Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Unit 3 Anesthetic Agents > Flashcards

Unit 3 Anesthetic Agents Flashcards

1
Q

Anesthesia

A

loss of sensation or state without feeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

General anesthesia

A

Clinical state where there is an induced loss of consciousness or total insensibility (no pain) in a reversible manner
Full body, can cause decreased respiration, decreased blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Local anesthesia

A

limited to small area; minimal system disturbances

Commonly not adequate for many different procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Triad of anesthesia

A

Asleep, pain-free, still

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ideal anesthetic agent

A

Unconsciousness, amnesia, analgesia (no pain), skeletal muscle relaxation, areflexia, good minute-to-minute control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Is there any one drug considered to be an ideal anesthetic?

A

No

Use adjuvant drugs prior to anesthesia to make more safe & comfortable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Preanesthetic Medication uses

A

Relieve anxiety (benzodiazepines), Prevent allergic rxn (antihistaminics), prevent nausea/vomiting (antiemetics), analgesia (opiods), prevent bradycardia & secretion (atropine, glycopyrrolate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

4 phases of general anesthesia

A

Induction, Maintenance, Emergence, & Recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Induction phase

A

Initial administration until desired level is achieved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Maintenance phase

A

Desired level of anesthesia is maintained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Emergence phase

A

From sub-optimal concentration of anesthetic until it reaches zero

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Recovery phase

A

From discontinuance of anesthetic agent until full restoration of function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

4 Stages of Anesthesia

A

Analgesia, Excitement, Surgical Anesthesia, Medullary Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Analgesia Stage

A

1st stage

No pain, amnesia, euphoria; start to fall asleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Excitement Stage

A

2nd stage Excitement, delirium, combative behavior
More asleep than stage 1
Want to get through this phase as fast as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Surgical Anesthesia Stage

A

Stage 3
Unconsciousness, regular respiration, decreasing eye movement
Want in this stage for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Medullary Depression Stage

A

Stage 4
Do not want to enter this stage
Respiratory arrest, cardiac depression & arrest, no eye movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Inhalable general anesthetics

A

Gasses/vapors
Usually used for maintenance of anesthesia
Can be used for induction in pediatrics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

I.V. or fixed anesthetics

A

Used for induction & short surgical procedures

More common for maintentance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Anesthetic MOA

A

Depress spontaneous & evoked neuronal activity
Induce hyperpolarization, increase firing threshold (lesser activity), inhibit synaptic transmission & response to NT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Anesthetics may alter ion channels by

A

Increasing GABAa receptor Cl channel activity (enhance inhibitory NT), activate VG K channels (hyperpolarization & reduce activation), & inhibit glutamate NMDA receptors (decreased excitatory)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Advantages of inhalable anesthetic agents

A

Easy to control depth

Readily reversible, minute-to-minute control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Disadvantages of inhalable agents

A

Induction not as fast or smooth as fixed agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Factors that affect rate of onset & recovery of inhalable agents

A

Anesthetic concentration in inspired air, pulmonary ventilation rate, solubility in blood & lipid, pulmonary blood flow, arteriovenous concentration gradient, elimination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Higher concentration of anesthetic in inspired air =
Higher partial pressure in lungs & Faster onset of anesthesia
26
Increase alveolar ventilation =
more gas molecules into blood/time & faster anesthesia onset
27
Less soluble in blood =
more rapid rise in partial pressure in blood & faster induction However, also faster elimination from brain
28
More soluble in lipid =
more potent
29
high blood flow =
slower onset
30
Slower rate of uptake in alveolar/arterial =
fast induction
31
Minimum alveolar concentration (MAC)
concentration of anesthetic in inspired air at equilibrium when there is no response to noxious stimulus in 50% of patients
32
Lower MAC =
more potent anesthetic
33
Higher lipid solubility =
more potent anesthetic (lower MAC)
34
Anesthesia is produced when anesthetic px in brain is _____ MAC value
greater
35
Nitrous Oxide
``` Gaseous inhalation (laughing gas) Rapid onset & recovery (low blood/gas coefficient = poor solubility) ```
36
Nitrous Oxide advantages
Good analgesia Relatively safe, nontoxic Rapid onset/recovery 2nd Gas effect (reduces induction time for primary agent, which reduces required concentration & toxicity)
37
Nitrous Oxide limitation
Incomplete anesthetic Low potency (insufficient for surgical anesthesia) Diffusion hypoxia, increased risk of abortion & decreased conception probability
38
Nitrous Oxide Uses
Complimentary agent to other more toxic agents Cannot be SOLE anesthetic Minor procedures (dentistry) or EMS
39
Halothane
halogenated agent Today not used often (poor analgesia & muscle relaxation), slower recovery, caused decreased cardiac output & hypotension, high incidence of post-op hepatitis
40
Enflurane
Halogenated | Not used often today - CNS stimulation effects (EEG convulsive pattern, jerking, twitching)
41
Isoflurane
``` Halogenated Used for maintenance Pungency limits mask induction Very long duration Lower toxicity ```
42
Desflurane
Halogenated Fastest onset & recover, excellent minute-to-minute control 2nd most commonly used inhalable More irritating to respiratory passages than others - bronchial irritation with cough & laryngeal spasm
43
Sevoflurane
Halogenated most commonly used Mask induction, rapid onset & recovery, very potent, controllable (low solubility & high potency) Low airway irritation
44
IV drug use
Induction (most commonly) & maintenance
45
IV drug advantages
Quick induction, rapid & complete recovery
46
IV drug disadvantages
Can't reverse effects, slow elimination, CV & respiratory effects
47
Thiopental
Barbiturate Commonly used induction agent Rapidly diffuse out of brain & redistributes to other tissues (longer duration of action) Highly soluble
48
Propofol
IV anesthetic 99.9% of all inductions, can be used as continuous IV drip Good quality of recovery (awake, clear head)
49
Keatmine
IV anesthetic Dissociative anesthesia - intense analgesia, catalepsy, & amnesia (can appear to be awake) Non-competitive glutamate NMDA receptor antagonist Emergence phenomenon - unpleasant dreams & hallucinations Good for pts with compromised cardiac status Do NOT give to pts with psychiatric hx
50
Midazolam
Benzo | Good for sedation, amnesia, & anxiolytic properties (potentiate GABAa recepetors)
51
Local anesthesia
loss of sensation limited to a local area or region of body | Blocks generation & propagation of nerve impulse in a reversible, regional loss of function
52
Topical (surface) local anesthesia
To skin, wounds, burns, mucous membranes | Skin penetration is critical factor
53
Perineural Infiltration
injection of agent around specific area where anesthesia is desired Easy to deliver to specific area However increases potential for systemic absorption & toxicity
54
Nerve Block
Injection of agent around specific nerve to block conduction of sensory & motor fibers distal to block Less drug required to block larger areas distal to injection site However requires more skill/knowledge
55
Spinal Block
Injection of agent into CSF in lumbar subarachnoid space to reach roots of spinal nerve that supply specific region More reliable block, return of CSF ensures correct location of needle Conscious with minimal disruption of organ function However no titration or reversibility, time limitations
56
Epidural Block
Injection of agent into extradural space & block nerve root as it passes through space No time limitation, may be used 4-7 days post op Less reliable than spinal block
57
Local anesthetic MOA
Blockade of VG sodium channels | Decrease in generation & conduction of action potentials
58
Local anesthetic amides
Metabolized in liver | Longer 1/2 life & longer duration of action than esters
59
Local anesthetic esters
Metabolized in plasma via BChE | Short plasma 1/2 life & duration of action
60
Minimum anesthetic concentration (Cm)
minimum concentration of drug for standard block | Relative standard of potency
61
Bigger fiber size =
greater Cm (more drug required)
62
Fibers blocked first
Smallest fibers & myelinated fibers | B-fibers first, A-alpha last
63
Increase in pH =
Decreased Cm (need less of drug)
64
Increased Ca concentration =
increased Cm
65
Vasoconstrictor substances
reduce local blood flow & reduce systemic absorption & reduce LA toxicity Use epinephrine
66
Factors that affect reversal of local anesthesia
Dilution by ECF (high to low LA concentration), Absorption into circulation (most important factor), Redistribution to other areas, Use of vasoconstrictors
67
PABA (para-aminobenzoic acid) metabolite
Inactive metabolite from LA ester | Prone to allergic reactions
68
Hypersensitivity to LA
Esters most likely | Also commonly allergic to methyparaben (preservative)
69
Systemic toxicity to LA
Esters less likely because rapid metabolism
70
Bupivicaine adverse effects
systemic toxicity has cardiac selectivity that can lead to complete cardiac collapse & death
71
Treatment for LAST (local anesthetic toxicity)
IV lipid emulsion or IntraLipid | Absorbs circulating lipophilic toxin & reduces unbound free toxin available to bind to myocardium
72
Lidocaine
LA standard Can be given topically & by injection Most common for epidural going to C-section (2%) Intermediate-duration procedures
73
Lidocaine toxicity
CNS excitation, TNS (transient neurologic symptoms) - increased sensitivity or pain to touch
74
Bupivacaine
Amide LA Epidural infusion in labor & postoperative pain Spinal anesthetic
75
Articaine
Amide LA | Dental anesthetic
76
Cocaine
ester LA | topical for ear,nose, & throat procedures
77
Benzocaine
``` ester LA Topical only (high lipid solubility) ```
78
Chloroprocaine
Ester LA short duration procedures Epidural agent for labor (especially C section) - lower risk systemic toxicity & fetal exposure
79
Exparel-Liposome
LA encased bupivicaine - post op relief very expensive
80
EMLA (eutectic mixture of local anesthetics)
LA mixture Lidocaine + prilocaine topical
81
TAC (tetracaine, adrenalin, & cocaine)
topical LA in pediatric ER

Pharmacology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions