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MSK > Pharm 36 Objectives > Flashcards

Pharm 36 Objectives Flashcards

1
Q

What are the halogenated inhaled agents?

A
  • Desflurane
  • Isoflurane
  • Sevoflurane (preferred)
  • Halothane
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2
Q

What are the non-halogenated inhaled agents?

A

Nitrous oxide

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3
Q

What is the PK of the halogenated inhaled agents?

A
  • Absorbed through the lungs into the blood
  • Rate of absorption determined primarily by regional blood flow.
  • Distributed rapidly to the brain
  • Primarily excreted to the brain
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4
Q

What is the PK of the non-halogenated inhaled agent (nitrous oxide)?

A
  • Rapid induction and recovery
  • Less able to induce full LOC
  • No dose dependent effect on B/P and respiration
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5
Q

What is the MOA of halogenated inhaled agents?

A
  • Potentiates GABA at the GABA-A receptor
  • Opening of the chloride channel –> hyperpolarization of the neuron
  • Enhances the inhibitory effects of GABA
  • Depresses transmission at excitatory synapse
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6
Q

What is the MOA of parental agents?

A

Promotes release of GABA and major inhibitory neurotransmitter in the brain

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7
Q

What is the chemical advantage that correlates with easier administration when a phosphate group is added to the chemical structure of phenytoin or propofol –> fosphenytoin and fospropofol?

A
  • More water soluble and may produce less injection site pain
  • Dyslipidemia w/ prolonged infusion
  • Less chance for bacteremia
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8
Q

Define the “MAC” and how it correlates to potency for inhalational anesthetics.

A
  • Minimum alveolar concentration

- Measures the alveolar air that will produce immobility of 50% of pts exposed to painful stimulus

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9
Q

How does nitrous oxide relieve pain, induce loss of consciousness, and suppress respiratory function and blood pressure?

A
  • Low anesthetic potency (no LOC)
  • High analgesic/pain relief
  • No suppression on respiratory function and blood pressure
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10
Q

What are two potential advantages of adding nitrous oxide to other inhalation anesthetic agents for general anesthesia?

A

Enhance analgesia effect and “push” other agent —>CNS

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11
Q

What is the primary role of nitrous oxide?

A

Provide pain relief for a dental and minor surgeries where patient does not need to be unconscious.

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12
Q

What are the inhaled risks and toxicities?

A
  • Airway irritation
  • Potential for aspiration of gastric contents
  • Respiratory and cardiac depression: HypoTN, cardiac arrhythmias, sensitization of the heart to catecholamines.
  • Malignant hyperthermia
  • Hepatotoxicity
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13
Q

What are the risks and toxicities associated with IV Propofol?

A
  • CNS depression- respiratory depression
  • Apnea
  • HypoTN
  • Infection
  • Transient pain at injection site
  • Metabolic acidosis
  • Heart and kidney failure
  • Rhabdomyolysis
  • TMI
  • Death
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14
Q

What are the risks and toxicities associated with IV Ketamine?

A
  • ICP
  • Increase HR
  • HTN
  • Muscle rigidity
  • Flashbacks
  • Paranoia/dissociation
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15
Q

What is balanced anesthesia?

A

Using multiple drugs at lower dosages.

- This decreases the risk of toxicity seen at higher doses needed if using just one drug.

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16
Q

What is the roles of barbiturates as an adjunct to general anesthesia?

A

Rapid induction of anesthesia- LOC in 20 seconds

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17
Q

What is the roles of benzos as an adjunct to general anesthesia?

A

Promotes tranquility and reduce anxiety

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18
Q

What is the roles of opiods as an adjunct to general anesthesia?

A

Promote analgesia w/o affecting other senses (sight, touch, smell, hearing)

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19
Q

What is the roles of NM blockers as an adjunct to general anesthesia?

A

Reduce the amount of anesthesia needed and prevent contraction of skeletal muscles

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20
Q

What parenteral anesthetic is relatively contraindicated in the setting of head trauma and elevated intracranial pressure.

A

Ketamine

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21
Q

What are the Non-depolarizing NMB?

A
  • Pancuronium
  • Cisatracurium
  • Rocuronium
  • Vecuronium
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22
Q

What are the depolarizing NMB?

A

Succinylcholine

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23
Q

What is the MOA of the Non-depolarizing NMB?

A
  • Competitive antagonist of acetylcholine at nicotinic receptors in skeletal muscles
  • Do not cross the BBB and now well absorbed in the gut
  • Do not cause fasciculations and their effects can be reversed by cholinesterase inhibitors
  • Used in critically ill pts w/renal and hepatic failure
  • Longer duration of action
24
Q

What is the MOA of the depolarizing NMB?

A
  • Binds to nicotine receptors in skeletal muscles and causes persistent depolarization of the motor end plate
  • Produces muscle fasciculation followed by muscle paralysis effects cannot be reversed
  • Used to produce muscle relaxation before and during surgery and to facilitate intubation of the airway
  • Preferred for adults w/emergency surgery situations
  • Short duration of action
25
Q

What are 3 uses for neuromuscular blocking agents?

A
  • Endotracheal intubation
  • Mechanical ventilation
  • Electroconvulsion therapy
    (Surgical procedures requiring skeletal muscle relaxation)
26
Q

What is the risks with NMB?

A
  • Pts that only receive a NMB are paralyzed but can still feel pain and are conscious “anesthesia awareness”
  • Cont. to administer other prescribed medication and opioids even though the pt appears unresponsive
  • Apnea and HypoTN
27
Q

What is the potentially fatal risk/COD with NMB?

A

Hypoxia or Malignant hyperthermia

28
Q

How would you manage Malignant hypothermia?

A
  • MH kit or crash cart in the operating room with adequate supply of dantrolene
  • Dantrolene + sterile water repeat every 5 minutes
  • Stop administration of triggering agent
  • Hyperventilate w/ 100% oxygen
  • Bicarb for metabolic acidosis
  • Cooling measures: cold bottled fluids, cold IV bags, cold pack
29
Q

What is the reversal agent for non-depolarizing NMBs-pancuronium and citacurium?

A

Neostigmine

30
Q

What is the MOA of Neostigmine?

A

Increases acetylcholine levels at the neuromuscular junction and counteracts the neuromuscular blockade
(reverse neuromuscular blockade)

31
Q

What is the reversal agent for non-depolarizing NMBs-rocuronium and vecuronium.?

A

Sugammadex

32
Q

What is the MOA of Sugammadex?

A
  • Modified gamma cyclodextrin compound that forms a tight inactive complex
  • Fast recovery of neuromuscular function compared to neostigmine
33
Q

Why is Neostigmine and Sugammadex not useful in reversing succinylcholine?

A

Because succinylcholine is irreversibly bound to the receptors

34
Q

What is the etiology of Malignant hyperthermia?

A

A rare genetic disease triggered by inhaled anesthetic and NBMs (esp. succinylcholine) d/t presence of abnormal proteins in the muscle cells of the body
- Abnormal release of Ca+ from the SR occurs

35
Q

What is the first sign of Malignant hypothermia?

A

Steady rise in ETCO2 output

36
Q

What are other S/Sx of Malignant hypothermia?

A
  • Elevation in temp 43 degree Celsius
  • Difficulty intubating sustained muscle contractions
  • Generalized rigidity
  • Steady rise in HR
  • Increased respiratory drive
  • Vascular dysrhythmias- tachy and PVCs, hyperkalemia
37
Q

What are late/severe S/Sxs of Malignant hypothermia?

A
  • Shock
  • Cardiac arrest
  • Kidney failure
  • Blood coagulation problems
  • Internal hemorrhage
  • Brain injury
  • Liver failure
38
Q

What drugs are associated with Malignant hypothermia?

A
  • All anesthesia inhalations: Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane
  • Depolarizing NMB: Succinylcholine
39
Q

Room air oxygen is what %?

A

21%

40
Q

2 liters nasal prongs of oxygen is what %?

A

28%

41
Q

5 liters face mask oxygen is what %?

A

40%

42
Q

5 liters face mask oxygen 2/ reservoir bag is what %?

A

60%

43
Q

What IV anesthetic is used in children with septic shock?

A

Ketamine

44
Q

Succinylcholine is primarily used for what procedures?

A

muscle relaxer for endotracheal intubation

- very brief duration so poorly suited for prolonged procedures

45
Q

Pancuronium should be avoided in who?

A
  • May tachy-avoid in high-risk cardiac pts

- Pts with kidney and liver disease

46
Q

What is unique about Rocuronium?

A
  • Aside from succinylcholine, it the fastest NMB with an onset in 1-3 minutes
  • Persists for 20-40 minutes
47
Q

Vecuronium has less effect on what?

A

Cardiovascular effects

48
Q

Cisatracurium should be used in pt with what?

A

Kidney or liver dysfunction

49
Q

IV etomidate is useful in pts with what?

A
  • CVD (safe than barbiturates)

- rapid induction of anesthesia

50
Q

ASE of IV Etomidate

A

Highly emetogenic

51
Q

What are the indications for IV propofol?

A
  • MC’ly used anesthetic
  • considered an induction, maintenance general anesthesia
  • Mechanical vent
  • Radiation therapy
  • Endoscopy, MRI, etc.
52
Q

What is the MOA of Nitrous oxide?

A

Blocks the NMDA receptors

53
Q

Desflurane is more irritating to what?

A

Respiratory tract

54
Q

Isoflurane produces more what?

A
  • Muscle relaxation, causing more respiratory depression
55
Q

Why is Sevoflurane an ideal anesthetic?

A
  • Rapid and smooth induction and recovery

- Little cardiovascular or other organ tox

56
Q

Why is Halothane so dangerous and no longer used in the US?

A
  • Risk for cardiac dysrhythmias

- Produce hepatitis and hypersensitivity rxn

MSK (11 decks)

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