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Flashcards in Anesthetics Deck (30):
1

Types of anesthetics

inhaled, parenteral, local

2

Two important properties that drive onset, extent and duration

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

3

General anesthesia should always include

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

4

Inhaled anesthetics

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

5

Inhaled anesthetic MOA

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

6

Inhaled anesthetic ADRs

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

7

What is used to treat malignant hyperthermia

dantrolene and fluids

8

Parenteral anesthetics

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

9

Katamine is mostly used

in animals and some in dental procedures

10

Etomidate (Amidate) is used for

short term sedation (10 min)

11

Proprofol (Diprivan) is used

regularly in hospt setting for procedures and continuous infusions in ICUs

12

Parenteral anesthetics can also be used for

signal conduction alteration (arrhythmias)

13

Parenteral anesthetic MOA can make them dangerous

if inadvertently given IV when intended to be given locally

14

Local anesthetics MOA

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

Local anesthetic can be given with

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

16

How can local anesthetic toxicities be reversed

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

17

Effects of local anesthetics

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

Local anesthesthics tend to affect

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

19

The more lipophillic the anesthetic the...

more potent w/ faster onset

20

Order of local anesthetic blockade

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

21

Classes of local anesthetics

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

22

Topical administration

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

23

Infiltration administration

lidocaine, procaine, bupivacaine, local application, injection

24

Nerve block administration

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

25

Epidural administration

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

26

Local anesthetic ADRs

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

27

Local anesthetic toxicity

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

28

Lidocaine

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

Bupivacaine (marcaine), Ropivacaine (Naropin)

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

30

Long lasting local anesthetics

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