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40 Cards in this Set

  • Front
  • Back
Propofol used for
induction or maintenance of Gen. Anesthestia
Propofol prepared as...
1%isotonic oil-in-water emulsion, which contains egg lecithin, glycerol, and soybean oil
Propofol mode of action...
increases activity at inhibitory y-aminobutyric acid (GABA) synapses
Propofol pharmacokinetics...
elimination primarily through hepatic metab. to inactive metabolites
*induction does causes rapid unconsciousness followed by rapid awakening due to redistrib.
Propofol pharmacodynamics...
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 'em
thiopental, thiamylal, methohexital
Barbiturates do what?
rapidly produce unconsciousness (30-45 sec.)followed by rapid reawakening due to redistribution
Barbiturates mode of action
occupy receptors adjacent to GABA receptors in the CNS and augment the inhibitory tone of GABA
Barbiturates pharmacokinetics..
metabolism to inactive metab. occurs in liver
Barbiturates pharmacodynamics...
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.
Benzodiazepines name them
midazolam, diazepam, lorzepam
Benzos oftens used for
sedation and amnesia or as adjuncts to general anesthesia
Benzos mode of action...
bind at specific receptors in the CNS and enhance the inhibitory tone of GABA receptors
Benzos metabolized where?
Benzos pharmacocynamics...
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
What is Flumazenil?
competitive antagonist for benzodiazepine receptors in the CNS
Ketamine is _________ and is employed as ...
an arylcyclohexylamine and a congener of phencyclidine (PCP)
employed as an induction agent
Ketamine pharmacodynamics...
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
Ketamine adverse reactions...
oral secretions (coadmin. of antisialagogue (glycopyrrolate)), emotional disturbance, muscle tone, increased intracranial pressure, eye movements, anesthetic depth may be difficult to asses
Etomidate is and is used for...
is an imidazol-containing hypnotic unrelated to other anesthetics, it is most commonly used as an IV induction agent for general anesthesia
Etomidate mode of action...
augments the inhibitory tone of GABA in the CNS
Etomidate metabolized where?
and is similar to propofol how?
metabolized in the liver and by circulation esterases to inactive metabolites. time to loss of consc. and awakening is similar to pro.
Etomidate pharmacodynamics...
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 them.
morphine, meperidine, fentanyl, sufentanil, alfentanil, remifentanil
Opioids primary effect.
is analgesia, and therefore they are used to supplement other agents during induction or maintenance of general anesthesia
opioids used in high doses and as sole anesthetic in what type of surgery
Opioids mode of action...
bind at specific receptors in the brain and spinal cord
Opioids pharmacodynamics...
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
Opioid pharmacodynamics cont.
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
What is Naloxone?
pure opioid antagonist used to reverse unanticipated or undesired opioid-induced effects such as resp. or CNS depression
Naloxone mode of action.
competitive antagonist at opioid receptors in the brain and spinal cord
Inhalation anesthetics are usually adninistered for...
maintenance of general anesthesia but also can by used for induction, especially in pediatric patients
Dosages of inhalation anesthetics are expressed as ______, which is the
MAC, the minimum alveolar concentration at one atmosphere at which 50% of patients do not move in response to a surgical stimulus
Name the inhalation anesthetics.
gas: Nitrous oxide
Volitile agents: halothane, enflurane, isoflurane, desflurane, and sevoflurane
NO mode of action.
produces general anesthesia through interaction with the cellular membranes of the CNS, exact mech. not clear
NO pharmacodynamics.
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
What are volatile anesthetics?
liquids whose potent evaporative vapors (in a carrier gas) are used in inhalation anesthesia
Volatile anesthetics mode of action.
produce general anesthesia through interaction with the cellular membranes of the CNS, exact mechanism not clear
Volatile anesthetics pharmacodynamics.
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