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HD 2 > Pharm - anesthetics > Flashcards

Pharm - anesthetics Flashcards

0
Q

Halothane

A

inhaled general anesthetic
Mech:
SE: Malig. hyperthermia, hepatic toxicities, tachycardia/arrhythmia w/ epinephrine,
(good smell, does NOT irritate upper airways).
*not used anymore.

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1
Q

Nitrous Oxide

A

inhaled general anesthetic, but used mostly as analgesic.
*LOW potency (105 MAC), can’t be used alone.
*good smell, does NOT irritate upper airways.
SE: distend closed air spaces
Contraind: methionine synthase path def., pneumothorax, high ICP, pulm HTN, 1st trimester pregnancy

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2
Q

Enflurane

A

inhaled general anesthetic
Mech:
*bad smell
SE: Malig. hyperthermia, upper airway irritation, seizure activity on EEG, renal toxicity, possible hepatotoxicity.

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3
Q

Isoflurane

A

Inhaled general anesthetic, cheapest
*bad smell
SE: malig hyperthermia, upper airway irritation & laryngospasm, coronary steal syndrome (potent vasodilation => shunt blood away from already ischemic areas), possible hepatotoxicity

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4
Q

Desflurane

A

inhaled general anesthetic, expensive
0 metabolism -> rapid induction & fastest recovery.
*bad smell -> not used for induction (get coughing)
SE: malig hyperthermia, upper airway irritation => transient BP & HR rise

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5
Q

Sevoflurane

A

inhaled general anesthetic, expensive
* smooth induction, & fast recovery.
SE: malig hyperthermia, possible hepatotoxicity
*good smell, does NOT irritate upper airways

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6
Q

Xenon

A

newer inhaled general anesthetic

SE: NO malig. hyperthermia

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7
Q

Thiopental

A

IV barbiturate, (RAPID anesthetic/inducing agent & sedative)
*excellent hypnosis, poor amnesia, no analgesia.
Mech: activate GABA & chloride channels -> inhibit post-synaptic neurons => depress RAS
SE: hypotension (mild), transient apnea worse w/ opioids, cerebral vasoconstriction, crystallization in veins -> necrosis

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8
Q

Methohexital

A

IV barbiturate, (RAPID anesthetic/inducing agent & sedative)
*excellent hypnosis, poor amnesia, no analgesia.
Mech: activate GABA & chloride channels -> inhibit post-synaptic neurons => depress RAS
SE: hypotension (mild), transient apnea worse w/ opioids, cerebral vasoconstriction, crystallization in veins -> necrosis

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9
Q

Midazolam (Versed)

A

IV or oral Benzodiazepine agonist;
anxiolytic, sedative & anesthesia inducer; & anti-convulsant.
* Excellent anterograde amnesia + calming, no analgesia.
Mech: increase Cl- gating of GABA (post-synaptic n. endings)
*P450 metabolism, SLOW induction, long context-dep. 1/2 life.
SE: minimal heart & ventilation effects

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10
Q

Diazepam (valium)

A

IV or oral benzodiazepine agonist (sedative) & anticonvulsant;
* Excellent amnesia & calming esp. perioperative, no analgesia;
- onset slower than midazolam.
Mech: increase Cl- gating of GABA (acts on post-synaptic n.)
SE: *minimal heart & ventilation effects

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11
Q

Lorazepam (Ativan)

A

IV or oral benzodiazepine (sedative), esp. perioperative.
* #1 amnesia & calming, no analgesia; *very SLOW induction.
Mech: increase Cl- gating of GABA (acts on post-synaptic nn)
SE: *minimal heart & ventilation effects

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12
Q

Flumazenil

A

IV benzodiazepine antagonist
* Excellent amnesia, unpredictable hypnosis, no analgesia
Mech: increase Cl- gating of GABA

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13
Q

Propofol

good bc low risk for post-Tx nausea/vomiting

A

IV general anesthetic (#1!) & inducing agent; for total IV anesthesia.
Mech: slows GABA dissociation from Rs –> membrane hyperpol.
painful on injection into small veins
Metab: hepatic
SE: decrease SVR, BP & inotropy -> possible bradycardia/asystole (give anti-ACh), apnea & bronchodilation, EEG burst suppression;
*risk bacterial infection or allergic rxn

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14
Q

Etomidate

A

IV general anesthetic & inducing agent
*excellent hypnosis, poor amnesia, no analgesia.
Mech: enhance effects of GABA (inhibitory), short 1/2 life.
SE: adreno-cortical suppresion, minimal heart effects, myoclonus, cerebral vasoconstrictor & EEG excitation, post-op vomiting common. Painful injection.

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15
Q

Ketamine

A

IV general anesthetic & inducing agent;
*excellent analgesia, good hypnosis & amnesia.
Mech: NMDA Rs, Monoamine Rs, opioid Rs, mACh Rs, & volt-gated Ca2+ channels (NOT GABA)
SE: hallucinations, sympathetic CNS stimulation, myoclonus, slow nystagmus, emergence delirium (esp. F)
NOT for pts w/: pulmonary HTN or high ICP

16
Q

Dexmedetomidine

A

IV sedative agent or w/ other induction drugs.
Mech: alpha-2 agonist –> negative feedback to presynaptic neuron
slow onset, injection = painful.
SE: hypotension, bradycardia.

17
Q

Lidocaine

A

injected local anesthetic for nerve block & regional analgesia;
Mech: amide, FAST ONSET
SE: cauda equina syndrome if used as spinal block

18
Q

Mepivacaine X

A

injected local anesthetic for nerve block & regional analgesia;

19
Q

Etidocaine

A

injected local anesthetic for nerve block and regional analgesia,
Mech: amide
SE: ~cardiotoxic

20
Q

Prilocaine

A

injected local anesthetic for nerve block and regional analgesia;
Mech: amide
SE: methemoglobinuria

21
Q

Ropivacaine

A

injected local anesthetic for nerve block and regional analgesia;
Mech: amide, S-enantiomer so less toxic
SE: allergic rxn more likely

22
Q

L-bupivacaine

A

injected local anesthetic for nerve block and regional analgesia;
Mech: amide ester => S-enantiomer (less cardiotoxic),
*LONGest duration of action!
SE: dysrhythmogenic

23
Q

Articaine. X

A

injected local anesthetic for dental analgesia;

Mech: ester & amide

24
Q

Benzocaine. X

A

spray local anesthetic for topical use;

Mech: ester

25
Q

Cocaine

A

topical local anesthetic, usually used in ENT;

Mech: ester

26
Q

Procaine. X

A

injected local anesthetic for nerve block and regional analgesia;
Mech: ester

27
Q

Chloroprocaine. X

A

injected local anesthetic for nerve block and regional analgesia;
Mech: ester

28
Q

Tetracaine

A

local anesthetic, esp as intrathecal.
Mech: ester
SE: ~cardiotoxic

29
Q

risks/side effects of barbiturates: (4)

A

(methorexital, thiopental)
Heart: hypotension/decreased BP
Lungs: upper airway reflexes NOT depressed (be ready to control)
Skin/Soft tissue: necrosis if IV not properly placed!
Brain: decreased ICP and isoelectric EEG

30
Q

“MAC”

A

= “Mean Alveolar Concentration” at 1 atm that induces anesthesia in 50% of test subjects.
*used to compare potencies of inhaled anesthetics,
Low # = most potent.

31
Q

Epinephrine

A

Most potent vasoconstrictor, used to reduce systemic absorption of local anesthetic.
*SE: HR increase (immediate if intravascular!)

32
Q

3 major take-aways regarding ALL inhaled anesthetics

A
  1. bc of steady state, alveolar partial P = partial P in brain
  2. Higher % INSPIRED [ ] increases –> reach desired % faster
  3. Better ALVEOLAR VENTILATION (rate & depth) –> faster increase in Fa
    (Fi ~= Fa)
33
Q

Mech. of action of volatile anesthetics

A

block Na channels, stimulate GABA & background K+ channels;
Best use pattern:
Sevofluorane for induction, Desfluorane for maintenance.

34
Q

What these mean for local anesthetics:

  1. pKa
  2. protein binding
  3. lipid solubility
A
  1. Lower pKa = faster the onset of action
  2. more protein bounding = longer duration of action
  3. more lipid soluble = more potent (also more cardiotoxic)
35
Q

Side effects of Local Anesthetics

A
  1. Allergic reaction (esp. esters, or preservatives)
  2. Cardiotoxicity: 1st HTN, high HR, 2nd: low CO, hypotension
  3. Neurotoxicity: 1st circumoral numbness, lightheaded, 2nd tonic-clonic convulsions, 3rd unconsciousness, respiratory arrest
    * *treat w/ lipid emulsion in case of toxicity!
36
Q

General mech of action of local anesthetics

A
  1. Block Na+ channels: prevent depolarization & repol. for APs
  2. Anti-inflammatory: via GPCRs, decrease PMN infiltration.
37
Q

Amide vs amine local anesthetics

A

Amides: (2 I’s in the name) allergies rare, more STABLE, hepatic metab.
Esters: (one i in the name) ALLERGIES more common, less stable, breakdown by plasma cholinesterase.

HD 2 (14 decks)

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