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Intro to Pharmacology > Week 8 - Dissociative and Inhalant Anesthetics > Flashcards

Week 8 - Dissociative and Inhalant Anesthetics Flashcards

1
Q

Dissociative anesthesia, which is characterized by ____ and ______ sleep,
is a term used to describe the CNS state produced by ______ anesthetics.
Different ____ of the CNS seem to become dissociated from one another –
the EEG reveals ______ of some portions of the brain and ______ activity of the
limbic system.

A

analgesia, superficial, dissociative, levels, depression, enhanced

Limbic system is a collection of different structures in the middle of the brain: Thalamus, Hippocampus, Amygdala, Hypothalamus

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2
Q

Examples of dissociative agents?

A

Ketamine
Tiletamine

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3
Q

Dissociative Anesthetics
Drugs that _____ pain by ____ off or ____ the brain’s perception of pain
* Induce a state of ? (4)
* Characterized by (2) ?
* Different levels of the CNS seem to become ____ from one another
* Many ____ (laryngeal) are maintained
* _____ analgesia is good, but _____ analgesia is poor
* Muscle relaxation is ____ (animals are described as _____)
* Rapidly cross the _____ and affect the fetus

A

inhibit, cutting, dissociating, sedation, amnesia and analgesia, analgesia and superficial sleep, dissociated, reflexes, Somatic, visceral, poor, cataleptic, placenta

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4
Q

Pharmacological effects of dissociative anesthetics on the CNS?

A

Increased cerebral blood flow and intracranial pressure

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5
Q

Pharmacological effects of dissociative anesthetics on the cardiovascular system?

A

Depression (in healthy animals it can be paradoxical and lead to stimulation)

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6
Q

Pharmacological effects of dissociative anesthetics on the respiratory system?

A

Cats develop an apneustic breathing pattern (be careful!)

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7
Q

Effects of Cyclohexylamines described in humans
* Altered _____ and _____ perceptions _____ genuine hallucination
* Produce feelings of _____ from environment and _____
* Highly ____
* Long-term effects can be memory ___ and ___
* Can result in (3)?

A

visual, auditory, without, detachment, depersonalization, addictive, loss, depression, hyperthermia, convulsions and death

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8
Q

Cyclohexylamines
Subjects under influence of these drugs:
General indicators (4)?

A
  • Blank stare
  • Confused
  • Chemical odor
  • Cyclic behavior
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9
Q

Ketamine is known for more than 60 years
* It is a ____-_______ ________ agent used for induction and maintenance of GA
* Used in combination with ____ and muscle ____
* Mostly administered ___ and ___ injection or infusion in which species?
* In adult horses and cattle, it is only administered ____

A

non-Barbiturate , anesthetic, sedative, relaxant, IM, IV, cats, dogs, small ruminants, and swine, IV

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10
Q

MOA: interrupts the connection between the ____ and the ____ system (on systemic level), stimulates opioid receptors providing ___ and ___, and stimulates _____ release –> (2)

A

cortex, limbic, sedation, analgesia, catecholamine, increased cardiac output, bronchodilation

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11
Q

Ketamine is described as a “unique drug” because it has ?

A

hypnotic
analgesic
amnestic
effects

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12
Q

Ketamine: Mechanism of Action MOA: the blockade of _________ receptors
(_____), ion channels mainly involved in excitatory ______ Neurotransmission.
Ketamine, the classical ________ _______, is a ?

A

N-methyl-D-aspartate, NMDARs, Glutamatergic, NMDAR antagonist, non-
competitive inhibitor of NMDARs

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13
Q
A
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14
Q

Ketamine affects ______-Receptors on ______
interneurons eventually resulting in high ____ and low _____ levels

A

NMDA, GABA, GABA, Glutamate

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15
Q

Ketamine affects many other targets: ?

A

dopaminergic,
serotonergic, adrenergic, opioidergic, cholinergic as well
as acts on serotonin, norepinephrin, and dopamine
reuptake transporters and various other ion channels.

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16
Q

Ketamine
Water _____, ____ and non- _____ when administered IV
* Has _____ onset and provides ______ in ______ infusion
* ____ binding to plasma proteins (12-47% binding)
* Lipid-solubility is __ times higher than thiopental — _______ distribution and ___ onset
* Is metabolized in the _____
* Excreted by the _____ (detected in urine)
 Used alone:
Cats: for ____ procedures or to _____ restraint
 Used with other drugs: ______ and ____ to induce general anesthesia
 Sub-anesthetic dose:
Constant-rate infusion (CRI) for _____

A

soluble, stable, irritant, rapid, anesthesia, continuous, Low, 5, extensive, rapid, liver, kidney, minor, facilitate, tranquilizers, opioids, analgesia

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17
Q

Ketamine combinations: Animals usually receive a ______
(e.g. ACE, xylazine, diazepam) along with ketamine in order to provide muscle _____
Ketamine
1. In horses what combo is used?
2. In dogs and cats what combo is used?
3. In pigs, cattle, and goats what combo is used?

A

tranquilizer, relaxation

  1. xylazine is used prior to administration of ketamine
    (provide muscle relaxation)
  2. xylazine, diazepam, midazolam, or dexmedetomidine
    (prevent seizures, provide muscle relaxation)
  3. diazepam or xylazine (provide muscle relaxation)
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18
Q

Ketamine
Adverse Effects:
* In horses and dogs seizures are common following administration of ketamine _____.
* Can cause ____ ulceration (ophthalmic _______ will protect)
* In cats can lead to _____ salivation resulting in ____ obstruction (___-_____ drugs will prevent this)
* ______ State in cats

Contraindications can occur in…
* In animals with ____ injuries and _____
* In animals with ____ trauma or ______ tumors

A

alone, corneal, ointment, profuse, airway, Anti-Cholinergic, Trancelike, cornea, ulcers, head, intracranial

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19
Q
A

Transcelike state due to ketamine usage alone

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20
Q
  1. Telazol is made up of which 2 drugs?
  2. Contains equal amounts of _______ and _____
  3. Routes of administration? Produces what effects?
  4. Used for ____-term anesthesia in uncooperative dogs and feral cats
  5. Used in many other domestic and exotic species in combination:
     Horses: ?
     Pigs: ?
     Small ruminants and camelids: ?
A
  1. Tiletamine + Zolazepam
  2. Tiletamine, Zolazepam
  3. IM, SC and IV to produce sedation and anesthesia
  4. short,
  5. xylazine and butorphanol, xylazine and ketamine, alone or with xylazine
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21
Q

Telazol
Adverse effects:
1. Recoveries in dogs may be accompanied by muscle?
2. Hyperthermia
3. Tachycardia in dogs
Contraindications:
- In animals with corneal ulcers
- In animals with head trauma

A
  1. tremors,
    paddling, and whining
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22
Q

Inhalant Anesthetics
MOA * Exact mechanisms of anesthetic effects are not known
* No specific receptor has been identified
* The fact that chemically unrelated compounds produce anesthesia
argues against the existence of a single receptor

A
23
Q

Inhalant Anesthetics
Drugs possessing anesthetic properties that can be delivered via inhalation

Primary site of action: _____ and ______ _____
- Provide _____ and ______
- Administered by anesthetists through an anesthesia ___,
connected to some type of anesthetic ____ and an anesthetic ______ _____.

A

brain, spinal chord, analgesia, unconsciousness, mask, vaporizer, delivery system

24
Q
  1. Why is “Inhalation Anesthesia” considered safer than “Injectable Anesthesia”?
  • The depth of anesthesia can be more _____ _____ using gas anesthetic
  • Can ______ up the depth of anesthesia faster
     Can only be made deeper with ______
     Since inhalant agents are excreted through the ______ system, they are often ___ for animals with liver or kidney problems (why)?
     Animals under inhalation anesthesia are breathing ___% oxygen while animals
    anesthetized with injectables are breathing ____ air (~ __% O2)
     Most patients under inhalation anesthetics are _____ (airway stays ____)
A
  1. Injectable -> can not make them lighter until the drug is metabolized.
    readily altered, lighten, injectables, respiratory, safer, 100, metabolic pathway of the drug, room, 21, intubated, open
25
Q

Disadvantages of Inhalational Anesthesia
 Inhalation anesthesia requires an anesthetic machine
 Cost and skills to use it

 Induction is much slower with gas anesthetics than injectables
 You have to deal with the waste anesthetic gas produced
 Safety issues

A
26
Q

Uptake and Distribution of Inhalant Anesthetics (IAs)
* Uptake
 From the ____ (delivered via face __ or ____ tube)
 The greater the concentration, the more _____ the uptake
* Distribution
 Determined largely by ?
 To ___ and other ____
* Elimination
 IAs are almost entirely eliminated by the ____
* Metabolism
 ____ metabolism is minimal

A

lungs, mask, tracheal, rapid, regional blood flow, CNS, tissues, lungs, Hepatic

27
Q

Physical and Chemical Properties of IAs?

A
  • Vapor Pressure
  • Blood:Gas Partition Coefficient
  • Minimum Alveolar Concentration (MAC)
  • Rubber and Plastic Solubility (components of anesthetic delivery equipment)
28
Q

Vapor Pressure

  • VP is an indicator for IA’s ability to ______
  • The tendency of an IA in the ____ state to enter the _____ (____) state
  • Determines how readily an IA will _______ in the ______
  • VP is ______- and ______- dependent
A

evaporate, liquid, gaseous, vapor, evaporate, vaporizer, temperature, anesthetic

29
Q

IAs: classification

 Volatile agents
- _____ vapor pressure (evaporates more easily,~30% at RT)
 Delivered from a ____ vaporizer to control the delivery concentration
 All precision vaporizers are made to deliver only ____ specific agent such as ?

 Nonvolatile agents
- ___ vapor pressure (of ~3% at RT)
- Delivered from a ___-______ vaporizer such as?

A

High, precision, one, Isoflurane, Sevoflurane, Desflurane, Halothane, Dietyl ether, Low, non-precision, Methoxyflurane

30
Q

Blood:Gas Partition Coefficient
- Indicates _____ of induction and _____ from inhalant agents.
The measure of the _____ of an IA in ____ as compared to?

 Low Blood:Gas partition coefficient
- Agent is more soluble in alveolar gas than in blood at equilibrium
- Agent is less soluble in blood
- Faster expected induction and recovery

 High Blood:Gas partition coefficient
- Agent is more soluble in blood than in alveolar gas at equilibrium
- Agent is less soluble in alveolar gas (absorbed into blood & tissues)
- Slower expected induction and recovery

A

speed, recovery, solubility, blood, alveolar gas (air)

31
Q

Minimum Alveolar Concentration (MAC)
The measure of the potency of a drug used to determine the average setting
on the vaporizer that will produce surgical anesthesia

 MAC may be altered by ?
 Every patient must be monitored as an _____

A

age, body T, metabolic activity, obesity, pregnancy, disease state and other agents present

individual

32
Q

Which drugs pictured in the graph to the right have more potency? Less?

A

Potency of drug used to determine average setting on vaporizer that would produce surgical anesthesia.
Potency correlates with lipid solubility -> oil to gas

Agent with highest potency as the lowest MAC.

33
Q

Inhalant Anesthetics (Ias)
–> Focus on these top 3:
1. List the Halogenated Compounds used as inhalant anesthetics?
2. Diethyl Ether is _______, ____-smelling, ____ volatile, extremely _____ liquid). Replaced in the 60s because causes _____ and is now mainly used as a ____ in labs today.
3. Nitrous oxide (N2O) (“_______ gas”, not ____ to organs, _____ smell)

–> Not used anymore:
4. Chloroform (colorless, odorless, hepatotoxic, severe CNS depressant,
no longer used as an anesthetic)
5. Halothane (no longer available to buy)
6. Xenon gas (investigational, very expensive)

A

Enflurane (1970-80)
Isoflurane (1981)
Desflurane (1992)
Sevoflurane (1994)

colorless, sweet, highly, flammable, nausea, solvent, laughing, toxic, unpleasant

34
Q

Halogenated Organic Compounds
The exact MOA for IAs remains mostly ______.
Fundamentally, IAs work within CNS by ______ signals through ____ receptors, ____ receptors, __ and __ receptors, and _____ receptor

A

unknown, inhibiting, GABA, NMDA, M, N, serotonin

35
Q

Pharmacological effects of halogenated organic compounds on the CNS?

A

Dose-related reversible CNS depression
Hypothermia
Safe for epileptic animals

36
Q

Pharmacological effects of halogenated organic compounds on the cardiovascular system?

A

Depress cardiovascular function
Effects on HR variable

37
Q

Pharmacological effects of halogenated organic compounds on the respiratory system?

A

Dose-dependent ventilation depression

38
Q

Adverse Effects:
Dose-related reversible CNS depression
Hypothermia
Safe for epileptic animals
Depress cardiovascular function
Effects on HR variable
Dose-dependent ventilation depression
CNS: increase intracranial pressure in patients with head trauma or brain tumors
Cardio: decrease blood pressure and renal blood flow
Respiratory: Hypoventilation
Carbon dioxide retention and respiratory acidosis

A
39
Q

Isoflurane and
* The most commonly used inhalant agents in ______ ______
Properties:
* ____ vapor pressure: need a _____ vaporizer
* Good for induction with ___ or ____
* Low ____ solubility
* Stable at ___, no _____ needed
* Has ____ blood:gas partition coefficient: ____ induction
and recovery (Sevo is ____ than Iso) Important

  • High controllability of depth of anesthesia for Sevo
  • Sevo is more expensive
  • MAC = 2.34% to 2.58% for Sevo:
  • MAC = 1.3% to 1.63% for Iso:
  • MACs helps determine
    initial vaporizer setting
  • Sevo has a higher anesthetic index in dogs than isoflurane
A

North America, High, precision, mask, chamber, rubber, RT, preservatives, low, rapid, faster

40
Q

Pharmacological effects of isoflurane on the CNS?

A

Maintains cerebral blood flow

41
Q

Pharmacological effects of isoflurane on the cardiovascular system?

A

Maintains cardiac output, heart rate, and rhythm (fewest adverse effects)

42
Q

Pharmacological effects of isoflurane on the respiratory system?

A

Almost completely eliminated through the lungs (89%)

43
Q

Pharmacological effects of isoflurane on other parts of the body?

A

Other effects:
* Induces adequate to good muscle relaxation
* Provides little or no analgesia after anesthesia

44
Q

Pharmacological effects of savoflurane on the CNS?

A

Maintains cerebral blood flow

45
Q

Pharmacological effects of savoflurane on the cardiovascular system?

A

Minimal cardiovascular depression

46
Q

Pharmacological effects of savoflurane on the respiratory system?

A

Almost completely eliminated through the lungs (89%)
Minimal hepatic metabolism

47
Q

Pharmacological effects of savoflurane on other parts of the body?

A

Other effects:
* Induces adequate to good muscle relaxation
* Provides little or no analgesia after anesthesia

48
Q

Desflurane
Properties:
* Very similar to ______
* Used with a special ______ vaporizer
* ______ blood:gas partition coefficient: very ___ induction and recovery
* Good for induction with ___ or ____
* MAC = 7.2% to 9.8%: ____ potent inhalant agent
* Eliminated by the ___
* Cheap or expensive?

A

isoflurane, precision, Lowest, rapid, mask, chamber, least, lungs, Expensive

49
Q
A
50
Q

Other Inhalation Agents
1. Halothane: ___ commonly used anymore (used in ____)
Being replaced by ____ and _____.
* Methoxyflurane is no longer available in ______ _____
* Nitrous oxide
Used primarily in ___ medicine; some veterinarians
use a gas at __, no _____ is required

A

Not, pigs, isoflurane, sevoflurane, North America, human, RT, vaporizer

51
Q

CNS and Respiratory Stimulants

Doxapram: a specific respiratory stimulant used for shortening recovery
following inhalation anesthesia
Used: in neonate puppies and kittens after C-section
IV administration or sub-lingual drops
Effects:
* Analeptic agent
* Reverses respiratory depression from inhalant agents and barbiturates
* Stimulates respiration and speeds recovery
* Lowers seizures threshold
* Wide margin of safety

A
52
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A
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Intro to Pharmacology (31 decks)

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