Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
99 Cards in this Set
- Front
- Back
|
What are the four stages of anesthesia |
Stage 1: Analgesia Stage 2: Delirium or Excitement Stage 3: Surgical Anesthesia Stage 4: Respiratory or Medullary paralysis |
|
|
Describe Stage 1 Analgesia |
Conscious Reflexes intact Normal respiration |
|
|
Describe Stage II Delirium or Excitement |
Unconsciousness and is an uncomfortable time for the patient |
|
|
Describe stage III Surgical Anesthesia Plane I and II |
Return of regular respiratory movements Normal heart rate and pulse Eye reflexes disappear |
|
|
Describe Stage III surgical anesthesia Plane III and IV |
Intercostal paralysis Diaphragmatic breathing remains |
|
|
Describe Stage IV Respiratory or Medullary Paralysis |
Complete Cessation of all respiration Diaphragmatic is last to go Must be reversed quickly with artificial breakthing or patient will die |
|
|
TRUE OR FALSE Modern Anesthesia Techniques seldon show these exact stages |
TRUE |
|
|
What is Flaggs approach |
Induction Maintenance Recovery |
|
|
What is induction |
Preoperative meds Adjunctive drugs and anesthetic required for induction |
|
|
What is maintenance |
Begins and remains at depth allowing sufficient surgical manipulation until completetion |
|
|
What is recovery |
Termination of surgical procedure untill fully responsive |
|
|
INHALATION ANESTHETICS |
................ |
|
|
What are the two different subtypes for inhalation anesthetics |
Gases Volatile Liquids |
|
|
What are the different gases used |
Nitrous Oxide Cyclopropane |
|
|
Describe Volatile Liquids |
Evaporates quickly
Low boiling point |
|
|
Whar are the different types of Volatile Liquids |
Halogenated hydrocarbons
Halogenated Ethers Ethers |
|
|
What are the different type of Halogenated hydrocarbons |
Halothane Desflurane Sevoflurane |
|
|
What are the two newer agents of Halogenated Hydrocarbons |
Desflurane Sevoflurane |
|
|
What are the different types of Halogenated Ethers |
Enflurane Isoflurane |
|
|
The Blood Gas Partition Coefficient does what |
Compares Solubility |
|
|
Describe the blood gas partition coefficient |
The less soluable the anesthetic the more rapid the onset and recovery of the patient |
|
|
What has a least hangover effect |
Gases that are least soluable in the blood |
|
|
MAC minumum Alveolar Concentration is used for what |
compare potency |
|
|
Describe MAC
|
At 1 atmosphere To prevent 50% of patients from responding to surgical stimulus The lower the MAC the more potent the anesthetic |
|
|
Which one causes an anesthetic to be more potent a High MAC or a Low MAC |
LOW MAC
|
|
|
If anesthesia is induced via rapid IV agent and N2O-O2 is given with WHAT? to give an excellent balanced anesthesia |
Volatile Anesthetic
|
|
|
N2o combined with potent volatile anestetics does what (2) |
Reduces the concentration of the agent required
Increases the margin of safety of the inhalation (Theraputic Index) |
|
|
Describe Halothane (5) |
Fruity Pleasant Smell Safe for Asthmatics Epinephrine can cause arrhythmias Peripheral neuromuscular blocking agents (D-Tubocurarine) are required AGENT IS NOT AS COMMON TODAY |
|
|
What is Halothane not as commonly used today |
slight potential for postanesthetic hepatitis from metabolites |
|
|
Describe Enflurane (6) |
Pleasant Smell Low Tissue Solubility Good Analgesia and muscle relaxation Depresses repiration, controlled with assisted ventilation Less CARDIAC sensitivity to epi Less Metabolized (Absense in Hepatotoxicity) |
|
|
Describe Isoflurane (5) |
Chemically related to Enflurane PUNGENT SMELL
Low tissue solubility Undergoes little metabolism so liver toxcitiy is not a problem Limited Cardiac Sensitivity to epi |
|
|
Describe Desflurane (2) |
Low Volatiltiy (Special Vaporizer is required) Not used for INDUCTION (Causes cough and laryngospasm) |
|
|
Describe SEVOFLURANE |
Releases F- when metabolized causing RENAL damage |
|
|
Sevoflurane is chemically unstable when exposed to what |
CO2 absorbents producing a potentially nephrotoxic Compound |
|
|
What is the Advantage to Sevoflurane |
Low Blood/ Gas Partition Coefficients |
|
|
What are other General Anesthetics (6) |
Ultrashort acting Barbiturates Propofol (diprivan) Ketamine Opiods Droperidol and Fentany Benzopines |
|
|
What are the three different types of Barbiturates |
Methohexital Sodium (Brevital) Thiopental (Pentothal) Thiamylal (Surital) |
|
|
Describe Barbiturates (3) |
Highly lipid soluble-Prolong recovery No Analgesia effects (Needs Locals) Non- Reversible |
|
|
Describe Propofol (Diprivan) (6) |
Unrelated to another general Anesthetic Patients feel bettern and begin ambulation sooner than an other agent (Antiemetic effects) Titrated POPULAR for outpatient surgery (oral surgery) Milk of Amnesia Apnea occurs in 50-80% of patients |
|
|
Describe Ketamine (5) |
Related to PCP Hallucinogen Analgesia without loss of Consciosness AKA DISSOCIATIVE ANESTHESIA (disruption of association pathays with brain) Emergence Phenomena Excessive Salivation |
|
|
What are Opiods commonly used for |
Preanesthetic medication |
|
|
What is a MAJOR DISADVANTAGE to Opiods |
Prolonged Respiratory Depression |
|
|
What is the reversal agent with an opiod antagonist |
Naloxone |
|
|
Droperidol and Fentany (INNOVAR describe them |
Neuroleptanalgesia (Wakeful anesthetic state) |
|
|
Adding N2O-O2 to droperidal and Fentany (INNOVAR) causes what |
Neuroleptanalegesia |
|
|
Droperidol and Fentanyl have a rapid return to consciousness but slow recover due to what |
Droperidol |
|
|
Serious Adverse effects is a Boards like chest from intercostal paralysis requireing ventialation caused from |
Fentanyl |
|
|
Describe Benzodiazepines |
Integral part of conscious sedation and preaneshetic medication for years |
|
|
REVIEW QUESTIOS |
.................. |
|
|
Gases that are more soluable in the blood have what |
A greater hangover effect |
|
|
Gases that are least soluable in the blood have what |
Less hangover effect |
|
|
What is a class of drugs that have a long hangover effect |
Barbiturates |
|
|
MAC measures what |
Compares Potency |
|
|
Blood/Gas Partition Coeficient compares |
Solubility |
|
|
Do Barbiturates have a narrow or wide theraputic index |
Narrow |
|
|
Describe Barbiturates (3) |
Non reversible No analgesia effects High hangover rate |
|
|
What drug wears off the fastest and is known as milk of amnesia |
Propferol |
|
|
What drug do oral surgeons like and is often used for out patient surgery |
Propferol |
|
|
What drug is related to hallacinogens and has a short anegesia state
|
Ketamine |
|
|
What type of drug is often used for premedication and has a prolonged respiratory depression |
Opiod |
|
|
What drug can be used to reverse an opiod antagonist |
Naloxone |
|
|
CHAPTER 11 ANTIAXIETY ANGENTS |
................. |
|
|
Describe Benzodiazepines (2) |
Wide Therapuetic index Well absorbed orally |
|
|
What pregnancy Category is Benzodiazepines |
D and X |
|
|
What is Phase I Metabolism |
Results in active metabolism Drugs that inhibit heptatic metabolism or hepatic disease decrease Phase I |
|
|
What is Phase II Metabolism |
Not broken down Secreted Non active metabolites Much less effected by drugs or hepatic disease |
|
|
Lower doses of Benzos cause what |
Anxiolytic properties |
|
|
Higher doeses of BEnzo cause what |
Induces sleep Hypnosis |
|
|
What is the most common adverse reaction for Benzos |
CNS Depression |
|
|
TRUE OR FALSE When using BENZOS it is difficult to achieve overdose when a single agent is used |
TRUE |
|
|
What drug is used to Reverse a Benzodiazepine agent |
Flumazenil |
|
|
Benzodiazepines work on what |
GABA Receptors |
|
|
What is the only Benzodiazepine drug that is an Anxiolytic |
Diazepam (Valium) |
|
|
What are three Benzodiazepines that are sedative hypnotics |
Lorazepam (Activan) Triazolam (Halcion) Midazolam ( Versed) |
|
|
Which Benzodiazepine can cause Thrombophlebitits |
Diazepam |
|
|
Diazepam is what |
The oldest drug used Associated with Thrombophlebitis w. Intravenous use |
|
|
What is Lorazepam used for |
Extensively as a sedative and anxiolytic before anesthesia LONGEST DURATION |
|
|
Elimination pathway is what |
ONE-STEP conjugation reaction |
|
|
Describe Triazolam |
Treatment of Insomnia No active metabolites Can only be taken orally |
|
|
Triazolam is most commonly used for |
ORAL conciousness Sedation |
|
|
Midazolam (4) |
IN OFFICE GO TO DRUG Intravenous Consciouness sedation No Thrombophlebitits Short duration of action |
|
|
What Benzo is not available in the US Also known as the date rape drug |
Flunitrazepam |
|
|
BARBITURATES |
................. |
|
|
Babiturates have a wide or narrow therapuetic index |
NARROW Has many drug interactions |
|
|
What Nonbenzodiazepines are a pregnancy Category B and is used mainly for night-time hypnotic for restful sleep before sedation |
Zolpidem (Ambien) |
|
|
What is the newest class of Nonbenzos |
Eszopiclone (Lunesta)
|
|
|
REVIEW QUESTIONS |
....................... |
|
|
What Benzo is the oldest drug |
Diazepam |
|
|
Which Benzo causes Thrombophlebitis with intravenous use |
Diazepam |
|
|
Which Benzo is the IN OFFICE GO TO DRUG |
Midazolam |
|
|
Which Benzo has the longest duration |
Lorazepam |
|
|
What Benzo is the safest for Liver disease |
Lorazepam |
|
|
Which Benzo is used extensitly as a sedative and anxiolytic before anesthesia |
Lorazepam |
|
|
What Benzo is used to treat Insomnia |
Triazolam |
|
|
Which Benzo can only be taken orally |
Triazolam |
|
|
Which benzo is the only one that does not produce sedative sleep |
Diazepam |
|
|
What Benzo is great for a pre op sedative |
Lorazepam due to the long duraion |
|
|
What drug is used to reverse the benzos |
Flumazeni by IV |
|
|
What are the two drug classes that cause respiratory depression |
Opiod Barbituritates |
