Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia Pharm > Week 1 - Anesthesia Pharm > Flashcards

Week 1 - Anesthesia Pharm Flashcards

1
Q

Roles of the Anesthesia Provider

A

Perform and document a thorough preanesthesia assessment and evaluation

Obtain/document informed consent for planned anesthetic

Formulate a pt-specific plan for anesthesia care

Implement and adjust plan based on pt’s physiologic response… intervene to maintain optimal physiologic condition

Monitor: oxygenation, ventilation, CV, temp, NMBs, positioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define Pharmacodynamics

A

The action of the drug on the body

“Relationship between the concentration of drug and the magnitude of effect”

Nature of the drug, receptors/receptor sites, inert binding sites, MOA, therapeutic/toxic effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Pharmacokinetics

A

The effect of the body on the drug

“Relationship between the drug dose and the time course of drug levels in the bloodstream” - at the receptor site of desired action

Binding, permeability, henderson-hasselbach, distribution, elimination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Agonists vs Antagonists

A

Agonists: cause desired action at receptor

Antagonists: have affinity for receptor but NO efficacy (no action at receptor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Competitive Antagonist vs Non-Competitive Antagonist

A

Competitive: antagonism shifts agonist concentration effect curve to the right (binds to same site as agonists - effect is which ever has higher concentration)

Non-Competitive: antagonists may bind irreversibly to the receptor. Lowers number of active receptors available, less effect seen, tend to bind to another site which changes the desired receptor site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ED/C50 and ED/C95

A

The dose (concentration) of drug needed to obtain 50% and 95% of maximal effect

Lower ED50 = more potent drug

During anesthesia induction we frequently give 2-3x the ED95 to achieve rapid onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define Potency of a Drug

A

A function of affinity for the receptor and function at the receptor

High affinity with low potency = low potency
Low affinity with high potency = HIGH potency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define Therapeutic Index

A

Toxic Dose (TD50) divided by Effective Dose (ED50)

High TI indicates relative safety of a drug – the higher the TI the safer the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define Dissociation Constant

A

Describes the propensity for a drug-receptor complex to break apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define Clearance

A

Rate of Elimination divided by Plasma Drug Concentration

Clearance by an organ = extraction capability of the organ X blood flow to the organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Zero Order Kinetics vs First Order Kinetics

A

Zero Order: clearance of drug is constant and NOT dependent upon plasma concentration (Unit/Time)

First Order: clearance of drug is proportional to the plasma concentration (% Eliminated/Time) - basis of the half-life model of drug metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does half-life vary with Volume of Distribution and Clearance?

A

Directly with Vd and inversely with clearance

Higher Vd takes longer to clear
High clearance = shorter half-life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the phases of metabolism?

A

Phase I: converts parent drug to more polar (hydrophobic –> hydrophilic)

Phase II: conjugate drug with polar moiety making it more water soluble and excretable

CYP iso’s: P450, P2D P3A(4,5), (50% CYP rxn) responsible for most drug metabolism
Enzyme Induction: stimulation of drug metabolizing enzymes in the liver; usually phase I enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Metabolism - Phase I Reactions

A

Oxidation, Reduction, Hydrolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Metabolism - Phase II Reactions

A

Makes drugs water soluble for excretion

Glucuronidation, Acetylation, Glutathione Conjugation, Glycine Conjugation, Sulfation, Methylation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CYP inducers vs CYP inhibitors

A

CYP inducers: phenobarbital, dilantin, rifampin, carbamazepine, ethanol, barbiturates, St. John’s wort

CYP inhibitors: cimetidine, grapefruit juice, amiodarone, metronidazole, omeprazole, SSRI’s, diltiazem, erythromycin

17
Q

Lower molecular weight drugs vs High molecular weight drugs

A

LMW: <100, can get more places and have less specific actions and more side effects

HMW: >1000, are often poorly absorbed and distributed

18
Q

Define Plasma Binding

A

Drug bind to proteins in the blood

Effectively eliminates drug from the concentration gradient which determines drug movement and action

19
Q

What affects the cessation of action of most anesthesia medications?

A

Redistribution from active site and removal of administration

Metabolism is relatively unimportant in the cessation

20
Q

Volume of Distribution

A

Units of drug in body/Units of drug in plasma

Low Vd means most of the drug is in the plasma and very little has moved elsewhere
High Vd means drug moves throughout the body and less remains in the plasma

21
Q

What are Contact Sensitive Half-Times?

A

Time required for plasma concentration of a drug to decrease 50% after discontinuing administration

Longer infusion, more drug into tissues, absorbed and held
Drug accumulates at different rates based on physiochemical properties of the drug

Remifentanil has very short/stable CSHT - predictable, rapid emergence
Propofol and Fentanyl have longer CSHT - less predictable, longer emergence

22
Q

What are the four major options for anesthesia?

A

1) Monitored Anesthetic Care (MAC) with or without local anesthesia (Deep monitored Anesthesia)
2) Peripheral Nerve Block with or without a MAC
3) Regional (conductive) anesthesia (Spinal or Epidural)
4) General anesthesia (with or without intubation, LMA, iGel, Mask, etc)

23
Q

How do you determine which anesthetic to do?

A

Preferences of pt, surgeon, anesthesia provider
Coexisting diseases of pt
Site of surgery/Body position during surgery
Likelihood of reflux or aspiration
Suspected airway issues
Expected (not scheduled) duration of procedure
Anticipated recovery location and time

24
Q

What are the components to general anesthesia?

A

Anxiolysis
Analgesia
Hypnosis
Paralysis

Decrease Somatic and Autonomic Systems

25
Q

IV Anesthesia Agents and Adjuncts

A

Analgesics: Morphine, Meperidine, Fentanyl, Alfentanyl, Sufentanil, Remifentanil, Hydromorphone

Amnestics: Midazolam, Diazepam, Lorazepam

Hypnotics: Sodium Thiopental, Sodium Brevital, Propofol, Etomidate

Paralytics: Succinylcholine, Mivacurium, Rocuronium, Cisatracurium, Vecuronium, Pancuronium, Curare

26
Q

What do you do for Monitored Anesthesia Care (MAC)?

A

Patient evaluation and agreement to MAC
Support vital functions and VSS
Provide sedation, anxiolysis, analgesia, hypnotics, anesthetic drugs, other meds needed
VS monitoring, respiratory pattern/depth
Psychological support/physical comfort
Anything else needed by the pt, for the pt, to the pt to facilitate the procedure
Unconscious pt is NOT a MAC state
Monitor the amount of Local given by the surgeon and warns of toxicity levels

27
Q

What drugs are given during MAC anesthesia?

A 
Midazolam
Fentanyl, Alfentanil
Propofol (bolus, infusion)
Dexmedetomidine
Ketamine
Benadryl
Keta-Propo-Fentanyl?
28
Q

Locations of Peripheral Nerve Blocks

A

Cervical Plexus
Brachial Plexus (Interscalene, Supraclavicular, Infraclavicular, Axillary)
Median/Ulnar/Radial Nerve Block
Femoral/Saphenous/Sciatic/Popliteal/Ankle

29
Q

Pros and Cons of Peripheral Nerve Blocks

A

Pros: Good for extremity anesthesia, Allow for conscious patient, Beneficial if unable to perform more invasive anesthetic

Cons: Unpredictable sensory and motor effects, Local anesthetic toxicity (LAST) - lipid rescue

30
Q

Types of Regional Anesthesia

A

Spinal/Subarachnoid Block (SAB): rapid placement, rapid onset high quality sensory and motor blockade, less pain during surgery (some residual after), less PONV

Epidural/Caudal: lower risk for PDPH, less systemic HoTN than SAB, extended blockade via indwelling catheter, Postoperative analgesia

31
Q

Risks of Regional Anesthesia

A 
Hypovolemia
Increased ICP
Coagulopathy
Sepsis
Infection at puncture site
Pre-existing neuromuscular disease
32
Q

What are the phases of general anesthesia?

A

Induction: Anxiolysis,
Analgesia; IV, inhalation, or IM induction; Muscle relaxants

Airway Management: Mask, ETT, LMA, iGel???

Maintenance: Inhalation agent, TIVA, Muscle relaxation, Analgesia

Emergence: post-op pain management, reduction of anesthesia, muscle relaxant reversal and monitoring, spontaneous respiration, extubation, transport to PACU and transfer of care

Anesthesia Pharm (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions