Term
| What are the IV agents used for Induction? |
|
Definition
Thiopental
Propofol
Etomidate |
|
|
Term
| What is Balanced Anesthesia? |
|
Definition
Using multiple drugs instead of just one to:
Relieve Anxiety
Prevent Secretions
Induce unconsciousness
Relax Muscles |
|
|
Term
| What is a problem with formulation of IV anesthetics? |
|
Definition
| Being highly lipophilic makes it hard for them to be in solution |
|
|
Term
| What are some side effects of the the formulation problems of IV agents? |
|
Definition
Thrombophlebitis
Concentration and speed sensitive |
|
|
Term
| What IV agent is formuated with pH adjustment to be in solution? |
|
Definition
Thiopental
(Induction agent)
|
|
|
Term
| What IV agent is formulated with Propylene to be in solution? |
|
Definition
Etomidate
(induction agent)
|
|
|
Term
| Which IV agents reinforce the inhibitory effects of GABA? |
|
Definition
Barbiturates (Thiopental)
Benzodiazepines
Etomidate
Propofol |
|
|
Term
| Which agent acts like GABA in high concentrations? |
|
Definition
|
|
Term
| What agents block Glutamate from binding to the NMDA receptor? |
|
Definition
|
|
Term
| What actions does Propofol have? |
|
Definition
Reinforce inhibitory effect of GABA
Act like GABA in high concentrations
Inhibit simulatory actions of Glutamate by blocking NMDA receptor |
|
|
Term
|
Definition
| Binds within the Na/Ca ion channel on the NMDA receptor - inhibits glutamatergic signaling |
|
|
Term
| How does Propofol affect cortical simulation? |
|
Definition
| Propofol binding stimulates GABAergic inhibitory interneurons synapsing on pyramidal neurons to attenuate excitatory inputs from ascending arousal pathways. |
|
|
Term
| What Cortical Pathways does propofol inhibit? |
|
Definition
MOA pathways
Cholinergic Pathways
Lateral Hypothalamic neurons |
|
|
Term
| What drug prolongs binding of GABA to receptor? |
|
Definition
|
|
Term
| What drugs cause an allosteric change in the GABA receptor activity? |
|
Definition
Benzodiazepines
(Diazepam, Lorazepam)
|
|
|
Term
| What do both Barbiturates and Benzodiazepines require for their action? |
|
Definition
|
|
Term
| Without addition of alcohol, which drugs have a ceiling at medullary depression on CNS effects? |
|
Definition
|
|
Term
| Why is the use of Barbiturates limited? |
|
Definition
| Because of its Toxic profile, Binds to the receptor for much longer time, can cause coma |
|
|
Term
| Why after about 15 minutes, does a patient regain consciousness if more anesthetic is not administered? |
|
Definition
Redistribution to other organs
Brain --> Skeletal muscle and Skin |
|
|
Term
| Does a long elimination half life correspond to a long duration of clinical action? |
|
Definition
| No, Highly lipid soluble drugs undergo rapid redistribution from their main site of action to non-active sites |
|
|
Term
| What three things influence half-lives and durations of action for IV anasthetics? |
|
Definition
Rate of redistribution
Amount of drug accumulated in fat
Drug's metabolic rate |
|
|
Term
| What drugs half lives increase dramatically with increased duration? |
|
Definition
|
|
Term
| What IV agent has an increased effect on cerebral blood flow? |
|
Definition
|
|
Term
| What agent has no effect on cerebral oxygen consumption? |
|
Definition
|
|
Term
| What agent increases intracranial pressure? |
|
Definition
|
|
Term
| What agent has no effect on Mean Arterial Pressure, HR, or CO? |
|
Definition
|
|
Term
| What agents have a significant affect on HR? |
|
Definition
Ketamine
(and Thiopental and Propofol to a lesser degree) |
|
|
Term
| What agent has No effect on Respiration and Minute Volume? |
|
Definition
|
|
Term
| What agent has the most significant decrease in Minute Volume? |
|
Definition
|
|
Term
| What 3 agents have a very significant decrease in cerebral blood flow, cerebral oxygen consumption, and intracranial pressure? |
|
Definition
Thiopental, Etomidate, Propofol
(all induction agents) |
|
|
Term
| What agent worsens Porphyria and can change the pharmocokinetic profile of concurrent drugs? |
|
Definition
|
|
Term
| What is propofol useful for and what is a problem with it? |
|
Definition
Useful - Antiemetic
Can cause Propofol infusion syndrome
Killed Michael Jackson - The King of Pop |
|
|
Term
| Why is Etomidate not used in the ICU? |
|
Definition
Inhibition of steriodogenesis
(inhibits production of cortisol) |
|
|
Term
| What are some useful properties of Ketamine? |
|
Definition
Analgesic
Intact pharyngeal or laryngeal reflexes
Bronchodilator for refractory asthma |
|
|
Term
| What is a problem with Ketamine and how can it be treated? |
|
Definition
Hallucinations with emergence
treated with benzodiazepines |
|
|
Term
| What is the Dissociated state that Ketamine can produce? |
|
Definition
| eyes open but unconscious and pain-free |
|
|
Term
| What happens in Propofol infusion syndrome? |
|
Definition
Iatrogenic Disease:
Metabolic acidosis, Rhabdomyolysis of skeletal and cardiac muscle, Arrhythmias, Myocardial failure, Renal Failure, Hepatomegaly |
|
|
Term
| What are the risk factors for Propofol Infusion Syndrome? |
|
Definition
Poor oxygen delivery
Sepsis
Serious cerebral injury
high propofol dosage |
|
|
Term
| What are the Benzodiazepines use for IV Anesthesia? |
|
Definition
|
|
Term
| When are Benzodiazepines useful? |
|
Definition
| When no analgesia is required |
|
|
Term
| What benzodiazepine has the longest half life? |
|
Definition
|
|
Term
| What Benzodiazepine has 3 active metabolites? |
|
Definition
|
|
Term
| How is Lorazepam eliminated? |
|
Definition
| Its metabolite is conjugated |
|
|
Term
| Why is there minimal change in the CV system with benzodiazepines? |
|
Definition
Immediate reflex response
- Mobilization of blood from periphery
-Increased HR and myocardial contractility
(Minimal decreasing effects on venous return, myocardial contractility, and CO) |
|
|
Term
| What is the biggest issue of using opioids for surgery? |
|
Definition
| Dose-Dependent respiratory depression |
|
|
Term
| What are all the issues of using opioids during surgery? |
|
Definition
Respiratory Depression
"wooden chest" syndrome
Increased intracranial bloodflow and pressure
nausea, vomiting, constipation, miosis
Overdose triad |
|
|
Term
| What are five signs of Malignant Hyperthermia? |
|
Definition
Increase in End Tidal CO2
Total body rigidity
Tachycardia, tachypnea
Respiratory and metabolic acidosis
Cardiac arrest |
|
|
Term
| Who is at risk for Malignant Hyperthermia? |
|
Definition
Geneticall suseptible individuals
Mostly - young males with undiagnosed myopathy (50% mortality) |
|
|
Term
| What is the mechanism of Malignant Hyperthermia? |
|
Definition
| Intracellular calcium release from sarcoplasmic reticulum |
|
|
Term
| What are the triggers of Malignant Hyperthermia? |
|
Definition
Succinylcholine
All volatile anesthetic agents (including desflurance, sevoflurane) |
|
|
Term
| How is Malignant Hyperthermia Treated? |
|
Definition
Dantrolene
Stop trigger agent, hyperventilate with O2
avoid calcium channel blockers
Correct hyperkalemia and acidosis
Cool core temperature |
|
|
