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Flashcards in Topic 17 Deck (84):
1

Dissociative Anesthetics drug names

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

2

Dissociative Anesthetics are used alone or with?

tranquilizers and opiods to induce anesthesia

3

Dissociative Anesthetics MOA

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

4

Ketamine peak action after given IV

1-2 minutes

5

Ketamine peak action after given IM

10 minutes

6

Ketamine duration of effect

20-30 minutes
–Increased dose prolongs duration but doesn’t increase anesthetic effect

7

how are Dissociative Anesthetic metabolized?

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

8

Dissociative Anesthetic Effects on the CNS: (6)

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

9

Dissociative Anesthetic Effects on the Cardiovascular System: (4)

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

10

Dissociative Anesthetic Effects on the Respiratory System: (3)

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

11

what drug is a α₂-agonist sedative

Dexmedetomidine (Precedex)

12

Dexmedetomidine

(Precedex)

13

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

Etomidate (Amidate)

14

Etomidate

(Amidate)

15

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

Etomidate (Amidate)

16

Benzodiazepines are what type of drug?

Tranquilizers-all controlled substances

17

Benzodiazepines drugs

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

18

Benzodiazepines target what receptor

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

19

why are Benzodiazepines relatively safe?

lethal dose is 1000x greater than the typical therapeutic dose

20

Diazepam (Valium) half life

1-4 days (long duration)

21

Ativan (Lorazepam) half life

10-20 hours (medium duration)

22

Versed (Midazolam) half life

2-6 hours (short duration)

23

which Benzodiazepine should you not mix with water-soluble drugs

Diazepam (Valium)

24

Diazepam

(Valium)

25

Ativan

(Lorazepam)

26

Versed

(Midazolam)

27

which Benzodiazepine is Water soluble/poorly lipid soluble

Lorazepam (Ativan)

28

which Benzodiazepine is Water soluble

Midazolam (Versed)

29

Benzodiazepine Reversal drug name

Flumazenil (Anexate)

30

Flumazenil

(Anexate)

31

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

Flumazenil (Anexate)

32

what 2 drugs are the most commonly used Halogenated Organic Compound

Isoflurane and sevoflurane

33

describe the Uptake of Halogenated Organic Compounds

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

34

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

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

35

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

blood supply
--Lipid solubility determines entry into tissues through cell walls

36

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

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

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

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

38

name 3 Effects of Halogenated Organic Compounds

--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

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

their anesthetic vaporizer

40

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

a reliable, dose-dependent vasodilatory response.
•This is caused by a combination of direct vasodilatory effect and sympatholytic effect.

41

name 2 Potential Disadvantages for Volatile Anesthetics

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

42

what is coronary steal syndrome

Arteriolar dilation of normal vessels diverts blood away from stenotic areas

43

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

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

44

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

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

45

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

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

46

name the 4 Volatile agents *know*

Isoflurane, sevoflurane, desflurane, and halothane

47

how are volatile agents delivered? *know*

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

name a Nonvolatile agent

Methoxyflurane

49

how are non-volatile agents delivered?

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

50

Blood:Gas Partition Coefficient= *know*

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

Low blood:gas partition coefficient= *know*

–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

High blood:gas partition coefficient= *know*

–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

what does the Blood:Gas Partition Coefficient determine

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

Minimum Alveolar Concentration (MAC)=

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

what does a low MAC mean

more potent the anesthetic agent
lower the vaporizer setting

56

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

monitored as an individual

57

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

1-2x

58

what is the archetypical halogenated volatile anesthetic

Halothane

59

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

Halothane

60

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

Halothane

61

what is the Most commonly used inhalant agent in North America

Isoflurane

62

describe Isofluranes vapor pressure

High vapor pressure: need a precision vaporizer

63

describe Isofluranes blood:gas partition coefficient

Low blood:gas partition coefficient: rapid induction and recovery

64

describe Isofluranes MAC

1.3% to 1.63%: helps determine initial vaporizer setting

65

describe Isofluranes rubber solubility

Low rubber solubility

66

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

Isoflurane

67

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

Isoflurane

68

which inhalant agent is Almost completely eliminated through the lungs

Isoflurane

69

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

Isoflurane

70

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

Isoflurane

71

describe Sevofluranes vapor pressure

High vapor pressure: needs a precision vaporizer

72

describe Sevofluranes Blood:gas partition coefficient

LOW Blood:gas partition coefficient
--rapid induction and recovery

73

describe Sevofluranes MAC

2.34% to 2.58%
High controllability of depth of anesthesia

74

describe Desfluranes vapor pressure

Used with a special precision vaporizer

75

describe Desfluranes Blood:gas partition coefficient

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

76

describe Desfluranes MAC

7.2% and 9.8%
–Least potent inhalant agent

77

describe how Desflurane is eliminated

lungs

78

which inhalent agents is known as the One Breath Anesthesia

Desflurane
--Cause in one breath you’re asleep and in one breath you’re awake

79

Nitrous Oxide is an excellent? poor?

Excellent analgesic, poor anesthetic (by itself)

80

describe Nitrous Oxides vapor pressure

Doesn’t require a precision vaporizer

81

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

80% N₂O!

82

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

1. comes out of tissue very fast
2. Diffusion Hypoxia

83

Unlike other gas anesthetics, nitrous oxide is a?

compressed liquid

84

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

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