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82 Cards in this Set
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- Back
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What are the 2 ways for CNS drugs to get in there?
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1. Lipid soluble drugs are able to diffuse across the BBB
2. Active trasport |
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What is the feature of drugs with low blood solubility?
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Rapid induction and recovery
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What is the feature of drugs with high blood solubility?
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Slow induction and recovery
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What is the feature of drugs with low lipid solubility?
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Low potency = high Km
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What is the feature of drugs with high lipid solubility?
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High potency = low Km
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How does solubility relate to MAC
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The degree of lipid solubility is inversely proportional to MAC
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What is MAC
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Minimal alveolar concentration at which 1/2 the population is anesthatized
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What is a patient factor that changes MAC?
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Age
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Characterize N2 in terms of solubility
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Low blood solubility = fast induction
Low lipid solubilty = low potency |
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Characterize halothane in terms of solubility
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High blood solubility = slow induction
High lipid solubility = high potency |
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Why does high blood solubility lead to slow induction?
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If a drug is highly blood soluble, then you need to spend more time to saturate the blood
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How does tissue solublility factor into anesthetic kinetics?
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High tissue solubilty means there will be a high AV concentration gradient
This means that, as with high blood solubility, more time is taken to saturate = slow induction |
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How can lung function be altered to change anesthetic kinetics?
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Increased rate and depth of ventilation increases the gas concentration in the alveoli
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Inhaled anesthetics: what is the common suffix
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"-flurane"
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Inhaled anesthetics: what is one that doesn't have the common suffix?
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N20
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Inhaled anesthetics: mechanism
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unknown
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Inhaled anesthetics: what are some effects (4)
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1. Respiratory depression
2. Myocardial depression 3. N&V 4. Increased cerebral blood flow |
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Inhaled anesthetics: why does cerebral blood flow increase?
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Due to decreased CNS metabolic demand
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Which anesthetic decreases cerebral blood flow?
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Thiopental is an IV barb which decreases cerebral blood flow
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What is the toxicity of halothane
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H for hepatotoxic
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What is the toxicity of methoxyflurane
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Meth for nephrotoxic
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What is the toxicity of enflurane
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E for epileptic (it decreases seizure threshold)
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What anesthetic drug combo increases the risk for malignant hyperthermia?
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Succinyl choline + halothane
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What is a toxicity of N20?
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expansion of trapped gas
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Thiopental: what class of drugs
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Barbituriate
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Thiopental: characterize solubility
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Low blood and high lipid solubility = fast onset with high potency
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Thiopental: use (2)
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Anesthesia induction
Short surgical proceedures |
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Thiopental: how is the effect terminated
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Rapid redistribution into fat and tissues
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Thiopental: cerebral blood flow
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Decreases cerebral blood flow
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Midazolam: what type of drug
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benzo
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Midazolam: what's the brand name
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versed
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Midazolam: what is commonly used for (2)
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1. Most common drug used in endoscopy
2. As an adjuct with inhaled anesthetics |
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Midazolam: what are the toxicities (3)
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1. Amnesia - a good thing
2. Decreased BP 3. Post-operative respiratory depression |
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Midazolam: how is OD treated?
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Flumazenil
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Ketamine: what type of drug
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Aryl-cyclo-hexyl-amine
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Ketamine: what street drug is it related to
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PCP
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Ketamine: what is the effect
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Dissociative
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Ketamine: what is the mechanism
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Blocakge of NDMA receptors
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Ketamine: what organ is stimulated
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the heart
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Ketamine: what are the psychological effects
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Disorientation, hallucinations, and bad dreams
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Ketamine: what happens to cerebral blood flow?
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Increased cerebral blood flow
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Opiates: which are used for anesthesia and how?
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Morphine and fentanyl are used with other CNS depressants during general anesthesia
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Propofol: what is the use
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Rapid induction of anesthesia and short procedures
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Propofol: To what is preferred and why
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Preferred to thiopental because it has less postoperative nausea
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Propofol: mechanism
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Potentiates GABA
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Propofol: why is it white and what can this mean?
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White because of high glyceride content which means that there is an increased risk of pancreatitis
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What is the common suffix for the local anesthetics?
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"-caine"
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How do you tell if a drug is a amide or an ester?
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Esters have 1 "i" and amides have 2 "i"
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Local anesthetics: mechanism
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block Na+ channels by binding to specific receptors on the inner aspect of the channel
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Local anesthetics: to which channel to they preferentially bind and what does this mean?
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Activated Na+ channels which means they are more effective on rapidly firing neurons
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Local anesthetics: what is the deal with tertiary amine forms?
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They penetrate the membrane in the uncharged form and then bind to ion channels in the charged form
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Local anesthetics: are they acidic or alkaline?
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alkaline
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Local anesthetics: what is the deal with infected tissue?
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Incfected tissue is acidic which means that alkaline anesthetics become charged and cannot penetrate the membrane effectively. This means more drug is needed
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Local anesthetics: what is the order of nerve blockage and what does this mean?
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1. Small fibers faster than large ones (more dominant effect)
2. Myelinated fibers faster than unmyelinated ones 3. All small fibers are knocked out before any large ones are. 4. Result: Pain is gone first, then temp, touch, pressure goes last. |
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Local anesthetics: with what drug are they usually given and why?
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Vasoconstrictors, usually epinephrine
1. Decrease bleeding 2. Keep the drug local |
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Local anesthetics: which one is not given with a vasoconstrictor
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cocaine
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Local anesthetics: what abx is not given with these drugs?
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Esters are metabolized into PABA and so patients take sulfonamide abx should not get esters because the abx effectivity is reduced
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Local anesthetics: to which type do people tend to be allergic and what is the alternative.
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People tend to be allergic to esters and so you would give these patients an amide instead
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Local anesthetics: use?
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1. Minor surgical procedures
2. Spinal anesthesia |
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Local anesthetics: toxicities?
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1. CNS excitation
2. alterations in BP |
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Local anesthetics: which one is cardiotoxic
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Bupivicaine
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Local anesthetics: which one is arryhtogenic
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Cocaine
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Paralytics: to which receptors are these specifcic
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The NMJ nicotinic Ach receptor
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Paralytics: use
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paralyis during intubation, ventilation and surgery
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Paralytics: what are the 2 major types
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Depolarizing and non-depolarizing
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Paralytics: what is the only depolarizing drug
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Succinylcholine
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Succinylcholine: what are the toxicities?
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1. Hypercalcemia
2. Hyperkalemia |
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Succinylcholine: describe Phase 1
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Prolonged depolarization
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Succinylcholine: what is the antidote during phase 1
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there is none
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Succinylcholine: what potentiates phase 1
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AchEI
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Succinylcholine: describe phase 2
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repolarized but blocked
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Succinylcholine: what is the antidote during phase 2
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AchEI - neostigmine is choice
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Non-depolarizing: what is the common suffix?
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"-urium" or "-onium"
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Non-depolarizing: which 2 have the shortest 1/2 life?
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vecuronium and rocuronium
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Non-depolarizing: what is the toxicity of tubocuraine
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histamine release which can lead to BP drops
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Non-depolarizing: what is the mechanism
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competitive blockade of Ach NMJ receptors
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Non-depolarizing: what is the antidote
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AchEI - neostigmine is choice
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Dantrolene: what are the 2 uses
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1. Neuroleptic malignant syndrome
2. Malignant hyperthermia |
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What is malignant hyperthermia?
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An AD genetic condition of gene RYR1 which codes for skeletal muscle ryanodine receptors
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Dantrolene: what causes MH?
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Succinyl choline + halothane (or another -ane)
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Dantrolene: which gas does not cuase MH?
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N20
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Dantrolene: mechanism
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prevents Ca2+ release from SR of skeletal muscle
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