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HSS3106 - Pharmacology > Lecture 12- Anesthetic Medications > Flashcards

Lecture 12- Anesthetic Medications Flashcards

1
Q

What are the key things that make an ideal anesthetic? (7 things)

A
  1. rapid and pleasant induction and withdrawl
  2. skeletal muscle relaxation
  3. analegisa –> inability to feel pain
  4. high potency
  5. wide therapeutic index
  6. nonflammable
  7. chemical inertness
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2
Q

What does it mean if a drug has a “high therapeutic index”?

A

means the drug is…
a. SAFER
b. LESS TOXIC

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3
Q

What are the 4 stages of Anesthesia?

A
  1. Analgesia
  2. Excitement
  3. Surgical Anesthesia
  4. Medullary Paralysis
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4
Q

What is the first stage of Anesthesia

A

ANALGESIA
- pain is removed but still conscious

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5
Q

What is the second stage of Anesthesia

A

EXCITEMENT
- unconscious but possible unpleasant shaking, violence, fear

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6
Q

What is the third stage of Anesthesia

A

SURGICAL ANESTHESIA
- progressive muscle relaxation and unconsciousness
- risk of respiratory depression

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7
Q

What is the fourth stage of Anesthesia

A

Medullary Paralysis
- respiratory failure
- circulatory collapses

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8
Q

What are the 8 preoperative medications as adjuncts to surgery NAME and TRADE NAME?

A
  1. Diazepam –> valium
  2. Meperidine –> Demerol
  3. Sodium citrate/citric acid –> Bicitra
  4. Cimetidine –> Tagamet
  5. Famotidine –> Pepcid
  6. Lansoprazole –> Prevacid
  7. Metoclopramide –> Reglan
  8. Atropine
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9
Q

What are preop medications used for?

A
  • reduce anxiety
  • sedate
  • produce amnesia
  • increase comfort
  • reduce gastric acidity
  • increase gastric emptying
  • decrease nausea and vomiting
  • reduce incidence of aspiration
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10
Q

What is General anesthesia?

A
  • whole body affected
  • become unconscious by depressing CNS
  • all muscles relaxed, reflexes dissappear reduces pain
  • used in combination for smoothly and slowly induce anesthesia and allow prompt recovery, ensure wide safety margin, reduce side effects
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11
Q

What are the 2 types of General Anesthesia?

A
  1. Inhalation (Volatile liquids)
  2. Intravenous
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12
Q

What are the 3 phases of General Anesthesia?

A
  1. Induction
  2. Maintenance
  3. Emergence
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13
Q

What is the “induction phase” of general anesthesia?

A
  • uses IV or inhalation techniques
  • uses:
    a. sedative-hypnotics
    b. adjuvant IV agents (pain killers)
    c. Neuromuscular blocking agent (blocks muscle mvmnt during surgery)
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14
Q

What is the “maintenance phase” of general anesthesia?

A
  • making sure to maintain anesthetic state
  • combo of IV and inhalation or total IV
  • uses:
    a. Neuromuscular blocking agent (muscle relaxation)
    b. hemodynamic monitoring and support
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15
Q

What is the “emergence phase” of general anesthesia?

A
  • return of consciousness and movement at the end of surgical procedure
  • discontinue anesthetic and adjuvant agents
  • reversal of Neuromuscular blocking agent
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16
Q

What is the most important and common mechanism of action of general anesthesia?

A
  • GABA-A agonists
    steps:
    1. enhance GABA effect on GABA-A
    2. hyperpolarize resting potential
    3. supress neuronal excitability
    4. produce CNS inhibition
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17
Q

In simple terms, what is the mechanism of action for general anesthesia?

A

Stimulate inhibitory / Inhibit stimulatory

18
Q

What are other mechanisms for general anesthesia?

A

-NDMA anatagonists –> inhibit NMDA receptors to prevent neurotransmission of pain

19
Q

What are 3 IV anesthetics?

A
  1. propofol
  2. ketamine
  3. fentanyl
20
Q

What is propofol?

A
  • IV anesthetic
  • GABA agonist
  • most common
21
Q

What is Ketamine?

A
  • IV anesthetic
  • NMDA receptor anatagonist
22
Q

What is fentanyl?

A

-IV anesthetic
- opioid agonist
- analgesic and sedative

23
Q

What are 3 inhalation anesthetics?

A
  1. desflurane
  2. nitrous oxide (laughing gas)
  3. Sevoflurane
24
Q

What are inhalation anesthetics?

A
  • volatile liquids or gases
  • delivered via specialized airway circuits
  • has “minimal alveolar concentration”
25
Q

What is the mechanism of action for inhalation anesthetics?

A

UNKNOWN!!!

26
Q

What are common adverse effects of general anesthesia?

A
  • stress of surgery in DIABETIC patients can INCREASE GLUCOSE LEVELS
  • post-op nausea and vomiting
  • sore throat
  • shivering, chills
  • ALL CNS RELATED!!!
27
Q

What is the dangers of “malignant hyperthermia”?

A
  • when there is a rapid increase in body temperature
  • life threatening (like deep-frying a person!)
  • can develop during anesthesia
28
Q

What are “local” anesthetics?

A

-provide regional or topical anesthesia
- NO loss of consciousness

29
Q

What are 2 groups of local anesthetics?

A
  1. esters (short, long, and surface action)
  2. amides (medium, and long action)
30
Q

What is the name of the amide local anesthetic?

A

Lidocaine

31
Q

What is amide local anesthetic used for?

A
  • inhibition sodium channels –> inhibits nerve impulse transmission
  • fast and short
  • higher risk of toxicity
  • increases patient comfort and cooperation during minor surgery
32
Q

What are the adverse effects of amide local anesthetics?

A

TOXIC depending on dose
CNS related and cardio-related (hypotension, arrythmias)

33
Q

What is the common contraindications for all medications?

A
  • pregnant
  • senior
  • child
  • certain conditions
  • liver/kidney disease
34
Q

What are the 2 ester local anesthetics?

A
  1. Benzocaine –> americaine
  2. procaine –> novocain
35
Q

What are ester local anesthetics?

A
  • rapid onset and short duration
  • higher incidence of allergic reactions due to PABA
  • used topically
36
Q

What are the 6 specific anesthetic applications?

A
  1. Topical
  2. Infiltration
  3. field block
  4. nerve block
  5. spinal
  6. epidural
37
Q

What is topical anesthesia?

A
  • for urethra, vagina, rectum, and skin
  • cyroanesthesia = application of freezing agent
38
Q

What is local infiltration anesthesia?

A
  • used by dentists!!
  • blocks nerves (shuts down sodium channels near by)
  • in an area/tissue near nerve
  • very common!!
39
Q

What is field block/regional anesthesia?

A
  • affects a single nerve, deep plexus, or network of nerves
  • series of injections to form a wall of anesthesia around an operative field
40
Q

What is spinal anesthesia?

A

-injected into the SUBARACHNOID space via a spinal needle
- pushes through dura to get into spinal column (go too far, hit spinal cord!!!)
- quicker

41
Q

What is epidural anesthesia?

A

inject local anesthetic into epidural space via a catheter (just outside spinal cord)
- slowly absorbed into CSF
- for labor and delivery

HSS3106 - Pharmacology (18 decks)

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