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Pharma 8: General Anaesthetics Flashcards

(46 cards)

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1
Q

General anesthesia

Definition

Stages

A

The absence of sensation, which is associated with a reversible loss of consciousness

Stages:
Stage 1: Analgesia
Stage 2: Excitement
Stage 3: Surgical Anesthesia
Stage 4: Medullary Paralysis
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2
Q

Thiopental

Type

A

Barbiturate

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3
Q

Thiopental

MOA

A

GABA-A modulator—> enhance GABA-A mediated synaptic inhibition

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4
Q

Thiopental

Adv

A

Fast and potent anesthesia

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5
Q

Thiopental

Disadv

A

Weak analgesia, muscle relaxation]

Laryngospasm

Cardio, resp depression

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6
Q

Thiopental

Metabolism

A

Slowly metabolized and accumulates in body fat—> prolonged effect if given repeatedly

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7
Q

Benzodiazepines

A

Lorazepam

Midazolam

Etomidate

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8
Q

Benzodiazepines

MOA

A

Enhance GABA-A mediated synaptic inhibition

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9
Q

Common use of Lorazepam and Midazolam

A

Premedication given ORALLY to reduce anxiety and ease amnesia

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10
Q

Midazolam use

A

For endoscopy where full anesthesia not required

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11
Q

Entomidate use

A

IV

An induction agent preferable to Thiopental in pt with circulatory failure and also cuz its metabolized faster

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12
Q

Opioids

A

Morphine

Fentanyl

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13
Q

Opioids MOA

A

uReceptor agonists that are used with other anesthetics to cause analgesia

U receptor activation—> inhibit AC—> reduce cAMP—> increase K conductance, decrease Ca conductance—> reduce transmitter release and synaptic transmission

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14
Q

Opioids (morphine, fentanyl) cause

A

Hypotension

Respiratory depression

Muscle rigidity

Postanesthetic N/V

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15
Q

Opioids as amnesiacs

A

NOT GOOD

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16
Q

Propofol

Use

A

Anxiolytic/hypnotic

Induces and maintains anesthesia

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17
Q

Propofol

Recovery, onset

A

Both rapid

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18
Q

Propofol effect of intracranial pressure

A

Reduced

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19
Q

Propofol as anelgesic

20
Q

Propofol as amnesiac

21
Q

Propofol

Side effects

Study These Flashcards
A

Hypotension

Transient apnea on induction

22
Q

Propofol MOA

Study These Flashcards
A

Potentiates GABA via GABA-A receptor—>affects endocannabinoids system

23
Q

Ketamine

MOA

Study These Flashcards
A

NMDA receptor ANTAGONIST

24
Q

Ketamine

Uses

Study These Flashcards
A
  1. Dissociate anesthesia ie pt appears awake but is unconscious(even unconscious )and pain free ie it causes sedation, amnesia, immobility.
  2. Analgesia
25
What limits use of KETAMINE
Postoperative hallucinations—> used as an animal tranquilizer
26
INNOVAR preparation Combination of
Droperidol—>neuroleptic, D2 antagonist) Fentanyl—> opioid
27
INNOVAR preparation Use
NEUROLEPT ANALGESIA Pt remains responsive to simple commands/question, BUT in deep state of sedation/analgesia —> used for minor surgical procedure as endoscopy
28
Route of inhaled drugs
Introduced to blood via lungs—>alveolar blood—>brain, other tissues
29
Potency of inhaled drugs measured by
MEAN ALVEOLAR CONCENTRATION Low MAC—> more potent Eg isolfurane (1.2) more potent than nitrous oxide (100)
30
Concentration of inhaled anesthetic (gas) is proportional to
Partial pressure (tension)
31
Partition coefficient
Ratio of the concentration of the agents in 2 phases at equilibrium !solubility of gas in media—>P.C
32
Speed of induction and recovery depend on
1. Anesthetic properties i. blood gas partition coefficient ii. oil gas partition coefficient 2. Physiological factors i. alveolar ventilation rate ii. cardiac output
33
Blood gas partition coefficient
Lower solubility of drug—> less drug transferred vis lung to blood to achieve partial pressure—> equilibrium reached faster→low Bg partition Ie. Blood gas partition coefficient is INVERSELY related to induction and recover speed ie DIRECTLY proportional to time Eg. NO (0.5) faster than halthone (2.4)
34
Different scenarios of blood gas coefficient ie high and low
High BG coefficient: more soluble agent →more drug needed to saturate blood→ more time to raise partial pressure and depth of anesthesia Low BG coefficient: less soluble agent→less drug needed to saturate blood→less time it takes to raise partial pressure and depth of anesthesia
35
Oil gas partition coefficient considers
solubility in fat with high lipid solubility→delaying recovery from anesthesia because t accumulates in body fat HALTHONE
36
Oil gas partition coefficient directly related to
potency
37
The MOA of general anesthetics on a molecular level
acts through modulatory sites 1. enhance activity of inhibitory GABA-A 2. enhance activity of inhibitory GLYCINE 3. INHIBIT excitatory recpeotrs like intotropic Glu and nAChR 4. Act on TREK→K channel→activated to reduce membrane excitability
38
Halthone advantages
Prototype 1. best for pediatric use 2. good for asthmatics because it relaxes sm
39
Halthone disadvantages
1. reduces hepatic and renal blood flow 2. arrhythmia 3. Sensitizes heart to CA via B1-AR 4. hypotension 5. MALIGNANT HYPERTHERMIA 6. potentially FATAL hepatotocxicity
40
Isolfurane advantages
Most widely used 1. low organ toxicity 2. rapid recovery 3. muscle relaxation 4. DOES NOT sensitize heart to CA 5. NO INCREASE IN ICP 6. Cardiac output stable
41
Isolfurane disadvantages
Irritates resp tract | Strong coronary vasodilator→worsen cardiac ischemia in pt with cor disease
42
NO | advantages
1. good analgesic 2. SAFEST INHALATION ANESTHETIC→no resp depression and least hepatotoxic 3. rapid onset, recovery 4. non irritating
43
NO disadvantages
1. weak ANESTHESIA→must be used with others for surgery 2. no muscle relaxation 3. Prolonged and repeated administration (<6hrs)→Bone marrow supression ie anemia and leucopenia 4. enters gaseous cavities→expansion
44
How to reach balanced anesthesia
1. To reach unconscious state rapidly→ THIOPENTAL/PROPOFOL (IV administration) 2. To maintain unconsciousness→ NO +/- ISOFLURANE (at least one inhalation agent) 3. To produce analgesia→MORPHINE (IV analgesic) 4. To relax skeletal muscles for tracheal intubation or thoracic surgery→PANCRONIUM (!must use mechanical ventilator)
45
IV anesthetics
``` thiopental midazolam fentanyl propofol kentamine INNOVAR ```
46
Inhaled anesthetics
HALOTHANE NO ISOFLURANE

CNS (28 decks)

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