Pharm 11 Anesthetics Flashcards Preview

Test 7 > Pharm 11 Anesthetics > Flashcards

Flashcards in Pharm 11 Anesthetics Deck (46):
1

General Anesthetic definition

Loss of awareness, memory, and perception, not actual loss of sensation

2

Stage 1 of anesthesia

Analgesia

3

Stage 2

Excitement
Irregular respiration
Vomiting

4

Stage 3

Surgical
Regular respiration
Reflexes (eyelash) are abolished

5

Stage 4

Medullary depression
Need full circulatory and respiratory support

6

Speed of induction correlations:
1. Gas concentration
2. Pulmonary ventilation
3. Blood solubility
4. Pulmonary circulation
5. A-V concentration gradient

1. Direct
2. Direct
3. Inverse
4. Inverse
5. Inverse

7

Blood:gas partition coefficient

High solubility = high coefficient = slow induction

8

Redistribution

Gas solubility in other body tissues, important for determining elimination from the brain

9

Minimum Alveolar Concentration

Low MAC = High Potency
-Concentration that produces absence of response in 50% of patients

10

Elderly MAC

Lower than normal

11

Halothane effect on heart

Sensitization to catecholamines -> arrhythmias

12

Halothane effect on liver

Occasional severe hepatitis

13

Drug causing nephrotoxic effect

Methoxyflurane (due to inorganic fluoride release)

14

Effect on pregnancy

Increase in abortions, no mutations

15

-Thiopental-
Speed
Elimination

30s onset, 10m duration
Redistribution

16

-Thiopental-
Action
SE

Sedative (barbiturate), poor analgesia

Decrease HR (Hypotension)
Decrease Resp

17

-Benzodiazepines-
Speed

Slower than Thiopental

18

-Benzodiazepines-
Action
SE

Sedative, no analgesia
Anterograde amnesia

Prolong recovery

19

-Narcotics-
Action
SE

Good analgesia, no anesthesia

Respiratory depression

20

-Ketamine-
Action
MOA
SE

Dissociative Anesthesia
NMDA antagonist

CV stimulation
Post-op illusions

21

-Propofol-
Action
Speed

Anestesia (most popular)
Anti-emetic
Fast

22

-Propofol-
SE

Respiratory depression

23

-Etomidate-
Action
SE

Rapid hypnotic
No analgesia

Nausea, Vomiting

24

-Promazine-

Adjunct
-Anti-emetic
-Sedation

25

-Promethazine-

Adjunct
-Anti-emetic
-Sedation

26

Local anesthetic basic action

Prevent pain by interruption nerve conduction

27

Local anesthetic specific action

Block voltage-gated sodium channels

28

Local anesthetic pH effects

Weak base
-Uncharged at body pH (for uptake)
-Cationic and higher pKa (for action)

29

Differential sensitivity

Attack fast firing channels (pain) first because Na channel needs to be open for action

30

Ester metabolism

Rapidly hydrolyzed in blood by pseudocholinesterase

31

Amide metabolism

Redistributed first, then hydrolyzed in liver by CYP450. Liver disease causes toxicity

32

Local anesthetic problem

Vasodilation leads to systemic absorption. Give with epinephrine

33

Lidocaine (amide) CNS effect

Drowsiness -> Activation -> Depression -> Respiratory failure

34

Local anesthetic CV problem

Decrease excitability -> antiarrhythmic

35

Epidural LA issues

Hypotension due to sympathetic blockade

36

Cocaine toxicity

Hypertensive vasoconstriction
Arrhythmias

37

LA hypersensitivity

Esters metabolized to PABA - some patients allergic

38

LA for burn patients

Benzocaine - hydrophobic, stays on wound

39

LA for arrhythmia

Lidocaine and Procainamide

40

-Cocaine-
E/A
Use
action
SE

Ester
Useful for vasoconstriction
Medium
Systemic toxicity

41

-Procaine-
E/A
Use
action
SE

Ester
Novicaine
Short
few

42

-Tetracaine-
E/A
Use
action
SE

Ester
Topical, spinal
Long
Toxic (lipophilic)

43

-Benzocaine-
E/A
Use
action
SE

Ester
Surface only (wounds)
surface only
surface only

44

-Lidocaine-
E/A
Use
action
SE

Amide
Patients with Ester Sensitivity, better than procaine
Medium
none

45

-Mepivacaine-
E/A
Use
action
SE

Amide
Obstetrics
Medium
neuro effects in baby

46

-Bupivacaine-
E/A
Use
action
SE

Amide
Post-op nerve blocks, obstetric epidural
Long
Toxic (lipophilic)
better for baby