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Quarter 3 > Anesthesia Pharm II > Flashcards

Anesthesia Pharm II Flashcards

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1
Q

Opioid receptors

A

mu, delta, and kappa

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2
Q

Opioid mechanism of action

A
  • opioid binds receptor
  • Ca2+ channels close
  • K+ channels open
  • cells hyperpolarize
  • transmission blocked

primary effect is a decrease in neurotransmission

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3
Q

Where are opioid receptors located

A

brain, spinal cord, and peripheral nerves

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4
Q

Common clinical effects of Opioids (8)

A
  • impairs sympathetic compensatory responses
  • itching
  • depression of ventilation
  • increased CO2 increases ICP
  • sedation
  • biliary spasm
  • nausea/vomiting
  • urinary retention
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5
Q

Meperidine

(Demerol)

A
  • antispasmodic effect
  • renal excretion
  • CNS stimulant
  • shivering
  • serotonin syndrome
  • demethylation to normeperidine in the liver
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6
Q

Fentanyl

A
  • renal excretion
  • stable hemodynamics
  • no amnestic effect
  • depression of ventilation
  • skeletal muscle rigidity possible
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7
Q

Sufentanil

A
  • renal and biliary excretion
  • bradycardia
  • skeletal muscle rigidity
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8
Q

Rank in order of duration

morphine, meperidone, fentanyl

A

fentanyl < meperidone < morphine

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9
Q

Remifentanil

A
  • ester linkage susceptible to hydrolysis
  • rapidly titratable
  • respiratory depression
  • no change in ICP

*must add a longer acting agent to cover post-op pain

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10
Q

Context-Sensitive half-time of Remifentanil

A

4 minutes

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11
Q
A

Sufentanil

Fentanyl

Alfentanil

Remifentanil

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12
Q

Rank in order of increasing context-sensitive half time:

Sufentanil, Fentanyl, Alfentanil, Remifentanil

A

Remifentanil

Sufentanil

Alfentanil

Fentanyl

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13
Q

Codeine

A
  • interindividual variability
  • cough supressant
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14
Q

Hydromorphone

(Dilaudid)

A
  • 5x more potent than morphine
  • faster onset
  • oral dose every 4 hours
  • agitiation/restlessness
  • dangerous when combind with other sedatives
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15
Q

Oxycodone

A

moderate to severe pain

high abuse potential

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16
Q

Hydrocodone

A

high abuse potential

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17
Q

Methadone

A
  • used for chronic pain
  • prolonged duration of action
  • overdose possible
  • used to control withdrawal symptoms
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18
Q

Opioid Agonist-Antagonist

A
  • binds to mu receptors, but produce limited effects
  • may antagonize effects of other narcotics
  • may produce dysphoric effects
  • low abuse potential
  • limited respiratory depression
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19
Q

Pentazocine

(Talwin)

A

combined with naloxone to prevent “powdering”

can develop phyiscal dependence

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20
Q

Suboxone

A

treats opioid addiction

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21
Q

Naloxone

A
  • nonselective antagonist of all 3 opioid receptors
  • treats depression of ventilation
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22
Q

Naltrexone

A

treats alcoholism

Q24 hour dosing

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23
Q

PCA pumps

A

(patient-controlled anesthesia)

  • Settings
    • drug concentration
    • loading dose
    • lockout interval
    • basal rate
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24
Q

Which opioid has a cephalad movement?

A

Morphine

less lipid soluble compared to fentanyl/sufent

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25
Side effects of Neuraxial Opioids
* itiching * urinary retention * nausea/vomiting * depression of ventilation \*does not appear in breast milk \*may be reversed by naloxone
26
Masimo Acoustic Monitor
alarm that triggers when patient stops breathing * 81% sensitive * do not give to a person at risk of hypoventilation
27
Withdrawal symptoms
* yawning * diaphoresis * lacrimation * coryza (stuffy nose) * insomnia * abdominal cramps * nausea/vomiting
28
What can cause an increase of NMB activity?
CO2 retention * patient can hypoventilate in PACU and become "recurarized" * Treatment * increase FIO2 * sit patient up * assist ventilation * additional reversal
29
What can reverse a spasm of the sphincter of Oddi?
naloxone or glucagon (2mg IV)
30
4 Parts in a Nociceptive system
* transduction * transmission * modulation * perception
31
What accounts for perception of sensory-discriminative component of peripheral pain stimuli?
forebrain somatosensory cortex
32
What accounts for the perception of motivational affective components of pain?
Limbic cortex and Thalamus
33
(3) Primary afferent nocicpetors
A-beta, A-delta, and C fibers
34
A-alpha fibers
proprioception myelinated wide diameter fastest conduction speed
35
A-beta Fiber
touch myelinated wide diameter fast conduction speed
36
A-delta fiber
pain (mechanical and thermal) myelinated narrow diameter slow conduction speed
37
C fiber
pain (mechanical, thermal, and chemical) non-myelinated narrowest diameter slowest conduction speed
38
sensory nerves travel to what part of the spine?
dorsal root (posterior) ## Footnote also dorsal root ganglion
39
Gate Theory of Pain
painful stimuli can only be reached when "gate" is open * can be closed by inhibitory impulses * rubbing painful area * A-beta fibers faster than C fibers
40
"wind up" sensitization
repeated peripheral noxious stimuli where the pain increases with each stimulus, but the intensity of that stimulus remains the same
41
Heterosynaptic activity-dependent plasticity
a brief intense stimulus increases the efficiency of the dorsal horn synapses causing subsequent subthreshold inputs to result in pain
42
(4) ascending pathways of pain perception
--spinothalamic tracts (STT) --spinomedullary projections --spinobulbar projections --spinohypothalamic tract (SHT)
43
Spinothalamic Tract (STT)
* originates in dorsal horn * travel up contralateral side
44
Spinobulbar projections
the integration of nociceptive activity with processes that serve homeostasis and behavior
45
Spinohypothalamic Tract (SHT)
important for autonomic, neuroendocrine, and emotional aspects of pain
46
Neurotransmitters involved in Pain
glutamine enkephalin norepinephrine GABA
47
Somatic Stimuli
easily localized and a distinct sensation
48
Visceral pain
diffuse and poorly localized
49
Complex Regional Pain Syndrome (CRPS)
reflex sympathetic dystrophy * Type I - absence of major nerve injury * Type II - specific nerve injury * hyperalgesic
50
Perfusion pressure
MAP - CVP
51
Transmural pressure
pressure outside the tube minus pressure inside the tube
52
GABA mechanism of action
increases Cl- conductance hyperpolarizes and inhibits postsynaptic neuron
53
(6) GABA agonists
* propofol * etomidate * benzodiazepines * nonbenzodiazepines and benzodiazepines * barbituates * alcohol
54
Diprivan pH
7 - 8.5 uses disodium edetate and sodium hydroxide
55
Generic Propofol pH
4.5 - 6.4 uses sodium metabisulfite
56
propofol's context sensitive half-time with 8 hour infusion is less than 40 minutes
57
6 effects of Propofol
* decreases cerebral metabolic rate * decreases cerebral blood flow * decreases ICP * autoregulation maintained * does NOT modify evoked potentials * tolerance does not develop
58
6 Cardiovascular effects of Propofol
* decreases: * BP * SVR * contractility * does not alter SA or AV node function * does NOT prolong QTc interval
59
Propofol infusion syndrome
lactic acidosis with infusions over 24 hours
60
Etomidate
* GABAA receptor * rapid in onset * hydrolyzed in the liver and plasma esterases * involuntary myoclonic movements * NO analgesic properties
61
Effects of Etomidate
* lowers ICP and CMRO2 * minimal effects on contractility * nausea * adrenocortical supression
62
What occurs after a decrease in SVR?
lower blood pressure reduced filling of the LV secondary to increased pericardial pressure prevents a compensation in stroke volume to maintain BP
63
Midazolam
* water soluble * metabolized by P450 and excreted by kidneys * anticonvulsant
64
Effects of Midazolam
* decreases CMRO2 * decreases cerebral blood flow * decreases hypoxic drive * especially with fentanyl
65
Lorazepam
slow onset and long duration * delays emergence * suitable for withdrawal symptoms
66
Flumazenil
competitive antagonist of benzodiazepines * may result in seizures * no negative cardiovascular side effects
67
(3) Nonbenzodiazepine Benzodiazepine drugs
Zaleplon (sonata) Zolpidem (ambien) eszopiclone (lunesta)
68
what classification do the "sleeping agents" fall under?
nonbenzodiazepine benzodiazepine
69
Ketamine Characteristics
* intense analgesia at "sub-anesthetic" doses * emergence delirium * hemodynamically stable * not a respiratory depressant
70
What receptor does Ketamine bind?
NMDA (N-methyl-D-aspartate) \* Glutamate is the neurotransmitter and glycine is the co-agonist
71
Which sedative is useful in patients who are unable to be monitored or have a maintained airway?
Ketamine
72
Ketamine cautions
* aspiration risk * hypersensitive reflexes * delirium
73
Dexmedetomidine | (Precedex)
* potent alpha2 agonist * mainly on pontine locus ceruleus * inhibitory * decreases plasma catecholamines * decreases MAC
74
spasm of the muscles causing backward arching of the head, neck, and spine, as in severe tetanus, some kinds of meningitis, and strychnine poisoning
opisthotonos
75
Artery of Adamkieqicz
provides the major blood supply of the lumbar and sacral cord 1. located between T8 and L1
76
Ideal anesthetic for aortic insufficiency
* decreased SVR * preserved or increased HR
77
Ideal anesthetic for aortic stenosis
* preserved SVR * prevent tachycardia
78
Aortic Stenosis concerns
* left ventricular hypertrophy * vasodilators are hard to recover from * CPR is ineffective * easy to kill someone * avoid spinals
79
Ideal anesthetic for Mitral Regurge
decreased SVR and preserved HR
80
Ideal anesthetic for Mitral Stenosis
preserved SVR and decreased HR
81
Causes of QT prolongation
* Sevo and Iso * Type 1A and III antiarrhythmic agents * hypokalemia * hypocalcemia * Droperidol
82
Normal QTc interval
\< 430 in male and \< 450 in females
83
Equation for QTc
QTc = QT / sqrt(RR)
84
Which is the best inhalational agent for a cardiac ablation?
Sevo | (TIVA even better)
85
Which inhalational agent causes "steal"
Isoflurane
86
does minute ventilation increase/decrease with inhalational agents?
decrease
87

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