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Phar300 > lect 16 drugs and surgery > Flashcards

lect 16 drugs and surgery Flashcards

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1
Q

first used anesthetic

A

diethyl ether

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2
Q

non flammable anesthetic later developped

A

halothane

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3
Q

in addition to general anesthetic other drugs used to suppress what

A

ANS, endocrine reflexes, somatic reflexes

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4
Q

mixture of other drugs to anesthetic increase both what

A

effectiveness of anesthesia and safety of anesthesia

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5
Q

how to suppress pain reflexes in surgery

A

anelgesics or muscle relaxants

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6
Q

drugs that reverse muscle relaxation so no paralyzation

A

reversal agents

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7
Q

inhalational aanesthtics examples (5)

A

diethyl ester prototype. halothane, isoflurane, nitrous oxide, sevoflurane

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8
Q

anesthesia used for short procedures

A

intravenous anesthetics

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9
Q

types of intravenous anesthetics

A

benzo, barbiturates, opoids. propofol

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10
Q

most commonly used IV anesthetic worldwide to induce anesthesia

A

propofol

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11
Q

rate of drug delivery is determined by what

A

partial pressure of anesthetic in gas

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12
Q

partial pressure of gas is proportional to what

A

its concentration

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13
Q

induction of drug gas pathway

A

alveoli–>blood vessels–>main arterial blood–>brain due to high flow

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14
Q

metabolism of inhalation anesthetic

A

not much so most is unchanged and breathed out

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15
Q

if anesthetic soluble in blood than what happens to brain

A

not much availability going into brain and takes longer to leave the blood

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16
Q

effective anesthetic that get quick to brain and less amount than halothane

A

nitrous oxide (lipid soluble)

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17
Q

does blood flow affect rate of anesthetic uptake in different locations

A

yes greater blood flow in brain even if its a very small proportion to the total of the body

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18
Q

two factors increasing affecting rate of induction

A

increased concentration of anesthetic and increased alveolar ventilation

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19
Q

two factors decreasing affecting rate of induction

A

increased solubility

increased cardiac output

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20
Q

elimination of inhalation anesthetic

A

via exhalation

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21
Q

minimal alveolor concentration meaning

A

amount of drug that produces anesthesia in 50% of patients

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22
Q

how to calculate total MAC

A

take each gas component in mixture since it is additive to get 1 MAC

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23
Q

anesthetic effect on respriration

A

depresse respiration, pCO2 high and minute ventilation decreases

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24
Q

anesthetic effect on cardiovascular

A

cardiovascular depression, blood pressure declines. cardiac output variable differentiates between drugs

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25
inhalation anesthetic that is less powerful at depressing blood pressure
sevoflurane
26
anesthetic that does not cause pCO2 buildup and CO not badly affected. most often the choice of drug
isoflurane
27
has huge MAC and used as adjuvant
nitrous oxide
28
why was halothane replaced
unwanted effects like nausia vomiting and sensitization of CV system
29
why is isoflurane widely used (3)
no cardiac sensitization, good muscle relaxant, no toxic metabolites
30
anesthetic barbiturate that cant be used because build up in tissue and has long half life
thiopental
31
rapid onset and short half life intravenous anesthetic
propofol
32
why is diazepam not good for anesthetic
slow induction and super long half life when administered for longer
33
midazolam produces amnesia so mix it with what to get what phenomenon?
mix with opioid to get conscious sedation
34
opioids as analgesics effect on respiration and brainstem
depressed respiration, lower ventilation. more or less nausia
35
opioids benefits for surgery
relief of pain and anxiety reduction
36
total intravenous anesthesia
propofol for induction + opioid such as remifentanil + drug for amnesia such as midazolam + short acting muscle relaxant
37
neurolept analgesia
fentanyl opioid + droperidol (antipsychotic) for minor surgery to relieve stress but not unconsciousness
38
neurolept anesthesia
add also nitrous oxide
39
ketamine
only intravenous anesthetic that stimulates cardiovascular system
40
side effects of ketamine
dissociative anesthesia or dysphoria (intense hallucinations, anxiety and memories of surgery) so not favorite drug
41
use of ketamine
burn patients, short term procedures for kids with cardiovascular concerns
42
drugs that can treat nausea
ondanseron, 5HT blockers
43
treat cough
dextromethorphan
44
treat bradycardia (CV depression)
stimulants
45
muscle relaxation treatment and reverse by what
anticholinergics muscarinic agonists
46
revrse msucle relaxation drug
muscarinic agonists
47
main site of action of anesthetics
synapses
48
presynaptic anesthetics and example
decrease transmitters release by blocking Ca channels. interfere with vescile docking/release (ex. isoflurane)
49
postsynaptic anesthetics
effects on ligand gated ion channels increasing inhibition (GABA) snd decreasing excitation (glutamatergic transmission NMDA, cholinergic receptors)
50
all anesthetics show power to increase inhibition by acting on gaba a receptors except
ketamine
51
ketamine mostly has effects on what and blocks what
effect on spinal cord and blocks NMDARs
52
neuromuscular blocking agents
blocks various reflexes and allow endotracheal intubation and ventilation so patient not fighting respirator. permit lower levels of aanesthetics
53
neuromuscular blocking agent permit lower levels of what
anesthetics
54
competitive nondepolarizing blocking agent
reversible and competitive, compete with acetylcholine for binding. can be short intermediate or long acting
55
metabolism of nondepolarizing agents
plasma cholinesterase inactiavtes some of them when diffused from synapse to plasma. broken down in liver, excreted in kidneys
56
depolarizing non competitive agents
short half life, rapid onset. binds to cholinergic receptor such that channel stays open for a long time. receptor becomes desensitized
57
depolarizing non competitive agent example
succinylcholine
58
both depolarizing and nondepolarizing neuromuscular agents dont cross BBB
TRUE
59
rare genetic defect that blocks inactivation succinylcholine
genetic defect in plamsa pseudocholinesterase
60
defect in plasma pseudocholinesterase use to inactivate succinylcholine does one
trouble breathing (apnea) increase as succinylcholine keeps getting administered
61
local anesthetics
smaller fibers like a delta and c fibers carrying pain so more sensitive to local anesthetics
62
local anesthetics target what channels
voltage gated sodium channels along the axon
63
local anesthetics effects on sodium
block sodium influx, blocking propagation of action potential
64
local anesthetics act better on which type of nerves and why
unmyelinated nerves because larger surface area of plasma membrane so easy access of anesthetic inside cell
65
local anesthetic is often injected with what in order to prolong their action aand why
adrenaline because it causes vasoconstriction, reduce in blood flow so longer for anesthetic to reach systemic circulation. (altered pharmacokinetics)
66
example of local anesthetic
lidocaine
67
local anesthetics are weak acids or bases
weak bases
68
what happens to local anesthetics if tissues ph lowered.
decrease in amount of lipid soluble drug that can enter neuron-->decrease effect of local anesthetic
69
two categories of local anesthetics
ester (procaine) and amides (lidocaine)
70
standard structure of local anesthetic
ring, linker region and amine group
71
local anesthetics with ester links are metabolized by what
metabolized by plasma cholinesterase and shorter half lives
72
local anesthetic duration with ester links in spinal fluid
longer duration because spinal fluid is low in esterase
73
metabolism of local anesthetic amides
metabolized in liver and longer half life so more potency
74
side effects of local anesthetic
large amounts can cause respiratory and cv arrest because interfering with neuronal activity. loss of sensation of cold, heat, pain, touch, deep pressure
75
EMILA cream and used for what
mixture of local anesthetics in cream form to increase absorption across skin as it changes solubility used to relieve pain associated with vaccinations so that kids dont feel anything

Phar300 (18 decks)

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