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Pharm Final Exam > Topic 17 > Flashcards

Topic 17 Flashcards

1
Q

Dissociative Anesthetics drug names

A

Phencyclidine (street drug PCP)
ketamine hydrochloride
•Only ketamine is used legally

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2
Q

Dissociative Anesthetics are used alone or with?

A

tranquilizers and opiods to induce anesthesia

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3
Q

Dissociative Anesthetics MOA

A

Disrupts nerve transmission in some brain sections
•Selective stimulation in parts of the brain
•Trancelike state

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4
Q

Ketamine peak action after given IV

A

1-2 minutes

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5
Q

Ketamine peak action after given IM

A

10 minutes

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6
Q

Ketamine duration of effect

A

20-30 minutes

–Increased dose prolongs duration but doesn’t increase anesthetic effect

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7
Q

how are Dissociative Anesthetic metabolized?

A

All dissociatives are either metabolized in the liver or excreted unchanged in the urine
–Avoid use in critters with liver or kidney disease

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8
Q

Dissociative Anesthetic Effects on the CNS: (6)

A 
Cataleptoid state
Intact reflexes
Ocular effects (Eyes remain open/Central dilated pupil)
Muscle tone (Normal to muscle rigidity)
Analgesia (Somatic and Visceral)
Sensitivity to sensory stimuli
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9
Q

Dissociative Anesthetic Effects on the Cardiovascular System: (4)

A 
Increase in heart rate
Increased cardiac output
Increased mean blood pressure
Effects due to stimulation of the SNS 
--so they make sick hearts work harder
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10
Q

Dissociative Anesthetic Effects on the Respiratory System: (3)

A

Respiratory rate and tidal volume remain stable
Respiratory depression usually insignificant
Apneustic respiration at higher doses

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11
Q

what drug is a α₂-agonist sedative

A

Dexmedetomidine (Precedex)

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12
Q

Dexmedetomidine

A

(Precedex)

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13
Q

what drug is a Noncontrolled, sedative-hypnotic imidazole drug with no analgesic properties and has Minimal effects on the cardiovascular and respiratory systems?

A

Etomidate (Amidate)

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14
Q

Etomidate

A

(Amidate)

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15
Q

what drug is One of the few injectable anesthetics (>Propofol) to decrease ICP and is Like a much safer, fast-acting barbituate

A

Etomidate (Amidate)

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16
Q

Benzodiazepines are what type of drug?

A

Tranquilizers-all controlled substances

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17
Q

Benzodiazepines drugs

A

Diazepam (Valium)
Ativan (Lorazepam)
Versed (Midazolam)

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18
Q

Benzodiazepines target what receptor

A

targets Υ-amino-butyric acid receptors (GABA) since GABA is the major inhibitory CNS neurotransmitter

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19
Q

why are Benzodiazepines relatively safe?

A

lethal dose is 1000x greater than the typical therapeutic dose

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20
Q

Diazepam (Valium) half life

A

1-4 days (long duration)

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21
Q

Ativan (Lorazepam) half life

A

10-20 hours (medium duration)

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22
Q

Versed (Midazolam) half life

A

2-6 hours (short duration)

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23
Q

which Benzodiazepine should you not mix with water-soluble drugs

A

Diazepam (Valium)

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24
Q

Diazepam

A

(Valium)

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25
Q

Ativan

A

(Lorazepam)

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26
Q

Versed

A

(Midazolam)

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27
Q

which Benzodiazepine is Water soluble/poorly lipid soluble

A

Lorazepam (Ativan)

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28
Q

which Benzodiazepine is Water soluble

A

Midazolam (Versed)

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29
Q

Benzodiazepine Reversal drug name

A

Flumazenil (Anexate)

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30
Q

Flumazenil

A

(Anexate)

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31
Q

what drug effectively reverses the effects of benzodiazepines by competitive inhibition at the GABA receptor sites

A

Flumazenil (Anexate)

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32
Q

what 2 drugs are the most commonly used Halogenated Organic Compound

A

Isoflurane and sevoflurane

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33
Q

describe the Uptake of Halogenated Organic Compounds

A

Liquid anesthetic is vaporized and mixed with oxygen-blend gas
Mixture travels to lungs (alveoli) &/or oxygenator and diffuses into the bloodstream

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34
Q

for Halogenated Organic Compounds, what is the diffusion rate dependent on

A
  1. concentration gradient (alveoli/capillary &/or opposite sides of oxygenator membrane/pseudomembrane)
    - -Concentration gradient is greatest during initial induction
  2. lipid solubility
35
Q

for Halogenated Organic Compounds, what is the Distribution to tissues dependent on

A

blood supply

–Lipid solubility determines entry into tissues through cell walls

36
Q

for Halogenated Organic Compounds, what is the Depth of anesthesia dependent on

A

partial pressure of anesthetic in the brain

–Partial pressure in the brain is dependent on partial pressure of the anesthetic in blood and alveoli

37
Q

for Halogenated Organic Compounds, what is the Maintenance of anesthesia dependent on

A

sufficient quantities of anesthetic delivered to the lungs &/or oxygenator bundle fibers

38
Q

name 3 Effects of Halogenated Organic Compounds

A
  • -Increased intracranial pressure in patients with head trauma or brain tumors
  • -Decreases blood pressure and may decrease renal blood flow
  • -Carbon dioxide retention and respiratory acidosis
39
Q

what is One of perfusionists’ most effective tools for changing blood pressure/arterial pressure

A

their anesthetic vaporizer

40
Q

Increasing the level (percentage) of volatile anesthetic provides what? What is it caused by?

A

a reliable, dose-dependent vasodilatory response.

•This is caused by a combination of direct vasodilatory effect and sympatholytic effect.

41
Q

name 2 Potential Disadvantages for Volatile Anesthetics

A

Very significant hemodynamic variability from patient to patient.
Possibility of coronary steal syndrome

42
Q

what is coronary steal syndrome

A

Arteriolar dilation of normal vessels diverts blood away from stenotic areas

43
Q

which Volatile Anesthetics causes steal and new ST-T segment depression

A

Forane

–May not be important since Forane reduces SVR, depresses the myocardium yet maintains CO

44
Q

what are 5 Physical and Chemical Properties of Inhalant Anesthetics? know

A 
–Vapor pressure
–Partition coefficient
–Minimum alveolar concentration (MAC)
–Rubber solubility
–Cardiac output dependent
45
Q

The tendency of an inhalation anesthetic to vaporize to its gaseous state determines what? know

A

how readily an inhalation anesthetic will evaporate in the anesthetic machine vaporizer
–So its Temperature and anesthetic agent dependent

46
Q

name the 4 Volatile agents know

A

Isoflurane, sevoflurane, desflurane, and halothane

47
Q

how are volatile agents delivered? know

A

Delivered from a precision vaporizer to control the delivery concentration
–All precision vaporizers are made to deliver only one specific halogenated agent
–High vapor pressure

48
Q

name a Nonvolatile agent

A

Methoxyflurane

49
Q

how are non-volatile agents delivered?

A

Delivered from a nonprecision vaporizer
–Low vapor pressure
***NO LONGER USED (but now you understand why they are referred to as “precision vaporizers”

50
Q

Blood:Gas Partition Coefficient= know

A

The measure of the solubility of an inhalation anesthetic in blood as compared to alveolar/oxygenator gas Indication of the speed of induction and recovery for an inhalation anesthetic agent

51
Q

Low blood:gas partition coefficient= know

A

–Agent is relatively less soluble in blood than alveolar/oxygenator gas
–Faster expected induction and recovery
(Wants to go from blood to gas fast for a fast recovery)

52
Q

High blood:gas partition coefficient= know

A

–Agent is more soluble in blood at equilibrium
–Agent is less soluble in alveolar/oxygenator gas
–Agent is absorbed into blood and tissues (sponge effect)
–(Slower expected induction and recovery)

53
Q

what does the Blood:Gas Partition Coefficient determine

A

the clinical use of the anesthetic agent

  • Maintenance
  • Recovery
  • How soon you have to turn down/off my vaporizer so volatile anesthetics won’t depress the heart as we try to wean
54
Q

Minimum Alveolar Concentration (MAC)=

A

The concentration of anesthetic vapor in alveoli that is required to prevent a motor response in 50% of patients subjected to surgical pain stimuli
–isn’t really a minimum concentration, it’s really an average concentration

55
Q

what does a low MAC mean

A

more potent the anesthetic agent

lower the vaporizer setting

56
Q

MAC may be altered by age, metabolic activity, body temperature, disease, pregnancy, obesity, and other agents present so every patient must be?

A

monitored as an individual

57
Q

A vaporizer setting of roughly ____ the MAC of an agent is required for surgical anesthesia and completely depends on the individual

A

1-2x

58
Q

what is the archetypical halogenated volatile anesthetic

A

Halothane

59
Q

which halogenated volatile is somewhat arrhythmogenic and metabolized (a BAD thing!) by producing hepatotoxic byproducts

A

Halothane

60
Q

which halogenated volatile contributes to malignant hyperthermia (particularly when used in conjunction with succinylcholine)

A

Halothane

61
Q

what is the Most commonly used inhalant agent in North America

A

Isoflurane

62
Q

describe Isofluranes vapor pressure

A

High vapor pressure: need a precision vaporizer

63
Q

describe Isofluranes blood:gas partition coefficient

A

Low blood:gas partition coefficient: rapid induction and recovery

64
Q

describe Isofluranes MAC

A

1.3% to 1.63%: helps determine initial vaporizer setting

65
Q

describe Isofluranes rubber solubility

A

Low rubber solubility

66
Q

which inhalant agent Maintains cardiac output, heart rate, and rhythm
–Fewest adverse cardiovascular effects

A

Isoflurane

67
Q

which inhalant agent Depresses the respiratory system and Maintains cerebral blood flow

A

Isoflurane

68
Q

which inhalant agent is Almost completely eliminated through the lungs

A

Isoflurane

69
Q

which inhalant agent Induces adequate to good muscle relaxation and Provides little or no analgesia after anesthesia

A

Isoflurane

70
Q

which inhalant agent Can produce carbon monoxide when exposed to a desiccated carbon dioxide absorbent

A

Isoflurane

71
Q

describe Sevofluranes vapor pressure

A

High vapor pressure: needs a precision vaporizer

72
Q

describe Sevofluranes Blood:gas partition coefficient

A

LOW Blood:gas partition coefficient

–rapid induction and recovery

73
Q

describe Sevofluranes MAC

A

2.34% to 2.58%

High controllability of depth of anesthesia

74
Q

describe Desfluranes vapor pressure

A

Used with a special precision vaporizer

75
Q

describe Desfluranes Blood:gas partition coefficient

A

LOWEST blood:gas partition coefficient: very rapid induction and recovery

76
Q

describe Desfluranes MAC

A

7.2% and 9.8%

–Least potent inhalant agent

77
Q

describe how Desflurane is eliminated

A

lungs

78
Q

which inhalent agents is known as the One Breath Anesthesia

A

Desflurane

–Cause in one breath you’re asleep and in one breath you’re awake

79
Q

Nitrous Oxide is an excellent? poor?

A

Excellent analgesic, poor anesthetic (by itself)

80
Q

describe Nitrous Oxides vapor pressure

A

Doesn’t require a precision vaporizer

81
Q

Nitrous Oxide is Often mixed with other gas anesthetics to produce better analgesia- but NEVER more than how much?

A

80% N₂O!

82
Q

Nitrous Oxide is Very poorly soluble in blood and tissues presenting two problems for us?

A
  1. comes out of tissue very fast

2. Diffusion Hypoxia

83
Q

Unlike other gas anesthetics, nitrous oxide is a?

A

compressed liquid

84
Q

list the inhaled agents from most soluble in blood to the least

A 
halothane (most)
isoflurane
sevoflurane
nitrous oxide
desflurane (least)

Pharm Final Exam (8 decks)

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