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Pharmacology > Pharm 16- Anesthetic Agents I > Flashcards

Pharm 16- Anesthetic Agents I Flashcards

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1
Q

Anesthetic agent

A

any drug used to induce a loss of sensation without or without unconsciousness

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2
Q

Adjunct

A

a drug that is not a true anesthetic, but htat is used during anesthesia to produce other desired effects such as sedation, muscle relatxation analgesia reversal neuromuscular blockage or parasympathethic blocker

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3
Q

4 Classifications of Anesthetic Agents and Adjuncts

A

Route of administration
Time of administration
Principal effect
Chemistry

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4
Q

Route of administration classificiations

A

Inhalant
Injectable
Oral
Topical

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5
Q

time of administration classifications

A

preanesthetic
induction
maintenance

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6
Q

Principle effect classificaitons

A 
local vs. general
sedatives and tranquilizers vs analgesics
neuromuscule blockers
anticholinergic agents
reversal agents
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7
Q

Describe general anesthesia

A

Reversible

produced by administration of one or more anesthetic drugs

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8
Q

4 characteristics of general anesthesia

A

Unconsciousness
Immobility
Muscle relaxation
loss of sensation

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9
Q

Describe surgical anesthesia

A

A stage of general anesthesia
Analgesia and muscle relaxation
eliminate pain and patient movement during the proceudre

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10
Q

Sedation

A 
CNS depression
drowsiness
drug-induced
various levels
 slightly aware or unaware of surroundings
aroused by noxious stimulation
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11
Q

What are the uses for sedation

A

minor proceudres

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12
Q

Tranquilization

A

calmness
patient is reluctant to move
aware of surroundings but doesn’t care

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13
Q

hyponosis

A

drug-induced
sleeplike state
impairs patient’s ability to respond to stimuli
patient can be arroused with sufficient stimulation

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14
Q

Narcosis

A

drug-induced sleep
patient is not easily aroused
associated with narcotic drugs

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15
Q

Local anesthesia targets what?

A

Small, specific area of the body

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16
Q

Local anesthesia produces what effect?

A

Loss of sensation to a specific area

Drug is infiltrated into the desired area

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17
Q

Where is topical anesthesia applied?

A

Body surfaces or a wound

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18
Q

What does topical anesthesia produce?

A

Superficial loss of sensation

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19
Q

What does regional anesthesia produce

A

Loss of sensation to a limited area of the body

Ex. nerve blocks, epidural

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20
Q

Balanced Anesthesia

A

Multiple drugs in smaller quantities
Maximizes benefits
Minimizes adverse risks
Gives anesthetist greater control

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21
Q

Agonists

A

bind to and stimulate target tissue; most anesthetic agents and adjuncts

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22
Q

Antagonists

A

Bind to target tissue but don’t stimulate reversal agents

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23
Q

Partial Agonists and Agonist-Antagonists

A

Opioids
Partial agonists
Agonist-antagonists
used to block pure agonists

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24
Q

Analgesia

A

most general anesthetics are not analgesics
Must provide analgesic pre- and post operatively
no pain perception while anesthetizes

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25
Do true analgesics provide general anesthesia?
NO
26
Why shouldn't you mix drugs in a single syringe?
They may not be compatible
27
What should you look for when mixing two drugs?
A precipitate
28
Most anesthetic agents and adjuncts are soluble in what?
Water
29
What is an example of a drug that is not water soluble?
Diazepam (Valium)
30
Opioids are derivatives of what?
Opium
31
Opioids produce what?
Analgesia and sedation; result of action on receptors in the brain and spinal cord
32
What can be used for anesthesia induction when combined with other drugs?
Opioids
33
How are opioids classified?
Agonists, partial agonists, agonist-antagonists, or antagonists
34
Common Opioid Agonists
``` Morphine (Contin) Oxymorphone (Oxycontin) Hydromorphone (Dilaudid) Fentanyl (Actiq, Duragesic) Meperidine (Demerol) Remifentanil (Ultiva) Hydrocodone (Vicodin) ```
35
Common Opioid Partial Agonist
Buprenorphine (Buprenex)
36
Common Opioid Agonist-Antagonists
Butorphanol (Stadol) Nalbuphine (Nubain) Pentazocine (Talwin)
37
Common Opioid Antagonists
Naloxone (Narcan) Naltrexone (Depade, Revia) Methynaltrexone (Relistor)
38
Which opioids are not controlled substances?
Antagonists and Nalbuphine
39
How are opioids administered?
IV, IM, SC, Oral, Rectal, Intranasal inhalant, transdermal, subarachnoid, and epidural
40
Describe the margin to safety for opioids
Wide; reversal agents
41
What are class C1 drugs used for?
Just for research
42
How do opioids work?
Mimic endogenous opioid peptides -B-Endorphins, dynorphins, enkephalins "Runner's High" Prevent nerves from transmitting impulses; prevent presynaptic release of neurotransmitters, particularly excitatory afferent neurotransmitter; decrease perception of pain
43
Agonists MOA
Bind to and stimulate mu and kappa receptors | Best for moderate to severe pain
44
Partial Agonists MOA
For moderate pain- they have lower efficacy
45
Agonist-Antagonists
Typically bind to delta, mu, and kappa receptors but typically stimulate only kappa receptors (reversal agent/mild pain)
46
Antagonists MOA
Bind to but don't stimulate delta, mu and kappa receptors (reversal agents)
47
What are the best things we have for severe pain?
Pure opioid agonists; used as a premedication for painful surgery
48
Effects of Opioids: CV Effects
Bradycardia, except meperidine which has antimuscarinic effects that can produce tachycardia
49
Effects of Opioids: Respiratory Effects
Decreased rate and tidal volume (dose-related)
50
Effects of Opioids: Cough Suppression
codeine (usually), morphine
51
Effects of Opioids: Miosis
Small pupil size
52
Effects of Opioids: GI
Salivation, vomiting by stimulation of the chemoreceptor trigger zone (CTZ) Initial diarrhea, vomiting, flatulence GI stasis follows initial GI stimulation
53
Effects of Opioid: Urinary Retention
Deaden ability to respond to a full bladder
54
Effects of Opioid: Histamine Release
Allergic rxns very common with morphine use | Avoid in asthmatics
55
Effects of Opioids: Intraoccular pressure and intracranial pressure
(in red)
56
What are opioids used for?
Cough Suppressants (codeine, dextromethorphan) Preanesthetic Analgesia Acute pulmonary Edema (CHF)- vasodilation, reduce anxiety and "drowning"
57
Opioids as a preanesthetic
Agonists, partial agonists, agonist-antagonist May be used along or in combination with: Tranquilizers Anticholinergics
58
Opioids as analgesia
prevent and tx postop pain | used with tranquilizer to produce neuroleptanalgesia
59
Neuroleptanalgesia
a state of quiescence, altered awareness, and analgesia produced by a combination of an opioid analgesic and a neuroleptic. "Tranquil dreaming"
60
What two types of drugs are used to create a neuroleptanalgesia?
Opioids | Tranquilizers
61
Opioids
Morphine Buprenorphine Butorphanol Hydromorphone
62
Tranquilizers
Diazepam Midazolam Thorazine
63
Opioid Antagonists
Reversible undesirable effects (CNS/Respiratory depression) Wake up the patient following sedation Emergensices/overdoses
64
What are two examples of opioid antagonists?
Naloxone (Narcan) Hydrochloride | Naltrexone
65
Naloxone (Narcan) hydrochloride
IM- 5 minutes to reversal or slow IV administration- 2 min to reversal Duration of action 30-60 minutes
66
Naltrexone
Like naloxone but longer-acting and has the potential for liver toxicity
67
Tramadol (Ultram)
Like an opiate but not one Usually give P.O. Like opioids it is a weak centrally acting u receptor agonist providing moderately strong analgeisa
68
How does Tramadol (Ultram) work?
Blocks serotonin release and reuptake of norepinephrine
69
What is Tramadol (Ultram) prescribed for?
Rheumatoid arthritis | Fibromyalgia
70
Tramadol (Ultram) Side Effects
Similar to opioids but geerally milder (Except serotonin syndrome which can be fatal) - Agitation - Muscular tremors - Sweating - Hyperthermia - Seizures
71
What type of problems are seen with tramadol (Ultram)
dependence and withdrawal problems with long-term use similar to opioids
72
How can tramadol (ultram) be partially reversed?
Opioid antagonists
73
Injectable Anesthetics
Can produce unconsciousness Don't provide analgesia or muscle relaxation Used with other agents Administered "to effect" IV
74
Name 3 injectable anesthetics
1. Barbiturates 2. Propofol 3. Etomidate
75
Subclasses of barbiturates are based on what?
Duration of action OR chemical structure
76
Types of Barbiturates
Ultrashort Short Intermediate Long-acting OR: Oxybarbiturates vs Thiobarbiturates
77
Ultrashort Barbiturates
Thiopental Sodium & Methohexital | Induce general anesthesia
78
Short Barbiturates
Pentobarbital Induce general anesthesia Tx epilepsy
79
Oxybarbiturates
Penobarbitol Pentobarbital Methohexital
80
Thiobarbiturates
Thiopental and thiamylal
81
Action of Barbiturates
Not fully understood Mimics inhibitory neurotransmitter GABA Causes CNS depression and loss of consciousness Termination effect: agent leaves brain; is metabolized, excreted, or redistributed
82
A "Normal" dose of barbiturates could produce what
Prolonged unconsciousness or death in hypoproteinemia
83
Protein Binding- Barbiturates
Free (unbound) drug enters the brain Hypoproteinemia results in more free drug Increased drug amounts to brain
84
Thiopental
Ultra short-acting Redistributed to muscle and fat slowly released Continuous or repeated dosing may lead to full muscle nad fat and prolonged recovery, amking it "seem" like a longer-acting drug (first order >> zero order kinetics)
85
Methohexital
Ultra short acting Redistributed to muscle nad fat but released faster Muscle and fat don't get "full" saturate so there is no prolonged recovery with continuous or repeated doses (zero order kinetics avoided)
86
Phenobarbital
Long acting Sustained effect caused by slow uptake and rleease from the brain, therefore good for seizure disorders. Release is dependent on kidney excretion which is slowest
87
Pentobarbital
Short acting Brain levels decresae based on liver metabolism Faster than kidney excretion
88
What is the #1 drug for anesthetic induction in most of hte owrld?
Propofol (PropoFlo, Diprivan)
89
How is propofol's action terminated?
Both metabolized by liver and excreted by the kidneys, the primary way Propofol's action is terminiated is by redistribution

Pharmacology (23 decks)

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