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General Anesthetics Flashcards

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1
Q

What are the three phases of general anesthesia?

A

Induction, maintenance and recovery

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2
Q

Which drugs are administered to a patient during the induction phase?

A

Anxiolytic, opiod, general anesthetic and muscle relaxant

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3
Q

Which drugs are administered to a patient during the maintenance phase?

A

Opioid + general anesthetic/muscular relaxant

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4
Q

Which general anesthetics do not potentiate the action of GABA at GABA A receptors

A

Cyclopropane, ketamine and xenon

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5
Q

What are the GABA A receptors?

A

ligand gated CL- channels made up of five subunits generally compromising two alpha two beta and one gamma or delta subunit

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6
Q

Specific mutations of the alpha subunit of the GABA A receptor do what?

A

inhibit volatile but not IV anesthetics

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7
Q

Specific mutations of the beta subunit of the GABA A receptor do what?

A

Inhibit both volatile and IV anesthetics

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8
Q

Volatile anesthetics may bind where?

A

Between the alpha and beta subunits

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9
Q

IV anesthetics bind where?

A

Only on the beta subunit

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10
Q

what are some functions of potassium channels?

A

Regulation of cell excitability, cell volume, cell growth, proliferation, and even cell death

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11
Q

What are the K2P channels?

A

They are a diverse family of K+ selective ion channels that contribute to background or leak current in excitable and non excitable tissues

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12
Q

K2P channels do what?

A

They control the negative resting potential of eukaryotic cells and regulate cell excitability by conducting K+ ions across the plasma membrane

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13
Q

Which K2P channels are expressed in the dorsal root ganglion neurons?

A

K2P2 family name is TREK

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14
Q

What are some physiological roles of the K2P2 channels?

A

Involved in depression, ischemia, nociception, myelinated axons, general anesthesia, ventricular tachycardia, cardiac fibrosis, migraine

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15
Q

K2P4 channels are highly expressed where?

A

In the dorsal root ganglion

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16
Q

What are some physiological and /or pathological roles of the K2P4 channels?

A

Myelinated axons, post surgical neuropathic pain

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17
Q

To which family does the K2P5 channel belong to?

A

TALK family

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18
Q

The K2P5 channels are highly expressed where?

A

Dorsal root ganglion

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19
Q

What are some physiological and/or pathophysiological roles of the K2P5 channels?

A

Renal volume control, migraine, Balkan endemic nephropathy

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20
Q

To which family do the K2P9 channels belong to?

A

TASK

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21
Q

What are some physiological and/or pathophysiological roles of the K2K9 channels?

A

aldosterone secretion, respiratory stimulation, cancer, BBMRS, inflammation, pain, general anesthesia, sleep duration

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22
Q

To what family do the K2P18 channels belong to?

A

TRESK

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23
Q

Where are the K2P18 channels highly expressed?

A

C-fibers of the dorsal root ganglion and the TRG (trigéminal ganglion)

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24
Q

What are some physiological and/or pathophysiological roles of the K2P18 channels?

A

Migraine and nociception

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25
K2P channels have ...
2 subunits each with four helical transmembrane domains (TM1-TM4), two pore forming loops (P1-P2) and a large intracellular region which apart from the TRESK channels forms the C terminus
26
The subunits of the K2P channels dimerize to...
create a selectivity filter containing four pore-loop domains
27
In addition to forming homodimers, there is strong evidence that the K2P channels form what?
heterodimers both within families
28
Which K2P channels are activated by volatile general anesthetics at clinically relevant concentrations with halothane being the most effective?
TREK-1, TREK-2, TASK-1, TASK-3, and TRESK
29
Which K2P channels are activated by gaseous anesthetic agents such as NO, cyclopropane, and xenon
TREK and TRESK channels
30
Certain K2P channels are regarded as molecular entities underlying what?
The leak K channels responsible for anesthetic-evoked membrane hyperpolarization in various neurons
31
What is one defining characteristic of the THIK channels?
they are inhibited by halothane
32
The TASK-1 channel is activated by?
Halothane
33
The TASK-1 channel is inhibited by what has at high concentrations?
Isoflurane
34
Which gases activate the TREK-1 channel?
Halothane, isoflurane, chloroform, NO and xenon
35
Which gases activate the TREK-2 channel?
Halothane, Isoflurane, chloroform
36
Which gases activate the TASK-3 channels?
Halothane, Isoflurane
37
Which gases activate the TRESK channel?
Halothane, Isoflurane, chloroform, NO
38
The DRG neurons compromise a heterologous population of...
primary afferent, somatosensory, and nociceptive neurons
39
K2P channels appear to be important in the..
mitigation of inflammatory pain
40
Genetic analysis of the KCNK18, the genetic hay encodes for the K2P18 channel, identified several mutations some of which were associated with..
Migraine
41
The K2P18 channels mediate the largest component of the...
background K+ current in dorsal root ganglion neurons
42
The K2P18 channels are associated with...
Significantly decreased thresholds for withstanding mechanical pain (allodynia), activation of astrocytes and microglia, and up regulation of connection-36 and connexin-43, components of neuronal and astrocyte-oligodendrocyte gap junctions respectively.
43
Changes in the activity of other K2P channels are also involved in the pathology of what?
Nerve injury
44
Which channels decrease the thermal sensitivity of the dorsal root ganglion neurons?
K2P2, K2P4, K2P10
45
glutamate is a...
major excitatory neurotransmitter
46
Glutamate activates which receptors?
AMPA, kainate, and NMDA receptors
47
The NMDA receptor is an important site for...
NO, Xenon, and ketamine
48
Which gas inhibits the NMDA receptor by competing with glycine?
Xenon
49
Ketamine blocks the pore of the...
NMDA channel
50
Increasing the levels of the general anesthetics leads to...
Decreased motor, reflex, respiratory, and thermoregulation
51
If there are high concentrations of the general anesthetic in the absence of artificial respiration it can lead to...
Death from respiratory failure
52
What are the effects of Isoflurane and other halogenated gases on the sympathetic system?
They decrease it which leads to a decrease in venous and arterial tone which leads to a decrease in venous and arterial pressure
53
What is the effect of nitrous oxide and ketamine on the sympathetic system?
increase sympathetic and plasma noradrenaline which leads to an increased heart rate and helps to maintain the blood pressure
54
What is the effect of halothane ?
Induce ventricular extra systoles and will increase sensitization to adrenaline
55
Halothane doesn’t cause any harm except if...
catecholamine secretion is excessive (pheochromocytoma) this will lead to an increase in ventricular fibrillation
56
All general anesthetics depress respiration and increase the arterial PCO2 except which gases?
NO, ketamine, and xenon
57
Desflurane induces a
Cough reflex in the patient
58
Desflurane is indicated only for which phase?
The maintenance phase
59
Propofol can be used as a what?
Continuous infusion
60
Which IV analgesic produces excitatory effects during induction and recovery as well as adrenocortical suppression?
Etomidate
61
Which IV analgesic produces postoperative nausea, vomiting, salivation, as well as raised intracranial pressure?
Ketamine
62
Which two IV anesthetics produce little respiratory depression?
Ketamine and midazolam
63
Which IV anesthetic produces little cardiac depression?
Midazolam
64
Is thiopental used in the induction phase?
Yes | It is never used in the maintenance phase
65
What is one effect of etomidate?
suppresses production of Adrenal steroids: increase in mortality in severely ill patients
66
Etomidate should be avoided in what type of patients?
At risk of having adrenal insufficiency
67
It is preferable to use thiopental in which type of patients?
Patients at risk of circulatory failure
68
What are some general characteristics of inhaled anesthetics?
Decreased cerebrovascular resistance and increased brain perfusion, bronchodilation, there is solubility in blood and in the tissues
69
Minimum alveolar concentration is small for what?
Potent anesthetics such as Isoflurane
70
Minimum alveolar concentration is large for?
Less potent agents such as nitrous oxide
71
The more lipid soluble a anesthetic is means that...
Less concentration is needed for them to produce an anesthetic effect (higher potency)
72
Minimum alveolar concentration equals what?
Potency

Neuro pharmacology (4 decks)

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