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Pharmacology > Unit 3-General Anesthetics > Flashcards

Unit 3-General Anesthetics Flashcards

1
Q

Nitrous Oxide

Class

A

Inorganic gas

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2
Q

Nitrous Oxide

Mechanism

A

NMDA receptor antagonist

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3
Q

Nitrous Oxide

Uses

A

Mask induction in children; adjuvant to volatile anesthetics for maintenance, opioids

But does not produce muscle relaxation

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4
Q

Nitrous Oxide

Side effects

A

Post-operative nausea and vomiting; inactivates vitamin B12 (leading to abnormal embryonic development, abortion); accumulates in closed, air-containing spaces (bowel, middle ear, pneumothoraces, air emboli) because N2O insoluble in blood

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5
Q

Isoflurane

Class

A

Volatile anesthetic

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6
Q

Isoflurane

Uses

A

Most potent

Gold standard for maintenance of anesthesia

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7
Q

Isoflurane

Side effects

A

Pungent; dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; increase in HR; malignant hyperthermia

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8
Q

Desflurane

Class

A

Volatile anesthetic

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9
Q

Desflurane

Uses

A

Least soluble, least potent bc completely fluorinated (allows for rapid emergence from anesthesia)

Maintenance of anesthesia

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10
Q

Desflurane

Side effects

A

Most pungent (airway irritation symptoms); dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; increase in HR; malignant hyperthermia

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11
Q

Sevoflurane

Class

A

Volatile anesthetic

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12
Q

Sevoflurane

Uses

A

Less soluble, less potent (but not irritating)

Mask induction in children and adults; maintenance of anesthesia

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13
Q

Sevoflurane

Side effects

A

Can form CO if not combined with CO2 correctly; dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP, decrease in respiratory function; relaxes skeletal muscle; malignant hyperthermia

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14
Q

Methohexital

Class

A

Barbiturates

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15
Q

Methohexital

Mechanism

A

GABAa receptor agonist, antagonist of NMDA-glutamate receptor; produce hypnosis & sedation, but is anti-analgesic

Redistribute from brain to muscle and fat, metabolized by liver; dosed based on lean body mass

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16
Q

Methohexital

Uses

A

Induce general anesthesia

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17
Q

Propofol

Class

A

Alkylphenol (a fatty acid)

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18
Q

Propofol

Mechanism

A

GABAa receptor agonist (hypnosis), antagonist of NMDA-glutamate receptor; some a2 receptor activity;

acts on GABAa and glycine receptors in spinal cord

rapid onset and offset

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19
Q

Propofol

Uses

A

Anti-emetic at low doses; induction and maintenance of general anesthesia; sedation in ICU, procedural sedation

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20
Q

Propofol

Side effects

A

Propofol infusion syndrome: being given for several days leads to metabolic acidosis, rhabdomyolysis, heart & renal failure, lowering of BP, bradycardia, and death (likely due to fatty acid oxidation)

Painful injection site; supports bacterial growth

Administered IV in a lipid emulsion (cause of pain); be aware of allergies (egg and soy in emulsion); no malignant hyperthermia

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21
Q

Etomidate

Class

A

Carboxylated imidazole

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22
Q

Etomidate

Mechanism

A

GABAa receptor agonist (only D-isomer)

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23
Q

Etomidate

Uses

A

Hypnosis; no analgesic activity

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24
Q

Etomidate

Side effects

A

Pain on administration (due to solvent, propylene glycol); involuntary myoclonic movements due to subcortical disinhibition (not a seizure); post-operative nausea and vomiting; single dose inhibits cortisol synthesis

Minimal cardiorespiratory depression (good agent in patients with minimal cardiac reserve)

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25
Ketamine Class
Phencyclidine
26
Ketamine Mechanism
NMDA receptor antagonist, kappa opiate agonist; leads to dose-dependent unconsciousness, amnesia, analgesia Causes functional disorganization by depressing parts of cortex and thalamus, stimulating limbic system
27
Ketamine Uses
Sedative/anesthetic for pediatric/developmentally delayed patients; induction in patients with reactive airway disease, hypovolemia (trauma patients), cardiac disease; with propofol for IV procedural sedation; adjuvant during and after surgery to reduce opiod use; part of multimodal pain therapy regimen; depression treatment
28
Ketamine Side effects
Stimulates sympathetic nervous system outflow; increases cerebral blood flow, ICP; emergence delerium; nystagmus, lacrimation, salivation, and dissociative anesthesia Racemic mixture (S more potent); metabolized by P450 (norketamine, a third to a fifth as effective); great bronchodilator; contraindicated in CAD patients and those with with intracranial lesions
29
Dexmedetomidine Class
a2 adrenergic agonist
30
Dexmedetomidine Mechanism
Binds a2a and a2b in locus coeruleus and spinal cord (produces sedation, sympatholysis, and analgesia)
31
Dexmedetomidine Uses
Awake intubations, awake craniotomies; adjunct to general anesthesia in patients susceptible to narcotic-induced post-op respiratory depression; withdrawal/detoxification Since GABA not hit, sedation is easier to wake from and is similar to non-REM sleep; FDA approved only for ventilation of ICU patients for under 24 hours
32
Dexemedetomidine Side effects
Limited respiratory depression (wide safety margin)
33
Succinylcholine Class
Depolarizing NMB
34
Succinylcholine Mechanism
Divalent ACh molecule; attaches to all ACh receptors, overstimulating them (first seen as disorganized muscular contractions (fasiculations), then paralysis)
35
Succinylcholine Uses
Skeletal muscle relaxant (intubation)
36
Succinylcholine Side effects
Malignant hyperthermia; cardiac dysrhythmias, hyperkalemia, increased intraocular pressure, increased intracranial pressure Increased intragastric pressure, myalgias, masseter spasm Hydrolyzed by pseudocholinesterase (in plasma); blockade cannot be reversed; only NMB with rapid onset and ultra-short duration of action
37
Pancuronium Class
Amino steroid non-depolarizing NMB
38
Pancuronium Mechanism
Competitive blockade of ACh (no depolarization); vagolytic Only long acting non-depolarizing agent; supplied as liquid; 80% excreted unchanged in liver (low metabolism in liver); reverse with AChEI
39
Pancuronium Uses
Skeletal muscle relaxant; avoid in patients with renal insufficiency
40
Pancuronium Side effects
Increase in HR (vagolytic)
41
Vecuronium Class
Amino steroid non-depolarizing NMB
42
Vecuronium Mechanism
Competitive blockade of ACh (no depolarization) Intermediate acting; supplied as a powder (reconstitute); hepatic metabolism, hepatic and renal excretion; reverse with AChEI
43
Vecuronium Uses
Skeletal muscle relaxant
44
Vecuronium Side effects
No cardiovascular effects
45
Rocuronium Class
Amino steroid non-depolarizing NMB
46
Rocuronium Mechanism
Competitive blockade of ACh (no depolarization) Intermediate acting; supplied as a liquid; hepatic metabolism, hepatic and renal excretion; can speed onset with higher dose; reverse with AChEI
47
Rocuronium Uses
Skeletal muscle relaxant (can substitute succinylcholine in rapid sequence intubation)
48
Rocuronium Side effects
No cardiovascular effects
49
Sugammadex Class
Selective relaxant binding agent
50
Sugammadex Mechanism
Complexes with rocuronium, rendering it inactive; no effect on AChesterase so do not need to use antimuscarinic
51
Sugammadex Uses
Immediate reversal of rocuronium Not yet FDA approved
52
Sugammadex Side effects
Decrease in blood presure, nausea and vomiting, dry mouth
53
Atracurium Class
Isoquinoline non-depolarizing NMB
54
Atracurium Mechanism
Competitive blockade of ACh (no depolarization) Undergoes spontaneous, non-enzymatic degradation (Hofman elimination); intermediate acting; reverse with AChEI
55
Atracurium Uses
Skeletal muscle relaxant; use in patients with liver or renal dysfunction
56
Atracurium Side effects
Histamine release (especially if given as rapid IV bolus), with resultant hypotension and tachycardia
57
Cis-atracurium Class
Isoquinoline non-depolarizing NMB
58
Cis-atracurium Mechanism
Competitive blockade of ACh (no depolarization) Undergoes spontaneous, non-enzymatic degradation (Hofman elimination); intermediate acting; reverse with AChEI
59
Cis-atracurium Uses
Skeletal muscle relaxant; use in patients with liver or renal dysfunction
60
Cis-atracurium Side effects
Unlike atracurium, no histamine release or downstream effects
61
Edrophonium Class
AChE-I
62
Edrophonium Uses
Reversal of NMB Short-acting, fast onset
63
Neostigmine Class
AChE-I
64
Neostigmine Uses
Reversal of NMB (most commonly used) More complete antagonism than edrophonium
65
Pyridostigmine Class
AChE-I
66
Pyridostigmine Uses
Reversal of NMB Longer duration of action than neostigmine, edrophonium
67
Glycopyrrolate Class
Anti-muscarinic
68
Glycopyrrolate Uses
Reversal of neuromuscular blockade's muscaranic effects Could also use atropine
69
Glycopyrrolate Side effects
DUMBELLS
70

Pharmacology (26 decks)

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