Term
Give the 7 characteristics for a good anesthetic |
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Definition
1. Rapid smooth induction 2. State of unconsciousness 3. Amnesia 4. Blocks reflexes that cause brachospam 5. Skeletal muscle relaxation 6. Good analegesia 7. Rapid and smooth recovery |
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Term
| Name the 3 types of Anesthesia |
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Definition
1. Balanced anesthesia
2. Neuroleptanethesia
3. Dissociative anesthesia |
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Term
| What is balanced anesthesia |
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Definition
| It's the use of combination of drugs to take advantage of the best properties of each to minimize unwated side effect |
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Term
| What is Neurolepanesthesia |
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Definition
| Combination of antipsychotic drugs & an analgesic, it produces analgesia w/ amensia |
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Term
| Define dissociative anesthesia |
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Definition
| Catonia, amensia and analgesia |
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Term
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Definition
| Minimal alveolar concentration |
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Term
| Define Minimal alveolar concentration |
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Definition
| It's the alveolar concentration of anesthetic gas at which 50% of patients fail to respond to a surgerical stimuli |
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Term
| MAC is an index of _______ of the inhaled GA, the lower the MAC the _____ potent the drug |
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Definition
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Term
| How many stages of analgesia are there |
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Definition
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Term
| Where is stage I analgesia used? What's the definition of it? |
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Definition
| The patient is conscious, but does not fell pain; You'll find this in dental procedures |
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Term
| What Adverse reactions can happen during stage II anesthetics? |
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Definition
| Delirium and violent thrashing |
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Term
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Definition
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Term
| Why is Stage IV anesthetics bad? |
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Definition
| Medullary paralysis resulting in death |
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Term
| What's the Meyer-overton theroy |
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Definition
the more lipid soluble the drug the more potent it is
Anesthetics dissolve in the membrane and disrupt nervous conductance |
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Term
| What are the 4 problems w/ the Lipid theory |
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Definition
1. Neither anestheic induced expansion of the membrane or lipid fluidization cannot explain the effect of gernal anesthetics
2. Isomeric selectivity not explained
3. Site of action is the synapse not nervous conduction
4. Does not explain the specificity of general anesthetics to affect certain aspects of CNS function and not others |
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Term
| What is the Neurophysiologic theroy |
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Definition
| Synaptic transmission is more sensitive to anethetics in a area w/ a lot of synpases |
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Term
| General anasthetics enchance the opening of which neurotransmitters |
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Definition
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Term
| Which receptors do anasthetics target? |
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Definition
| NMDA receptors and Nicotinic Ach receptors |
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Term
| NMDA receptors are the target of _____ & _____ and inhibit _______ activity |
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Definition
Keramine and NO
glutamates |
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Term
| The site of action of GA III are |
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Definition
GABA: amnesia, hypnosis
Glycine: Immobility
Nicotinic: amensia |
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Term
| What is the effect of inhaled gas on the CVS |
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Definition
1. Decrease arterial blood pressure
2. Vary on effects of heart rate and CO |
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Term
| What's the effect of inhaled gases on the hepatic system? |
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Definition
| Depresses hepatic blood flow |
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Term
| What's the effect of GA on the respiratory system |
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Definition
1. Depresses respiration
2. Decrease in TV
3. Increase respiratory rate
4. Rate does not compensate for TV decrease |
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Term
| What effect on the kidney does GA have |
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Definition
| Depresses glomerular filtration and renal plasma flow |
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Term
| Which anesthtic can be used on uterine smooth muscles? |
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Definition
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Term
| Give the mechanism of action for NO |
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Definition
1. Causes release of endorphins in the CNS
2. Inhibits NMDA receptors
3. No activity on GABAA receptor |
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Term
| Where is NO metabolized? Is it the liver? Is it the lungs? |
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Definition
| It's excreted by the lungs and is not metabolized in the liver |
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Term
| How potent is NO? Why would you give it in combo w/ something? |
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Definition
| It has a low potency and you would give it in combo to reduce the MAC of the other GA to 40-60% |
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Term
| When would you use NO by itself? |
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Definition
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Term
| Would you use NO as a ICU sedative? |
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Definition
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Term
| Give the effects of NO on body systems |
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Definition
CVS: depresses
Pulmoonary: little effect
Liver & kidney: No effect
Skeletal: No effect
Uterus: relaxes |
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Term
| Why does NO cause short term hypoxia? How can this be avoided? |
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Definition
| It pulls oxygen w/ it, avoid by giving 100% oxygen after w/drawal |
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Term
| If NO interacts w/ bacteria in the gut, what does it cause? |
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Definition
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Term
| NO suppress ______ ______ after 24 infusion |
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Definition
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Term
| List the effects of NO abuse |
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Definition
1. Neuropathy resembing Vit B deficiency
2. Increases risk of abortion
3. Possible fetal malformation
4. Brain damage: Peripheral sensory neuropathy
5. Light headedness, dizziness, nausea |
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Term
| Halothene has the _____ solubility of current GA |
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Definition
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Term
| What kind of channels does Halothane act on? |
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Definition
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Term
| Halothane affects 3 types of receptors what are they? |
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Definition
| GABAA, glycine and inhibits nicotinic receptors |
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Term
| Halothane gets metabolized by |
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Definition
|
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Term
| Is halothane a good analgestic? |
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Definition
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Term
| In what age group would you use Halothane |
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Definition
| In children, it has a lack of odor and it's used in developing countries due to low cost |
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Term
| List the adverse effects of Halothane |
|
Definition
1. Hepatotoxicity leading to necrosis
2. Arrhythmias
3. Runaway temperature |
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Term
| Which receptors does Enflurane act on |
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Definition
| Acts on GABAA, Glycine and inhibits nicotinic receptors |
|
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Term
| what effect does Enflurane have on the heart |
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Definition
| Lower's the BP and depresses CO |
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Term
| What's the side effect of Enflurane |
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Definition
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Term
| What's the mechanism of action of Isoflurane? |
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Definition
| Acts on Glycine, GABAA and inhibits nicotinic receptors |
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Term
| What effect does Isoflurane have on the heart |
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Definition
Decrease BP and not CO
Increase HR |
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Term
| What is the most widely used inhalation anesthetic in the US |
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Definition
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Term
| What's the Mechanism of action of Desflurane? |
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Definition
| Acts on GABAA, Glycine receptors and inhibits nicotinic receptors |
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Term
| What's the effect of Desflurane on the heart |
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Definition
Decrease BP but not CO
Increase HR |
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Term
| What's the clinical uses for Desflurane |
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Definition
| Widely used, but not in mask induction |
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Term
| What's the adverse effect of Desflurane |
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Definition
1. Irritating to the airways
2. Can cause laryngospasm |
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Term
| Sevoflurane has the _____ solubility of all the liquids |
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Definition
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Term
| What's the metabolism of Sevoflurane |
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Definition
|
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Term
| What effect on the heart does Sevoflurane have? |
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Definition
| Decreases BP, CO and respiration |
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Term
| When is Sevoflurane used? |
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Definition
| Same day surgery and mask induction in children |
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Term
| What is the adverse effect of Servoflurane? |
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Definition
| Kidney toxicity due to interacting w/ soda lime of rebreathing apparatus |
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Term
| What are the advantages and disadvantages of IV agents? |
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Definition
Advantages are low cost and rapid onset of action
Disadvantages are it's harder to lower blood level |
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Term
|
Definition
| Thiopental and Methohexital |
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Term
| Thiopental and Methohexital is redistrubuted where? |
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Definition
|
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Term
| What is the MOA of thiopental and methohexital |
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Definition
Acts on GABAA and glycine receptors
Enchances agonist binding increasing the sensitivity of GABAA R to GABA |
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Term
| thiopental and methohexital can induce state ___ anesthesia |
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Definition
|
|
Term
| When are thiopental and Methohexital used? |
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Definition
|
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Term
| What are the side effects of thiopental and methohexital? |
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Definition
1. Decrease cerebral metabolism resulting in decrease cerebral blood flow and intracranial P
2. Causes hypotension due to vasodilation & slight depression of myocardial contractility |
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Term
| Compared to thiopental, propofol liver clearance is |
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Definition
|
|
Term
| What has the faster recovery time propofol or thiopentol |
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Definition
|
|
Term
| What's the MOA of propofol |
|
Definition
Acts on GABAA and glycine receptors
Enchances agonist binding and increases sensitivity of GABAA R to GABA |
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|
Term
| can propofol induce stage III? |
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Definition
|
|
Term
| What are the clinical uses of Propofol? |
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Definition
Induction of anesthesia and maintence
Same day surgeries |
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Term
| Propofol causes _____ grogginess than thiopentol |
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Definition
|
|
Term
| What are the adverse effect of propofol |
|
Definition
1. Decrease cerebral metabolism resulting in decrease cerebral blood flow and intracranial P
2. Causes hypotension due to vasodilation & slight depression of myocardial contractility |
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|
Term
| What are the pharmacokinetics of Etomidate and Ketamine? |
|
Definition
Acts on GABAA and glycine receptors
Enchances agonist binding and increases sensitivity of GABAA R to GABA |
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Term
| What's the MOA of Etomidate? |
|
Definition
|
|
Term
| What effect does etomidate have on the CVS? how about the respiratory system? |
|
Definition
|
|
Term
| When is Etomidate best suited for clinical |
|
Definition
| induction of patients w/ CAD or CVD |
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|
Term
| What are the side effects of Etomidate |
|
Definition
Pain at the site of injection
Myolconic movements
Increase in nausea and vomiting
Death due to suppression of adrenocorticosteriods |
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|
Term
| What's the MOA of keramine |
|
Definition
| Antagonist of NMDA class of glutamate receptors |
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|
Term
| What are some of the pharmacologic effects of ketamine |
|
Definition
| Produces Cataonia, amenesia and increaes SNS |
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|
Term
| When would you use Ketamine |
|
Definition
Pediatric patients
Patients at risk for hypotension and brochospams
Good for cardiac patients |
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|
Term
| What are the side effects of Ketamine |
|
Definition
Increases cerebral blood flow and increases intracranial pressure
Hallucinations |
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|
Term
|
Definition
| Midazolam, Diazepam and Lorazepam |
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|
Term
|
Definition
|
|
Term
| What's the MOA of benzodiazepines |
|
Definition
| Enhance GABAA receptor activity |
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|
Term
| are benzodiazepines true anesthesia? |
|
Definition
|
|
Term
| When would you use Benzodiazepines |
|
Definition
reduce anxiety
sedation
induce amnesia
reduce dose of other drugs |
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|
Term
| What are the side effects of Benzodiazepines |
|
Definition
| Depress respiration and BP |
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|
Term
| Opiods are the primary analgesic for |
|
Definition
|
|
Term
|
Definition
Morphine
Fentanyl
Alfentanil
Sufentanil
Remifentanil |
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|
Term
| Which of opiods has the longest duration of action? how about the shortest half life? |
|
Definition
|
|
Term
| Which opiod is the most potent? which is the least? |
|
Definition
|
|
Term
| Opiods are excellent analgesic, but not good at causing |
|
Definition
|
|
Term
| What are the clinical uses of opiods |
|
Definition
Adjuncts to reduce the amount of anesthetics required
Relieve pain experienced during and after surgery
Hgih doses can be used in cardiac surgery |
|
|
Term
| which opiod is used in short procedures |
|
Definition
|
|
Term
| What are the side effects of opiods |
|
Definition
Prolong respiratory depression causes stone chest
Nausea and vomiting
Can increase CO in patients w/ cardiac disease |
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