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N934: Advanced Principles of Anesthesia > Neuro Pharmacology > Flashcards

Neuro Pharmacology Flashcards

(80 cards)

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1
Q

Describe the affects of inhaled anesthetics on CMRO2, CBF and ICP

A

decrease CMRO2
increase CBF and increase ICP

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2
Q

What VA does not follow typically affects on CMRO, CBF and ICP?

A

nitrous oxide

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3
Q

Describe the affects of IV anesthetics on CMRO2, CBF and ICP

A

Decrease CMRO2
Decrease CBF
Decrease ICP

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4
Q

Describe the affects of local anesthetics on CMRO2, CBF and ICP

A

decrease CMRO2
Decrease in CBF
Decrease in ICP

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5
Q

Describe the affects of ketamine on CMRO2, CBF and ICP

A

+/- CMRO2
increase CBF
increase ICP

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6
Q

Describe the affects of opioids on CMRO2, CBF and ICP

A

+/- CMRO2
+/- CBF
+/- ICP

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7
Q

The effects of vasoactive drugs on cerebral physiology are dependent on

A

basal BP (+/- 20% of patients baseline)
Magnitude of drug induced change in BP
status of autoregulation
status of the BBB

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8
Q

How much more soluble is nitrous oxide more soluble in the blood then nitrogen?

A

34x

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9
Q

What are the physiological affects of nitrous oxide?

A

increase in CBF
Increase in CBV
Increase in ICP
(more dramatic if sole agent)
Unsure of CMRO2 affects

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10
Q

What are the affects of N2O influenced by?

A

other agents and changes in CO2 tension

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11
Q

How much does an ICP increase with an intracranial tumor with 66% N20?

A

increased from an avg ICP of 13mmHg to 40mmHg

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12
Q

Alpha 1 agonist affect on CBF and CMRO

A

no effect
possible decrease in CBF

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13
Q

Alpha 2 agonist affect on CMF and CMRO

A

decreased CBF and CMRO

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14
Q

Beta agonist affect on CMF and CMRO

A

increase CBF and CMRO

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15
Q

Beta agonist (with BBB open) affect on CMF and CMRO

A

BIG increase in CBF and CMRO

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16
Q

Dopamine affect on CMF and CMRO

A

Increase in CBF
no effect on CMRO

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17
Q

High doses of dopamine affect on CMF and CMRO

A

decrease in CBF
no affect on CMRO?

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18
Q

Fenoldopam affect on CMF and CMRO

A

decrease in CBF
no effect on CMRO

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19
Q

Norepinephrine affect on CMF and CMRO

A

decrease no affect on CBF
increase, no affect on CMRO

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20
Q

Norepinephrine (open BBB) affect on CMF and CMRO

A

increase CMRO and CBF

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21
Q

Epinephrine affect on CMF and CMRO

A

increase in CBF an CMRO

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22
Q

Epinephrine (open BBB) affect on CMF and CMRO

A

increase in CBF and CMRO

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23
Q

Describe the affect of a bolus of an alpha 1 agonist

A

may transiently (2-5minutes) change CBF & cerebral SaO2

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24
Q

Describe the affect of a continuous gtt of an alpha 1 agonist

A

little effect CBF & cerebral SaO2

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25
Describe the overall affect of alpha 1 agonist on the brain
maintenance of CPP with these vasopressors does not have an adverse affe
26
Alpha2 agonist cause
decrease in CBF (25-30%) results from reduced CMRO2 leading to reduced CBF
27
Where are alpha 2 agonists found and what do they modulate?
found in brain and periphery modulate sympathetic outflow
28
Where are alpha 1 receptors found?
post-synaptic alpha receptors on vascular smooth muscle determine arteriolar resistance and venous capacitance (BP)
29
Alpha 1 agonist
phenylepherine norepinephrine
30
Alpha 2 agonist
clonidine precedex
31
Beta agonist examples
epinephrine
32
what do small doses of beta agonist cause?
little effect on CBF
33
What do large doses of beta agonists and physical stress cause?
increase in CMRO2 and CBF
34
What happens to MAP with epinephrine 0.05mcg/kg/min? [larger doeses]
increase in MAP may increase CMRO2 and CBF up to 20% Beta 1 receptor mediated effects response exaggerated with BBB defect
35
Beta blockers affect on CBF and CMRO2
little to no effect
36
Ace inhibitors and ARBS affect on CBF and CMRO2
little to no effect on CBF and CMRO2 autoregulation is maintained
37
What drugs are preferred for control of emergence hypertension after intracranial procedures?
labetalol and esmolol
38
Describe the use of barbiturates in neuro-anesthesia
dependent reduction in CBF and CMR until isoelectric EEG (maximum reduction in CBF adn CMR of nearly 50%[flat EEG])
39
What are barbiturates highly effective at?
lowering ICP
40
Describe the robin hood effect seen with barbiturates?
Reverse steal phenomenon CBF distributed from normal to ischemic areas in the brain
41
What is decreased more then CBF in barbiturate administration?
CMR decreases more than CBF metabolic supply exceeds metabolic demand
42
What are barbiturates also helpful for?
anticonvulsants
43
Benzodiazepines cause
a dose-dependent reduction in CMR and CBF
44
Benzodiazepines cause a greater reduction in CMR and CBF then what other class of drugs?
narcotics
45
Compared to barbiturates, propofol or etomidate, benzos have
less reduction
46
What is the reduction of CBF with benzodiazepines?
moderate reduction 12-34% with 0.15mg/kg
47
What is the benzo of choice and why?
midazolam b/c of its short neuro half life
48
What can benzodiazepines prolong?
emergence consider need for post-operative neuro exam
49
What do benzodiazepines depress?
RAS reticular activating system
50
Propofol causes a dose-dependent reduction in
CBF and CMR
51
What are two positive properties of propofol?
anticonvulsant short elimination 1/2 life
52
What is the most common induction agent for neuroanesthesia?
propofol
53
What are characteristics of etomidate?
decreases CMR, CBF and ICP
54
What are side effects of etomidate?
myoclonus on induction not associated with seizure activity on the EEG
55
What can small doses of etomidate activate?
seizure foci in patients with epilepsy
56
What is the only IV anesthetic that dilates cerebral vasculature and increases CBF?
ketamine increases (50-60%)
57
What drug does not increase ICP in neurologically impaired patients under controlled ventilation with concomitant administeration of propofol or a benzo?
ketamine
58
Why has ketamine been limited in neuroanesthesia in the past?
dissociative mechanism and stormy emergence
59
What are advantages to ketamine use?
stable hemodynamics in trauma (head injury, hypovolemia, multisystem trauma)
60
What does property does ketamine not effect?
CMR, but may vary regionally
61
What affect does ketamine have on a BIS?
does not lower may increase BIS
62
Why is there re-newed interest in ketamine?
may be neuroprotective as NMDA antagonist
63
How do NMDA antagonist help protect the brain?
may be protective against neuronal cell death
64
How does an NMDA antagonist work?
functionally dissociates the thalamus from limbic cortex
65
what is the role of the thalamus?
relays sensory impulses from the reticular activating system to the cerebral cortex
66
what is the limbic cortex?
involved with the awareness of sensation
67
Describe the effect of opioids on neuro-physiology
minimal affects of CBF, CMR, ICP (unless increase in PaCO2)
68
What opioid is traditionally avoided?
morphine d/t poor lipid solubility, slow onset and long duration of sedative effect
69
What do most anesthetics do to CNS?
decrease electrical activity
70
What complicates the effects of anesthetics?
other drugs, surgical stimulation, intracranial compliance, BP and PaCO2
71
IN general, anesthetic drugs
suppress CMR with the exception of ketamine and nitrous oxide
72
What does energy substrates depend on to get to the brain?
cerebral blood flow
73
what an influence the outcome in the setting of ischemia?
alternates in CBF
74
What can be controlled and is central to management of ICP?
CBF
75
What is usually parallel to the CBF?
Cerebral blood volume
76
Cerebral blood volume is a critical variable for
ICP
77
What is CBV?
~ 5ml/100g of brain (70ml)
78
When does CBF not parallel CBV?
cerebral ischemia Normal BP
79
What happens to CBF and CBV during cerebral ischemia?
CBV increases but CBF decreases
80
MAP=
CBF but cerebral vasoconstriction limits in CBV

N934: Advanced Principles of Anesthesia (16 decks)

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