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Pharm 3 Test 5 > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

What severly limited surgery before general anesthetics?

A

Pain and shock

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2
Q

What do general anesthetics induce?

A

Generalized, reversible depression of the CNS

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3
Q

What are the broad purposes for general anesthetic use?

A

Analgesia, amnesia, immobility, unconsciousness, skeletal muscle relaxation

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4
Q

Where is the immobilizing effect of inhaled anesthetics taking place in the body?

A

Spinal cord

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5
Q

Where does the sedative effects of inhaled anesthetics work in the body?

A

Supraspinal (amygdala, hippocampus, cortex)

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6
Q

What is the lipid theory for GA?

A

Lipid portions of the neuronal membrane are affected by the GA, causing ion channel structures to change

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7
Q

What is the Mayer and Overton theory?

A

Anesthetic action is correlated with oil/gas partition coefficiency. So, more lipid a drug is, the greater its anesthetic property

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8
Q

What is the membrane expansion theory?

A

Molecules penetrate into hydrophobic regions of the cell membrane and cause its expansion

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9
Q

What is the protein based theory?

A

Anesthetics bind to amphipathic sites on proteins, induce/prevent conformational change, alter kinetics, compete with ligands

Or

Specific protein acts with hydrophobic pockets on certain membrane proteins to produce anesthetic effect

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10
Q

What are the primary inhibitory channels?

A

Chloride channels (GABA and glycine), and potassium channels

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11
Q

What are the primary exhitatory channels?

A

Those activated by ach, so muscarinic, nicotinic

Also glutamate, AMPA, NMDA, and serotonin

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12
Q

How many molecules of GABA are needed to activate GABA receptors?

A

2

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13
Q

What is the hormonal theory?

A

GA induce unconsciousness by activating a cluster of cells at the base of the brain called supraoptic nucleus

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14
Q

What factors increase anesthetic requirements?

A

Chronic ETOH, infant, red hair, hypernatremia, hyperthermia, robustness of health

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15
Q

What factors decrease anesthetic requirements?

A

Acute ETOH, elderly patients, hyponatremia, hypothermia, anemia, hypercarbia, hypoxia, pregnancy

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16
Q

What are the three stages of GA?

A

Induction, maintenance, and recovery

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17
Q

Progressive deepening of anesthesia as the concentration increases in the ____

A

brain

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18
Q

Surgical anesthesia is reached ____ the body water and fat stores reach equillibrium

A

before

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19
Q

What is each stage of anesthesia characterized by?

A

Increased CNS depression

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20
Q

What are the four stages of anesthesia?

A

Analgesia, excitement, surgical anesthesia, medullary depression

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21
Q

What patients are at risk for delirium post op?

A

Elderly

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22
Q

In regards to delirium and altered transmission post op, what is the only neurotransmitter released?

A

Cholinergic transmission

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23
Q

What specific receptors do inhaled anesthetics work on?

A

None really, they are non-specific

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24
Q

Lipid solubility is proportional to ____

A

Potency

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25
Q

What are the two things anesthesia personal can control in regards to the alveolar concentrations of inhaled anesthetics?

A

Inspired concentration

Alveolar ventilation

26
Q

What is the first compartment anesthetic gas encounters?

A

Blood

27
Q

Inverse of MAC is an index of ____

A

Potency

Low MAC means high potency

28
Q

Low MAC number infers ____ onset of action

A

slower

29
Q

High MAC number infers ____ onset of action

A

rapid

30
Q

What type of anesthetic is nitrous oxide considered?

A

Dissociative evidently….

31
Q

What are the things to remember about nitrous oxide?

A

Not a full anesthetic
Low potency
High MACC
POSSESES GOOD ANALGESIC PROPERTIES

32
Q

What are the toxic side effects of nitrous oxide?

A

Megoblastic anemia, tinnitus, numbness peripheral neuropathy

33
Q

What is the prototype inhaled anesthetic that other agents are compared to?

A

Halothane

34
Q

Is halothane an analgesic, hypnotic, or both?

A

Hypnotic

35
Q

What are the side effects of halothane?

A

Toxic metabolites-leading to hepatotoxicity

MH

36
Q

What do you treat MH with?

A

Dantrolene, muscle relaxant that blocks Ca release

37
Q

What are halothanes disadvantages?

A

Hypotension, bradycardia
Respiratory depression
Increased ICP and CBF

38
Q

What are the characteristics of isoflurane?

A

Potent agent and rapid induction/recovery

39
Q

Isoflurane does not ____ cardiac tissue for arrythmias?

A

sensitize

40
Q

What are the disadvantages of isoflurane?

A

Pungent smell and respiratory irritation

41
Q

What are the characteristics of enflurane?

A

Potent agent and rapid induction/recovery (Like iso)

42
Q

What are the side effects of enflurane on the heart? in general?

A

Little effect on the heart

Can cause respiratory depression, decreased bp, increased CBF and ICP, MH

43
Q

What does enflurane produce that is unique for its class?

A

Produces some level of muscle relaxation alone

KNOW THIS!!!!!!!!!!!!!!

44
Q

What are the characteristics of desflurane?

A

Fastest onset of action/recovery of the halogenated ethers

45
Q

What agent supposedly has the fastest onset of action?

A

Sevo

46
Q

What are the characteristics of sevo?

A

Decrease in BP

47
Q

What are the toxic side effects of sevo?

A

MH, hypotension, mild increase in CBF and ICP, potentially nephrotoxic

48
Q

How fast are thiopental and methohexital?

A

FFASSTT

49
Q

What do receptors do thiopental and methohexital act on?

A

GABAa, activating the inhibitory pathway through Cl influx

50
Q

What are the side effects of thipoental and methohexital?

A

Reduced CBF and ICP, dose dependent decrease in BP

51
Q

What is etomidate used for specifically?

A

Hypnotic

52
Q

What does etomidate have an increased level of compared to the barbs?

A

Higher margin of safety

53
Q

What are the side effects of etomidate?

A

Decreased ICP and CBF, respiratory depression, N/V with long term use

54
Q

What is the benefit of Fospropofol?

A

No pain on injection as compared to propofol

55
Q

What makes ketamine unique?

A

Its the only non opiate IV anesthetic with analgesic properties

56
Q

What is ketamine good for?

A

Children, poor risk geriatric patients, and in unstable patients

57
Q

What does NMDA receptors allow?

A

Sodium and calcium to flow INTO the cell, letting K flow out

58
Q

What receptors do benzos act on?

A

GABAa

59
Q

What are the side effects of benzos?

A

Respiratory depression and hypotension

60
Q

What is Innovar a combo of?

A

Droperidol and fentanyl

61
Q

What broad category is droperidol classified as?

A

Neuroleptic

62
Q

What is the use of Innovar?

A

Short procedures

Pharm 3 Test 5 (4 decks)

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