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115 Cards in this Set
- Front
- Back
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Chlorpromazine
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Antipsycho - Blocks D2 Receptors
high sedation and postural HT Phenothiazine Class |
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Phenothiazine
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Major class of Anti-Psychos
Chlorpromazine, fluphenazine, thioridazine |
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Fluphenazine
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Antipsycho - Blocks D2 Receptors
Phenothiazine Class |
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Thiothixene
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Anti-psycho
Thioxanthine class |
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Haloperidol
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Anti-Psycho
high extrapyramidal effects Butyrophenone Class treats tourette's |
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Clozapine
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Anti-psycho - blocks 5HT and D2
No elevated prolactin, no TD, but can cause granular cytosis = need to monitor blood. Also weight gain. |
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Resperidone
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Anti-Psycho
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Olanzapine
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New gen Anti-psycho
weight gain |
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New gen Anti-psycos
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Olanzapine
Quetiapine ziprasidone Aripiprazole |
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Tradition Anti-psyco Action
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Block Alpha-Adreno/choline/dopamine/hitamine Rec.
Dry mouth, dec gastric secretion and motility Prolactin release, weight gain, NMS |
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Tardive dyskenesia
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Associated with Anti-psychos
hypersensitivity of Dopamine Rec. Often irreversible use min. dose, drug holidays Clozapine does not cause this, but has its own side effects (granular cytosis) |
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Tourette's Syndrome
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Involuntary movements, ticks, outbursts
Haloperidol to treat |
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Depression
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(endogenous) sadness, irritability, thoughts of death and suicide
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Bipolar Disorder
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Swings of mania and depression
treat with: lithium or fluoxetine+olanzapine |
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Mania (4 medications and type of agent)
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Carbamazepine - anti-epi
Valproic Acid - anti-epi Resperidone - anti-psycho Arpiprazole - anti-psycho |
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Tricyclics
drugs names and class and common side effects |
Anti-depressants
imipramine, -pramine, -triptylene, doxepine sedation - atropine-like: dry mouth, blurred vision CV effects: arrythmia, tachy, postural HT |
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Mirtazapine
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tetracyclic anti-dep
alpha 2 antagonist - stimulates CNS |
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Monoamine oxidase inhibitors
indication and contraindiction |
MAO Inhib. anti-depressant
Tyramine in diet along with MAOS = HT |
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Tranylcypromine
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MAO inhbitor - similar to amphetamine, reversible
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Phenelzine
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MAO irev. inhibitor
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isocarboxazid
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Rev MAO inhibitor
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Selegiline
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Path form MAO inhibitor
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SSRIs
3 drugs |
selective serotonin reuptake inhib.
Anti-deps Fluoxetine - prozac Paroxetine - paxil Sertraline - zoloft approved for addicition, bulimia, alcholism |
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Beyond SSRIs
3 drugs |
venlaflaxine
duloxetine = block nor epi and serotonin reuptake st johns wort - herbal remedy under trial |
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OCD Treatment
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SSRIs
Fluoxetine Paroxetine Sertraline |
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Generalized Anxiety Disorder
Characteristics and 3 drugs of choice |
GAD - irritability, muscle tension, autonomic arousal,
Alprazolam (benzodiazepine), most common paroxetine - paxil - antidep - 5HT vanlaflaxen - "beyond SSRI" - both norepi and 5HT |
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Panic Attacks
Symptoms and drugs |
Anxiety
Fear, chest pain, tachy, sweating, breathing, swallowing alprazolam, sertraline, paroxetine, vanlaflaxin |
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Benzo Metabolism
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Benzodiazepine to nordiazepam to oxazepam
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Flumazenil
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Benzo antagonist - antidote
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Beta-carboline
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inverse antagonists of benzos, bind same rec. but elicit opposite response, convulsions/tension
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Benzo Theraputic Uses
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Anxiolytics
anticonvulsants - clonazepam muscle relaxants - diazepam sedative - IV diazepam, trilazam withdrawl - diazepam |
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Buspirone
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No CNS depression
Treat GAD non-benzo |
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Epilepsy
Characterize |
convulsions caused by irregular firing of nerves
Imbalance between NMDA and GABA to treat: decrease NMDA, increase GABA |
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Epi Seizer types:
Partial |
Simple: older child, adults: no conscious impairment
complex: older children/adults: some conscious impairment |
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Epi Seizer types:
Generalized |
absence - 4-8yr - partial loss consciousness throughout day
tonic-clonic- all ages - jerking, falling spasms infantile - 4-9months - flexure, convulsions, death |
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Infantile spasms
Treatment |
Vigabatrin - increases GABA in brain, inhibits GABA aminotransferase
Causes loss of vision ACTH approved - unknown mechanism |
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Main mechanisms for anti-epi drugs
Three mech. with drugs examples |
1) promote inactivate stated of voltage Na channels (carbamazepine, phenytoin)
2) GABA mediated synaptic inhibition (barbs and benzos) 3) limit activation of T current (Ca volt chan) (ethosuximide) Multiple drug therapy for multi types of seizures |
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Metrazole Tests
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Test given to animal subjects to induce absence seizure.
block with ethosuximide or sodium valproate |
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Maximal electroshock test
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Tonic-clonic type seizure induced in mice with shock.
block with carbamazepine or phenytoin |
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Phenobarbital
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Anti-epi - Used against partial seizures and tonic-clonic seizures
Increases GABA Induces liver P450 enzyeme act. |
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Phenytoin
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Anti-Epi
all forms except absence no sedative effect blocks Na chan gingival hyperplasia, nystagmus |
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Fosphenytoin
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Anti-epi -
Phenytoin prodrug - metabolized to active form by blood phosphates |
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Carbamazepine
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Anti-epi
all except absence blocks Na chan Vs. trigeminal neuralgia double vision/dizzy/ataxia |
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ethosuxamide
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Anti-epi
drug for absence seizures Reduces Ca chan conductance in thalamus dizzy/ataxia/nausea |
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Valproic/dipropylacetic acid
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Anti epi-
blocks tonic-clonic and partial primarily secondary drug for absence Na chan and increase GABA liver failure, pancreatitis, not for preggers |
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clonazapam
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Anti-epi Benzo
absence seizures if no others work facilitates GABA sedation/drowsiness |
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Status epilepticus
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continued state of epilepsy
lorazepam IV - a benzo |
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Gabapentin and Lamotrigene and pregabalin
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add on drug for adult partial seizures
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Topiramate
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Partial and tonic-clonic seizures
migranes weight loss, dizzy, hyperthermia |
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Sedative/Hypnotics
General Characteristics |
Sedative - tranquillize
Hypnotic - induce sleep same drugs work along continuum benzos and barbs |
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Barbiturates
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extend along entire continuum from wakefulness to death (anesthesia and coma)
use is restricted increase duration of cl- chan opening does induce P450 in liver, increases metabolism of other drugs GABA mimetic |
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Benzodiazepines
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Most common sedative-hypnotic
does not extend into anesthesia/coma/death end of spectrum increases frequency of Cl- chan opening do not induce P450 enzymes in liver not GABA mimetic |
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Hypnotics and GABA
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Both benzos and barbs act on GABAa ionophore, which regulates Cl- ions into the cell
Different variations of the ionophore exist throughout the body, benzos and barbs act on different variations |
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Benzo Receptor Agonists
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Agonists:triozalam, diazepam
trad. benzo drugs for sedation activate gaba - Cl- enters cell - supressed |
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Benzo Receptor Antagonists
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flumazenil - imidazodiazepine
blocks benzo but not other sedatives - wake up instantly diazepam binding inhibitor blocks benzo at receptor |
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Benzo inverse agonist
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beta-carboline - binds benzo receptor but causes stimulation (opposite response)
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Benzo application
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wide use- anti anxiety, anti-epi, sedative
because of different distribution throughout the brain |
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Triazolam
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sleep inducer
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zolpidem and eszopiclone
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sleep inducers, bind benzo rec but are structurally unrelated to benzo. faster peak activity. can use for longer period of time.
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Parkinsons disease symptoms
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tremor at rest
rigidity bradikinesia postural instability extrapyramidal component effected |
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PD patho
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extrapyramidal system
4 neurotransmitters: DOPA and ACH (gaba and gluta) loss of dopamine secreting cells |
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Iatrogenic PD
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haloperidol, phenothiazine - block DA Rec
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Primary Goals of Anesthesia
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preserve px life
provide good surgical field block pain |
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Balanced Anesthesia
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combination of drugs are used for best results and least side effects
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Nuroleptanesthesia
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combo of anti-psyco and analgesic
analgesia with amnesia px drowsy but awake |
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Dissociative Amnesia
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ketamine
catonia, amnesia, analgesia |
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MAC
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minimum alveolar concentration
minimum amount of drug needed in lungs to produce no response from surgical stimulus on 50% of patients lower the MAC the more potent the drug |
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stages of anesthesia
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stage 1 - analgesic, conscious
stage 2 - delirium - not good, go past stage 3 - surgery, substages, good stage 4 - medullary paralysis - death - not good |
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Sites of general anesthesia
by stage |
1 - substantia geletinosa
2- inhibitory neurons 3- brain stem - reticular formation 4 - medulla |
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Meyer-overton
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Theorized that anesthetic potency was based solely on lipid solubility
was incorrect |
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blood gas partition Coef.
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PC = molar conc. in blood / molar conc in lungs
lower the PC the faster it will induce anesthesia |
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second gas effect
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if two gasses are given one at a higher concentration the second gas will enter at a faster rate than if given alone. the first gas essentially pulls the second one along with it
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anesthesia pharmokinetics
summarize 4 main points |
1) lower PC = faster induction
2) rate of induction is not related to MAC 3)increased ventilation yields faster induction 4)in combo, higher concentration gases can pull lower concentration at a higher rate than if alone |
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Anesthesia effects on main systems
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all exclude N2O
CVS: dec. mean arterial BP Resp: depress TV, increase rate = depress Resp. Liver: low, except halothane kidney: low effect skeletal muscle: relax smooth muscle: relax, no preggers, only N2O |
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Advantages to using Anesthesia Gas
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easily change blood concentration by changing gas concentration mix
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Nitrous oxide
properties |
excreted through lungs, no liver metabolism
fast onset, fast recovery low potency sedative, analgesic not used long term alone - sedative analgesic full anesthesia used as adjunct very slight effect to body systems side effects short term: hypoxia, can pull O2 out with it, give with O2 long term: bone marrow possible risks with fertility |
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Nitrous Abuse
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death by asphyxiation
long term abuse: brain damage, verbal memory loss |
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halothane
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20% liver metabolism, too high.
poor kinetics, very soluble used to be used on children b/c can be used with mask induction. hypatotoxicity, malignant hyperthem, arrythmia cheap |
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malignant hyperthermia
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caused by halothane
dantrolene to treat |
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enflurane
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not used. causes seizures.
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isoflurane
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most commonly used in US. not as good with children. no harmful side effects known.
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desflurane
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rapid induction rapid recovery, faster than isoflurane
irritates airways, no mask induction |
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sevoflurane
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high metabolites, but no indication of liver/kidney damage
mask induction, replacing halothane for children interracts with soda lime in rebreather, toxic. use fresh gas no rebreathing. |
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CVS and anesthesia
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desflurane and isoflurane have least effect on Cardiac Output
all suppress BP |
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IV anesthesia
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lower cost, rapid onset
harder to lower conc, therefore shorter acting lipophillic -> brain and spinal cord can infuse into fat and leach out later with effect |
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Ultra-Short acting barbs
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thiopental and methohexital
prolonged use leads to grogginess dec. cerebral metabolism hypotension, depressed resp, laryngospams |
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propofol
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better maintenance drug, better recovery,
hypotension, no grogginess |
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etomidate
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used for induction only
terrible side effects death, myclonic movement, painful, nausea, vomitting, less resp and cardio depression |
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ketamine
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PCP
dissociate anesthesia - catatonic increases CVS: HR, CO, BP increases intracranial pressue cardiac patients hallucinations |
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Anesthetis adjuncts:
benzos |
diazepam/lorazepam - long acting
midazolam - short acting sedation, reduce anx, amnesia |
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Anesthetis adjuncts:
opiods |
anagesia
morphine - long acting remifentanil - shortest can give full anesthesia prolonged resp. depression - stone chest |
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Cocaine
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first local anesthetic
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local anesthetic chem structure
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1) lipophilic group
2)amide or ester 3) hydrophilic group |
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Local anesthetic esters
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cocaine
procaine chloroprocaine tetracaine proparacaine benzocaine Esters don't have an I before the "caine" |
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Local anesthetic amides
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All have an I before the "caine"
lidocaine mepivacaine prilocaine etc |
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Ethers
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local anesthetics
pramoxine - hemmeroid phenacaine - ophthalmology |
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dyclonine
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ketone and ether local anesthetic
sucrets, throat lozenge and spray |
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pH and local anesthetic
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cationic acid to neutral base
non-ionic form penetrates membranes ionic form binds mote actively |
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pH Effects
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usually local anesthetic will come as salt in HCl or in carbonated solution
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Absorption of local anesthetic
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not important - can be toxic
given with epi as vasoconstrictor to minimize absorption |
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Uses for muscarinic Agonists
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eye surgery
glaucoma non-obs atony of bladder paralytic ileus xerostomia dx asthma |
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examples of muscarinic agonists
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Ach
bethanechol carbachol muscarine pilocarpine |
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muscarine
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toxic ingestion from mushroom
ab cramps, GI stimulation, excess secretion |
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pilocarpine
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muscarinic/cholinergic agonist
xerostomia, glaucoma |
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contraindications for musc. agonists
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asthma
hyperthyroidism peptic ulceration |
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cholinesterase inhibitors
uses |
prevent hydrolysis of Ach
-stigmine and edrophonium paralytic ilieum glaucoma myasthenia gravis reverse nuromusc blockade antimuscarinic toxication alzheimers - donepezil/rivastigmine |
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organophosphates
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irrev cholinesterase inhibitors
echothiophate - glaucoma malathion/parathion - agg pesticide soman/sarin - war chemical antidotes: atropine, lorazepam pralidoxime |
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scopolamine
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cholinergic antagonist
prevents motion sickness |
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benztropine
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cholinergic antagonist
reverses symptoms of iatrogenic PD |
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dicyclomine, glycopyrrolate
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cholinergic antagonist
dec. GI sec, motility, spasm |
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Oxybutynin, tolterodine
Darifenacin, solifenacin |
cholinergic antagonists
decrease mituration dec bladder spasms |
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Ipratropium
Tiotropium |
cholinergic antagonists
dec. broncial spasm and sec. |
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how to increase increase elimination via urine
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weak acid - make urine alkaline
weak base - make urine acidic |
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steroid hormone signaling
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activation of intracellular receptor then binding to DNA
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muscarinic receptor blockers useful for
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mydriasis and cycloplegia for eye exams
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