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

Week 8 - Injectable and Dissociative Anesthetics Flashcards

1
Q

Anesthesia is a ______ process resulting in the ___ loss of sensation in a body ____ or the ____ body.

A

reversible, total, part, whole

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2
Q

Anesthesia is induced by a drug or drug combination that depresses ______ nervous tissue activity (_____ and ______) or _____ (general anesthesia).

A

peripherally, local, regional, centrally

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3
Q

Under general anesthesia (GA) the animal is experiencing?

A
  1. unconsciousness
  2. hyporeflexia
  3. analgesia
  4. skeletal muscle relaxation
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4
Q

General anesthesia (GA) uses _______ and _____ agents to allow adequate surgical access to the operative site.

A

intravenous, inhaled

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5
Q

Name the four classifications of Anesthesia.

A
  1. Principal effect
  2. Chemistry (structures and actions)
  3. Route of administration
  4. Time of administration
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6
Q

What falls under the category of principal effect?

A

Principal effect:
* Local vs general
* Sedative and tranquilizers vs analgesics
* Neuromuscular blockers
* Anticholinergic agents
* Reversal agents

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7
Q

What falls under the category of routes of adminstration?

A

Route of administration:
* Inhalation
* Injectable (IM, IV)
Less common:
* Oral
* Topical
* Rectal
* Intraperitoneal (i.p.)

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8
Q

What falls under the category of chemistry (structures and actions)?

A

Chemistry (structures and actions):
* Barbiturates
* Non-barbiturates
* Cyclohexylamines (Dissociative agents)
* Inhalant Anesthetics
Injectable agents

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9
Q

What falls under the category of time of administration?

A

Time of administration:
* Pre-anesthetic
* Induction
* Maintenance

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10
Q

List the actions of anesthetic drugs

A
  • Pharmacokinetics
  • Pharmacodynamics
  • Drug distribution
  • Target tissues and stimulation (CNS: depression or stimulation)
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11
Q

Agonists ____ to and ____ target tissue (CNS)
* Most _____ and _____ are agonists.

A

bind, stimulate, anesthetics, adjuncts

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12
Q

Antagonists bind to target tissue but don’t ______
________ agents act as antagonists.

A

stimulate, Reversal

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13
Q

What is the purpose of combined anesthesia?

A

No single agent provides all desirable properties both rapidly and safely, therefore several categories of drugs are combined to produce optimal anesthesia

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14
Q

Combined or Balanced Anesthesia refers to the practice of administering ______ drugs concurrently in _____ quantities than would be required if each were given alone.

A

multiple, smaller

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15
Q

Combined or Balanced Anesthesia
* _______ benefits of each drug
* ______ adverse effects
* Allows anesthetist to produce CNS _______, ________,
and ___ relief that is appropriate for the patient and the procedure.

A

Maximizes, Minimizes, depression, immobilization, pain

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16
Q

Drug Combinations:
* Don’t mix drugs in a ____ syringe unless they are _____.
* Don’t administer a drug combination if a _____ develops when the drugs are mixed

A

single, compatible, precipitate

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17
Q
  • Exact mechanisms of anesthetic effects are ______.
  • No ______ receptor has been identified
  • The fact that chemically unrelated compounds produce anesthesia
    argues against the existence of a _____ receptor.
A

unknown, not known, single

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18
Q

Injectable Anesthetics ______ the CNS at ___ levels in a ____-dependent manner. Mainly used in ________ and treatment of ______.
* Can produce _____ when given alone.
* Used with ____ agents
* In general, don’t provide _____ or muscle _____
* IV administration: “to ____” ( _______ method)

A

depress, all, dose, anesthesia, seizures, unconsciousness, other, analgesia, relaxation, effect, titration

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19
Q

List the categories of Injectable anesthestics

A
  1. Barbiturates
  2. Non-barbiturates
  3. Dissociative agnets
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20
Q

List four examples of barbiturates used as injectable anesthetics.

A

 Thiopental
 Methohexital
 Pentobarbital
 Phenobarbital

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21
Q

List four examples of non-barbiturates used as injectable anesthetics.

A

 Propofol
 Etomidate
 Alphaxalone

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22
Q

List four examples of dissociative agents used as injectable anesthetics.

A

 Ketamine
 Tiletamine

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23
Q

Barbiturates are derivates of ?

A

Barbituric acid

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24
Q

Barbiturates are _____ substances. They do not provide ______ and there is no known _____ agent.

A

controlled, analgesia, reversal

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25
Q

Barbiturates are a group of _____- _______ medications used for treatment of ?

A

sedative, hypnotic, seizures,
preoperative anxiety, and inducing anesthesia

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26
Q

Name the classifications of Barbiturates based on time until onset.

Dr. Levenson said this was important

A
  1. Ultra short
  2. Short
    - Intermediate -
  3. Long-acting
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27
Q

Name two examples of ultra short barbiturates. Which species can these medications be used on? For what purpose?

A

Thiopental
Methohexital

Dogs, cats, horses
Induce general anesthesia

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28
Q

Name two examples of short barbiturates. Which species can these medications be used on? For what purpose?

A

Pentobarbitol

Lab animals
Induce general anesthesia
Treat epilepsy in small animals

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29
Q

Name two examples of long-acting barbiturates. Which species can these medications be used on? For what purpose?

A

Phenobarbital

Used as an anticonvulsant
& sedative

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30
Q

Barbiturates can be further classified into ____________ and __________.

A

Oxybarbiturates, Thiobarbiturates

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31
Q

Barbiturates can be further classified into ____________ and __________.

A

Oxybarbiturates, Thiobarbiturates

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32
Q

List some examples of Oxybarbiturates.

A

methohexital, phenobarbital, and pentobarbita

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33
Q

List some examples of Thiobarbiturates.

A

thiopental and thiamylal (more lipid soluble)

34
Q

These are the chemical structures of?

A
35
Q

These are the chemical structures of?

A
36
Q

Characteristics of Barbiturates:

Barbiturates are potent _______ but weak ______. They have a high ___ solubility, which allows them to ______ enter the ___ and _____ its function. Redistribution occurs very ____ to other tissues ( _____ muscle & ____ tissue)
* They can cause ?

A

anesthetics, analgesics, lipid, quickly, CNS, depress, rapidly, skeletal, adipose, apnea (stop breathing for more than 20 seconds = classified as Apnea), coughing, chest wall spasm, laryngospasm, and bronchospasm

37
Q

Barbiturate MOA

Barbiturates MOA
* Not fully understood (bind to ____-gated ___- channels resulting in ________ of the neurons)
* Mimics the inhibitory effects of ______.
* Causes CNS _____ and loss of _______.

Termination of effect: agents leave _____ and are (3) ?

A

GABA, Cl, hyperpolarization, GABA, depression, consciousness, brain, metabolized, excreted, or redistributed

38
Q

Barbiturates
Uses: ______ anesthetic induction
 To allow _____ (meds used for this? )
 Sustain with inhalation anesthetic (_______)
 Sustain with _____ doses or _____ infusion (_______)
 Used alone for _____ procedures

A

Rapid, intubation, thiopental and methohexital), thiopental, repeated, continuous, methohexital, short

39
Q

Factors that affect potency, onset, and duration of action of Barbiturates include:

A
  • Ionization –> non-ionized
  • Protein binding –> unbound drug, i.e., drug that’s not bound to plasma proteins
  • Lipid solubility –> lipid-soluble
  • Redistribution –> Blood carries drug to brain and other tissues
40
Q

Lipid Solubility
* Tendency of the drug to dissolve in _____, ____, and ____
* Affects the ability to penetrate the _____ _______.
* High solubility feature results in ultra-____-acting drug
* High solubility results in _____ tissue ______.
* Short acting drugs are _____ lipid soluble
* Long-acting drugs have ____ lipid solubility

A

fats, lipids, oils, cell membrane, short, rapid, redistribution, moderately, low

41
Q

Redistribution
* Drug is distributed fastest to _____-rich tissues
* Drug enters tissue based on _____ solubility
* Effect occurs when drug is in the tissue (____)
* Drug leaves the tissue when _____ level drops (animal _____)
* _____ carries drug to other tissues
* Drug is released by ___ and eliminated by?

A

vessel, lipid, brain, blood, recovers, Blood, tissues

42
Q

Barbiturate Redistribution
How it works ?
 _______ acting drug is given ___
 It then travels to the ___ (______ rich)
 It is _____ lipid soluble and crosses into brain cells _____.
 Dog is now _______ ~___ seconds
 Once the levels in the brain are _____ than in the blood, the molecules will move back ____ the concentration gradient
 Drug re-enters _____
 Redistributes to _____, ___ and other body _____
 Patient begins to recover in ___ - ____ minutes
 Over the next couple of hours drug is released from ____ and ___ and
 Eliminated from the body by ____ metabolism and excretion of _______ in the ____

A

Ultrashort, IV, brain, vessel, highly, quickly, unconscious, 30, higher, down, circulation, muscle, fat, tissues, 10, 15, muscle, fat, liver, metabolites, urine

43
Q

Pharmacological Effects of Barbiturates on the CNS?

A

Mild sedation to unconsciousness
Possible excitement at low doses

44
Q

Pharmacological Effects of Barbiturates on the cardiovascular system?

A

Cardiac depression
Increased cardiac sensitivity to epinephrine
Cardiac arrhythmias (thiopental)

45
Q

Pharmacological Effects of Barbiturates on the respiratory system?

A

Decreased respiratory rate and tidal volume
Brief apnea (thiopental)
Shallow breaths (pentobarbital)
respiratory acidosis
poor tissue oxygenation

46
Q

Pharmacological Effects of Barbiturates on other parts of the body?

A

Initial decreased motility
Later increased motility

Sneezing, coughing, laryngospasm
Incomplete muscle relaxation

47
Q

Adverse effects of Barbiturates on the cardiovascular system?

A

Cardiac arrhythmia
Bigeminy (the heart skipping a beat)

48
Q

Adverse effects of Barbiturates on the respiratory system?

A

Related to dose and rate of administration
Initial apnea (< 1-2 min)
Neonate respiratory depression (C-section using barbiturates)

49
Q

Other adverse effects of Barbiturates on the body?

A
  • Exaggerated potency in Sighthounds, critically ill patients,
    hypoproteinemic or acidotic patients
  • Tissue irritation and sloughs (if not IV)
  • Intra-arterial injection: vasoconstriction, pain, tissue necrosis
  • Death from overdose
50
Q

Barbiturates should not be used on which canine species?

A

Greyhounds

51
Q

During induction, barbiturates can cause?
* ________ injection
* Very ____ rate of _______
* Stage ___ excitement
* _______ concentration in brain to induce stage ____
* Action: Administer ____ drugs

A

Perivascular, slow, administration, II, Insufficient, III, more

52
Q

During recovery, barbiturates can cause?
* Pentobarbital
* Paddling and vocalization
* Action: Administer IV diazepam or
pre-anesthetic medications

A
53
Q

Barbiturate-Drug Interactions
* Enhance muscle _____
* Increase _____ enzyme activity
Prolonged use
Shorter duration of activity of drugs metabolized in the liver (opioids and diazepam)
* Administration with chloramphenicol (enhanced effects of pentobarbital and phenobarbital)

A

relaxants, hepatic

54
Q

Thiopental is _____-____ acting and can be used on ______ animals and ______. Once administered, thiopental has a ____ onset and ____ duration of action; patient completely recovers in ?

A

Ultra-short, small, horses, rapid, brief, 1-2 hr

55
Q

Thiopental is a _____ powder in multidose vials that must be ______ with _____ water, ____ saline, or __% dextrose in water.
1. What % concentrate should be used in small animals? Horses?

Not being tested on this

A

crystalline, reconstituted, sterile, normal, 5

  1. 2-2.5% solution (small animals)
    5% solution (horses)
56
Q

Thiopental has a shelf life of __ ____ refrigerated of 3 days at RT. Don’t use if a _____ is present

Not being tested on this

A

1 week, precipitate

57
Q

Dosing Thiopental ____ with protocol and procedure.
- Reduced up to ___% in debilitated animals
- Reduce dose in ____ sedated animals
- Give to ___
- Repeat doses are ______ leading to ______ recovery
- Don’t use for _____ maintenance
- Various protocols for administration.

A

varies, 80, heavily, effect, cumulative, prolonged, anesthetic

58
Q

Methohexital is ____-_____ acting and is similar to thiopental but _____ lipid solubility.

  • Can be useful on an _____ animal
  • _____ induction and intubation
  • Decreased risk of ______ aspiration
  • Safe for use during __-____.
  • Safe to use in ______ and other _______
  • A powder that must be ______ with _____ water.
  • ___-___% solution (small animals)
  • Shelf life: ?
A

ultra-short, higher, unfasted, Rapid, vomitus, C-section, greyhounds, sighthounds, reconstituted, sterile, 1-2.5, 6 weeks at RT

59
Q

Pentobarbital is ____-acting
* Largely replaced by ______
* Administered IP to _____ for general anesthesia
* Status epilepticus – treatment
 Administer ___ to stop seizures and produce ____ sedation
 ______ margin of safety
* Euthanasia

A

short, propofol, rodents, IV, heavy, Narrow

60
Q

Propofol is the ______ ______ used anesthetic in Vet Med (safe drug but expensive)
* ____-___ acting (highly lipophilic)
* Good for ______ cases (onset is ___ and ____, ~ ?)
* Can be used on which species?

A

most commonly, Ultra-short, outpatient, smooth, rapid, 40 sec)
Small animals, small ruminants, exotic animals, neonates of all species

61
Q

Propofol MOA: Activates _____ receptors (similar to _______)

A

GABAA, barbiturates

62
Q

Propofol
Uses:
 ___ bolus and ____ to treat status epilepticus in dogs and cats.
 _____ lipid soluble, highly _____ bound, ____ onset & __-____, and rapidly _____.
(good for _____ procedures or prior _____ anesthesia)
 Only good for ___ hr
 Onset of action: ___-___ sec
 Duration of action: _-__ min
 Complete and quick recovery (dogs: ___ min: cats___ min, faster than _____)
 Safe to use in animals with ___ trauma or increased ______ pressure
 ___ may not tolerate prolonged infusion

A

IV, CRI, Highly, protein, rapid, re-distribution metabolized, short, inhalant, 6, 30-60 , 5-10, 20, 30. barbiturates, head, intracranial, Cats

63
Q

Propofol
1. Available in what forms? What are the cons of this?
2. When handling, you must use _____ technique.
3. Discard unused drug within ___ hr of opening
4. __-year shelf life if unopened
5. It is more expensive than ?

A
  1. egg lecithin/glycerin/soybean oil aqueous emulsion Egg lecithin, glycerol, and soybean oil support bacterial growth
  2. Aseptic
  3. 6
  4. 3
  5. ketamine-diazepam or thiopental
64
Q

Pharmacological Effects of Propofol on the CNS?

A

Dose-dependent depression (sedation is part of induction GA)
Poor or no analgesia
Euphoric feelings

65
Q

Pharmacological Effects of Propofol on the cardiovascular system?

A

Cardiac depressant
Transient hypotension

66
Q

Pharmacological Effects of Propofol on the respiratory system?

A

Depressant with possible apnea
Administer slowly to effect
Monitor patient carefully

67
Q

Pharmacological Effects of Propofol on the other parts of the body?

A

Twitching during induction (dogs)
Muscle relaxation
Safe to use in animals with liver or kidney disease
Appetite stimulant (low doses)
Antiemetic
Decreases intraocular and intracranial pressure

68
Q

Adverse Effects of Propofol on the CNS?

A

Transient excitement and muscle tremors (induction)
Paddling, muscle twitching, nystagmus, opisthotonus (resembles seizures)

69
Q

Adverse Effects of Propofol on the cardiovascular system?

A

Hypotension - transient

70
Q

Adverse Effects of Propofol on the respiratory system?

A

Apnea (rapid injection, high dose)

71
Q

Adverse Effects of Propofol on the other parts of the body?

A

Seizure-like signs (treat with diazepam)
Pain with injection (perivascular injection does not produce tissue damage (compare to barb)
Cats: multiple doses: anemia, diarrhea, anorexia, blindness, aggression, even death.
Prolonged recovery

72
Q

Etomidate is a _______ ______ non-_______ drug of ____-___ duration with ____ margin of safety. Shows ____-like effects

A

sedative hypnotic, barbiturate, ultra-short , high, GABA

73
Q

Etomidate is used as an alternative to _____ or ______ in animals with ________ ______ dysfunction, _____ trauma, or that are _____ ill

A

thiopental, propofol, preexisting cardiac, head, critically

74
Q

Etomidate
MOA: binds to ____ receptor and allosterically enhances the affinity of _____ to its receptor

A

GABA, GABA

75
Q

Etomidate
PK: _____ hepatic hydrolysis, does not ______
Adverse effects:
* ____ and _____ upon IV injection
* May inhibit myocardial _________

A

Rapid, accumulate, Pain, hemolysis, contractility

76
Q

Pharmacological Effects of Etomidate on the CNS?

A

Clinical significance is unknown; Decreases cerebral blood flow, metabolic rate, and oxygen consumption

77
Q

Pharmacological Effects of Etomidate on the cardiovascular system?

A

Minimal depression

78
Q

Pharmacological Effects of Etomidate on the respiratory system?

A

Minimal depression

79
Q

Pharmacological Effects of Etomidate on the other parts of the body?

A

inhibits adrenal steroidogenesis reducing the normal
increase in plasma cortisol levels during anesthesia and surgery

80
Q

Alphaxalone is a ______ _______ _____ with rapid, ____-acting general ______ effects

A

synthetic, neuroactive, steroid, short, anesthetic

81
Q

Alphaxalone MOA

A

GABAa receptor agonist

82
Q

Alphaxalone can be administered via?

A

IV or IM injection

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