Intravenous And Inhalation Anesthetics

Front 1

Propofol

Back 1

2,6-diisopropylphenol

Front 2

Propofol used for

Back 2

induction or maintenance of Gen. Anesthestia

Front 3

Propofol prepared as...

Back 3

1%isotonic oil-in-water emulsion, which contains egg lecithin, glycerol, and soybean oil

Front 4

Propofol mode of action...

Back 4

increases activity at inhibitory y-aminobutyric acid (GABA) synapses

Front 5

Propofol pharmacokinetics...

Back 5

elimination primarily through hepatic metab. to inactive metabolites
*induction does causes rapid unconsciousness followed by rapid awakening due to redistrib.

Front 6

Propofol pharmacodynamics...

Back 6

CNS: induction dose=uncons.
low dose=sedation, no analgesic properies
CVS: depressant, dec. in arterial BP and CO
RESP. SYS: dec. in resp. rate and tidal volume

Front 7

Barbiturates...name 'em

Back 7

thiopental, thiamylal, methohexital

Front 8

Barbiturates do what?

Back 8

rapidly produce unconsciousness (30-45 sec.)followed by rapid reawakening due to redistribution

Front 9

Barbiturates mode of action

Back 9

occupy receptors adjacent to GABA receptors in the CNS and augment the inhibitory tone of GABA

Front 10

Barbiturates pharmacokinetics..

Back 10

metabolism to inactive metab. occurs in liver

Front 11

Barbiturates pharmacodynamics...

Back 11

CNS: uncons. by cause hyperalgesia in subhypnotic dose, produce dose dep. dec. in cerebral metab. and blood flow
CVS: dec. art. BP and CO, may inc. HR via baroreceptor reflexes
RESP. SYS: dec. resp. rate and vol.

Front 12

Benzodiazepines name them

Back 12

midazolam, diazepam, lorzepam

Front 13

Benzos oftens used for

Back 13

sedation and amnesia or as adjuncts to general anesthesia

Front 14

Benzos mode of action...

Back 14

bind at specific receptors in the CNS and enhance the inhibitory tone of GABA receptors

Front 15

Benzos metabolized where?

Back 15

liver

Front 16

Benzos pharmacocynamics...

Back 16

CNS: *produce amnestic, anticonvulsant, hypnotic, muscle relaxant and seditive effects in a dose dependent manner
*do not produce signif. analgesia
*reduce cerebral blood flow and metabolic rate
CVS: mild systemic vasodilation and reduction of CO. HR unchanged.
RESP. SYS: dec. in respit. rate and tidal volume

Front 17

What is Flumazenil?

Back 17

competitive antagonist for benzodiazepine receptors in the CNS

Front 18

Ketamine is _________ and is employed as ...

Back 18

an arylcyclohexylamine and a congener of phencyclidine (PCP)
employed as an induction agent

Front 19

Ketamine pharmacodynamics...

Back 19

CNS: produces a dissociative state accomp. by amnesia and profound analgesia, inc. cerebral blood flow, metabolic rate, and intracranial pressure
CVS: inc. HR and systemic and pulmonary artery blood pressure by causing release of endogenous catacholamines, often used for induct. in hemodynamically compromised patients
RESP. SYS: mildly depresses resp. rate and TV

Front 20

Ketamine adverse reactions...

Back 20

oral secretions (coadmin. of antisialagogue (glycopyrrolate)), emotional disturbance, muscle tone, increased intracranial pressure, eye movements, anesthetic depth may be difficult to asses

Front 21

Etomidate is and is used for...

Back 21

is an imidazol-containing hypnotic unrelated to other anesthetics, it is most commonly used as an IV induction agent for general anesthesia

Front 22

Etomidate mode of action...

Back 22

augments the inhibitory tone of GABA in the CNS

Front 23

Etomidate metabolized where?
and is similar to propofol how?

Back 23

metabolized in the liver and by circulation esterases to inactive metabolites. time to loss of consc. and awakening is similar to pro.

Front 24

Etomidate pharmacodynamics...

Back 24

CNS: no analgesic properties, Cerebral blood flow and metabolism dec. in a dose dep. manner
CVS: minimal changes in HR, BP, and CO, accordingly etomidate may be a preferred agent for induction or gen. anesthesia in a hemodynamically compromised patient
RESP.SYS: dose -dependent decrease in resp. rate and volume, resp. despressant effects of etomidate appear to be less than those of propofol or the barbiurates

Front 25

Opioids...name them.

Back 25

morphine, meperidine, fentanyl, sufentanil, alfentanil, remifentanil

Front 26

Opioids primary effect.

Back 26

is analgesia, and therefore they are used to supplement other agents during induction or maintenance of general anesthesia

Front 27

opioids used in high doses and as sole anesthetic in what type of surgery

Back 27

Cardiac

Front 28

Opioids mode of action...

Back 28

bind at specific receptors in the brain and spinal cord

Front 29

Opioids pharmacodynamics...

Back 29

CNS: produce sedation and analgesia, euphoria common, in large doses may produce amnesia and loss of consc., reduce the MAC of volatile and gaseous anesthetic agents, decrease cerebral blood flow and metabolic rate.
CVS: minimal changes in cardiac contractility (except meperidine, which is direct myocardial depressant), bradycardia
RESP. SYS:dose-dependant resp. depressant. Initally resp. rate dec, with larger doses tidal volume decreases, dec. ventilatory response to PaCO2, may produce apnea from resp. depression or muscle rigidity, dec. in cough reflex

Front 30

Opioid pharmacodynamics cont.

Back 30

dec. in pupil size, muscle rigidity may occur in chest, abdomen, and upper airway leading to diff. inability to ventilate, GI system: inc. in the tone and secretions of tract and dec. in motility, nausea and vomiting, urinary retention can occur

Front 31

What is Naloxone?

Back 31

pure opioid antagonist used to reverse unanticipated or undesired opioid-induced effects such as resp. or CNS depression

Front 32

Naloxone mode of action.

Back 32

competitive antagonist at opioid receptors in the brain and spinal cord

Front 33

Inhalation anesthetics are usually adninistered for...

Back 33

maintenance of general anesthesia but also can by used for induction, especially in pediatric patients

Front 34

Dosages of inhalation anesthetics are expressed as ______, which is the

Back 34

MAC, the minimum alveolar concentration at one atmosphere at which 50% of patients do not move in response to a surgical stimulus

Front 35

Name the inhalation anesthetics.

Back 35

gas: Nitrous oxide
Volitile agents: halothane, enflurane, isoflurane, desflurane, and sevoflurane

Front 36

NO mode of action.

Back 36

produces general anesthesia through interaction with the cellular membranes of the CNS, exact mech. not clear

Front 37

NO pharmacodynamics.

Back 37

CNS: analgesia, concent. greater than 60% may produce amnesia, B/c of high MAC (104%)it is usually combined with other anesthetics to attain surgical anesthesia
CVS: mild myocardial depressant and mild sympathetic nerv. sys. stimulant, HR and BP usually unchanged, may increase pulmonary vas. resistance in adults
RESP. SYS: mild resp. depressant, although less than volatile anesthetics

Front 38

What are volatile anesthetics?

Back 38

liquids whose potent evaporative vapors (in a carrier gas) are used in inhalation anesthesia

Front 39

Volatile anesthetics mode of action.

Back 39

produce general anesthesia through interaction with the cellular membranes of the CNS, exact mechanism not clear

Front 40

Volatile anesthetics pharmacodynamics.

Back 40

CNS: unconsciousness and amnesia at relatively low inspired concentrations (25% MAC), dose-dep. CNS depression, increases cerebral blood flow, dec. cerebral metabolic rate
CVS: myocardial depression, HR unchanged
RESP SYS:dose-dep. respir.depression with a dec. in tidal volume, increase in resp. rate and inc. in PaCO2, airway irritation
Muscular system: dose-dep. dec. in muscle tone, often improving surgical conditions