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Pharmacology III > Quiz 6 > Flashcards

Quiz 6 Flashcards

1
Q

4 A’s of anesthesia

A
  1. Analgesia
  2. Amnesia
  3. Akinesia
  4. Attenuation of automatic response
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2
Q

What are the 4 stages of anesthesia?

A
  1. Analgesia
  2. Excitement
  3. Surgical anesthesia
  4. Imminent death
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3
Q

What is the MAC?

A

Minimal Alveolar Concentration
-conc. of the agent in the lungs that prevents mvmt in 50% of Pts

**Use 1.3x the MAC

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4
Q

Use of nitrous oxide

A

Inhaled anesthetic

Sedation, analgesia & amnesia
Adjunct to inhalation & IV anesthesia

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5
Q

Use of Sevoflurane

A

Inhaled anesthetic

Induction & maintenance of general anesthesia

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6
Q

How does anesthesia leave the body?

A
  1. Biotransformation
  2. TransQ loss
  3. Exhalation

1/2 lives are compartment specific so the times vary

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7
Q

Who should you be cautious with using Nitrous oxide?

A
  1. Venous/arterial air embolism
  2. Pneumothorax
  3. Acute intestinal obstruction w/ bowel distension
  4. Intracranial air
  5. Pulmonary air cysts
  6. Intraocular air bubbles
  7. Tympanic membrane graftiing

Also dec. MAC of volatile liquid anesthetics

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8
Q

ADRs Sevoflurane

A
  1. Emergence agitation &/or delirium
  2. Perioperative hyperkalemia
  3. QT prolongation
  4. Potential to trigger malignant hyperthermia
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9
Q

Which anesthetic do you need to have fresh dessicant?

A

Sevoflurane

flammable & forms formeldahyde

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10
Q

What are the inhaled anesthetics?

A
  1. Nitrous oxide

2 Sevoflurane

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11
Q

What are the IV anesthetics?

A
  1. Propofol
  2. Etomidate
  3. Ketamine
  4. Methohexital
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12
Q

How does Propofol work & what is it used for?

A

Affects GABA channels to shut down nerve function

  1. Induction of anesthesia in Pts >3 y/o
  2. Maintenance of anesthsia in Pts >2 mo.
  3. Adults - for monitored care sedation during procedures
  4. Sedation in intubated mech. vent. ICU Pts
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13
Q

Can you reuse Propofol?

A

NO - has egg, lecithin & soy

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14
Q

Which drug might turn your urine or hair green?

A

Propofol

Kinetics not affected by obesity, cirrhosis or kidney failure

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15
Q

ADRs Propofol

A
  1. HOTN
  2. Resp. depressant
  3. Dec. cerebral blood flow & ICP
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16
Q

What are the ‘good’ side effects of Propofol?

A
  1. Antipruritic
  2. Antiemetic
  3. Antiseizure
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17
Q

What is Propofol Infusion Syndrome?

A

Occurs ~48h of propofol infusion

  1. Bradycardia leading to asystole
  2. HF cardiogenic shock
  3. Rhabdo
  4. Hyperlipidemia
  5. Fatty liver

FFA released into bloodstream causing acidosis

18
Q

What is Etomidate used for?

A

Induction & maintenance of general anesthesia

Don’t use <10 y/o

19
Q

Onset, Peak & duration of Etomidate?

A

O - 30-60 sec
Great lipid solubility

P - 1 min

D - 3-5 mins
Stop infusion & recover immediately

20
Q

ADRs Etomidate

A
  1. Myoclonus
  2. Dec. peripheral vascular resistance
  3. Resp.
  4. N/V
  5. “Cortisol” effect
21
Q

What is Ketamine used for & routes of administration?

A

Induction & maintenance of general anesthesia

  1. IV
  2. IM
  3. Oral
  4. Nasal
  5. Rectal
  6. SubQ
  7. Epidural
22
Q

Onset& duration of Ketamine?

A

O - 30 sec

D - 5-10 min

23
Q

Who should you be cautious with giving Ketamine?

A
  1. Coronary heart disease
  2. Uncontrolled HTN
  3. HF
  4. Arterial aneurysms
24
Q

ADRs Ketamine

A
  1. Inc. arterial BP
  2. Inc. HR
  3. Inc. CO

*Emergence phenomenon - disturbing dreams & delirium

25
Q

Uses of Methohexital & what class of drug is it?

A
  1. Induction of anesthesia
  2. Procedural sedation

Barbiturate

26
Q

Onset & duration of Methohexital

A

O - 30 sec

D - 20 min

27
Q

ADRs Methohexital

A
  1. Dec. BP from peripheral vasodilation
  2. Inc. HR
  3. Dec. vent. response
  4. Dec. renal blood flow & dec. GFR
  5. Dec. hepatic blood flow
28
Q

Uses of Fentanyl citrate

A
  1. Relief of pain, preop meds, adjunct to gen. anesthesia
  2. Block stress response from catecholamines, cortisol, ADH
  3. Reduction of dose of other anesthetics like inhaled, propofol, neuromuscular blockers
  4. Postop analgesia
29
Q

ADRs Fentanyl citrate

A
  1. Bradycardia
  2. Venodilation
  3. Dec. sympathetic reflexes
  4. Depressed cardiac contractility
  5. Hypoxic drive dec.
  6. Chest wall rigidity
  7. Dec. ICP
30
Q

What should you give a shivering Pt postop?

A

Meperidine

31
Q

What are the Benzos for anesthesia?

A
  1. Midazolam
  2. Diazepam
  3. Lorazepam
32
Q

Uses for Midazolam

A

aka Versed

  1. Induction & maintenance of gen anesthesia
  2. Preop sedation
  3. Moderate sedation prior to diagnostic or radiographic procedures
  4. ICU sedation
33
Q

Uses for Dexmedetomidine

A
  1. Sedation prior to &/or during surgical procedures of nonintubated Pts
  2. Procedural sedation prior to &/or during awake fiberoptic intubation
  3. Sedation of initially-intubated & mechanically-ventilated Pts during Tx in an intensive care setting
34
Q

Uses for Succinylcholine

A

Depolarizing neuromuscular blocker

To facilitate RSI & routine endotracheal intubation & to relax skeletal muscles during surgery

35
Q

ADRs Succinylcholine

A
  1. Arrhythmias, BP changes, tachycardia
  2. Hyperkalemia
  3. Jaw rigidity, muscle fasciculation, postop muscle weakness
  4. Malignant hyperthermia
36
Q

How can you tell if non-polarizing neuromusclar blockers are wearing off?

A

Thumb goes in - adductor pollicis

37
Q

How do you reverse Rocuronium?

A

non-depolarizing neuromuscular blocker

Neostigmine - acetylcholinesterase inhibitor

38
Q

Uses for Rocuronium

A
  1. To facilitate RSI & routine endotracheal intubation & to relax skeletal muscles during surgery
  2. Facilitate mechanical ventilation in ICU Pts
39
Q

What is malignant hyperthermia?

A

Inherited metabolic disorder of skeletal muscle
-Abnormal Ca hemostasis

Rapid onset of extremely high fever w/ muscle rigidity

40
Q

Tx malignant hyperthermia

A
  1. Discontinuing precipitant
  2. Manage metabolic acidosis
  3. Institute cooling
  4. Monitor electrolytes
  5. Watch urinary output
41
Q

Uses of Dantrolene

A
  1. Mgmt malignant hyperthermia
  2. Prevention of malignant hyperthermia in susceptible Pts
  3. Tx of spasticity assoc. w/ UMN disorders

Pharmacology III (20 decks)

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