Miscellaneous Quiz / General Anesthetics

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Can you name the General Anesthetics?

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Methohexital class
Drug SE: Similar to halothane less hepatotoxicity more renal toxicity (polyuric renal insufficiency)
Sevoflurane class
Drug CV effects: Similar to halothane (less effect on rate). Decrease in vascular resistance
Drugs P-kinetics: 'Rapid onset and short duration (rapid recovery). Primarily metabolized in liver. '
Drug P-kinetics: Slow onset & recovery
Drug CV effects: Decrease in systemic BP, negative inotropic effects
Drugs Brain effects: Decrease in metabolism, O2 utilization, and cerebral blood flow. (No increase in ICP - better in pts w/ cerbral swelling)
Thiopental class
Lorazepam class
Drugs Resp effects: depressant
Drug Use: Induction or maintenance. Used in short applications only b/c of nephrotoxicity (OB-GYN)
Enflurane class
Drug Brain effects: may cause burst suppression on EEG
Drug SE: Hypotension, apnea & pain at site of injection, muscle mvmt expensive (bacterial infections). Acidosis in children
Class MOA: Increase the threshold of firing. Depress both axonal & synaptic transmission. Depresses spontaneous & evoked activity of neurons either by the Meyer-Overton hypothesis
Drug P-kinetics: Slow onset & recovery; naloxone reversal available
Drugs P-kinetics: Medium rate of onset & recovery, medium solubility
Drug P-kinetics: Rapid onset & moderately fast recovery. NO analgesic effects - opiods required. Degraded in liver and plasma
Class Kidney and Liver effects:decreased blood flow
Drug Uses: Used in induction & for maintenance: antiemetic properties, 'day surgery'. Sedation in critical care setting. Not for peds
Drug Uses: CV stability; decreased steroidogenesis. Induction when prolonged infusion is NOT required
Morphine class
Drug Use: Standard induction agent: CV depression; avoid in porphyrias
Drug Use: Induction or maintenance. . Used in pediatric and outpatient anesthesia
Drugs Other effects: May exacerbate porphria by inducing synthesis of ALA synthase
Drugs MOA: Unclear (probably GABA-A channel effects)
Atropine class
Drug MOA: unknown, probably similar to fluranes
Drugs SE: Anterograde amnesia in >50%.
May induce mild sizure activity (muscle twitching -- prob harmless)
Drug SE: Hepatotoxicity (fatal fulminant hepatic cirrhosis). Generation of flouride ions during metabolism may be nephrotoxic, Malignant hyperthermia (reversal is Dantrolene IV whi
Class Resp effects: Decrease tidal vol, increase rate, decrease in minute ventilation, resp depressant (reduce responses to CO2 & hypoxia), pooling of mucus --> atelectasis & resp
Drug SE: Emergence phenomena (disorientation, sensory & perceptual illusions, & vivid dreams -- Diazepam reduces symptoms).
Drugs SE: Similar to halothane less hepatotoxicity
Drug Resp effects: minimal
Propofol class
Drug CV effects: Similar to halothane except (less HR effects, decrease CO)
Succinylcholine class
Drug CV effects: CV stimulation via excitation of central sympathetic nerves, possibly inhibiting NE reuptake.
Drugs enhancing NM blockade
Drug MOA: May involve inhibition of NMDA glutamic acid receptors. Produces dissociative anesthetic: catatonia, amnesia, profound analgesia w/o LOC
Drug SE: Involuntary muscle mvmts, monoclonus (no EEG signs), n/v, pain at inj site, adrenocortical suppression, prolonged use may cause hypotension, e- imbalance, & oliguria
Drug Use: Induction or maintenance. Used for pediatric anesthesia.
Midazolam class
Thiamylal class
Nitrous Oxide class
Drug P-kinetics: Highly lipophilic. Moderately rapid onset and recovery
Tubocurarine class
Diazepam class
Drug P-kinetics: Rapid onset & rapid recovery (faster than barbituates). Rapidly metabolized in the liver + extrahepatic degradation = advantagous in liver dz
Drugs use: Used in balanced anesthesia (anesthesia premedication) & conscious sedation; CV stability; marked amnesia
Drug Use: Induction or Maintenance
Halothane class
Sufentanil class
Class Brain effects: Decrease metabolic rate; decrease cerebral resistance --> increased blood flow = not good choice for neurosurgery esp when ICP is elevated.
Alfentanil class
Fentanyl class
Drug Resp effects: Slight decrease in RR
Remifentanil class
Drug CV effects: Minimal, good choice for CV surgeries and those w/ hypotension and MI risk
Drug Use: Maintenance
Drug SE: Amnesia, hypoxia. Prolonged exposure --> megaloblastic anemia (OR staff)
Drug CV effects: Similar to desflurance
Drug P-kinetics: Incomplete anesthetic; rapid onset & recovery
Drug Resp effects: less respiratory effects
Drug P-kinetics: Medium rate of onset & recovery, medium solubility
Drug CV effects: Similar to halothane
Drug P-kinetics: Rapid onset & recovery
Ketamine class
Class Uterine Smooth Muscle Effects: potent uterine muscle relaxants. Useful for fetal manipulation during delivery
Desflurane class
Drug uses: Used in balanced anesthesia, short procedure induction (remifentanil and alfentinil), conscious sedation & spinal epidural; neuroleptic anesthesia (fentanyl, NO, and dro
Drug CV effects: Decreases in MAP, bradycardia, increase RAP (depressed cardiac function)
Drug Use: Induction, used in combo to reduce dose of other, not used alone
Drug P-kinetics: Low volatility; poor induction agent ; rapid recovery
Ethomidate class
Drug uses: Dissociative anesthesia, induction agent in children undergoing short, painful procedures, high-risk geriatric patients, & patients in CV shock. Outpatients & pts w/ ast
Drugs P-kinetics: Slow onset, plateau & slow recovery, flumazenil reversal available. Only midazolam is H2O-soluble, become lipid soluble at physiologic pH. Midazolam: faster onset
Isoflurane class
Drug CV effects: Similar to isoflurane: transient tachycardia do to sympathetic discharge, decrease vascular resistance
Drug Brain effects: Increases cerebral blood flow, O2 consumption, & ICP. DO NOT use in pts w/ increased ICP
Methoxyflurane class
Drug CV effects: Produces sympathetic discharge, may balance negative effects of other inhalants when used in common
Drugs CV effects: Myocardial depressant = decreased SV, CO, & BP

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