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Pharmacology > Anesthetics > Flashcards

Anesthetics Flashcards

1
Q

What are the volatile liquid general anesthetics?

A

halothane, isoflurane, desflurane, enflurane, sevoflurane (HIDES)

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2
Q

What is the gas general anesthetic?

A

nitrous oxide

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3
Q

What type of general anesthetics are inhaled?

A

volatile liquids and gas

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4
Q

What type of general anesthetics are IV?

A

thiopental (barbiturates), midazolam (benzodiazepines), propofol (phenols), morphine (opioids)

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5
Q

What are the local anesthetic drugs?

A

cocaine, procaine, tetracaine, lidocaine, bupivacaine

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6
Q

General anesthetics use what type of channel?

A

ligand gated

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7
Q

Local anesthetics use what type of channel?

A

voltage gated

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8
Q

What are general anesthetics?

A

drug induced absence of ALL sensations

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9
Q

What are the sensations that are absent with general anesthetics?

A

unconsciousness, analgesia, amnesia, loss of reflexes

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10
Q

How are general anesthetics mainly administered?

A

inhalational and IV

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11
Q

What is balanced anesthesia?

A

anesthesia with a mx of inhaled and intravenous anesthetics

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12
Q

What are the classes of sedative-hypnotics from high to low?

A

general anesthesia> deep sedation> moderate sedation> minimal sedation

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13
Q

What is the therapeutic indices range for inhalational anesthetics?

A

2 to 4

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14
Q

What are the kinetics of uptake and distribution of inhalational anesthetics?

A
  1. rate of entry controlled by respiration, a cyclic process
  2. elimination occurs in the lungs
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15
Q

What are the two drugs that are NOT eliminated by lungs?

A

methoxyflurane and halothane

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16
Q

What is tidal volume?

A

amount of air in lung when you take a breath

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17
Q

What is the rate of respiration?

A

number of breaths per minute

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18
Q

What is minute ventilation?

A

amount of air going in and out of lungs per minute

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19
Q

What is the minimum alveolar conc. (MAC)?

A

conc. that results in immobility in 50% of patients when exposed to noxious stimulus

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20
Q

If the MAC is larger, what amount of conc. is needed to have an effect?

A

more

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21
Q

If the MAC is smaller, what amount of conc. is needed to have an effect?

A

less

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22
Q

What are the factors that affect uptake of inhalation anesthetics?

A

solubility in blood and conc. of anesthetic agent in the inspired gas

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23
Q

What is the coefficient of of solubility in blood?

A

blood:gas partition coefficient

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24
Q

What does the blood:gas partition coefficient/index of solubility define?

A

relative affinity of an anesthetic for blood in comparison to air

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25
Q

How does solubility affect the rate of rise of its tension in the blood then brain?

A

the lower the solubility, the faster the rate (smaller B:G = more pressure = faster delivery to brain)

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26
Q

What can increase the rate of induction?

A

an increase in teh inspired anesthetic conc.

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27
Q

What is pulmonary ventilation?

A

when increased, it will speed up the uptake of an anesthetic with higher B:G partition coefficient

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28
Q

What is the hypothesis of the pharmacodynamics of anesthetics?

A

direct correlation between lipid solubility and potency

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29
Q

What receptor is the target for most general anesthetics?

A

GABAa

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30
Q

GABAa channel activity is increased in the presence of what drugs?

A

benzodiazepines, barbiturates, propofol, enflurane

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31
Q

What is the practical approach to evaluate the depth of anesthesia?

A
  1. if the eyelid blinks when eyelashes are touched
  2. if patient swallowing reflex disappears
  3. if respiration becomes irregular in the rate and depth
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32
Q

What can reduce the respiratory tidal volume?

A

an increase in the depth of anesthesia

33
Q

What happens when potent halogenated agents are used?

A

arterial blood tends to vary directly with the depth of anesthesia

34
Q

What can be used as an approximate index of dosage when potent halogenated agents are used?

A

hypotension

35
Q

What is the cardiovascular effect on halogenated general anesthetics?

A

dose dependent reduction in blood pressure

36
Q

What is the respiratory effect on halogenated general anesthetics?

A

reduce ventilation in conc.-dependent way by depressing medullary centers in the brainstem; reducing minute ventilation

37
Q

What is an adverse affect of anesthetics?

A

malignant hyperthermia: rapid rise in body temp.

38
Q

What are the symptoms of malignant hyperthermia?

A

hyperthermia, tachycardia, hypertension, acidosis, muscle rigidity

39
Q

What makes malignant hyperthermia most common?

A

use of halothane and succinylcholine

40
Q

What is the drug used to prevent death from malignant hyperthermia?

A

dantrolene

41
Q

What is the main application of nitrous oxide?

A

adjuvant with other inhalational anesthetics

42
Q

What is the percentage of nitrous oxide needed to have analgesia (no pain) as an effect?

A

20%

43
Q

Can nitrous oxide achieve behavioral disinhibition, amnesia, or unconsciousness?

A

yes
40%- behavioral disinhibition
60%- amnesia
80%- unconsciousness

44
Q

Are barbiturates good analgesics?

A

NO; can increase sensitivity to pain

45
Q

What type of circulation do barbiturates have?

A

one arm-to-brain circulation

46
Q

What occurs in the circulation of barbiturates?

A

decreases arterial pressure due to a reduction in cardiac output

47
Q

What occurs in the respiration of barbiturates?

A

reduces minute ventilation by lowering the sensitivity of medullary respiratory center to carbon dioxide

48
Q

Propofol induces anesthesia as rapidly as what other type of drug?

A

barbiturates; but has shorter half-life

49
Q

How does propofol affect systemic arterial pressure?

A

decreases it due to peripheral vasodilation

50
Q

What can occur at the site of injection for propofols?

A

apnea

51
Q

Propofol is used mainly for what type of surgery?

A

“day surgery”

52
Q

What type of drug is known as “milk of amnesia”?

A

propofol due to it being lipid soluble

53
Q

What can benzodiazepines cause?

A

sedation, reduction in anxiety, amnesia, moderate depression of circulation and respiration

54
Q

Are benzodiazepines analgesic?

A

NO; they are amnesic

55
Q

What drug is used to reverse the action of benzodiazepines?

A

flumazenil

56
Q

Out of diazepam, midazolam, and lorazepam, which has a more rapid onset?

A

midazolam

57
Q

Are opioids an analgesic?

A

YES and very powerful

58
Q

What are the effects of opioids?

A
  1. mild decrease in blood pressure
  2. impair ventilation, depress respiration
  3. increase chest wall rigidity
59
Q

What is the antagonist used for opioid overdose?

A

naloxone

60
Q

What are local anesthetics?

A

reversibly block impulse conduction along nerve axons that use Na channels

61
Q

What are the effects of local anesthetics?

A
  1. block pain sensation
  2. cause vasoconstriction
  3. reduces bleeding
62
Q

What type of chemistry do local anesthetics include?

A

lipophilic group connected by an intermediate chain to an ionizable group (aromatic ring + ester/amide + tertiary amine)

63
Q

What are the esters of local anesthetics?

A
  1. cocaine (vasoconstrictor)
  2. procaine (vasodilator)
  3. tetracaine (vasodilator)
64
Q

What are the amides of local anesthetics?

A

lidocaine (vasodilator) and bupivacaine (vasodilator)

65
Q

What is the ONLY vasoconstrictor in local anesthetics?

A

cocaine

66
Q

Are local anesthetics weak acids or bases?

A

weak bases

67
Q

What form of local anesthetics penetrate the cell?

A

non-ionized form

68
Q

What form of local anesthetics occupy the Na channels?

A

ionized form

69
Q

What does epinephrine do during absorption in local anesthetics?

A

prolongs activity and reduces the dose and change of toxicity

70
Q

What are vasoconstrictor substances?

A

reduce the absorption of local anesthetics from depot site by decreasing the blood flow

71
Q

When should epinephrine NOT be administered?

A

when anesthetizing tissues with end arteries

72
Q

What type of local anesthetics have a shorter half-life?

A

esters

73
Q

What are amides metabolized by during elimination?

A

liver followed by hydrolysis (amidases)

74
Q

How do ester anesthetics become inactive products?

A

through hydrolysis by plasma cholinesterase and live esterase

75
Q

Local anesthetics have a HIGHER affinity for what states?

A

activated and inactivated states opposed to resting states

76
Q

What is conformational dependent?

A

the binding of local anesthetics to Na channel

77
Q

What type of channel do local anesthetics use?

A

voltage-gated Na channels

78
Q

What are the toxicity and adverse effects of the central nervous system?

A

excitation, convulsion, respiratory depression

79
Q

What are the toxicity and adverse effects of the cardiovascular system?

A
  1. direct effect on cardiac and smooth muscle
  2. indirect effect on autonomic nerves

Pharmacology (5 decks)

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