Pharm Dr. Kruggers Anesthetics--General/local

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MOA of general anesthetics

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Most are thought to act at GABA-A receptor - chloride channel

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Inhaled anesthetic with a low blood/gas partition coefficient

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Nitrous oxide

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Inversely related to potency of anesthetics

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Minimum alveolar anesthetic concentration (MAC)

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Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents

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Halothane and methoxyflurane

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Most inhaled anesthetics SE

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Decrease arterial blood pressure

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Inhaled anesthetics are myocardial depressants

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Enflurane and halothane

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Inhaled anesthetic causes peripheral vasodilation

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Isoflurane

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Inhaled anesthetic that may sensitize the myocardium to arrhythmogenic effects of catecholamines and has produced hepatitis

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Halothane

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Inhaled anesthetic, less likely to lower blood pressure than other agents, and has the smallest effect on respiration

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Nitrous oxide

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Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency

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Methoxyflurane

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Prolonged exposure to this inhaled anesthetic may lead to megaloblastic anemia

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Nitrous oxide

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Pungent inhaled anesthetic which leads to high incidence of coughing and vasospasm

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Desflurane

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DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics

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Dantrolene

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IV barbiturate used as a pre-op anesthetic

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Thiopental

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Benzodiazepine used adjunctively in anesthesia

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Midazolam

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Benzodiazepine receptor antagonist, it accelerates recovery from benzodiazepine overdose

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Flumazenil

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This produces "dissociative anesthesia", is a cardiovascular stimulant which may increases intracranial pressure, and hallucinations occur during recovery

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Ketamine

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Opioid associated with respiratory depression, but is used in high risk patients who may not survive full general anesthetia

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Fentanyl

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State of analgesia and amnesia produced when fentanyl is used with droperidol and nitrous oxide

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Neuroleptanesthesia

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Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension

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Propofol

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MOA of local anesthetics (LA's)

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Block voltage-dependent sodium channels

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This may enhance activity of local anesthetics

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Hyperkalemia

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This may antagonize activity of local anesthetics

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Hypercalcemia

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Almost all local anesthetics have this property and sometimes require the administration of vasoconstrictors (ex. Epinephrine) to prolong activity

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Vasodilation

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Local anesthetic with vasoconstrictive property, favored for head, neck, and pharyngeal surgery

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Cocaine

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Longer acting local anesthetics which are less dependent on vasoconstrictors

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Tetracaine and bupivacaine

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These LA's have surface activity

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Cocaine and benzocaine

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Most important toxic effects of most local anesthetics

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CNS toxicity

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Commonly abused LA which has cardiovascular toxicity including severe hypertension with cerebral hemorrhage, cardiac arrhythmias, and myocardial infarction

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Cocaine

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LA causing methemoglobinemia

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Prilocaine