Anesthetics Flashcards Preview

Pharmacology > Anesthetics > Flashcards

Flashcards in Anesthetics Deck (30)
Loading flashcards...
1
Q

Types of anesthetics

A

inhaled, parenteral, local

2
Q

Two important properties that drive onset, extent and duration

A

lipid solubility (determines potency, protein binding and DOA), Ionization constant

3
Q

General anesthesia should always include

A

sleep induction, loss of pain responses, amnesia, skeletal muscle relaxation, loss of reflexes

4
Q

Inhaled anesthetics

A

Ether, Nitrous oxide, Haltothane (Fluothane), Enflurane (Ethrane), Desflurane (Suprane), Isoflurane, Sevoflurane (Ultane)

5
Q

Inhaled anesthetic MOA

A

activate K channels, block Na channels to increase cellular threshold for firing, decreases neuronal activity

6
Q

Inhaled anesthetic ADRs

A

increases ICP, post op N/V, malignant hyperthermia: tachy, HTN, hyperkalemia, muscle rigidity, associated with sudden and massive release of Ca

7
Q

What is used to treat malignant hyperthermia

A

dantrolene and fluids

8
Q

Parenteral anesthetics

A

Ketamine, Etomidate (Amidate), Proprofol (Diprivan), short acting barbituates (sodium pentothal), benzodiazepines

9
Q

Katamine is mostly used

A

in animals and some in dental procedures

10
Q

Etomidate (Amidate) is used for

A

short term sedation (10 min)

11
Q

Proprofol (Diprivan) is used

A

regularly in hospt setting for procedures and continuous infusions in ICUs

12
Q

Parenteral anesthetics can also be used for

A

signal conduction alteration (arrhythmias)

13
Q

Parenteral anesthetic MOA can make them dangerous

A

if inadvertently given IV when intended to be given locally

14
Q

Local anesthetics MOA

A

blockade of voltage gated Na channels in a manner that is use-dependent, oftentimes given with a agonist such as epi with goal of vasoconstriction of microvascular to reduce blood flow to area and minimize wash out

15
Q

Local anesthetic can be given with

A

dexamethasone (corticosteroid) with the thought that it will increase duration by 50%

16
Q

How can local anesthetic toxicities be reversed

A

with use of IV lipid to remove anesthetic from sight of action

17
Q

Effects of local anesthetics

A

Nerves- dec conduction, vascular smooth muscle- vasodilation, heart- decrease excitability, reduce pacemaker activity, prolong ERP up to and including death in severe toxicity, CNS-increased excitability

18
Q

Local anesthesthics tend to affect

A

small myelinated neurons 1st, at higher concentration, they will block signal transduction through myelinated neurons

19
Q

The more lipophillic the anesthetic the…

A

more potent w/ faster onset

20
Q

Order of local anesthetic blockade

A

pain, sensation of temperature, touch/pressure, motor function, reversal/recovery is the opposite

21
Q

Classes of local anesthetics

A

Esthers- Procaine (Novocaine), tetracaine (pontocaine), Benzocaine; Amides- Lidocaine (Xylocaine), mepivacaine (Carbocaine), Bupivacaine (marcaine), Ropivacaine (Naropin)

22
Q

Topical administration

A

Benzocaine*** (only indication), Lidocaine, Tetracaine, used for diagnostic, procedures

23
Q

Infiltration administration

A

lidocaine, procaine, bupivacaine, local application, injection

24
Q

Nerve block administration

A

Bupivacaine, ropivacaine, drug is injected or catheter inserted for infusion to cluster of neurons (femoral, sciatic)

25
Q

Epidural administration

A

burivacaine, ropivacaine, injected directly into CSF, usually childbirth or abnormal surgeries, allows for complete blockade of large # of neurons

26
Q

Local anesthetic ADRs

A

CNS- sedation, restlessness, nystagmus, convulsions, CV- cardiac block, hypotension, arrythmias, vasodilation, allergic rxns- more common with esthers

27
Q

Local anesthetic toxicity

A

mostly related to inadvertent IV infusion via INTRAVASCULAR catheter or inadvertant IV injection, always aspirate before injecting to confirm placement; HTN, tachy, excitability

28
Q

Lidocaine

A

dental anesthesia, available as 1%, 2% in combo w/ epi, keep perservatives in mind, dose needed depends on area and duration needed, usually 2 hrs

29
Q

Bupivacaine (marcaine), Ropivacaine (Naropin)

A

most common for epidural or nerve blocks post op (femoral or sciatic), different anesthesia providers will use different concentrations, opioids added w/ epidurals

30
Q

Long lasting local anesthetics

A

Tetracaine (Pontocaine), Bupivacaine (Marcaine), Ropivacaine (Naropin)