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203 Cards in this Set
- Front
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gen anes:
a global but ----- depression of cns fx leading to the loss of response to and preception of all --- ---- |
reversible
external stimuli |
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gen anes:
a collection of ----- changes in behavior and --- |
component
perception |
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gen anes:
causes |
amnesia
immobility attenuation of autonomic responses analgesia unconsciousness |
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amnesia: loss of ---- during the procedure
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memory
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immobility: loss of --- to -- stimuli
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response
noxious |
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attentuation of ---- responses: to noxious stimuli
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autonomic
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analgesia: loss or --- of sensation of --
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alleviation
pain |
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unconscousness: unaware of --- and one's ----
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oneself
environment |
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general somatic afferent neurons sense:
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pain
touch temp (widely distributed) |
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special somatic afferent neurons sense
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position and movement
(in muscles, tendons, joints) |
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general visceral afferent neurons sense
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fullness
discomfort |
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3rd order neurons
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thalamus to sensory cortex
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2nd order neurons:
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varous reflex circuits to thalamus
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1st order neurons
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sensory receptors in periphery to dorsal horn neuron in spinal cord
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nerve ending has
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mechanoreceptor: touch, temp change
norciceptors: pain |
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the ability to discriminate the location of stimulus
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stimulus discrimination
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stimulus discrimination determined by difference in threshold for firing of different -- ----- in different --- upon receptor activation
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afferent neurons
locations |
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tactile sensation:
--- ---- ---- |
touch
pressure vibration |
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t/f
tactile has fast/slow conductance |
fast
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thermal sensation:
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cold
warmth pain |
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thermal sensation:
fast/slow conductance |
slow
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which will you feel first:
thermal or tactile |
tactile
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position sensation: sense of -- and --- --- and --- w/out vision
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limb
body movement position |
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position sensation mediated by
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proprioceptive receptors in muscle, joints and tendons
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nociceptive pain due to --- or impending -- ---
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acutal
tissue injury |
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neuropathic pain: a result of -- injury to ----
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direct
nerves |
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aucte pain involves -- response that include increased --- ---, --- ----
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autonomic
heart rate bp musle tension |
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visceral and somatic is -- pain
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nociceptive
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nonnociceptive pain is --- pain
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neuropathic
sympathetic pain. . . fx or soft tissure injury |
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inhalation anesthetics
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ether
nitrous oxide halothane |
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iv antesthetics
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barbiturates
ketamine propofol |
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cellular mech of anethesia
--polarizationof neurons |
hyperpolarization (post synaptic)
neurons (inhalation anest) |
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hyperpolar reduces the excitability of ---synaptic neurons and hence makeing the neurons nonresponseive to nt released from ----
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postsynaptic
presynaptic |
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effect on synaptic transmission
inhalation: inhibt -- synapses and enchance inhibitory synapses action on --- neurons |
excitatory
action on both pre and post synaptic neurons |
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effect on synaptic transmission
iv: act primarily on ---- neurons most of them enchance --- neutroransmission --- inhibits excitory glutamatergic neurotransmission |
post synaptic
inhibitory ketamine |
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most inhalation and iv anesthetics inteact w/ --- receptor
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GABAa
increase inhibitory gabanergic neurotransmission and depressing the cns |
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t/f
inhal and iv compete w. gaba binding |
f
they interact w/ B subunits suppress all components of anesthesia |
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most inhal and some iv enchance glycine gated ---- channel increasing the ------ neurotransmission in the spinal cord and -- ----
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Cl
inhibitory brain stem |
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some inhal inhibit some neuronal --- ----- receptors
produce analgesia or ---, but not ---- |
nicotinic ach
amnesia immobility |
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what inhibits nmda receptors
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nitrous oxide
xenon ketamine |
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inhibiting nmda receptors will produce
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unconsciousness
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--- inhalation, -- ---, and ---- activate two pore domain k channels
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halogenated inhalation anest
nitrous oxide xenon |
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activation of two pore domain k leads to ----polarization and thus --- of neurotransmission
produces ----- |
hyper
inhibition unconsiousness |
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halogenated inhalation inhibit -- synaptic neurotransmitter relase int he ------
contribute to ----- |
presynatpic
hippocampus amnesia |
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mac is the concentration at 1 atm required to prevent -- ---- to skin incisions of 1 cm in 50% of patients
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reflex responses
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at eq partial pressure of inhalatio anest in the alveolar is the same as that in the ---- so alveolar conc reflects the amount of anesth in the body
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blood
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the lower/higher the mac value the more potent mac is
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lower
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what's used measure inhalation potency
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mac
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what's used to measure iv potency
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EB50
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eb50 is free plasma concentration required to prevent --- --- to skin incision of 1 cm in 50% of patients
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reflex responses
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the higher he blood/gas partition, the slower/faster the indcution time, the longer
it take to reach eq w/in --- |
slower
brain |
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no used for
induction of -- anesthesia combined w/ ----- for outpatient dentistry to produce -- and --- |
general
O2 sedation analgesia |
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NO
due to high MAC usu in conjunction w/ --- or -- anesthesia |
inhalation
iv |
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NO
how to reduce SE |
when used as an adjunt will reduce the mac of of other inhal anes by 50% thus reducing SE
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how is no eliminated
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lungs
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t/f
NO has high cv effects |
f
minimal |
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what can occur w/ NO. . . use caution w/ this
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diffusion hypoxia
very soluable so can diffuse into alveoli and displace O2 so give while adminstering |
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t/f
longer term use of NO ok |
f
avoided cuz interacts w/ vit B12 and can lead to deficeiency |
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halogenated inhal anest replaced ether
why |
due to rapid onset and recovery
less post op complications (n/v) non-inflammable |
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halogenated inhal anest causes --- --- depression of the ---- and ----
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dose dependent
CV resp |
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halogenated inhalation anes causes
uterine ----- |
relaxation
not normally used for c-section operations |
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t/f
halog inhal anes produce good analgesia and muscle relaxation |
f
so need to be used in combo w/ NO, opioids, muscle relaxants |
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why use halothane w/ kids
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pleasant odor
lack of hepatotoxicity non IV delivery |
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t/f
halothane very potent |
t
low mac: 0.75% |
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halothane has slow/fast induction
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slow
due to high blood-gas coefficient |
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cv effects w/ halothane
decrease/increase HR decrease/increase CO decreased/increased ------ |
decreased HR, CO, BP
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halothane
sensitive myocardim to ----- increased risk of ----- |
catecholamines
arrhythmias |
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halothane mostly eliminated by
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expired air
(20% metabolized) |
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tox of halothane
--toxic repeated use can lead to ------ |
hepatotoxic
hepatitis . . .needs 6-12 mo grace period |
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enflurane widely used ---anethetic
provides ------ |
inhalational
unconciousness |
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enflurane produce --- -----and reduces need for ----
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muscle relaxation
relaxants |
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t/f
enflurane typically used for induction |
f
typically used for maintenance due to it's pungent odor no used in peds |
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which has faster induction:
enflurane or halothane |
enflurane (10 min)
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t/f
enflurane 90% metabolized |
f
less metabolized also little hepatoxic |
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enflurane
little effect on inducing -- --- |
cardiac arrhythmias
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enflurane causes significant --- ----
reduces --- --- |
resp depression
bp |
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enflurane
high conc can cause |
CNS excitation
seizures . . .avoid if epileptic |
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most widely used inhalation anesthetic
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isoflurane
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isoflurane provides ----
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unconsciousness
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isoflurane produces -- --- and reduces the need for ---
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muslce relaxation
relaxants |
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faster induction and recovery
isoflurane or halothane |
isoflurane (10 min)
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which has less metabolism and hepatotoxicity
isoflurane or halothane |
isoflurane
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t/f
isoflurane high chances of cardaic arrhythmias |
f
little effect |
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t/f
isoflurane decreases CO significantly |
f
little effect |
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isoflurane
-- and --- control on depth of anesthesia |
rapid
smooth |
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con of isoflurane
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mailgnant hyperthermia
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desflurane provides
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unconsciousness
some muscle relaxation |
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t/f
desflurane has slow induction and recovery |
f
fast mac: 6% |
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desflurane often used ---anesthesia
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mainatian
after induction w/ an IV agent |
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desflurane
why is it widely used as outpatient |
due to rapid on/off
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desflurane
eliminated --- via ----- |
unchanged
expired air |
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desflurane
what limits conc to be used |
irritating to resp tract
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sevoflurane
has rapid/slow onset and recovery |
rapid
mac: 2% more potent |
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sevoflurane
why widely used in kids |
due to lack of irritation ot resp tract
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sevoflurane
small fraction metabolized to |
F
mostly elimianted unchanged |
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sevoflurane
effect on CV |
reduce arterial bp
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t/f
sevoflurane tox: organ |
f
limited organ tox |
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s/s of malignant hyperthermia
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increased muscle rigidity
increased HR elevated body temp to as high as 110 F |
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malignant hyperthermia due to elevated body temp can cause
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cardiac arrest
organ failure death |
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known triggers of malignant hyperthermia
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halothane
enflurane isoflurane desflurane sevoflurane succinylcholine (neuromuscular blocker) |
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nontrigers:
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NO
barbiturates propofol ketamine etomidate local anesthetics |
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may require -- --- to trigger MH
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multiple exposure
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malignant hyperthermia
genetic disorder: |
autosomal dominant
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malignant hyperthermia involvesmutatins in :
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6 genetic foci
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primary mutation for malignant hyperthermia in
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RYR1
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ryr1 located on ----- storage oragnelle of -- --- ---
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ca
skeletal muscle cells SR |
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when does ryr open up
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when ca low (thru A site)
closes at high ca levels (thru I sites) |
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mutated ryr 1 receptor trigger agents that increase the affinity of - site and decrease the affinity of -- stie to ca
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increase for A
decrease for I so there's an increased Ca release from SR |
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reuptake of excessive ca burns a lot of -- and generates a lot of ---
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ATP
heat so temp increases eventually break down muscle tissue and causes cardiac arrest |
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malignant hyperthermia
r/t --- hx |
family
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w/ malignant hyperthermia what do you monitor
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temp
muscle rigidity HR |
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blood test for malignant hyperthermia
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creatine kinase
K phosphate myoglobin acidosis kidney fx |
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test for malignant hyperthermia
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genetic: L type voltage
halothane contracture: look at muscle contraction |
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tx of malignant hyperthermia
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dantrolene
muscle relaxant. .. block Ca release |
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most widely used anesthesics for adults
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IV
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IV anest. .. what caues rapid onset and short duration after a single bolus
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high lipophilicity
high perfusion |
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iv anest
accumulate in -- ---- |
fatty tissue
causing prolong recovery esp w/ muliple doses/infusion |
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terminatin of anesthe effect of iv anes due to
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redistribution out of cns
not to metabolism |
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who's given a lower dose of iv anes
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lower dose: elderly
higher dose: kids |
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thiopental:
-----ate |
thiobarbiturate
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thiopental used for --- of anest
in combo w/ |
induction
inhaled anesthetics |
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t/f
thiopental has high analgesic effects |
f
none |
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rapid/slow onset of thiopental
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rapid
unconsciousness in 20 sec due to high lipid solubility |
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t/f
thiopental has long duration |
f
short quickly diffuses out of brain |
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why long recovery period w/ thiopental
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accumulation in fat and muscles
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thiopental metabolized by
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mostly in liver
but slow . .. so long recovery |
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thiopental effects on cv
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decreased:
BP CO |
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thiopental effects on resp
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depress resp center of brain
blunts response to CO2 and hypoxia. making thiopental desirable agent for pts w/ cerebral edema |
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propofol
rapid/slow onset |
rapid
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propofol causes unconsciousness in 20 ---
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seconds
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doa of propofol
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short: 5-10 min due to high clearance
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t/f
propofol high accumulation |
f
little rapidly metabolized (10 x faster than thiopental) |
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most widely used iv anes in US
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propofol
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which is preferred
propofol or thiopental |
propofol
faster recovery no acculation effect |
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se of propofol
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hypotension
pain at injection site |
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ketamine
r/t |
pcp-phencyclidine
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ketamine produces less -- and -- than pcp
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sensory distortion
euphoria |
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ketamine produces ----- anethesia
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dissociative:
w/o complete loss of consciousness |
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dissociative anesthesia:
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analgesia
reduced sensory perception immobility and amnesia pts have eyes open, limb movements and spontaneous breathing |
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ketamine
rapid/slow onset |
rapid. .. unconscious in 20 sec
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ketamine doa
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longer: 10-15 min
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ketamine
increases/decreases bp |
increases
so useful in hypotensive pts |
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con of ketamine
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unpleasant recovry-delirium
hallucination irrational behavior |
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t/f
ok to use ketamine in kids |
t
used in minor sx |
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etomidate -- isomer
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D
active |
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etomidate
-- onset -- duration |
rapid
short (4-8 min) |
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best agent for cv probs
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etomidate
littely efect on cv system |
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who has less resp effects
etomidate or thiopental |
etomidate
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etomidate
useful for --- pts |
hypotensive
cuz doesn't affect bp |
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etomidate cons
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n/v
inhibit adrenocorticoid stress response so not recommended for long term infusion |
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local anest:
apply locally to ---- block action potential to stop nerve conductance and induce --- and -- paralysis |
reversibly
sensory motor |
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local anes:
reversible/irreverisble |
reversible
no damage to fibers and cells |
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primary use of local anes:
sx of : |
sx of skin/sq tissues
sx of eyes, earys, joints or pelvis labor/delivery diagnostic procedures |
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most local anes have a --bond
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amine
cuz esters attacked by esterases . ..shorter doa |
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what makes amines less effective
|
local low pH due to inflammation and acidosis
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local anes prevent ---- entry
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Na
so prevent depolarization stop action potential |
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local anest has get --- cells
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inside to bind to na channels and shut off
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local anest pass thru -- membranes and then becomes ------
binds to domain --- of Na channesl |
charged
4 |
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local anest is use dependent/independent inhibition
|
dependent
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local anest has higher affinity for na channels that are :
|
open. . .depolarized
so more inhibition w/ increase frequency of firing. .. so have to be in use for better blockade |
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which are blocked more by local anes
autonomic/sensory or motor |
autonomic/sensory
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inhibition sequence: what comes first w/ local
touch/pain/temp/preception |
pain/temp/touch before perception
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which are more sensitive open na channels or resting w/ local anest
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Na channels
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topical use
|
skin
mucous membranes . . .itching, minor sx |
|
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sub q use
|
minor sx
dental |
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electodelivery: use electric current to force drug into tissue. . .
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dental
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field block:
block all ---nerves that conduct into the target area |
sensory
regional anesthesia |
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spinal anesthesia block -- senosry and motor fibers for sx of:
|
somatic
sx of lower limb, pelvic structures, c-section, prostate sx |
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spial anes aka
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subarachnoid block
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advantages of local:
|
awake pts can help
less cv probs less n/v and resp probs |
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se of local
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ha
nerve damage patchy block or peration last too long extends too high |
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t/f
epidural given in spinal cord |
f
given in epidural space to block somatic sensory and motor fibers |
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use of epidural
|
labor/delivery
|
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epidural comlication
systemic ---- careful monitoring to prevent --- and ---tox |
systemic
cardiac depression neurotox |
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cocaine
-- anesthetic, but ---- stimulant low/high potency causes --constriction and useful to anesthesize internal sturctures of ----- |
local anesthtic
central low potency vasoconstriction nose |
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procaine
what's now preferred |
lidocaine
|
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procaine
low/high potency short/long action topically effective? |
low potency
short action not topicaly effective |
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procaine used in ------
reduce pain after: |
dentisry
after IM PCN |
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procaine more likely to induce --- rxn than -- type
|
allergic
amide |
|
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benzocaine
---effective |
topically
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t/f
benzocaine otc |
t
watch for skin irritation |
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benzocaine
may cause -- in some pts |
hypersensitivity
|
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benzocaine
may cause ---emia which may cause --ia |
methemoglobinemia
does not bind to O2 tissue hypoxia can occur |
|
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most widely used local anesthetic
|
lidocaine
|
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route of lidocaine
|
topically
injected |
|
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lidocaine
metabolized by |
cyp1A2
|
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lidocaine
insenstivity in some pts such as |
ADHD
|
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etidocaine
how does it differ from lido |
lasts longer
|
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etidocaine
used for |
sx procedures
L and D. . .infiltration and nerve block |
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bupivacaine/mepivacaine/ropivacaine
-- to -- potency |
med to high
|
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bupivacaine/mepivacaine/ropivacaine
-- to -- duration |
short to long
|
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bupivacaine/mepivacaine/ropivacaine
applied by ---, --- and --- |
infiltration
nerve block epidural |
|
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bupivacaine/mepivacaine/ropivacaine
widely used in -- procedures |
obstetrical
|
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bupivacaine/mepivacaine/ropivacaine
which has more cv complications (depression) |
bupivacaine
|
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prilocaine
--potency |
intermediate
|
|
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prilocaine
-- duration |
short
|
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prilocaine
use limited to ---- and ----- oftne used in --- |
infiltration
topical dentistry |
|
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prilocaine
why not used in iv regional anesth |
due to low cardiac toxic
|
|
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con of prilocaine
metabolite is -- and can cause --- |
toxic
methemoglobinemia |
|
|
ae of local anes
absorption into |
systemic circulation
|
|
|
ae of local
cns effects: |
restlessness
tremor euphoria follwed by drowsiness and sedation ha nausea |
|
|
high conc of local anest:
|
seizures
coma resp failure . . .death |
|
|
cv of local
|
myocardium
decreased excitability conduction rate and force |
