF ensures correct location of needle
Conscious with minimal disruption of organ function
However no titration or reversibility, time limitations

56
Q

Epidural Block

A

Injection of agent into extradural space & block nerve root as it passes through space
No time limitation, may be used 4-7 days post op
Less reliable than spinal block

57
Q

Local anesthetic MOA

A

Blockade of VG sodium channels

Decrease in generation & conduction of action potentials

58
Q

Local anesthetic amides

A

Metabolized in liver

Longer 1/2 life & longer duration of action than esters

59
Q

Local anesthetic esters

A

Metabolized in plasma via BChE

Short plasma 1/2 life & duration of action

60
Q

Minimum anesthetic concentration (Cm)

A

minimum concentration of drug for standard block

Relative standard of potency

61
Q

Bigger fiber size =

A

greater Cm (more drug required)

62
Q

Fibers blocked first

A

Smallest fibers & myelinated fibers

B-fibers first, A-alpha last

63
Q

Increase in pH =

A

Decreased Cm (need less of drug)

64
Q

Increased Ca concentration =

A

increased Cm

65
Q

Vasoconstrictor substances

A

reduce local blood flow & reduce systemic absorption & reduce LA toxicity
Use epinephrine

66
Q

Factors that affect reversal of local anesthesia

A

Dilution by ECF (high to low LA concentration), Absorption into circulation (most important factor), Redistribution to other areas, Use of vasoconstrictors

67
Q

PABA (para-aminobenzoic acid) metabolite

A

Inactive metabolite from LA ester

Prone to allergic reactions

68
Q

Hypersensitivity to LA

A

Esters most likely

Also commonly allergic to methyparaben (preservative)

69
Q

Systemic toxicity to LA

A

Esters less likely because rapid metabolism

70
Q

Bupivicaine adverse effects

A

systemic toxicity has cardiac selectivity that can lead to complete cardiac collapse & death

71
Q

Treatment for LAST (local anesthetic toxicity)

A

IV lipid emulsion or IntraLipid

Absorbs circulating lipophilic toxin & reduces unbound free toxin available to bind to myocardium

72
Q

Lidocaine

A

LA standard
Can be given topically & by injection
Most common for epidural going to C-section (2%)
Intermediate-duration procedures

73
Q

Lidocaine toxicity

A

CNS excitation, TNS (transient neurologic symptoms) - increased sensitivity or pain to touch

74
Q

Bupivacaine

A

Amide LA
Epidural infusion in labor & postoperative pain
Spinal anesthetic

75
Q

Articaine

A

Amide LA

Dental anesthetic

76
Q

Cocaine

A

ester LA

topical for ear,nose, & throat procedures

77
Q

Benzocaine

A 
ester LA
Topical only (high lipid solubility)
78
Q

Chloroprocaine

A

Ester LA
short duration procedures
Epidural agent for labor (especially C section) - lower risk systemic toxicity & fetal exposure

79
Q

Exparel-Liposome

A

LA
encased bupivicaine - post op relief
very expensive

80
Q

EMLA (eutectic mixture of local anesthetics)

A

LA mixture
Lidocaine + prilocaine
topical

81
Q

TAC (tetracaine, adrenalin, & cocaine)

A

topical LA in pediatric ER

Pharmacology (8 decks)

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