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Internship - Anaesthetics > BAC - Chapter 5: Anaesthetic Drugs > Flashcards

BAC - Chapter 5: Anaesthetic Drugs Flashcards

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1
Q

Advantages of IV induction agents:

A
  1. Rapid onset
  2. Smooth induction
  3. More pleasant for patient
  4. Less theatre pollution
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2
Q

Disadvantages of IV induction agents:

A
  1. Venipuncture needed
  2. Easily overloaded
  3. No elimination by lungs - needs metabolism and excretion
  4. Sudden loss of normal protective mechanisms & apnoea
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3
Q

Sodium Thiopentone - indications:

A
  1. Induction
  2. Maintenance
  3. Rx of status epilepticus
  4. Reduce ICP
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4
Q

Sodium Thiopentone - CIs:

A
  1. Allergy
  2. Porphyria
  3. CVS disorders - CCF, fixed CO, hypovolaemia
  4. Asthma - relative
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5
Q

Special precaution in Sodium Thiopentone:

A
  1. Intra-arterial injection
  2. Causes arterial spasm & thrombosis
  3. Prevention: don’t used veins next to arteries/ use 2.5% solution
  4. Rx: Inject papaverine 80 mg in 20 ml N/S.
  5. Anticoagulation
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6
Q

Propofol - precautions:

A
  1. Good culture medium
  2. CVS depression so beware in:
    Hypovolemia
    HPT
    Fixed CO
    Elderly
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7
Q

Propofol - Indications:

A
  1. Favoured IV induction agent - rapid return of consciousness
  2. Most suitable for TIVA - minimal accumulation
  3. Sedation for regional anaesthesia
  4. Sedation in ICU
  5. Agent for porphyria
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8
Q

PRIS - risky dose?

A
  1. > 5mg/kg/hr for > 48 hrs
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9
Q

PRIS - features:

A
  1. Lipaemia
  2. Metabolic acidosis
  3. Cardiomyopathy
  4. Cardiac failure
  5. Skeletal myopathy
  6. Death
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10
Q

Etomidate - Indications:

A
  1. Induction with CVS compromise
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11
Q

Etomidate - precautions:

A
  1. Suppress cortisol synthesis

2. Long infusion - Reduce immunological competence

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12
Q

Ketamine - features of induction:

A
  1. Dissociative anaesthesia:
    Catatonia
    Amnesia
    Analgesia
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13
Q

Ketamine - precautions:

A
  1. Distressing emergence phenomena
  2. Increased secretions - pre-med with anticholinergic
  3. Avoid in IHD/ HPT
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14
Q

Ketamine - Indications:

A
  1. Shocked pts
  2. Severe asthmatics - potent bronchodilator
  3. Paeds
  4. Difficult locations - accident scene
  5. Short procedures
  6. Analgesia + sedation - wound dressings
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15
Q

Ketamine - CIs:

A
  1. CVS disorders - HPT, IHD, AA
  2. Raised ICP
  3. Open eye injuries - raised IOP
  4. Psych pts.
  5. Pts. on TAD
  6. Thyrotoxicosis
  7. Early pregnancy
  8. Epileptics
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16
Q

Thiopentone - dose:

A
  1. Induction: 3-5 mg/kg

2. Infusion: 4mg/kg/hr

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17
Q

Thiopentone - preparation:

A

500 mg amp in 20 ml = 25mg/ml

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18
Q

Thiopentone - CVS affects:

A
  1. Decreases myocardial contractility
  2. Decreases CO by 10-20% d/t peripheral vasodilation
  3. Reflex tachycardia
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19
Q

Thiopentone - Resp affects:

A
  1. Central depression
  2. Potent apnoea
  3. A/W reflexes not abolished - risk of L/G or bronchospasm
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20
Q

Thiopentone - CNS affects:

A
  1. Decreased ICP
  2. Anticonvulsant
  3. Cerebral protection in focal ischemia
  4. Commonly used in neuroanaesthesia
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21
Q

Propofol - dose:

A
  1. Induction: 2-3 mg/kg

2. Infusion: 6-8 mg/kg/hr

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22
Q

Propofol - how to reduce pain when giving IV:

A
  1. Mixing with 10 mg lignocaine in syringe
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23
Q

Propofol - effect on emesis:

A
  1. Thought to be anti-emetic
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24
Q

Propofol - CVS affects:

A
  1. Up to 40% decrease in BP d/t:
    Myocardial depression
    Decreased PVR
  2. Tachycardia
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25
Propofol - Resp affects:
1. Apnoea common with induction 2. Decreased TV w/ infusion 3. Increased RR w/ infusion 4. Laryngeal reflexes suppressed - reduced risk of laryngospasm 5. Drug of choice for LMA
26
Propofol - CNS affects:
1. Anticonvulsant | 2. Reduces ICP
27
Etomidate - dose:
1. Induction: 0.2 - 0.3 mg/kg | 2. Maintenance: 10-20 ug/kg/min (generally not used for infusion d/t adrenal suppression)
28
Etomidate - effect on emesis:
1. 30% increased risk - "vomidate"
29
Etomidate - CVS affects:
1. Minimal CVS depression
30
Etomidate - Resp affects:
1. Ventilation affected less 2. No apnoea with induction 3. No histamine release 4. Good for asthmatics
31
Etomidate - CNS affects:
1. Reduces ICP
32
Ketamine - dose:
1. Induction: 2 mg/kg IVI 2. Infusion: 4-6 mg/kg/hr 3. Analgesia: 0.5 mg/kg
33
Ketamine - analgesic affect:
1. Intense visceral & somatic analgesia
34
Ketamine - emergence phenomena:
1. Delirium 2. Agitation 3. Nightmares
35
Ketamine - CVS effects:
1. Increases arterial BP by 25% 2. Increases HR by 20% 3. Increases myocardial O2 consumption
36
Ketamine - Resp effects:
1. Upper A/W reflexes remain largely intact 2. No histamine release 3. Potent Bronchodilator 4. Increases secretions
37
Ketamine - CNS effects:
1. Increases ICP | 2. Dissociative amnesia
38
Midazolam - dose:
1. Induction: 0.2 mg/kg 2. Sedation: 2.5 - 7.5 mg 3. Pre-med: 5mg IMI 4. ICU: 4. 1 Initial bolus of 5mg/kg 4. 2 Then infusion of 1-20 mg/hr titrated to response
39
Midazolam - affect on emesis:
1. Incidence of PONV
40
Midazolam - CVS affects:
1. Slight decrease in BP | 2. Slight increase in PR
41
Midazolam - Resp affects:
1. Risk of resp depression/ apnoea
42
Ways to create faster gas induction:
1. Increase concentration of gas 2. Increase flow rate 3. Use non-rebreathing circuit
43
Ways to increase elimination of volatile:
1. Increase minute ventilation | 2. Give high inspiratory O2 concentration
44
MAC - definition:
1. The alveolar concentration of a volatile 2. That prevents movement 3. In 50% of patients 4. In response to a surgical stimulus
45
N20 - MAC/ colour/ BG co-eff:
MAC: 105% Colour: Blue BG co-eff: 0.47
46
Halothane - MAC/ colour/ BG co-eff:
MAC: 0.75% Colour: Red BG co-eff: 2.4
47
Enflurane - MAC/ colour/ BG co-eff:
MAC: 1.7% Colour: Orange BG co-eff: 1.9
48
Isoflurane - MAC/ colour/ BG co-eff:
MAC: 1.15% Colour: Purple BG co-eff: 1.4
49
Desflurane - MAC/ colour/ BG co-eff:
MAC: 6% Colour: Blue BG co-eff: 0.42
50
Sevoflurane - MAC/ colour/ BG co-eff:
MAC: 2% Colour: Yellow BG co-eff: 0.65
51
Nitrous - CVS affects:
1. Stable
52
Nitrous - Resp affects:
1. Impairment of hypoxic drive
53
Nitrous - CNS affects:
1. Increases ICP
54
Nitrous - Renal affects:
1. Decreases RBF
55
Nitrous - CIs:
1. Diffuses rapidly into body cavities | 2. CI in: pneumocephalus, pneumothoracies, air emboli
56
Halothane - CVS affects:
1. Myocardial depression
57
Halothane - Resp affects:
1. Resp depression 2. Decreases hypoxic drive 3. Increases apnoeic threshold 4. Potent bronchodilator
58
Halothane - CNS affects:
1. Increases ICP
59
Isoflurane - CVS affects:
1. Decreases BP & SVR 2. Minimal cardiac depression 3. Not sensitise heart to catecholamines 4. Coronary artery dilation - coronary steal syndrome
60
Isoflurane - Resp affects:
1. Good bronchodilator
61
Isoflurane - CNS affects:
1. Good for neuroanaesthesia
62
What makes sevoflurane a smooth and rapid inhalational induction agent?
1. Decreased solubility | 2. Increased potency
63
Sevoflurane - Renal affects:
1. Potential for nephrotoxicity
64
Desflurane - Resp affects:
1. Increased salivation | 2. Laryngospasm
65
What changes to make when increasing or decreasing volatile concentration?
1. Increase fresh gas flow rate to make change occur more rapidly 2. Then turn down to low flow anaesthesia later
66
Which volatiles are implicated in MH?
1. All except N2O
67
Indications for mm. relaxation:
1. Facilitation of intubation 2. Improvement of surgical access 3. Prevent movement in delicate surgery 4. Manipulation of #s 5. Used in ECT & ICU
68
Types of mm. relaxants agents?
1. Depolarising agents | 2. Non-depolarising agents
69
Example of depolarising mm. relaxant?
1. Only suxamethonium
70
MOA of Sux:
1. Act as ACh-receptor agonist 2. Generates mm. action potential 3. Causes fasciculation 4. Then paralysis 5. Metabolised by pseudo-cholinesterase 6. Motor end plate remains depolarised 7. No further action potential can take place
71
Sux - dose:
1. 1 - 1.5 mg/kg
72
Sux - onset of action:
1. 30 sec
73
Sux - duration of action:
1. < 10 min
74
Sux - indication:
1. RSI | 2. Short acting mm. relaxation
75
Sux - S/E:
1. Bradycardia 2. HyperK - increases K by 0.5 3. Anaphylaxis 4. MH 5. Scoline apnoea 6. Massester spasm 7. Mm. pain
76
MOA of NDMR:
1. Bind to ACh-receptor 2. Doesn't generate action potential 3. Blocks ACh from binding 4. Competitive antagonist
77
Types of NDMR:
1. Benzylisoquinolones: Atracurium, Cisatracurium | 2. Aminosteroids: Vecuronium, Rocuronium
78
Atracurium - dose/ side effects:
1. Dose: 0.5 mg/kg | 2. S/E: Hypotension, tachycardia, bronchospasm
79
Cisatracurium - dose:
1. Dose: 0.15 mg/kg
80
Rocuronium - dose:
1. 0.6 - 1.2 mg/kg
81
Rocuronium - onset:
1. 45 sec - 3 min
82
Rocuronium - duration:
1. 30 - 40 min
83
Drug + dose to reverse NDMR:
1. Neostigmine | 2. Dose: 0.04 mg/kg
84
MOA of neostigmine:
1. Inhibits ACh-esterase 2. Increases concentration of ACh in NMJ 3. Displaces NDMR off nicotinic ACh-receptor
85
S/E of reversal with neostigmine:
1. Bradycardia 2. Bronchospasm 3. Secretions
86
How to Rx S/E of reversal with neostigmine:
1. Glycopyrrolate - 0.01 mg/kg | 2. Atropine - 0.02 mg/kg
87
Site of measurement of nerve stimulator?
1. Adductor pollicis
88
TOF pattern with DMR:
1. Constant decrease in twitch height
89
TOF pattern with NDMR:
1. Results in fade - each twitch is smaller than the preceding twitch
90
What is the TOF ratio?
1. Compares the ratio between the first twitch (T1) & fourth twitch (T4)
91
When to give neostigmine for reversal?
1. When there are 3 or more twitches on the TOF count
92
What is regarded as adequate reversal?
1. TOF ratio > 0.9
93
Def - local anaesthetic drug:
1. Drug which causes reversible interruption of conduction | 2. In autonomic, motor and sensory nerves
94
MOA of LA:
1. Inhibit Na-influx 2. By blocking Na channels 3. Block generation & propagation of electrical impulses
95
Types of LA drugs:
1. Esters - procaine, cocaine | 2. Amides - lignocaine, bupivacaine
96
Lignocaine - dose:
1. 3 mg/kg without ADR | 2. 7 mg/kg with ADR
97
Lignocaine - duration:
1. Around 1 hr
98
Bupivacaine - dose:
1. 2 mg/kg regardless of ADR
99
Bupivacaine - duration:
1. 4-6 hrs
100
LA toxicity - how does presentation differ between lignocaine vs bupivacaine in terms of toxicity?
1. Lignocaine: CNS Sx first, CVS collapse second | 2. Bupivacaine: CVS collapse first, CNS Sx second
101
CNS Sx in LA toxicity:
1. Dizziness 2. Perioral paresthesia 3. Slurred speech 4. Tinnitus 5. Metallic taste 6. Seizures
102
CVS Sx in LA toxicity:
1. Tachycardia 2. HPT 3. Decreased CO 4. Sinus bradycardia/arrhythmias
103
Prevention of LA toxicity:
1. IV access before giving local 2. Choose least toxic drug 3. Consider max dose for patient 4. Aspiration before administration 5. Observe pt 6. Stop injection immediately when noticing Sx
104
Mx of LAST:
1. Stop injection of LA 2. Call for Help 3. ABCD 4. Maintain airway - head tilt, chin lift 5. 100% O2 6. Ventilate if needed 7. IVF 8. Vasopressors - ephedrine, phenylephrine, ADR 9. Correct electrolytes 10. Convulsions - Rx w/ BZDs, no effect - thiopentone 11. Arrhythmias - amiodarone, Intralipid 20%
105
Intralipid administration dosage:
1. 100 ml stat 2. Run rest of bag over 15 mins 3. 2 more 100 ml boluses if needed

Internship - Anaesthetics (17 decks)

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