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13 Cards in this Set

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Inhaled Anesthetics- General Principals

1)Drugs must be ____ soluble to cross the _____

2)Drugs with decreased solubility in blood = ____ induction and ____ recovery time

3)Drugs with increased Lipid Solubility = ____ potency
1) Lipid, Blood-Brain Barrier

2)Rapid, rapid -- the drug doesn't need to be saturated in the blood before reaching the Brain, and it is easily excreted from lungs

3)Increased
Inhaled Anesthetics- Halothane, Enflurane, Isoflurane, Nitrous Oxide

1)MOA
2)Use
3)Toxicity
1) Unknown --> low solubility in blood allows for faster induction

2) Myocardial depression, respiratory depression, nausea, emesis, increased cerebral blood flow

3) Hepatotoxic (halothane), Nephrotoxic (methoxyflurane), Convulsions (enflurane)

Malignant Hyperthermia
Thiopental (Barbituate IV anesthetic)
1)MOA
2)Use
3)Toxicity
1) High Potency with High Lipid Solubility to cross BBB quickly and open GABA Cl- channels

2)Rapid induction of anesthesia, and for short procedures

3) Decreased Cerebral Blood Flow
Midazolam (Benzodiazepines IV anesthetic)

1)MOA
2)Use
3)Toxicity
1)Open GABA channel more frequently

2)Used in endoscopy and in conjunction with inhaled anesthetics

3)Post op resp depression, AMNESIA, and low BP
Ketamine
1)MOA
2)Use
3)Toxicity
1) PCP analog which acts as a dissociative anesthetic

2) rarely used for Anesthesia

3) Disorientation, hallucination, bad dreams, and increased ceebral blood flow
Opiates
Fentanyl and Morphine are given with anesthesia
Propofol
Used for rapid anesthesia induction because it has little post op nausea than Thiopental
Local Anesthetics
1)esters
2)Amides (have 2 i's in the name)
1)Procaine, Cocaine, tetracaine
2)lidocaine, mepivacaine,bupivicaine
Local Anesthetics
1)MOA
2)Principles
1) Block Na+ channels
Amides enter cell as uncharged form, then bind receptor as a charged form

2) In the affected acidic tissue, the anesthetic becomes charged and can't cross the membranes -->need to inject more

-Order of Blockade
Small diameter > Large Diameter and Unmyelinated > Myelinated

-Order of blockade (First on, Last off)
Pain>Temperature>Touch>Pressure

-Given with Epi to vasoconstrict to enhance localized action, and decrease bleeding
Local Anesthetics
1)Use
2)Toxicity
1) Minor Surgical Procedures, Spinal Anesthesia

2) If allergic to esters, use amides
CNS excitation, cardiotoxicity (bupivicaine), BP changes, Arrhythmias
Succinylcholine (Neuromuscular blockade)
1)MOA
2)Use
3) Reversal
1) Binds to ACh receptors in neuromuscular junction and it is much slower to release, so it causes less stimulation by ACh leading to paralysis (some initial fasiculation due to initial binding)

2)To keep a patient paralyzed during surgery

3)The patient can wake up with paralysis from the constant minor tone kept by Succinylcholine --> Treated with Cholinesterase Inhibitors (Neostigmine)
Nondepolzrizing Neuromuscular Block
All end in -ium (atraconium, mivacurium, etc)
1)MOA
2)Reversal
1)Competitive blockade of ACh receptors

2) reversed by cholinesterase inhibitors
Dantrolene
1)MOA
2)Use
1)Prevents Ca+ release from SR of skeletal muscle

2) Malignant Hyperthermia (inhaled anesthetics + succinylcholine), Neuroleptic Malignancy Syndrome (Antipsychotic side effect)