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Pharmacology > Exam 10: General Anesthetics > Flashcards

Exam 10: General Anesthetics Flashcards

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1
Q

purpose of atropine pre-op

A

Prevent bradyarrhythmias that can be caused by general anesthesia

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2
Q

Fast acting IV agent used to induce anesthesia

A

Propofol

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3
Q

Inhaled anesthetics used to maintain anesthesia after propofol

A

N2O plus another inhaled general anesthetic (-flurane)

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4
Q

emergence excitement

A

5-30% of patients experience restlessness, crying, moaning, thrashing when they come out of anesthesia

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5
Q

Drug that can be used to combat shivering due to hypothermia post-up

A

Merperidine

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6
Q

What property of inhaled anesthetics greatly affects how fast they work?

A

Water (blood) solubility
High solubility = slow induction
Low solubility = fast induction

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7
Q

Measurement of water solubility

A

Blood/gas partition coefficient

(concentration in blood)/(concentration in lung) when gas is in equilibrium

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8
Q

how quickly does N2O work? Why?

A

Fast

poorly soluble in blood (low blood/gas partition coefficient

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9
Q

How do we measure potency of inhaled general anesthetics?

A

MAC
Minimum Alveolar Concentration
Inhaled concentration for 50% of patients to not respond to pinprick pain

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10
Q

How does MAC relate to lipid solubility?

A

More lipid soluble = more potent

Less lipid soluble = less potent

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11
Q

What’s weird regarding lipid/water solubility of anesthetics?

A

Poorly water-soluble agents aren’t necessarily highly lipid soluble
Ex. N2O has low lipid and water solubility (fast induction, but low potency)

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12
Q

What’s a really good way to find out how conscious a sleeping patient is?

A

BIS
Bispectral Index
real time computer analysis of patient EEG
Give you a 0-100 scale from deep coma to awake

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13
Q

N2O side effects (3)

A
  1. air pockets (middle ear)
  2. Blood pressure change
  3. Depresses ventillary response to hypoxia
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14
Q

What is one side effect that N2O does NOT have compared to the other inhaled GAs/

A

Malignant hyperthermia

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15
Q

Inhaled anesthetic still used in 3rd world. Side effects?

A

Diethyl ether

Cheap, effective but irritates airway and is flammable

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16
Q

Problem with cyclopropane

A

Spontaneous combustion

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17
Q

Side effect of halothane

A 
decreased BP at 1 MAC
Vasodilation
Decreased cardiac output
bradycardia
Decreased GFR
Decreased ventilation rate
Halothane hepatitis
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18
Q

Pharmacokinetics of halothane

A

Blood:Gas partition = 2.3

Slowest induction, recovery

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19
Q

Rare, 50% fatal side effect of halothane

A

Halothane Hepatitis

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20
Q

Enflurane odor

A

Sweet

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21
Q

Halothane metabolism

A

liver

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22
Q

Enflurane side effects

A

Produces electrical seizure activity, though no

evidence, contraindicated for epileptics

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23
Q

Isoflurane odor

A

Pungent

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24
Q

Where is isoflurane excreted?

A

99% unchanged excreted from lungs

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25
Preferred inhaled GA for neurosurgery? Why?
Isoflurane | Modest vasodilation in cerebral vasculature, but metabolic rate of brain is decreased
26
Desflurane disadvantage
Irritating- causes coughing, secretions | you have to induce with IV before giving them this
27
Where is desflurane excreted?
99% unchanged excreted from lungs
28
Sevoflurane excretion
99% unchanged excreted from lungs
29
Potential danger of sevoflurane
Causes CO2 absorber to heat up, could potentially cause a fire
30
Advantage of sevoflurane over desflurane?
Non-irritating to airway, so you can use it to induce
31
Preferred inhaled GA for patients prone to myocardial ischemia? why?
sevoflurane | does not change cardiac output
32
2 characteristics of IV general anesthetics
1. Act fast (
33
Sodium thiopental mechanism
Barbiturate | Enhances effects of GABA at GABAA receptors
34
Sodium thiopental metabolism
Liver
35
Sodium thiopental side effects
Decreases brain metabolic rate, ICP, and cerebral blood flow Decreases heart contractility and causes vasodilation Decreases ventilation
36
Interesting use of Sodium thiopental
Lethal injection
37
Propofol constitution
Super fatty (white) Careful with patients with high triglyceride levels Not water soluble
38
Most common agent of induction of anesthesia in the USA
Propofol
39
Advantage of propofol over Sodium thiopental
no hangover (faster discharge, better outcomes)
40
propofol mechanism
Enhances effects of GABA at GABAA receptors
41
Side effects of propofol
1. Decreased ventilation (even more than Sodium Thiopental) 2. Major decrease in BP (vasodilation and less heart contractility) 3. May hurt on injection
42
Advantages of propofol
Safe in pregnant women | Anti-emetic properties
43
Who might be good patients with whom to use Etomidate?
Those prone to hypotension
44
Mechanism of Etomidate
Enhances effects go GABA at GABAA receptors | Also activates GABAA receptors without GABA being present
45
Side effects of etomidate
Pain on injection Myoclonic movements Nausea/vomiting Inhibit adrenal gland synthetic enzymes
46
Advantage of Etomidate over propofil
It doesnt decrease BP or cardiac output
47
Ketamine advantage
Produces profound analgesia
48
Ketamine mechanism
NDMA antagonist | Inhibits voltage sensitive Na, K channels
49
Side effects of ketamine
``` Increased cerebral blood flow Emergence delerium (1 hr post emergence, hallucinations, vivid dreams) ```
50
Ketamine effects of ventilation
Modest decrease in ventilation | Bronchodilation
51
Ketamine effects of CV system
Increases BP, CO and HR | useful for patients at risk of hypotension
52
Ketamine effects of urogenital system
Caron abuse leads to severe deterioration of the urinary bladder
53
What is the point of GA adjuncts
Decrease the dose of GA needed to reach desired anesthesia | "Balanced anesthesia"
54
Best benzo pre-op sedation (amnesia)
Midazolam (versed) it is water soluble, the others aren't also doesn't irritate blood vessels
55
Role of opioids in anesthesia
Minimize vascular reflex to noxious, painful stimuli | Potent analgesics, since only ketamine of the anesthetics has effective analgesic properties
56
Side effects of opioids
Nausea, vomiting | Decreased ventilation, HR, BP
57
What opioid has the shortest duration of action?
Remifentanil
58
Dexmedetomidine use in anesthesia
Alpha 2 agonist Used for sedation (off label) Does not decrease ventilation, so it is useful in non-intubated patients
59
How does anesthesia contribute to hypothermia?
Vasodilation is a side effect of most of the anesthetics we talked about (convective heat loss)
60
Mechanism of malignant hyperthermia
Ryanodine calcium channels do not close, leading to uncontrolled muscle contraction and heat generation
61
How can malignant hyperthermia kill you fast
Myocytes eventually lyse, releasing potassium which can cause fatal cardiac effects
62
Treatment for malignant hyperthermia
Dantrolene
63
Dantrolene mechanism
Ryanodine receptor inhibitor

Pharmacology (34 decks)

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