Pharm Anesthetics, Kinder II Flashcards Preview

Year 2 neuro exam 2 > Pharm Anesthetics, Kinder II > Flashcards

Flashcards in Pharm Anesthetics, Kinder II Deck (53):
1

what barbituates are used for IV anesthetic

thiopental and methohexital

2

MOA thiopental and methohexital

GABAa R increase channel opening duration
inhibit excitatory too

3

which barbituate has shorter elimination

methohexital

4

CNS effects thiopental and methohexital

dose dependent CNS depression
no analgesia

5

which barbituate anesthetic cannot be used for anticonvulsant

methohexital

6

respiratory effects thiopental and methohexital

depressors
transient apnea

7

use of thiopental and methohexital

induction anesthesia
propofol used more

8

what benzos are used perioperatively

midazolam
lorazepam
diazepam

9

MOA benzos

GABAa increase sensitibity to GABA and enhance inhibitory NT

10

benzos can be terminated by administration of what

flumazenil

11

what benzo is suitable for coninuous infusion

midolazam

12

CNS effects benzos

anticonvulsants- status epilepticus, alcohol withdrawal, local anesthetic induced seizure

13

resp effects benzos

severe resp depression if given with opioid

14

therapeutic use benzos

produce anxiolysis and anterograde amnesia

15

MOA etomidate

GABA like effects thorugh GABAa and Cl channels

16

metabolism etomidate

urine excretion and bile

17

CNS effects etomidate

cerebral vasoconstrictor
dec blood flow and ICP

18

CV effects etomidate

minimal hemodynamic effects! good for those with compromised cardiac contractility prior to anesthesia

19

endo effects etomidate

adrenocortical suppression
inhibits 11bhydroxylase for cholesterol -->cortisol

20

use of etomidate

alternative to propofol or barbituates for those with conmprmised cardiac contractility

21

MOA ketamine

inhibition of NMDA R

22

CNS ketamine

cerebral dilator and inc blood flow
can have emergence reactions :vivid color dreams hallucinations etc
"dissociative anesthesia" eyes open with slow nystagmic gaze

23

CV ketamine

can increase BP HR and CO
direct myocardial depressant( mainly critically ill patients)

24

therapeutic use ketamine

profound analgesia, SAN stimulation
bronchodilation
minimal respiratory depression

25

side effect ketamine

lacrimation and salivation increased
so give anticholindergic before administration

26

MOA dexmedetomidine

selective a2 agonist

27

CNS dexmedetomidine

hypnosis from activation a2 in locus ceruleus
analgesia at level spinal cord

28

CV effects dexmedetomidine

mod dec HR and systemic vascular R
bradycardia

29

therapeutic use of dexmedetomidine

short term sedation of intubated and ventilated patients in ICU setting

30

which IV anesthesia does not affect respirattion

dexemedetomidine

31

local anesthesia

loss of sensation in limited region of body

32

role of systemic circulation in local anesthesia

diminish or terminate its effect

33

structure most local anesthetics

lipophilic ring and ionizable group
aromatic ring and tertiary amine

34

what are the amide local anesthetics

bupivacaine
lidocaine
ropivacaine

35

what are the ester local anesthetics

benzocaine
cocaine
procaine
tetracaine

36

what are the long acting local anesthetics

bupivacaine
ropivacaine
tetracaine
(more lipophilic)

37

how are local anesthetics excreted

converted to water soluble by liver (amide) or plasma (ester) and excreted in urine

38

careful using amide type local anesthetics in what patients

those with hepatic disease since need hepatic metabolism

39

excretion uncharged local anesthetic

diffuse readily across lipid membrane so no excretion of neutral form occurs

40

how do local anesthetics work

block vNaCh

41

Potency local anesthetics

lipid solubility
so tetracaine, bupivacaine and ropivacaine are more potent

42

what are the intrinsic factors of susceptibility of nerve fibers

fiber diameter
firing frequency
anatomic arrangement

43

which nerve fibers are blocked first

smallest diameter
myelinated before unmyelinated

44

how does firing frequency affect nerve blocks

higher freq= more block
so sensory nn>motor nn

45

which pain fibers affected quickly by nerve block

A delta and C fibers because have high freq pain transmission

46

usual route of administration for local anesthetics

topical- nasal mucosa, wound, margins
injection

47

evolution of nerve block

sympathetic then temp then pain then light touch then motor

48

how do we prolong local anesthesia

add vasoconstrictor

49

processes of local anesthetic toxicity

systemic effects from intravasc injection by accident or absorption from site
neurotoxicity from local effects with direct contact with neural elements

50

CNS toxicity local anesthetic

sedation, light headedness, visiaul and auditory disturbances
restlessness
nystagmus, musc twitching, tonic-clonic convulsions

51

what do we give to prevent CNS toxicity local anesthetic

give benzo before

52

CV effects local anesthetics

arrhythmia and cardiac arrest
block Na Ch on heart so dec electrical excitability, conduction rate force and arteriolar dilation causing hypotension

53

cocaine CV effects

inhibits NE reuptake and results in vasoconstriction leading to ischemia, also have HTN and cardiac arrhythmias