Term
| To Perform Surgery, a patient has to be... |
|
Definition
| analgesic, amnesic, unconscious, and relaxed (muscles). |
|
|
Term
| Types of Preanesthetic Medications that can be given. |
|
Definition
| Anticholinergics, antiemetics, antihistamines, barbiturates, benzodiazepines, opioids, muscle relaxants. |
|
|
Term
What is the role of the following anesthetics:
1. Anticholinergics
2. antiemetics
3. antihistamines
4. barbiturates
5. benzodiazepines
6.opiods
7. muscle relaxants |
|
Definition
1. prevent decrease in HR; dry lung.
2. prevent emesis
3. prevent allergic rxns
4. to sedate
5. decrease anxiety, px. amnesia
6. analgesics
7.decrease muscle tone, easier intubation |
|
|
Term
| General Inhaled Anesthetics |
|
Definition
| Halothane (Fluthane), Isoflurane (Forane) NaO |
|
|
Term
|
Definition
Barbituates: Thiopental
Benzo: Diazepam Doperidol, Propofol Diprivan |
|
|
Term
| General Neuro Anesthetics |
|
Definition
| Innovar>>Droperidol and Fentanyc |
|
|
Term
|
Definition
| Bupivacaine (Marcaine), Lidocaine (Xylocaine) Tetracaine (Supracaine) |
|
|
Term
| The cell membrane should expand to/by approx ____% to have anesthetic effect. This expansion causes ______ of ____ channels. Results in ______ because of lack of ________. |
|
Definition
1
closure
Na+
unconsciousness
depolarization |
|
|
Term
| Modulation of a Ligand-Gated Membrane Channel with NO ANESTHETIC PRESENT |
|
Definition
| GABA binds to receptor. Cl- channel then opens. Hyperpolarization occurs. Normal excited behavior present. |
|
|
Term
| Modulation of a Ligand-Gated Membrane Channel When an Anesthetic is Inhaled |
|
Definition
| Binding GABA is enhanced. It increases the energy of Cl- and reduces neural excitability (anesthesia begins to occur). |
|
|
Term
| Stage Depths of Anesthesia |
|
Definition
Stage 1: Analgesia
Stage 2: Excitement (inc. BP and resp)
Stage 3: Surgical Anesthesia
Stage 4: Medullary Paralysis |
|
|
Term
| To avoid the dangerous Stage II of anesthesia, what can be given? |
|
Definition
|
|
Term
|
Definition
| Minimal Alveolar Concentration |
|
|
Term
|
Definition
Concentration of anesthetic needed to eliminate movement among 50% of patients challenged by skin incision.
This value decreases with increasing potency and lipid solubility. |
|
|
Term
| How Does Excessive uses of NO result in Spine Damage? |
|
Definition
| It deprives the body of Vitamin B12 |
|
|
Term
| When is a steady state achieved? |
|
Definition
| When the partial pressure of an anesthetic gas in compartments of the body (alveolar space, blood) is equivalent to the amount inhaled. |
|
|
Term
| Alveolar Wash-Up Is directly proportional to? Indirectly Proportional? |
|
Definition
Directly: functional resudual capacity of lung
Inversely: ventilatory rate |
|
|
Term
|
Definition
| The product of gas solubility in the blood, cardiac output, and the anesthetic gradient b/n alveolar and venous partial pressure gradients. |
|
|
Term
| Low Solubility of an Anesthetic Gas results in... |
|
Definition
| Faster induction and recovery time b/c less is needed to reach a steady state. |
|
|
Term
| These organs reach a steady-state in the most rapid time. |
|
Definition
| Brain, heart, liver, kidney, endocrine glands |
|
|
Term
| Inhaled Anesthetics Block the following: |
|
Definition
| Excitatory Postsynaptic Current of Nicotinic Receptors |
|
|
Term
| Therapeutic Uses of Halothane |
|
Definition
| Usually coadministered with NO, Opioids or locals. Relaxes skeletal and uterine muscle. Not hepatoxic in pediatric patients, but can be in adults. SUITABLE FOR CHILDREN! |
|
|
Term
| Pharmacokinetics of Halothane |
|
Definition
| Oxidatively metabolized in body by hydrocarbons. Not to be repeated at intervals of less than 2-3 weeks. |
|
|
Term
| Cardiac SAE'S of Halothane |
|
Definition
| Atropine-Sensitive Bradycardia. Arrhythmias. Concentration-dependent Hypotension. |
|
|
Term
|
Definition
| A toxic rxn, esp. in females is possible, though rare. Fever v+, anorexia, hepatitis. |
|
|
Term
| Malignant Hyperthermia and Halothane |
|
Definition
| Is possible b/c this is a hydrocarbon anesthetic. Due to an excitation-contraction coupling effect with an increase in Ca+ ion concentration (myoplasmic) |
|
|
Term
| Pharmacokinetics of Enflurane |
|
Definition
| Metabolized to a fluoride ion, which is excreted in the kidney. |
|
|
Term
|
Definition
| Causes CNS excitation. DON'T USE WITH SEIZURE PATIENTS |
|
|
Term
| Pharmacokinetics of Isoflurane |
|
Definition
| very stable molecule that undergoes little metabolism. Widely used. |
|
|
Term
|
Definition
| produces concentration-dependent hypotension, dilation of coronary vasculature. myocardium blood flow increases. |
|
|
Term
| Pharmacokinetics of Desflurane |
|
Definition
| low volatility and must be delivered via vaporizer. Great for outpatient SX |
|
|
Term
|
Definition
| laryngospasm, coughing, excessive secretions. |
|
|
Term
| Pharmacokinetics of Sevoflurane |
|
Definition
| low solubility in blood, rapidly taken up. Metabolized in liver and may be nephrotoxic. |
|
|
Term
| Pharmacokinetics of Nitrous Oxide |
|
Definition
| poorly soluble in blood and other tissues, allowing it to move rapidly. |
|
|
Term
|
Definition
| "second gas effect"--pneumothorax. Diffusion hypoxia. |
|
|
Term
| If malignant hypothermia occurs with Halothane, the drug of choice to treat it is... |
|
Definition
|
|
Term
| A good drug to pair with NO to produce anesthesia is... |
|
Definition
|
|
Term
| Thiopental Pharmacokinetics |
|
Definition
| Weak analgesic, potent anesthetic. Minor effects on the CV system. Hypotension poss w/shock patients. Barbiturate. |
|
|
Term
|
Definition
| Severe Hypotension with patient's in shock. Apnea, cough, chest wall spasm, laryngospasm, bronchospasm. |
|
|
Term
| Most common benzodiazepines that are used in conjunction with anesthetics |
|
Definition
| midazolam, diazepam, lorazepam |
|
|
Term
| Common opiods used during SX: |
|
Definition
| Morphine, fentanyl, sufentanil. |
|
|
Term
|
Definition
| hypotension, respiratory depression, muscle rigidity, postanesthetic v+ and nausea |
|
|
Term
| Pharmacokinetics of Etomidate |
|
Definition
| hypnotic anesthetic that lacks analgesic activity. Used with cardiac patients |
|
|
Term
|
Definition
| decrease in plasma cortisol and aldosterone levels, inhibition of 11-Beta-hydroxylase. |
|
|
Term
| Pharmacokinetics of Propofol |
|
Definition
| sedative/hypnotic drug. Supplemented with narcotics. |
|
|
Term
|
Definition
| muscle twitching, spontaneous movement, hiccups. decreases blood pressure and intacranial pressure. Euphoria!! |
|
|
Term
| Pharmacokinetics of Ketamine |
|
Definition
| interacts with N-methyl-D-aspartate receptors. metabolized in liver. used in children and young adults, short procedures. |
|
|
Term
|
Definition
| stimulation of heart and increase blood pressure and cardiac output. |
|
|
Term
| Areas where locan anesthetics act upon |
|
Definition
| small, unmyelinated nerve fibers |
|
|
Term
| this is added to a drug regimen when giving local anesthetics allowing the anesthetic to act longer |
|
Definition
|
|
Term
| SAE'S of Local Anesthetics |
|
Definition
| seizures, cardiovascular collapse. cardiotoxicity. Allergic reactions. |
|
|
Term
| Drugs you can use to treat Alcohol withdrawal symptoms |
|
Definition
1. Benzodiazepines: Diazepad (Valium)Chlordiazepoxide--decrease anxiety (Librium)
2.Phenothiazines--decrease psychosis. Chlorpromazine
3.Antiepileptic Drugs: Phenytoin |
|
|
Term
| Drugs used to treat Alcoholism |
|
Definition
| Disulfiram (Antabuse) and Naltrexone |
|
|
Term
| Give some diseases/disorders common with those that ingest large quantities of ethanol |
|
Definition
| Metabolic acidosis, hyperuricemia, fatty liver, hypoglycemia. |
|
|
Term
|
Definition
| Common with ethanol consumption. Increases px of NADH converts pyruvate to lactate. Too much conversion leads to this condition. |
|
|
Term
|
Definition
| When NADH transforms pyruvate to lactate, it competes with uric acid for excreation and decreases it. Uric acid builds up causing this condition (gout). |
|
|
Term
|
Definition
| An increase in NADH and an increase in glycerol-3 phospate and triglycerides causes an increase in triglycerides. Acetate->ACoA->FA |
|
|
Term
| Hypoglycemia and ethanol use |
|
Definition
| Caused by an increase in NADH, which decreases pyruvate amounts needed for gluconeogenesis. |
|
|
Term
| Hepatonecrosis and Ethanol Usages |
|
Definition
| Brough on by an increase in mitochondrial metabolism in the liver. NADH reoxidation is increased with an increase in 02 consumption. Risk of hypoxia occurs leading to necrosis. |
|
|
Term
| How Moderate Levels of Ethanol are Good for your Health |
|
Definition
| It increases good cholesterol (HDL) that protects against atheroma formation. Also decreases platelet aggregation. |
|
|
Term
| Example of why ethanol may be given (besides for recreational use) |
|
Definition
| Given topically, orally, or IV for poison management. |
|
|
Term
| What are the best absorption places for ethanol |
|
Definition
| stomach and especially small intestine via passive diffusion. Presence of food slows process. |
|
|
Term
|
Definition
| via liver. Metabolized to >90% CO2 and H20. Excreted in air, urine, milk, sweat. |
|
|
Term
| Rate of Metabolism for Ethanol |
|
Definition
| 100mg/kg/hr. Zero Order Kinetics |
|
|
Term
|
Definition
| Distrubutes into total body water (men=68% women=55%) |
|
|
Term
|
Definition
| If the body contains more than 70% ethanol in the membranes--bactericidal. |
|
|
Term
| Concentraion of Ethanol in Cell Membranes |
|
Definition
| If there is a 1% concentraion in cell membranes, it works similar to general anesthesia. |
|
|
Term
| How an overdose in ethanol can cause death |
|
Definition
| Too much in the membranes is like an overdose of anesthesia. Transport of Na+ and K+ and AA's are impaired, stopping conduction. |
|
|
Term
|
Definition
| drug given to alcoholics who want to stop drinking. Naltroxene can decrease the pleasurable effects produces by alcohol. |
|
|
Term
| Nutritonal Problems caused by Alcoholism |
|
Definition
| Peripheral Neuritis and/or malnutrition |
|
|
Term
| Effects of Ethanol on Thermoregulatory Center |
|
Definition
| cutaneous vasodilation--> heat loss, dec. arteriolar resistance and tachycardia. |
|
|
Term
| Effects of ethanol on the hypothalamus |
|
Definition
| causes an increase in gastric acid secretion, increasing intestinal motility. |
|
|
Term
| Effects of Ethanol on the Medulla |
|
Definition
| a toxic level can lead to peripheral collapse and respiratory depression. Ethanol has an inhibitory effect. |
|
|
Term
| This drug reverses alcoholic coma |
|
Definition
|
|
Term
| 1st Stage Withdrawal Effects |
|
Definition
| Hyperirritability, exaggerated reflexes, sleeplessness, tremor, muscular tension, thirst. |
|
|
Term
| A shot of whiskey is equivalent to what? Which is equivalent to what? |
|
Definition
| a glass of wine and a 12 oz beer |
|
|
Term
| Methanol is broken into what and by what? |
|
Definition
| It is broken into formaldehyde and then to formic acid. Catalyzed by dehydrogenase and/or catalase. |
|
|
Term
| What is formic acid toxic to? |
|
Definition
|
|
Term
|
Definition
| IV Na Bicarbonate or give ethanol before methanol is oxidized.n |
|
|
Term
|
Definition
| new drug used to treat methanol and ethylene glycol poisoning. It inhibits alcohol dehydrogenase |
|
|
Term
| What metabolizes ethanol into acetylaldehyde? |
|
Definition
| DH and Microsomal Ethanol Oxidizing System in the liver. |
|
|
Term
|
Definition
| Inhibits acetylaldehyde DH activity. |
|
|
Term
| You should not drink if you are on these types of drugs: |
|
Definition
| Benzodiazepines, phenothiazines, barbiturates, and many other drugs. |
|
|
Term
|
Definition
| Psychosis associated with delusions, hallucinations, disurbances of thinking or speech, associated with an increase in the CNS dopamine activity (1% population) |
|
|
Term
| Neuroleptic drugs produces antipsychotic effects by blocking what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| involved in the inhibition of adenyl cyclase |
|
|
Term
|
Definition
|
|
Term
| Current antipsychotic drugs work on what receptors: |
|
Definition
| Both dopaminergic as well as serotonin. |
|
|
Term
| Clozapine has a high affinity for what receptors? |
|
Definition
| D1,2, and 4, also 5-HT2, muscarinic, and alpha adrenergic receptors as well as dopamine D2 receptor antagonist. Minimal ability to cause extrapyramidal side effects. |
|
|
Term
| Risperidone blocks what receptors? |
|
Definition
| 5-HT2 receptors to a greater extent than D2 receptors. |
|
|
Term
| Some SAE's of Antipsychotic drugs |
|
Definition
| dystonia, akathisia, Parkinsonian syndrome, tardive dyskinesia. |
|
|
Term
| These medications are good for nausea due to vertigo |
|
Definition
| Meclizine and Dimenhydramine |
|
|
Term
| Medications used for nausea due to motion sickness: |
|
Definition
| scopolamine and promethazine |
|
|
Term
| These drugs are good for the treatment of nausea due to chemotherapy |
|
Definition
| domperidone, haloperidol, metoclopramide, prochloperazine |
|
|
Term
| Drugs used to treat nausea due to radiation therapy |
|
Definition
| thiethylperazine and domperidone |
|
|
Term
| The neuroleptics cause anticholinergic effects. |
|
Definition
| Thioridazine, Chlorpromazine, Clozapine, Olanzapine |
|
|
Term
| Anticholinergic effects caused by the drugs: thioridazine, chlorpromazine, clozapine and olanzapine |
|
Definition
| blurred vision, dry mouth, sedation, confusion, inhibition of GI and urinary tract. |
|
|
Term
|
Definition
| Site of paranoia and hallucinations |
|
|
Term
|
Definition
| visual activity impairment (center of reading, images and emotions) |
|
|
Term
|
Definition
| site of auditory hallucinations with schizophrenic patients |
|
|
Term
|
Definition
| learning and memory center of brain. impaired with schizophrenic patients |
|
|
Term
|
Definition
| invovled in emotions, site of agitation for schizo. patients |
|
|
Term
| Advese effects often seen with individuals treated with neuroleptic drugs |
|
Definition
| Tremors, postural hypotension, constipation, urinary retention, confusion, sexual dysfunction |
|
|
Term
| Neuroleptic Drugs that bind to Cholinergic (muscarinic) receptor |
|
Definition
| Thioridazine, chlorpromazine |
|
|
Term
| Neuroleptic Drugs that bind to alpha-adrenergic receptors that can cause orthostatic hypotension |
|
Definition
|
|
Term
| Neuroleptic drugs that bind to dopamine receptors causing a parkinsoniam reaction |
|
Definition
| All drugs, but particularly haloperidol, fluphenazine, thiothixene |
|
|
Term
| Neuroleptic drugs that bind to serotonin receptors |
|
Definition
| Risperidone, clozapine, aripiprazole, olanzapine, quetiapine |
|
|
Term
| These neuroleptic drugs bind to H1 histamine receptors causing sedation |
|
Definition
| promethazine and chlorpromazine |
|
|
Term
| To help balance out SAE's of Neuroleptic Drugs, this drug can be given |
|
Definition
| Benztropine. an anticholinergic drug |
|
|
Term
|
Definition
| "fly catching" that occurs with long term treatment with neuroleptic drugs. Motor disorder. Irreversible |
|
|
Term
| Neuroleptic Malignant Syndrome |
|
Definition
| Rxn to neuroleptic drugs. Symptoms include muscle rigidity, fever, stupor, unstable BP and myoglobinemia. Tx includes D/C meds and supportive therapy. |
|
|
Term
| Meds that can be used for therapy of Neuroleptic Malignant Syndrome |
|
Definition
| Dantrolene, bromocriptine |
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|
