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Pharmacology > Unit 3-General Anesthetics > Flashcards

Unit 3-General Anesthetics Flashcards

1
Q

Nitrous Oxide

Class

A

Inorganic gas

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2
Q

Nitrous Oxide

Mechanism

A

NMDA receptor antagonist

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3
Q

Nitrous Oxide

Uses

A

Mask induction in children; adjuvant to volatile anesthetics for maintenance, opioids

But does not produce muscle relaxation

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4
Q

Nitrous Oxide

Side effects

A

Post-operative nausea and vomiting; inactivates vitamin B12 (leading to abnormal embryonic development, abortion); accumulates in closed, air-containing spaces (bowel, middle ear, pneumothoraces, air emboli) because N2O insoluble in blood

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5
Q

Isoflurane

Class

A

Volatile anesthetic

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6
Q

Isoflurane

Uses

A

Most potent

Gold standard for maintenance of anesthesia

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7
Q

Isoflurane

Side effects

A

Pungent; dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; increase in HR; malignant hyperthermia

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8
Q

Desflurane

Class

A

Volatile anesthetic

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9
Q

Desflurane

Uses

A

Least soluble, least potent bc completely fluorinated (allows for rapid emergence from anesthesia)

Maintenance of anesthesia

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10
Q

Desflurane

Side effects

A

Most pungent (airway irritation symptoms); dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; increase in HR; malignant hyperthermia

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11
Q

Sevoflurane

Class

A

Volatile anesthetic

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12
Q

Sevoflurane

Uses

A

Less soluble, less potent (but not irritating)

Mask induction in children and adults; maintenance of anesthesia

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13
Q

Sevoflurane

Side effects

A

Can form CO if not combined with CO2 correctly; dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; malignant hyperthermia

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14
Q

Methohexital

Class

A

Barbiturates

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15
Q

Methohexital

Mechanism

A

GABAa receptor agonist, antagonist of NMDA-glutamate receptor; produce hypnosis & sedation, but is anti-analgesic

Redistribute from brain to muscle and fat, metabolized by liver; dosed based on lean body mass

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16
Q

Methohexital

Uses

A

Induce general anesthesia

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17
Q

Propofol

Class

A

Alkylphenol (a fatty acid)

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18
Q

Propofol

Mechanism

A

GABAa receptor agonist (hypnosis), antagonist of NMDA-glutamate receptor; some a2 receptor activity;

acts on GABAa and glycine receptors in spinal cord

rapid onset and offset

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19
Q

Propofol

Uses

A

Anti-emetic at low doses; induction and maintenance of general anesthesia; sedation in ICU, procedural sedation

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20
Q

Propofol

Side effects

A

Propofol infusion syndrome: being given for several days leads to metabolic acidosis, rhabdomyolysis, heart & renal failure, lowering of BP, bradycardia, and death (likely due to fatty acid oxidation)

Painful injection site; supports bacterial growth

Administered IV in a lipid emulsion (cause of pain); be aware of allergies (egg and soy in emulsion); no malignant hyperthermia

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21
Q

Etomidate

Class

A

Carboxylated imidazole

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22
Q

Etomidate

Mechanism

A

GABAa receptor agonist (only D-isomer)

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23
Q

Etomidate

Uses

A

Hypnosis; no analgesic activity

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24
Q

Etomidate

Side effects

A

Pain on administration (due to solvent, propylene glycol); involuntary myoclonic movements due to subcortical disinhibition (not a seizure); post-operative nausea and vomiting; single dose inhibits cortisol synthesis

Minimal cardiorespiratory depression (good agent in patients with minimal cardiac reserve)

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25
Q

Ketamine

Class

A

Phencyclidine

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26
Q

Ketamine

Mechanism

A

NMDA receptor antagonist, kappa opiate agonist; leads to dose-dependent unconsciousness, amnesia, analgesia

Causes functional disorganization by depressing parts of cortex and thalamus, stimulating limbic system

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27
Q

Ketamine

Uses

A

Sedative/anesthetic for pediatric/developmentally delayed patients; induction in patients with reactive airway disease, hypovolemia (trauma patients), cardiac disease; with propofol for IV procedural sedation; adjuvant during and after surgery to reduce opiod use; part of multimodal pain therapy regimen; depression treatment

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28
Q

Ketamine

Side effects

A

Stimulates sympathetic nervous system outflow; increases cerebral blood flow, ICP; emergence delerium; nystagmus, lacrimation, salivation, and dissociative anesthesia

Racemic mixture (S more potent); metabolized by P450 (norketamine, a third to a fifth as effective); great bronchodilator; contraindicated in CAD patients and those with with intracranial lesions

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29
Q

Dexmedetomidine

Class

A

a2 adrenergic agonist

30
Q

Dexmedetomidine

Mechanism

A

Binds a2a and a2b in locus coeruleus and spinal cord (produces sedation, sympatholysis, and analgesia)

31
Q

Dexmedetomidine

Uses

A

Awake intubations, awake craniotomies; adjunct to general anesthesia in patients susceptible to narcotic-induced post-op respiratory depression; withdrawal/detoxification

Since GABA not hit, sedation is easier to wake from and is similar to non-REM sleep; FDA approved only for ventilation of ICU patients for under 24 hours

32
Q

Dexemedetomidine

Side effects

A

Limited respiratory depression (wide safety margin)

33
Q

Succinylcholine

Class

A

Depolarizing NMB

34
Q

Succinylcholine

Mechanism

A

Divalent ACh molecule; attaches to all ACh receptors, overstimulating them (first seen as disorganized muscular contractions (fasiculations), then paralysis)

35
Q

Succinylcholine

Uses

A

Skeletal muscle relaxant (intubation)

36
Q

Succinylcholine

Side effects

A

Malignant hyperthermia; cardiac dysrhythmias, hyperkalemia, increased intraocular pressure, increased intracranial pressure

Increased intragastric pressure, myalgias, masseter spasm

Hydrolyzed by pseudocholinesterase (in plasma); blockade cannot be reversed; only NMB with rapid onset and ultra-short duration of action

37
Q

Pancuronium

Class

A

Amino steroid non-depolarizing NMB

38
Q

Pancuronium

Mechanism

A

Competitive blockade of ACh (no depolarization); vagolytic

Only long acting non-depolarizing agent; supplied as liquid; 80% excreted unchanged in liver (low metabolism in liver); reverse with AChEI

39
Q

Pancuronium

Uses

A

Skeletal muscle relaxant; avoid in patients with renal insufficiency

40
Q

Pancuronium

Side effects

A

Increase in HR (vagolytic)

41
Q

Vecuronium

Class

A

Amino steroid non-depolarizing NMB

42
Q

Vecuronium

Mechanism

A

Competitive blockade of ACh (no depolarization)

Intermediate acting; supplied as a powder (reconstitute); hepatic metabolism, hepatic and renal excretion; reverse with AChEI

43
Q

Vecuronium

Uses

A

Skeletal muscle relaxant

44
Q

Vecuronium

Side effects

A

No cardiovascular effects

45
Q

Rocuronium

Class

A

Amino steroid non-depolarizing NMB

46
Q

Rocuronium

Mechanism

A

Competitive blockade of ACh (no depolarization)

Intermediate acting; supplied as a liquid; hepatic metabolism, hepatic and renal excretion; can speed onset with higher dose; reverse with AChEI

47
Q

Rocuronium

Uses

A

Skeletal muscle relaxant (can substitute succinylcholine in rapid sequence intubation)

48
Q

Rocuronium

Side effects

A

No cardiovascular effects

49
Q

Sugammadex

Class

A

Selective relaxant binding agent

50
Q

Sugammadex

Mechanism

A

Complexes with rocuronium, rendering it inactive; no effect on AChesterase so do not need to use antimuscarinic

51
Q

Sugammadex

Uses

A

Immediate reversal of rocuronium

Not yet FDA approved

52
Q

Sugammadex

Side effects

A

Decrease in blood presure, nausea and vomiting, dry mouth

53
Q

Atracurium

Class

A

Isoquinoline non-depolarizing NMB

54
Q

Atracurium

Mechanism

A

Competitive blockade of ACh (no depolarization)

Undergoes spontaneous, non-enzymatic degradation (Hofman elimination); intermediate acting; reverse with AChEI

55
Q

Atracurium

Uses

A

Skeletal muscle relaxant; use in patients with liver or renal dysfunction

56
Q

Atracurium

Side effects

A

Histamine release (especially if given as rapid IV bolus), with resultant hypotension and tachycardia

57
Q

Cis-atracurium

Class

A

Isoquinoline non-depolarizing NMB

58
Q

Cis-atracurium

Mechanism

A

Competitive blockade of ACh (no depolarization)

Undergoes spontaneous, non-enzymatic degradation (Hofman elimination); intermediate acting; reverse with AChEI

59
Q

Cis-atracurium

Uses

A

Skeletal muscle relaxant; use in patients with liver or renal dysfunction

60
Q

Cis-atracurium

Side effects

A

Unlike atracurium, no histamine release or downstream effects

61
Q

Edrophonium

Class

62
Q

Edrophonium

Uses

A

Reversal of NMB

Short-acting, fast onset

63
Q

Neostigmine

Class

64
Q

Neostigmine

Uses

A

Reversal of NMB (most commonly used)

More complete antagonism than edrophonium

65
Q

Pyridostigmine

Class

66
Q

Pyridostigmine

Uses

A

Reversal of NMB

Longer duration of action than neostigmine, edrophonium

67
Q

Glycopyrrolate

Class

A

Anti-muscarinic

68
Q

Glycopyrrolate

Uses

A

Reversal of neuromuscular blockade’s muscaranic effects

Could also use atropine

69
Q

Glycopyrrolate

Side effects

Pharmacology (26 decks)

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