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23 Cards in this Set

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What is narcosis?

A state of unconsciousness

Name some intravenous anaesthetics

Propofol (quicker acting for day case surgery), Thiopentone (barbiturate-longer lasting), Etomidate (selective and stable and good cardiostability), Ketamine (NMDA receptor antagonist, causes dissociation, used in army field anaesthesia), Benzodiaepines

Name some inhaled anaesthetics

Ether/chloroform/halothane (all historical), isoflurane, sevofluarane, desflurane

Whats the difference between depolarising and non-depolarising muscle relaxants?

Depolarising bind to the nicotinic receptors very strongly, causing a massive depolarisation that quickly desensitises the receptors, non-depolarising block the agonist, acetylcholine from binding to the nicotinic receptor

What are some examples of depolarising and non-depolarising muscle relaxants?

depolarising: suxamthonium, non-depolarising: Atracurium, vecuronium, rocuronium

Which laminae of Rexed is most linked to pain transmission?

II. But the some of the others are involved to different degrees too

What are the central effects of opioids?

Analgesia, sedation, euphoria, Respiratory depression, anti-tussive, nausea and vomiting, pupillary constriction

What are the peripheral effects of opioids?

Hypotension, increased sphincter tone and reduced gastric mobility, urinary retention histamine release, possible immunosepressant

Name some endogenous opioid ligands

Enkephalin, beta endorphin, and dynorphin

Pros and cons of IM opioids?

advantages: safe, inexpensive, nurse assessment


disadvantages: pharmacovariability, painful injection, breakthrough pain



What are the side effects of spinal and epidural opioids?

respiratory depression, urinary retention, big increase in itching, nausea and vomiting

What percentage of oral opioids gets past first pass metabolism?

30%

Tell me about opioid excretion

Converted to polar metabolites in the liver and exreted via the kidney. Hydroxyl groups are conjugated with glucuronide (morphine). Esteres are hydrolysed by esterases (pethidine), N-demethylation also occurs (methadone)

What are neuromuscular blocking drugs used in surgery for?

Tracheal ventilation, mechanical ventilation and surgery where muscle relaxation is required

Are motor neurons long? Are they fast? Are they myelinated? What kind of conduction do they have?

Long- some longer than 1 metre


very fast 50-100 metres per second


myelinated


saltatory conduction

Do acetylcholine and neuromuscular blocking drugs need to occupy many or a few receptors respectively to produce their action?

Acetylcholine only needs to occupy a few receptors to cause a muscle contraction, therefore NMBD need to occupy around 90%!

How does suxamethonium work?

two Ach molecules together, which each bind to a subunit, cause the channels to open and cause a massive depolarisation. Fasiculation then relaxation Has a rapid onset of 90 seconds then a rapid offset of 3-5 minutes thanks to plasma cholinesterases

Talk to me about suxamethonium metabolism

metabolised in the plasma by plasma pseudocholinesterase, usually complete within about 5-10 minutes but some patients lack tis due to difference in E1 genes. Can cause patients to be apnoeic for 1-2 hours

Side effects of suxamethonium?

muscle pains, increased intracranial pressure, hyperkalaemia, increased vagal tone (bradycardia), anaphylaxis, potential for prolonged apnoea, and can be a trigger for malignant hyperpyrexia

What are the main classes of non-depolarising neuromuscular blocking agents?

Benzylisquinolinium such as tubocurarine


aminosteroids such as verucuronium and rocuronium

Benefits and downsides of atracurium?

Developed in the 1980s, it is metabolised quickly with no cardiac effects, providing a safety net for patients particularly those with hepato-renal failure. However it does cause release of histamine causing itch, wheals, systemic hypotension and bronchospasm

Why is vecuronium not used as much as atracurium?

Takes longer for clinician to prepare! It is an amino steroid

Tell me about rocuronium

is a rapid onset analogue of vecuronium. Has a novel reversal agent called sugammadex