general anesthetics

Question 1

anesthetic state

Answer 1

analgesia
amnesia
hypnosis
immobility
reduction of autonomic reflexes

Question 2

clinical phases

Answer 2

induction
maintenance
recovery

Question 3

depth of anesthesia

Answer 3

partial pressure
minimal alveolar concentration
blood/gas partition coefficient
oil/gas partition coefficient

Question 4

meyerton-Overton correlation

Answer 4

potency = lipid solubility

higher oil:gas = more potent

Question 5

minimal alveolar concentration (MAC)

Answer 5

prevents movement in 50% pts in response to noxious stimulus

inversely related to lipid solubility

age dependent

Question 6

blood/gas partition coefficient

Answer 6

rate of induction/recovery
solubility

lower = faster

Question 7

arteriovenous concentration gradients

Answer 7

highly perfused tissue (vessel rich group) limits GA capacity

Question 8

inspired anesthetic concentration

Answer 8

increase = faster induction

Question 9

pulmonary ventilation

Answer 9

increase = faster induction

Question 10

pulmonary/cerebral bloodflow

Answer 10

low CO = faster induction

Question 11

General anesthetic MOA

Answer 11

enhance inhibitory post-synaptic channel activity (GABA-A, glycine)
inhibit excitatory synaptic channel activity (ACh, glutamate)

Question 12

nitrous oxide

Answer 12

non-halogenated

balanced anesthesia

weak anesthetic
good analgesic

Question 13

nitrous oxide MOA

Answer 13

non-competitive NMDA antagonist

Question 14

nitrous oxide SE

Answer 14

diffusional hypoxia
neuropathies
megaloblastic anemia (oxidize cobalt in VitB12)

Question 15

halogenated “flurane”

Answer 15

reduce BP
depress ventilation

SE: pungent odor
increase cerebral bloodflow
malignant hyperthermia (tx: dantrolene IV)

Question 16

isoFLURANE

Answer 16

blood:gas 1.4
moderate onset/recovery

give w/O2 and N2O

use: neurosurgery

maintain CO
doesn’t sensitize heart to catecholamines

SE: bronchodilator

Question 17

desFLURANE

Answer 17

blood:gas .42
rapid induction/recovery

relax smooth muscle

use: outpatient surgery

SE: pungent odor, perioperative hyperkalemia, postoperative arrhythmias

Question 18

sevoFLURANE

Answer 18

blood:gas .69
rapid induction/recovery

relax smooth muscle

use: in/outpatient surgery

pleasant odor

SE: reacts with soda lime, nephrotoxic (compound A), epileptogenic

Question 19

IV

Answer 19

balanced anesthesia
rapid onset
short halflife
recovery due to redistribution
less CV depression

Question 20

methohexital

Answer 20

short-acting barbiturate

MOA: binds GABA-A receptor

use: outpatient surgery

SE: hyperalgesia, tachycardia, sweating

Question 21

ketamine

Answer 21

dissociative anesthetic

MOA: block glutamate receptors

use: diagnostic, minor surgery

SE: increase ICP, increase catecholamine release

contraindication: CV disorders

Question 22

etomidate

Answer 22

rapid onset
short duration

MOA: bind GABA-A

use: surgery if CV disease

SE: post-op nausea/vomiting, suppression of adrenal steroid synthesis

Question 23

propofol

Answer 23

rapid recovery

MOA: bind GABA-A

use: induction/maintenance

anti-emetic

SE: supports bacterial growth

Question 24

fospropofol

Answer 24

prodrug

Question 25

benzodiazepines

Answer 25

relieve anxiety, facilitate sedation MOA: bind GABA-A

Question 26

opioids

Answer 26

analgesia, decrease MAC MOA: bind opiate receptors SE: respiratory depression

Question 27

antihistamines

Answer 27

prevent allergies MOA: block H1 and H2 receptors

Question 28

anti-emetics

Answer 28

prevent nausea/vomiting MOA: block D2, 5HT3 receptors

Question 29

skeletal muscle relaxants

Answer 29

facilitate intubation prevent muscle contractions MOA: bind nicotinic receptors at NMJ, competitive antagonist of nicotinic receptors SE: malignant hyperthermia, hyperkalemia, bradycardia, histamine relase, tachycardia