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Dr Potter.

General AnetheticsEverything Nitro

Everything Halophane

About Isoflourane Non Toxic

IV MidazolamEverything Propaphol

Familiar Ketamine

Know Fentanyl

Induction

Emergence

General

Dissasociative

Gaba A Blocking NMDA or Opiod ReceptorsGeneral Decrease BP and inhibit Respiration except nitrousHypothermia Nausea vomiting except propophol

Ketamine has bad emergence

Gases

Low coefficient = Fast inductionHigh = Slow induction

High solubility long time to meet equilibriumBreathing faster = faster induction

Higher pulmonary perfusion will make induction take longer as saturation will take

longerfaster tissue perfusion areas faster effect

More blood flow, longer to take effect?

Minimum Alveolar Concentration = Potency

MAC is additive with 2-3 drugs

Low number = very potent

Nitrous has 105% so cant do general but use 2/3 a MAC of this and 1/3 of

something else.

Diffusion hypoxia

Nitrous can come out in the lungs and displace oxygen. It is also typically added tospeed the induction of other drugs (2nd gas effect)

Halophane

Sensitizes the heart to catecholamine and can get arrythmias

Repeated use causes hepatitisIncreases miscarriages

Worst at triggering malignant hypothermia

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IsoflouraneNontoxic popular

Fast recovery

NitrousGood analgesic bad anesthetic

Rapid onset / recovery

Doesnt cause drop in BP

Decreases Hypertension

Doesnt cause respiratory depression

Nausea and vomiting

Can get into body cavities

Drug of abuse

Peripheral neuropathy

Megoblastic Anemia with chronic use

IV Drugs

Thiopental

Midazolam

Propaphol can have allergic reactions

Severe respiratory depression with opiatesInjection site reactions

Reverse the IV drugs with flumanazil

Ketamine causes dissociative amnesia with severe emergence delerium not muchnausea or vomiting

Fentenyl lipid soluable

Look at

Procaine

Lidocaine

Ubivicane worst on heart if injected into vessel

Know they block sodium activated sites from INSIDE the cell and have to be non-

ionized and only what is inside the cell is active

PH changes from abscesses affect ionization and ability to diffuse

Toxic when they are systemically administratedCardiovascular effects, can stop heart

Cocaine vasoconstrictor and increases sympathetic activity

Prilocaine broken down into metabolite causes methhemeglobenemia that can betreated with methlyene blue

Procaine worst at causing allergic rxns by metabolized to PABA

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Lidocaine intermediate

Know the difference between the amides and the estersEsters are very quickly metabolized by pseudocholine esterase

Amides have slower metabolizem

Lidocaine is an amide

If there are two Is in the name, they are amidesOnly one I makes them estersLidocaine is used in infiltration blocks, epidurals, and antiarythmics

Antihistamines

Diphenhydromine very anticholenergic, highly sedating, motion sickness. H1

receptor. Very good

Promethazine

Loratidine

Citeridine

Fexofenadine (Allegra)Azelastine (Astelin NS; Astepro)

Know the actions of histamine, the release, and effects on H1 and H2, vaso dialation

and drop in BP. Reflex tachycardia, hives, swelling, bronchospasm

H2 in stomach will increase gastric acid

Flush, flare, wheel on skinAnaphalazis, epi, corticosteroids, and antihistamines.

1stgen gets into the brain and is anticholenergic, motion sickness, anti emetic,

sedative

2nd generation doesnt get into the brain at all or as well and dont block muscarinic,

Citeridine is eliminated by kidney so better in liver disease and better interaction

profile

Dry mouth

Poisening will look like atropine

Can lower seizure threshold

2nd generation can cause arrythmias, but it is rare.

Chromalyn inhibits histamine release Nasal, or inhaled for asthma

Azelastine blocks histamine release and receptor, used nasally

Albuterol Basic Rescue Inhaler immediate effect that lasts 4-6 hours

Salmeterol is longer acting USE CORTICO Steroids to decrease fungal

infections and are PROPHALACTIC only as they will NOT stop an attack in

progress

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