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22 Cards in this Set
- Front
- Back
NMB - depolarizers
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1. succinylcholine
2. initially stim cholinergic receptor bu then slowly seperate 3. reversed by cholinesterase enzyme 4. pseudocholinesterase deficiency take 3-5d to recover while typicallyon takes 5min, seen pregnant women and liver dz 5. SE: fasciculations, prolonged paralysis, increased intraocular pressure, bradycardia, and elevated serum K tiggering malignant hyperthermia |
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NMB - nondepolarizers
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1. -cur drugs prevent Ach from stimuliating nicotinic receptors
2. standard reversal: neostigmine (cholinesterase inhibitor) and glycopyrrolate (antimuscarinic) to prevent Ach induced bradycardia - also atropine but cross BBB, glycopyrrolate does not |
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inhalation anesthetic drugs
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1. enflurane
2. isoflurane 3. deslurane 4. sevoflurane 5. halothane |
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MAC
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1. MAC of 1 = dose prevents movement of pt 50% of the time to painful stimuli
2. MAC of 1.3 = dose prevents movement of pt 100% of time to painful stimuli 3. higher levels needed: young, chronic alcoholics, hypernatremic ppl, cocaine users 4. lower elvels needed: pregnant ppl, elderly, hyponatremic ppl, anemic pppl, ppl taking lithium or clonidine |
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Factors governing uptake volatile anesthetics
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1. cardiac output: higher CO causes high anesthetic uptake which slows rise alveolar partial pressure and induction is delayed
2. solubility: low bld solubility mean quicker uptake 3. uptake = (lambda x CO x (Pa-Pv))/B.P. -B.P. = barometric pressure, lambda = solubility |
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nitrous oxide
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1. used aid general anesthesia, not strong enough to be used alone
2. SE: N/V 3. inhibits B12 dependent enzyme methionine synthase and thymidilate synthase causing megaloblastic and pernicious anemia and peripheral neuropathies |
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halothane
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1. highly potent
2. good pediatric induction - odor isnt pungent 3. SE: halothane hepatitis which why no longer used 4. under anaerobic/hypoxic conditions, is reduced and releases Fl- causing hepatitis |
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isoflurane
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1. slowest recovery but also cheapest
2. potent with pungent odor |
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sevoflurane
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1. MAC of 2%, nonflammable
2. good for pediatric induction, odor isnt pungent |
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desoflurane
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1. quickest recovery due low solubility
2. useful in outpatient setting 3. reaches steady state quickest |
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inhalation anesthetics
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1. 3 uptake factors: solubility, CO, partial pressure difference
2. unitary hypothesis - all are GABAa modifiers 3. MAC is guide dosing, varies based age, meds, and health state |
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Adjuvants in anesthesia/IV anesthetics
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1. thiopental
2. methohexital 3. propofol 4. etomidate 5. ketamine -short acting induction agents -rapid onset -no analgesic or muscle relaxant activity |
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thiopental
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1. barbiturate analog phenobarbital
2. high potency, high lipid solubility - for short surgery 3. rapidly redistributed to fat and tissue terminating effect |
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methohexital
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1. shorter duration than thiopental
2. given rectally to kids |
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propofol
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1. #1 induction agent, non-barbiturate
2. quicker recovery time than barbiturates, good for oupatient 3. CV depression, large drop BP 4. administered in lipid emulsion 5. potentiates GABAa 6. some post-op anti-emetic properties |
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etomidate
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1. non-barbiturate imidazole
2. ultrashort acting 3. little resp and CV depression - good elderly |
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ketamine
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1. drug of abuse - PCP analogs act dissociative anesthetics
2. block NMDA receptors 3. CV stimulant - increased HR, BP, and CO 4. intense analgesia |
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benzodiazepiens
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1. safer than barbiturates - higher therapeutic index
2. reduce anxiety, some amnesia w/out significant CV and resp depression 3. pre-anesthetic, little to no analgesia 4. bind GABAa opening Cl channel and hyperpolarizes 5. reversal - flumazenil (selective antagonist) 6. midazolam replacing diazepam |
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opioids/narcotics
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1. morphine - MS-6 is active, renal elimination
2. fentanyl - given intra-operative, less histamine release 3. hydromorphone - give post-op, 5X potent morphine 4. meperidine - 1/10th potent morphine, lot SE, not used 5. sufentanil - 1000x more potent than morphine 6. remifentanil - can give liver or kidney fx -analgesics supplement volatile anesthetics -contribute to overal MAC |
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Post-Op N/V
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avoid:
1. opioids and hypnotics 2. nitrous oxide 3. high does reversal agents (neostigmine) -increase O2 and hydration, decrease air into stomach -caused by central and peripheral (GI - CNX) pathways - propofol is protective anti-emetic |
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anti-emetic agents
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1. ondansetron: post-op prophylaxis
2. metoclopraminde 3. droperidol - DA antagonist, risk fatal arrhythmia |
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anti-nausea agents
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1. anticholinergic - scopalamine, cross BBB, sedation
2. anti-histamine - dimenphenhydrinate, block H1 3. anti-serotinergics - no sedation, extrapyramidal rxns, central and peripheral effects, -setron drugs 4. propofol 5. steriods - dexamethasone, acute SE flushing and perineal itching 6. dronabinol - legal marijuana, helps chemo associated nausea, SE can be nausea |