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Flashcards in PHARM - anesthetics Deck (34):
1

five major effects of general anesthesia

1) unconsciousness
2) amnesia
3) analgesia
4) inhibition of autonomic reflexes
5) skeletal muscle relaxation

2

describe the anesthesia induction process

- IV anesthetic until unconscious
- management with inhaled or IV
- muscle relaxant if intubation required
- anti-anxiety at the beginning if needed

3

describe maintenance of anesthesia

- inhaled or IV drugs
- monitoring of vitals
- use of opioid for pain, such as fentanyl

4

example of a reversal agent for muscle relaxants

neostygmine

5

how does general anesthesia work?

reduce excitatory stimulation
- ACh (nicotinic/muscarinic)
- excitatory amino acids (NMDA, Kainate, AMPA)
- serotonin (5-HT)
increase inhibitory stimulation
- GABA, glycine
- potassium channels

6

list these inhaled anesthetics in terms of solubility and discuss onset and recovery: nitrous oxide, halothane, isoflurane, sevoflurane

least soluble - nitrous oxide - rapid, rapid (incomplete)
low solubility - sevoflurane - rapid, rapid
mid range solubility - isoflurane - middle, middle
most soluble - halothane - middle, middle

7

relate opioids to inhaled anesthetics

can depress respiration and make induction take longer

8

what is anesthetic potency?

minimal alveolar concentration needed to prevent response to a surgical incision in 50% of cases

9

alveolar concentration formula that should work for 95% of patients

1.3xMAC

10

4 stages of anesthesia depth

1) analgesia - awake to drowsy
2) excitement - delirium, proposal can eliminate this
3) surgical anesthesia - muscles relaxed, breathing regular, no more spontaneous movement, careful monitoring
4) death

11

physiological effects of anesthesia on brain

- decrease metabolic activity
- decrease blood flow
- vasodilation

12

physiological effects on cardiovascular system of anesthesia

- contractility down
- MAP down
-

13

resp effects of anesthesia

- decrease tidal volume
- increase RR

14

why does propofol go strait to the CNS quickly?

lipid solubility

15

how is propofol administered?

IV

16

local anesthetics can be divided into two categories...

esters
amides

17

what are the local esters and how are they used?

- benzocaine, cocaine - surface action
- procaine - short acting
- tetracaine - long acting

18

what are the local amides and how are they used?

- lidocaine - medium acting
- bupivicaine - long acting

19

contrast metabolism and half life of amides and esters

esters - minutes, broken down by pseudocholinesterases
amides - 1.5-3.5 hours, broken down by P450 enzymes

20

how do local anesthetics work?

block voltage gated sodium channels preventing action potentials

21

characteristics of nerves better suited for local anesthetics

- narrower
- heavily myelinated
- peripheral
- rapidly firing

22

which inhaled anesthetic can lead to megoblastic anemia?

NO2

23

isoflurane - type, PD, PK

- inhaled general
- PD - unknown, lipid soluble, potentiates GABA, opens K+
- PK - lungs 95%

24

sevoflurane - type, PD, PK

- inhaled general
- PD - unknown, GABA and K+
- PK - lungs primarily, 5% liver

25

NO2 - type, PD, PK

- inhaled
- PD - close NMDA, open K+
- PK - 100% lungs

26

ketamine - type, PD, PK

- IV, IM general anesthetic
- PD - close NMDA, potentiates NO2
- PK - liver, kidney

27

propofol - type, PD, PK

- short acting IV for induction
- PD - GABA
- PK - minutes, liver

28

midozolam - type, PD, PK

- adjunct, sedative
- PD - enhances GABA
- PK - 15-20mins, liver

29

ketamine caution

can cause emergence reactions with psychologic manifestations

30

propofol caution

- aseptic technique required, susceptible to contamination

31

midolozam caution

- respiratory arrest
- use only in hospital/ambulatory setting

32

etomidate type, PD, PK

- general anesthetic and adjunct
- hypnotic
- not analgesic
- PD - GABA
- PK - liver, half life 75 minutes

33

remefentanil

- opioid
- very short acting
- analgesia/sedation

34

bupivicaine

- long acting local