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General Anesthetics Flashcards

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1
Q

Nitrous Oxide (N2O) class?

A

Inorganic gas. Hypnotic, analgesic, NO muscle relaxation

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2
Q

N2O mxn? Is it soluble in blood? What does this mean?

A

NMDA antagonist; relatively insoluble in blood; rapid induction of anasthesia

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3
Q

N2O for?

A

Mask induction in children

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4
Q

N2O side effects?

A

PONV, inactivates B12 (abnormal embryonic development), accumulates in closed air spaces (bowel, middle ear, pneumothoraces, air emboli) because N2O is insoluble in blood

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5
Q

MAC of N2O?

A

104%

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6
Q

Isofluorane class?

A

Volatile anasthetic, will somewhat relax skeletal muscles

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7
Q

Isoflurane for?

A

Gold standard for maintenance of general anasthesia

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8
Q

Isoflurane MAC?

A

1.17% – Most potent of the 3 volatile anesthetics

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9
Q

Isoflurane side effects?

A

Pungent (makes mask induction difficult)

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10
Q

Desflurane class?

A

Volatile anesthetic

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11
Q

Desflurane MAC?

A

6.6% – Least potent, least soluble (allowing for rapid emergence from anesthesia)

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12
Q

Desflurane side effects?

A

Most pungent – will cause airway irritation symptoms (coughing, copious salivation, breath holding, laryngospasm)

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13
Q

Sevoflurane class?

A

Volatile anesthetic

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14
Q

Sevoflurane MAC?

A

1.8% – Middle potency between Isoflurane & Desflurane. Also, middle solubility.

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15
Q

Sevoflurane for? Why?

A

Mask induction in children and adults because it is the least pungent.

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16
Q

Sevoflurane side effects?

A

Produces inorganic Fl- ions; In combination with CO2 forms “compound A” (nephrotoxic in rats); forms CO when exposed to strong bases; exothermic rxns can cause fires

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17
Q

Volatile anesthetics?

A

Isoflurane, Desflurane, Sevoflurane

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18
Q

Effects of volatile anesthetics on CNS?

A

Dose dependent depression of EEG, potentials (↑ latency,↓ amplitude), Cerebral metabolic rate. Dose dependent increase in Cerebral blood flow (CBF) (may be blunted by hypocapnia produced by deliberate hyperventilation), ICP

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19
Q

Effects of volatile anesthetics on cardiovascular system & blood flow?

A

Dose dependent decreases in: vascular resistance, BP
BUT: Minimal effects on myocardial contractility. Isoflurane and desflurane ↑ HR (Likely due to pungency stimulating airway receptors and eliciting reflex tachycardia). Redistribution of blood flow
↑ blood flow to brain, muscle and skin & ↓ blood flow to liver, kidneys, gut.

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20
Q

Effects of volatile anesthetics on respiratory function?

A

Dose dependent decrease in Tidal volume, Ventilatory response to hypoxia and hypercarbia. Dose dependent increase in respiratory rate, Relaxation of airway smooth muscles (bronchodilation)

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21
Q

Effects of volatile anesthetics on NMJ?

A

Direct relaxation of sk muscle; Potentiate the effects of NMJ blockers; Malignant hyperthermia

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22
Q

Methohexital class?

A

Barbiturate

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23
Q

Methohexital mxn?

A

GABAa binding, @ higher concentrations, direct antagonist at the GABAa receptor, inhibit excitatory NTs, antagonise NMDA; hypnosis, sedation, ANTI-analgesic

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24
Q

Methohexital for?

A

Induction of general anesthesia

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25
How is methohexital effect terminated? What is the onset timing?
Rapid onset, short duration of action, effects terminated via redistribution away from the brain, metabolized by the liver
26
How is methohexital dosed?
Based on lean body mass?
27
Methohexital physiologic effects on heart and lungs?
Dose dependent decrease in BP due to vasodilation; negative inotropic; Dose dependent respiratory depression
28
Propofol class?
Alkylphenyl (a fatty acid)
29
Propofol mxn?
GABAa receptor agonist; antagonist NMDA; some alpha2 activity; directly depresses spinal cord neurons via GABAa and glycine receptors
30
Most commonly used IV anasthetic today?
Propofol
31
Propofol for?
anti-emetic at low doses; induction and maintenance of general anesthesia; sedation in ICU; procedural sedation
32
Propofol side effects?
Propofol infusion syndrome: metabolic acidosis, rhabdomyolysis, renal failure, BP, bradycardia, death (esp if given >48 hours at high-dose infusion along wtih catecholamine & glucocorticoid use); Pain at injection site; Supports bacterial growth; Allergies to egg and soy; NO malignant hyperthermia
33
Onset of propofol? How is it metabolized?
Rapid onset and offset; Met in liver and lung and mets excreted in kidney
34
Etomidate class?
Carboxylated imidazole
35
Etomidate mxn?
GABAa receptor agonist
36
Etomidate for?
Hypnosis -- NO analgesic activity
37
Etomidate side effects?
Pain on administration (due to its solvent, propylene glycol), involuntary myoclonic movements (not a seizure), PONV, inhibits cortisol synthesis
38
When is etomidate specifically useful & why?
MINIMAL cardiorespiratory depression, so this is really good in patients with minimal cardiac reserve
39
Onset and offset of etomidate?
Rapid onset and offset
40
Ketamine class?
Phencyclidine?
41
Ketamine mxn?
NMDA rec antagonist, possibly an opiate agonist in the brain and SC
42
Ketamine for?
Dose-dependent unconsciousness, amnesia, analgesia: For pediatric, dev delayed patients, induction in patients with reactive airway disease, hypovolemia, cardiac disease; with propofol for IV procedural sedation; adjuvant during and after surgery to reduce opiod use; pain therapy; depression
43
Ketamine side effects? Contraindications?
sympathetic stimulation, including incr. SVR, PVR, HR, cardiac work, and cardiac O2 compensation; increase cerebral flow & ICP; emergence delirium; uncoordinated movements; nystagmus; lacrimation; salivation; dissociative anesthesia; Contraindicated in CAD (but can be used in those with cardiomyopathy, tamponade, restr. pericarditis, congenital heart disease), intracranial lesions
44
Ketamine is metabolized by?
P450 -- met is norketamine (1/3 - 1/5 as effective)
45
Ketamine can be administered?
IV, IM, orally, intranasally, rectally
46
Ketamine is an excellent ____ and can be used in those with ____.
Bronchodilator, Reactive airway disease.
47
Dexmedetomidine class?
Alpha 2 agonist
48
Dexmedetomidine mxn?
Bind a2a/b in LC and SC -- sedation, sympatholysis, analgesia
49
Dexmedetomidine for?
Awake intubations, craniotomies; Adjunct to general anesthesia in pts susceptible to narcotic-induced post-op respiratory depression; w/drawal/detox
50
Dexmedetomidine side effects?
Limitied resp depression -- wide safety margin
51
What is unique about dexmedetomidine? What is it's only approved use?
GABA is not hit -- sedation is easier to wake from and more similar to non REM sleep. Approved for ventilation of ICU pts < 24 hrs.
52
Succinylcholine class?
Depolarizing NMB
53
Succinylcholine mxn?
Attach to all AChR and overstimulate then to paralysis (fasciculations --> paralysis)
54
Succinylcholine for?
Sk musc relaxant (intubation)
55
Succinylcholine side effects?
Malignant hyperthermia; Cardiac dysrhythmias, hyperkalemia, increased intraocular and Intracranial presure, masseter spasm, increased intragastric pressure, myalgias
56
What is the timing of succinylcholine? How is it terminated?
Rapid onset and ULTRA-shor duration of action 9-12 min); Blockade cannot be reversed -- diffuses away and hydrolyzed by pseudocholinesterase in plasma
57
Pancuronium class?
Amino steroid non-depolarizing NMB
58
Pancuronium mxn?
Competitive block of ACh, vagolytic
59
Pancuroinium for?
Sk muscle relaxant
60
Avoid pancuronium in?
Renal insuffic (80% excreted unchanged -- low mets in liver)
61
Pancuronium side effects?
Increase HR
62
Pancuronium timing?
Onset (3-5 min), Only long acting non-dep NMB (60-90 min)
63
Vecuronium class?
Amino steroid non-dep NMB
64
Vecuronium mxn? Timing?
Comp block of ACh; onset 3-5 min, duration 20-35 min
65
Vecuronium for?
Sk musc relaxant
66
Vecuronium side effects?
No heart effects
67
Rocuronium class?
Amino steroid non-dep NMB
68
Rocuronium mxn? Timing?
Com block of ACh; onset 1-2 min, duration 20-35 min
69
Rocuronium for?
Sk muscle relaxant (can substitute succinylcholine in rapid sequence intubation)
70
Rocuronium sid effects?
No heart effects
71
Sugammedex class?
Selective relaxant binding agent?
72
Sugammedex mxn?
Complexes with rocuronium, rendering it inactive, no effect on Achesterase (hence no need for anti-muscarinic administration) -- Allows for a faster and more complete recovery of rocuronium-induced blockade
73
Sugammedex for?
imm reversal of rocuronium
74
Sugammedex side effects?
not yet FDA approved -- N/V, dry mouth, decrease in BP
75
Cis-atracurium class?
isoquinoline non-dep NMP
76
cis-atracurium for?
Sk muscle relaxant -- used in pts with liver or renal dysfunction
77
cis-atracurium side effects?
no hist release or downstream effects
78
atracurium class?
isoquinoline non-dep NMB
79
atracurium mxn?
comp block of Ach (no depolarization)
80
cis-atracurium mxn?
comp block of Ach (no depolarization)
81
atracurium side effects?
Hist release (esp if rapid IV bolus), hypotension, tachycardia
82
ACHEIs? Which is most commonly used? Which is shortest acting/fastest onset? Which is longest duration?
Edrophonium, Neostigmine, Pyridostigmine. Edro is shortest acting/fastest onset. Neo is most common. Pyrido is longest duration.
83
Glycopyrrolate class?
Anti-muscarinic
84
Glycopyrrolate for?
Reverse muscarinic effects that may occur with addition of an ACHEI to alleviate muscle relaxation (only want nicotinic synapses to recover!)
85
Elimination of isoquinoline agents? Why is this important?
Hoffman elimination (non-enzymmatic degradation) -- Useful in pts with liver or renal dysfunction

Pharmacology (46 decks)

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