Pharm Induction Agent Flashcards
(32 cards)
What neurotransmitter binds to NMDA receptors and what does binding do?
Glutamate, causes influx of positively charged ions(na and ca), causing excitatory effect
Ketamine blocks
NMDA receptor and glutamate from bonding causing failed initiations in action potential
Precedex works where
Alpha 2 agonist, acts as false norepinephrine, body blocks release of norepinephrine causing sedation. Chlonidine does same
What do chemoreceptors do?
Pick up increase levels of co2 and send signals to breath
Induction agents have an average onset time of ______ and one dose without any agents will give up to
30seconds and up to 9min
With induction agents CO does what to onset of action?
Increases
Single dose termination __________ determined by extent or speed of metabolism
iS NOT
Who are still on barbiturates for seizures?
Typically elderly
What substitutions on barbituric acid cause the hypnotic sedative and anticonvulsant effect?
N1, carbon2, carbon5
Thipental substitutes what part of barbiruric acid?
Sulfur on C2
Why do some drugs cause myoclonic movements with inductions?
Natural response of body d/t sympathetic outflow, fentanyl and esmolol help block
What does methohexital substitute on barbituric acid?
Oxygen on c2
Difference between barbs and benzia with gaba?
Benzos need gaba to work, barbs do not with longer and higher doses
Caused of decreased plasma protein concentration? Barbs
Uremia,hepatic disease, 3rd trimester of pregnancy
Drugs that compete with barbs for protein binding sites
Aspirin Naproxen Indomethacin Warfarin Can potential kick barbs off binding sites and increase barb toxicity
Metabolism of barbs
Primarily oxidation Secondarily by n-dealkylation Desulfuration Destruction of barb acid ring Results in inactive metabolites excreted urine
Long term barb use can induce?
Cyp450 microtonal system and increase barb metabolism
Barba analgesia?
No
Barbs cns effect?
Can be titrated to produce mild to complete loc. Significant post anesthesia drowsiness. Dose dependent decrease CMRO2 and CBF Decrease ICP and IOP Anticonvulsant
Barb cv effects
Induced depression of medullary vasomotor center, decrease in sympathetic systems outflow of CNS.
Modest decrease in peripheral blood pressure d/t peripheral vasodilation.
May see increase in heart rate if baroreceptors are still active.
Decreased venous return.
Hypotension and decreased CO in some patients.
Barb exaggerated hypotension response observed in following scenarios?
Large induction dose Rapid injection Hipovolemia Cardiac tamponado Cardiomyopathy CAD Cardiac Valvular Disease
Respiratory effects barbs
Dose related. Respiratory depression Decrease in minute ventilation Laryngospasm Bronchospasm Transient apnea induction Decrease in stimulation by CO2 to breath( mediated by medullary and pontine vent centers) Decrease ventilators response to hipercapnia and hypoxia Suppression laryngeal reflexes and cough
Which induction agent may cause immunosuppression?
Barbs, case studies only
Anaphylactic reactions 1:30,000
Barbs
