Anesthetics, Analgesics

Front 1

What is the significance of anesthetics with decreased solubility in blood?

Back 1

rapid induction and recovery times . Ie. N20

Front 2

What is the significance of anesthetics with increased solubility in lipids?

Back 2

increased potency = I/ MAC. Ie. Halothane

Front 3

Inhaled Anesthetics list them

Back 3

halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, nitrous oxide

Front 4

Inhaled Anesthetics What is good about lower solubility?

Back 4

the quicker the anesthetic response, and the quicker the recovery

Front 5

Inhaled Anesthetics What are these drug's effects?

Back 5

myocardial depression, respiratory depression, nausea/emesis, increase cerebral blood flow

Front 6

What toxicity mactches the following drugs 1. Halothane 2. Methoxyflurane 3. Enflurane 4. Rare

Back 6

1. Hepatotoxcity 2. Nephrotoxicty 3. Proconvulsant 4. Malignant hyperthermia

Front 7

What do barbituates, benzodiazepines, arylcyclohexylamines and narcotic analgesics have in common?

Back 7

they are IV anesthetics

Front 8

What the pharmacokinetics and uses of thiopental?

Back 8

high lipid solubility, rapid entry into brain. Used for induction of anesthesia for short surgical procedures. Terminated by redistribution from brain. Decreased cerebral blood flow

Front 9

Give an example of a benzo and what is this class's shortcoming?

Back 9

midazolam used for endoscopy. Used with gaseous anesthetics and narcotics. May cause severe post-op respiratory depressio and amnesia

Front 10

What does Ketamine (PCP analog and an arylcyclohexylamine) do?

Back 10

dissociative anesthetic. Cardiovascular stimulant. Causes disorientation, hallucination, bad dreams. Increases cerebral blood flow.

Front 11

How are narcotic analgesics used? Examples?

Back 11

Morphone and fentanyl are used with CNS depressant during general anesthesia.

Front 12

What is the advantage of propofol

Back 12

used for rapid anesthesia induction and short procedures. Less post-op nausea than thiopental

Front 13

Local anesthetics Name some esters?

Back 13

procaine, cocaine, tetracaine,

Front 14

Local anesthetics Name some amides?

Back 14

lidocaine, bupivacaine, (amides have two I's in name!)

Front 15

Local anesthetics What is the mechanism and clinical use?

Back 15

bind receptor and block Na channels. Tertiary amine local anesthetics penetrate membrane in uncharge form, then bind charged form. Use for minor surgical procedures, spinal anesthesia.

Front 16

Local anesthetics How do you decide to use ester or amides?

Back 16

if allergic to esters, give amides

Front 17

Local anesthetics what is the toxicity

Back 17

CNS excitation, severe cardiovascular toxicity (bupivacaine), hypertension, arrhythmias (cocaine)

Front 18

Local anesthetics In infected ________ tissue, anesthetics are charged and cannot penetrate membrane. Therefore, ______ anesthetics are needed.

Back 18

acidic; more

Front 19

Local anesthetics What is the order of nerve blockade for size and myelination? Which factor predominates?

Back 19

small diameter> large diameter. Myelinated fibers> unmyelinated fibers. Size factor predominates

Front 20

Local anesthetics what is the order of loss of sensation?

Back 20

pain first, then temp, then touch, then pressure

Front 21

Local anesthetics Why would you give these drugs with vasoconstrictors?

Back 21

to enhance local action

Front 22

Opiod analgesics List as many as you can.

Back 22

morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan

Front 23

Opiod analgesics Mechanism: They act as _____ for opiod receptors to modulate synaptic transmission

Back 23

agonists

Front 24

Opiod analgesics which drugs act at the mu, delta, kappa receptors?

Back 24

morphine enkephalin, dynorphin

Front 25

Opiod analgesics Clinical use?

Back 25

pain, cough supression (dex), diarrhea (loperamide), acute pulmonary edema, methadone maintenance programs

Front 26

Opiod analgesics What are the major toxicities?

Back 26

addiction, respiratory depression, constipation, miosis, additive CNS depression wth other drugs

Front 27

Opiod analgesics Tolerance does not develop to __________and ______

Back 27

miosis and constipation

Front 28

Opiod analgesics How would you treat toxicity?

Back 28

naloxone, naltrexone (opiod R antagonist)

Front 29

List three nonaspirin nonselective NSAIDS?

Back 29

ibuprofen, naproxen, indomethacin

Front 30

What is the mechanism of nonselective NSAIDs?

Back 30

reversibly inhibit COX 1 and 2. Blocks PG synthesis

Front 31

What are nonselective NSAID clinical use (3As)?

Back 31

Antipyretic, analgesic, anti-inflammatory. Indomethacin is used to close a PDA.

Front 32

What are common NSAID toxicities?

Back 32

renal damage, aplastic anemia, GI distress, ulcers

Front 33

Where is cox2 found?

Back 33

in inflammatory cells and mediates inflammation and pain

Front 34

Why is cox2 inhibition better than cox1?

Back 34

cox1 helps to maintain gastric mucosa, thus, should not have the corrosive effects of other NSAIDs on the GI lining (less incidence of ulcers and bleeding)

Front 35

Clinical Use of cox2 inhibitors?

Back 35

RA and osteoarthritis

Front 36

Acetaminophen What is its mechanism and where does it work?

Back 36

reversibly inhibits cox, mostly in CNS. Inactivated peripherally.

Front 37

Acetaminophen What are its 2 As?

Back 37

antipyretic, analgesic but NOT anti-inflammatory.

Front 38

Acetaminophen Overdose effects?

Back 38

hepatic necrosis, acetaminophen metabolites depletes glutathine and forms toxic tissue adducts in the liver