Pharm Winter Exam 2 General Anesthetics

Front 1

Inhalant Agents

Back 1

Nitrous Oxide
Halothane (Flourothane)
Isoflurane (Forane)
Sevoflurane (Ultane)
Desflurane (Suprene)

Front 2

Intravenous Agents

Back 2

Midazolam (Versed)
Propofol (Diprivan)
Etomidate (Amidate)
Ketamine (Ketalar)

Front 3

Opioid Analgesics

Back 3

Fentanyl (Sublimaze)

Front 4

Halothane (Fluothane)

Back 4

1) MAC: 0.75; Blood/gas 2.54
2) Slow induction, rapid awakening

Front 5

Halothane (Fluothane)

Side effects

Back 5

1) Uterine Relaxation
2) Respiratory depression
3) Blood Pressure decreases linearly with amount
4) Sensatization to catecholamines, arrythmias
5) Uterine relaxation/ miscarriages
6) reduced renal function/ urine flow
7) Hepatic Necrosis with repeated administration
8) Malignant Hyperthermia with succinylcholine

Front 6

Enflurane

Back 6

Contraindicated in patients with seizure disorders.
May cause CNS stimulation and seizures.
Floride production=reversible kidney damage

Front 7

Isoflurane (Forane)

Back 7

Rapid induction emergence
Useful in neurosurgery
Low liver kidney Toxicity
Coronary steal
Does not depress myocardium or sensitize it to catecholamines

Front 8

Sevoflurane (Ultane)

Back 8

Rapid effect
Least airway irritation
Safest in Cardiovascular disease

Front 9

Desflurane (Suprane)

Back 9

Rapid emergence, induction
Good for outpatient surgery
Pungent odor, irritates airway
Not used for induction

Front 10

Metabolism of Inhaled anesthetics

Back 10

1) Cl and Br may be removed from Halothane causing immune reaction and hepatitis
2) Evoflurane and Sevoflurane release Floride-kidney toxicity (rare)

Front 11

Malignant Hyperthermia

Back 11

Rapid rise in heat production
Caused by use of succinylcholine with inhaled anesthetics.
May be fatal
Treat with Dantrolene

Front 12

Effects of General Anesthetics

Back 12

Decrease BP
Decrease Respiratory Drive
Increase Cerebral blood flow
Increase Intracranial pressure
Hypothermia

Front 13

Effects of General Anesthetics

Emergence

Back 13

Hypertension
Tachycardia
Myocardial ischemia (CAD patients)
Excitment(Crying, thrashing, moaning)
Shivering
Can Reduce with Opioids

Front 14

Mechanism of action General Anesthetics

Back 14

1) GABAa agonist (Barbituates, Benzodiazepines, Propofol)
2) Block NMDA (Ketamine)
3) Opioid Receptor (Opiates)

Front 15

Nitrous Oxide

Back 15

Low potency for Anesthesia
Good Analgesia (Dental)
Attenuates Hypotension
Cause Diffusion Hypoxia
No malignant Hyperthermia
Little respiratory depression

Front 16

Nitrous Oxide

Adverse effects

Back 16

1) Causes Euphoria-abuse
2) Trapped gas will expand
3) Chronic low level exposure-Peripheral neuropathy
4) Megaloblastic anemia
5) Don't use within three months of eye surgery

Front 17

Nitrous Oxide

Uses

Back 17

Speeds induction
With other drugs for "Balanced anesthesia"

Front 18

Thiopental (pentothal)

Back 18

Induction for short procedures (onset 30-60sec)
Contraindicated in patients with acute intermittent porphyria- causes demyelination of nerves

Front 19

Midazolam (Versed)

Back 19

1) Sedation, Anxiety relief,
Anterograde amnesia
2) Preanesthetic and induction
3)Short procedures it is combined with Fentanyl
4) Reversed by flumanzenil

Front 20

Propofol (Diprivian)

Back 20

1) DOC for most procedures
I2) nduction and maintenance
3) Induction equal to thiopental emergence 10 times faster
4) Decrease cerebral blood flow, metabolism and intracranial pressure= good for neurosurg
5) Safe in pregnancy

Front 21

Propofol (Diprivian)

Adverse effects

Back 21

1) Severe Respiratory depression
2) Pain at injection site
3) Anaphylactic reactions
4)LESS nausea and vomiting

Front 22

Etomidate (Amidate)

Back 22

Increase GABA receptors and displace inhibitors
Rapid onset short duration
No hypotension

Front 23

Etomidate (Amidate)

Adverse effects

Back 23

1) Nausea and vomiting
2) Decrease seizure threshold
3) Hiccups

Front 24

Ketamine (Ketalar)

Back 24

1) Catatonic state
2) Dissociative anesthesia, profound analgesia
3) Little respiratory depression
4) Used in children
5) Uncommon Nausea and vomiting

Front 25

Ketamine (Ketalar)

Adverse effects

Back 25

1) Increase BP and HR
2) Emergence delerium: bizzare dreams hallucination, even psychosis
3) Date rape drug
4) Abused

Front 26

Fentanyl (Sublimaze) Sufentalnil (Sufenta)

Back 26

1) IV
2) Rapid onset, Good analgesia
3) Lollipops for kids
4) Midazolam combined for short procedures