mod 4 final exam

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mgseaturtle
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mod 4 final exam
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2012-04-09 01:04:33
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neuropharm general anesthetic drugs
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  1. Who is the father of anesthesia and what did he invent?
    William T. Morton

    Invented the ether dome which is administered as a mask during surgery.
  2. What are the four goals of anesthesia?
    1. Anesthesia (make pt unaware of what is going on)

    2. Akinesia (keep pt still during surgery)

    3. Muscle relaxation (enables access through muscles to bones and body cavities during surgery)

    4. Autonomic control (prevents dangerous surges in hemodynamics during surgery)
  3. What are the two major categories of anesthetics?
    1. Inhalation (drugs dissolved in gas)

    2. Intravenous (All depress the CNS)
  4. What does the ending "ane" mean?
    Menas that they are short strings of carbons
  5. Nitrous oxide
    inhalational anesthetic drug
  6. chloroform
    inhalational anesthetic drug
  7. Haloethane
    inhalational anesthetic drug
  8. Isoflurane
    inhalational anesthetic drug
  9. Enflurane
    inhalational anesthetic drug
  10. Methoxyflurane
    inhalational anesthetic drug
  11. Desflurane
    inhalational anesthetic drug
  12. Sevoflurane
    inhalational anesthetic drug
  13. Thiopental (barbiturate)
    Intravenous anesthetic drug
  14. Methohexital (barbiturate)
    Intravenous anesthetic drug
  15. Propofol (Michael Jackson drug)
    Intravenous anesthetic drug
  16. Ketamine (vetrinary anesthetic)
    Intravenous anesthetic drug
  17. Diazepam (Valium)
    Intravenous anesthetic drug
  18. Midazolam (benzodiazepine)
    Intravenous anesthetic drug
  19. Etomidate
    Intravenous anesthetic drug
  20. Fentanyl (analgesic narcotic, found in 50% of short procedure anesthetics)
    Intravenous anesthetic drug
  21. What are the three processes of anesthesia?
    1. Pre-medication

    2. Induction

    3. Maintenance
  22. Explain the pre-medication portion of the anesthesia process.
    *Calm and relax pt with minimal effcts on breathing and cardiovascular function.

    *Start with short acting benzodiazepine to relax pt

    *Others: analgesics, muscle relaxants, beta blockers, antacids, H2 blockers
  23. Explain the induction portion of the anesthesia process.
    *Usually induced with an intravenous drug very quickly

    *Intubation followed by gaseous anesthetics
  24. Explain the maintenance portion of the anesthesia process.
    gaseous anesthetics provide good control of depth
  25. What are the four stages of anesthesia?
    1. Analgesia

    2. More pronoiunced analgesia, anterograde and retrograde amnesia

    3. Loss of reflexes, skeletal muscle relaxation

    • 4. Respiratory and cardiac depression
  26. In which stage of anesthesia is there loss of consciousness (cannot stay awake no matter what?
    Stage 2
  27. Which stage of anesthesia is a good reference for when you should be preforming surgery?
    Stage 3
  28. What are the four planes within stage 3 of anesthesia?
    Plane 1: eyes moist, pupils mitotic

    Plane 2: eyes dry, pupils mid dilated

    Plane 3: loss of corneal reflex-->tested to know if you are at a good place to preform surgery

    Plane 4: maximal pupoil dilation, apnea-->must support respiratory and cardiac systems at this stage. have gone too far to perform surgery at this plane
  29. What is the CNS target of analgesia?
    Spinal cord and cortex
  30. What is the CNS target of amnesia?
    Cortex, hippocampus
  31. What is the CNS target of loss of consciousness?
    Brainstem, cortex, hypothalamus, RAS
  32. What is the CNS target of loss of reflexes?
    Spinal cord
  33. What is the CNS target of skeletal muscle relaxation?
    Spinal cord
  34. Describe the effects of general anesthetic drugs based on this graph.


    1. As you increase concentration of drug or increase the time it is inhaled, you will see an increase in the number of patients that do not respond and are not able to form memories.

    2. Some effects happen at lower concentrations of a drug than others

    3. Dose response curve changes over time
  35. What is the prototype anesthetic drug?
    Diethyl ether (very flammable)
  36. How are the derivatives of ether similar?
    All have same basic skeleton, just added various halogens to make it less flammable.
  37. Name the derivatives of diethyl ether.
    • 1. Halothane
    • 2. Isoflurane
    • 3. Enflurane
    • 4. Methoxyflurane
  38. Between 1840 and 1850 which inhalation anesthetics were around?
    chloroform, ether, and NO were around for recreation
  39. Between 1951 and 1990 which inhalation anesthetics were around?
    halothane, still used in operating rooms today
  40. Between 1991 and 2003 which inhalation anesthetics were around?
    Propofol
  41. What are the two important determinants of how drug levels in the brain are determined?
    1. Partial pressure

    2. Lipid solubility
  42. What is partial pressure?
    Concentration of a gas in a mixture of gases (O2)
  43. Describe lipid solubility.
    1. Measured by blood/gas partition coefficient--> usually an oil to water ratio

    2. Solubility of gasious drugs when exposed to blood-> degree to which it dissolved in blood determines blood and brain concentration

    3. Determines onset of effects--rate at which levels build up

    4. Deteremines blood (and brain) levels of drug
  44. What is the Meyer-Overton equation?
    for a general anesthetic drug, the partition coefficiet is inversely proportional to anesthetic potency
  45. What is this graph about inhalational anesthtic potency show?

    x-axis: scale goes from 1-1000 (1000 times more soluble in a different substance)

    y-axis: 1 = 100% of inspired gas would be gas of interest
  46. Explain the solubility in blood and effect latency chart of NO vs. Haloethane.

    *NO has low oil/gas ratio

    *Halothane has high oil/gas ratio

    *NO sees blood compartment as very small (lipid insoluble)

    *Halothane perceives blood compartment as very large (lipid soluble) and it must be filled up (high dosage) to have an anesthetic effect in brain
  47. What happns to the onset of effects and the recovery rates as the partition coefficient increases?
    they are both slower
  48. What is minimal alveolar concentration?
    Concentration of gas you need in alveoli you ned to have an ansethetic effect
  49. Which inhaled anesthetics have rapid onset and recovery?
    1. Nitrous Oxide

    2. Desflurane (has poor onset)

    3. Sevoflurane
  50. Which inhaled anesthetics have medium onset and recovery?
    1. Isoflurane

    2. Enflurane

    3. Halothane
  51. Which inhaled anesthetics have slow onset and recovery?
    1. Methoxyflurane
  52. How are the partition coefficient, minimal alveolar concentration, onset and recovery all related in the inhaled anesthetic drugs?
    The more rapid the onset/recovery is, the lower the partition coefficeint and the higher the minimal alveolar concentration is.

    (Remember: when everything is high/rapid the only thing that is low is the partition coefficient......when everything is low/slow the only thing that is high is the partition coefficient)
  53. What is the mechanism of action of inhalational anesthetics?
    *Specific and non-specific actions on neuronal activity

    *Direct and indirect effects on various types of ion channels

    *Binding sites on ion channel proteins

    *Binding sites of cell membrane lipids
  54. Describe the general interactions with ion channels in inhaled anesthetics.
    Action potential opens the pre but the presence of durg molecules do not allow for conduction, so it is inhibited (anesthetized).
  55. Name each hypothesis for binding of inhalational anesthetics.
    1. Lock and Key

    2. Protein dynamics
  56. What is the lock and key hypothesis?
    Molecules bind within and around protein and cause a conformational change of the globular protein that closes the pore.
  57. What is the protein dynamics hypothesis?
    *Inhaled general anesthetic drugs may not cuase conformational changes in ion channels or transmitter receptors

    *Flexible loops on protein are impinged upon by neurotransmitter molecule and the pore closes
  58. Name 5 adverse side effects of inhaled anesthetics.
    1. Respiratory and cardiac depression

    2. Hypotension

    3. Some increase in skeletal muscle tone

    4. Diabetes insipidus (hypoglycemic reaction from methoxyflurane)

    5. Hepatotoxicity - circulating environmental halothane caused severe liver damage to OR docs due to poor regulation of drug (is tightly regulated now)
  59. Do intravenous anesthetics induce rapid or slow state of unconsciousness?
    Rapid
  60. What is potency correlated with?
    Lipid solubility
  61. What type of neurotransmission do intravenous anesthettics enhance?
    GABA (inhibitory) neurotransmission

    (45% of synapses in the brain utilize GABA as their neurotransmitter while another 45% of synapses in the brain utilize Gluatmate which is an excitatory neurotransmitter)
  62. What type of clinical settings are intravenous anesthetics used in?
    Multiple clinical settings (anesthesia, insomnia, anxiety, epilepsy)
  63. Are intravenous anesthetics good muscle relaxants?
    yes
  64. What are the two most common drug classes of intravenous anesthetics?
    1. Benzodiazepines

    2. Barbiturates

    **Benzodiazepines have almost completely replaced barbiturates in use
  65. Which intravenous anesthetics have the shortest and longest half lives?
    *Thiopental has SHORTEST half life of 10-12 minutes

    *Diazepam has LONGEST half life of 20-40 hours followed by propofol which has a half life of 5-10 hours.
  66. As far as respiratory and cardiac depression of intravenous anesthetics which of these drugs has a large safety margin and which one has a small safety margin?
    *Benzodiazepines: large safety margin

    *Barbiturates: small safety margin
  67. Name three adverse side effects of intravenous anesthetics.
    1. Respiratory and cardiac depression

    2. Hypotension

    3. Pharmacogenetics
  68. Describe adverse side effects of intravenous anesthetics interms of pharmacogenetics (idiosyncratic reactions)?
    • 1. Malignant hyperthermia (succinylcholine)
    • *Certain polymorphisms in calcium channels that make some people very suceptible to succinylcholine.
    • *Causes rise in body temperature, tachycardia, sweating, hallucinations
    • --> there is now a screening for the known calcium channel mutation to prevent this reaction


    2. Psychosis (ketamine)
  69. Thiopental
    Rapid onset

    Rapid recovery

    Barbiturate; induction; cardiovascular depression
  70. Methohexital
    Medium onset

    Slow recovery

    Barbiturate; maintenance of anesthesia
  71. Propofol
    Rapid onset

    Rapid recovery

    Induction and maintenance; lowers BP; replacing barbiturate
  72. Ketamine
    Medium onset

    Medium recovery

    NMDA antagonist; cardiac stimulant; increase blood flow; glutamate receptor
  73. Diazepam
    Medium onset

    Slow recovery

    Benzodiazepine; conscious sedation; slower recovery
  74. Midazolam
    Slow onset

    Slow recovery

    Benzodiazepine; sedation; marked amnesia (commonly found in date rape drugs)
  75. Etomidate
    Rapid onset

    Medium recovery

    Cardiac stabilizer/ skeletal muscle activator
  76. Compare and contrast general anesthetics therapeutic considerations.

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