Anesthetic Pharmacology 1 Flashcards Preview

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Flashcards in Anesthetic Pharmacology 1 Deck (30)
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1
Q

GA
RA
MAC
SAC

A

General blocks normal nociception distal from site of injury

Regional at or near site of injury

Monitored anesthesia care - level that requires creful monitoring

Not considered anesthesia and can be administered by non-anesthesiologists in different setting (sedation/analgiesia)

2
Q

How anesthesia blocks
Motor reflexes
Pain and suffering
Autnomic reflexes

A

Akinesia
Analgesia and hypnosis
Autonomic stabilization

3
Q

Balanced anesthesia

A

Several different agents used to maximize benefits of each agent

4
Q

IV agents

A

Hypnotic/sedative
Opitates
Paralytics

5
Q

IV agent features

A

Lipid soluble that cross BBB

Rapid onset to reduce anxieety and slow delays

6
Q

Barbituates

A

Anhydrous sodium salts
Require reconstitution
pH>10
May precipitate qwith acidic

Accidental arterial injection results in thromboembolic complications

7
Q

Mech of action of Barbituates

A

GABA-A channel agonists

Activates CNS Cl- channels…results in enhancment of both inhibitory NT and inhibition of excitatory transmission

8
Q

Redistribtuion of barbitituates

A

Clinical effect terminated as moved from brain to lean tissues and fat

Hangover from slow elimination through metabolism

9
Q

Metab of barbituates

A

Hepatic
Metabolites inactive (exceted in bile and urine)
Affect by CYP inducers
Increase production of porphyrins…contraindicated in patients with acute intermittent porphyria

10
Q

Physio effects of barbituates

A

Rapid onset and awakening
May result in hypotension (vasodilation (Veno) and myocardial depression…blunts baroreceptor reflex but tachycardia will occur)
Significant resp depression (apnea common)
Decreased cerebral metabolic rate, CBF, and ICP

11
Q

Benzodiazepines

A

Not normally as IV anesthesia

Most common preop anxiolysis
Potent amnestic agents (Lorazepam will produce hsort term retorgrade…rest as anterograde)
Lipid soluble and protein bound (albumin)(accounts for rapid onset)

Redistributed

12
Q

Benzos used for anesthesiology and others

A

Midazolam
Lorazepam

Diazepam
Alprazolam
Oxazepam

13
Q

Mech of action benzos

A

GABA receptor activation (gamma subunit)

14
Q

Metab of benzos

A

Microsomal oxidation (midazolam and diazepam)

Glucuronide conjugation (lorazepam)

Diazepam oxidized to 2 major metabolites that may prolong effect

Midazolam into 1 inactive mtabolite

15
Q

Physio effects of benzos

A

Vraible onset

Mild to moderate hypotension (vasodilation (Veno) but minimal myocardial depression)

ignifanct resp depression (apnea common)

Decreased in CMRO2, CBF, and ICP are agent dependent

16
Q

Propofol

A

Agent of choice for IV anesthesia

Very rapid onset and rapid termination due to redistribtuion

May be used for general, MAC and sedation in OR, ICU or other procedral areas

17
Q

Propofol solubility

A

Insoluble in aqueous

Formulated as emulsion with soybean oil, glycerol, egg yokl lecithin

Some promote bacterial grwot

18
Q

Propofol mech

A

GABA activator in CNS

Terminated by redistribtuion
Very high plasma clearance explains lack of hangover compared to thiopental

Rapid hepatic metabolism to inactive metabolites that are excreted through kidney s

19
Q

Propofol physiologic and other effects

A

Hypotension (vasodilation, myocardial depression, blunting of baroreceptor, abolished reflexive tachycardia)

Significant resp depression (apnea requiring vewntilator)

Reduces CMRo2, CBF, and ICP

Pain on injection

No analgesic or anxiolytic effect

Reduces risk of PONV and can be used to tx PONV

20
Q

Etomidate

A

Hemodynamically stable

Rapid loss of consciousness
Little anxiolysis and no analgesia

Carboxylated imidazole that is insoluble

Supplied in propylene glycol mix

21
Q

Etomidate Mech

A

Rapid onset

Lipid soluble

GABA a chloride channel efect

Recovery dependent on redistribtuion

Metabolized via plasam ester hydrolysis to inactive metabolites excreted in urine and bile

22
Q

Physio effects of etomidate

A

CV stability after bolus

Moderate resp depression

23
Q

CNS effects of etomidate

A

Reduces CBF and CMRO2

Produce excitatory spikes on EEG

May activate pre-existing seizure foci

Spontaneous myoclonic activity

24
Q

Other effects of edomidate

A

Increase risk of PONV

Associated with pain

Associated with adrenocortical suppression (inhibtion of 11beta-hydroxylase needed to convert cholesterol to cortisol)

25
Q

Ketamine including mech

A

Dissociative anesthesia

Different from hypnosis

Brain remains active but disconnected from normal reality

Anatagosim of NMDA receptor

26
Q

KEtamine structure and metabolized

A

Partially H20 soluble and hihgly lipid soluble

Low protein binding

Terminated by redistribtuion

Metabolized by N-demethylation in the liver…active metabolite less potent and metabolized to inactive that are excreted in urine

27
Q

Clinical effects of ketamine

A

Patients do not fall asleep

Reflexes partially preserved (airway reflex response variable)

Eyes may remain open with nystagmus

Lacrimation and salivation

28
Q

Emergence reactions

A

Nightmares
Fear and confuusion

Less in children

29
Q

Clinical effects of ketamine

A

Increase CBF, CMRO2 and ICP

Contraindicated with intracranila pathology

Reduces risk of seizures and can be used to terminate status epilepticus

Myocardial depressant

Increased BP, HR, and CO (symp stimulation and NE surge from adrenals)

Not associated wiht resp depression (relaxes bronchial smooth muscle)

30
Q

4 components of anesteisa

A

Amensia, akinesia, analgesia, hypnosis