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Year 2 - Theme 1 > Analgesia sedation - Local anaesthetics > Flashcards

Analgesia sedation - Local anaesthetics Flashcards

1
Q

What is the gate theory

A
  • Melzack and Wall
  • C fibres lets pain through
  • Ab Fibres stimulate inhibitory neurones
  • Descending Pathways prevent central passage
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2
Q

Fibres involved in pain modification

A
  • Nociceptor C, A delta fibres
  • Central Interpretation
  • Not just Drugs!
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3
Q

Pain score systems

A
  • Linear
  • Smiley/Sad Faces
  • Mild Moderate Severe Excrutiating
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4
Q

Pain ladder 1

A
  • NSAIDS/Paracetamol
  • Weak Opiates/ Local Anaesthetics
  • Strong Opiates
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5
Q

Pain ladder 2

A
  • Strong opioids by injection, local anaesthesia
  • Opioids by mouth(as pain decreases)
  • Aspirin and NSAIDs
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6
Q

What are opioid receptors antagonised by

A
  • Naloxone
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7
Q

Examples of naturally occurring opioids

A
  • Morphine

- Codeine

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8
Q

Example of a semi synthetic opioid

A
  • Diamorphine
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9
Q

Example of a synthetic opioid

A

Fentanyl

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10
Q

Example of a weaker opioid

A

Codeine

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11
Q

Methods of opioid administration

A
  • Intravenous pca/infusion
  • Intramuscular
  • Oral
  • Intra nasal/aerosol
  • Epidural/spinal
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12
Q

Locations of opioid receptors

A
  • Pons and Mid brain
  • Periaqueductal Grey Matter
  • Nucleus Raphe Magnus
  • Spinal Cord Posterior Horn 1 and 2
  • G I T
  • Peripheral Tissues
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13
Q

Subtypes of opioid receptors

A
  • MU 1 and 2 OP3
  • Delta OP1
  • Kappa OP2
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14
Q

Side effects of morphine

A
  • Respiratory Depression/Airway Loss
  • Nausea and Vomiting
  • Constipation/Pruritis
  • Miosis
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15
Q

Features of ketamine

A
  • NMDA Receptors
  • Kappa and delta receptors
  • Not GABA
  • Analgesic local/general
  • Anaesthetic
  • Sedative
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16
Q

Side effect of ketamine

A
  • Emergence phenomena
17
Q

Features of NSAIDS

A
  • Act by inhibiting Cyclooxygenase 1and 2

- Analgesic, Antipyretic, Anti inflammatory

18
Q

Features of aspirin

A
  • Acetylsalycilic acid
  • Oxidative phosphorylation
  • Air Hunger
  • Reyes Syndrome
19
Q

Features of paracetamol

A
  • Mechanism of Action ? Central prostaglandin effect/unknown
  • Side effects
  • OVERDOSE Hepatotoxicity/glutathione depletion
  • N acetylcysteine
20
Q

Other analgesia

A
  • Anxiolysis
  • Local anaesthetics
  • Antidepressants,antiepileptics,Tramadol
  • Guanethadine, ketamine, clonidine
  • Acupuncture
  • Inhalational Nitrous oxide
  • Penthrox (methoxyflurane)
  • Magnesium
21
Q

Features of antiemetics

A
  • Avoidance of emetics N2O Sevoflurane
  • Use propofol
  • Cyclizine
  • Ondansetron
  • Hyoscine 1944
  • Metoclopromide
  • Steroids
  • Prochlorperazine
  • cannabinoids
  • People remember!
22
Q

Ramsay sedation scale

A 
1 - Patient Anxious
2 - Cooperative
3 - Responds only to commands
4 - Brisk response to Glabellar Tap/Shout
5 - Sluggish Response
6 - No response
23
Q

Examples of benzodiazepines

A
  • Midazolam, Diazepam, Lorazepam
24
Q

Physiology of benzodiazepines

A
  • Gabba- aminobutyric Acid
  • Inhibitory Neurotransmittor
  • Receptors A and B
25
Q

Side effects of benzodiazepines

A
  • Over Sedation
  • Loss of Airway
  • Respiratory Depression
  • ABC
  • Flumazanyl with caution
  • Myth of safety ,Light Anaesthesia
26
Q

Other sedatives

A
  • Low Dose Vapours
  • Ketamine
  • Hyoscine
  • Propofol Low dose
  • Major Tranquillisers
  • Alpha 2 agonists
27
Q

Classification of local anaesthetics

A
  • Amides -NH.CO-
  • Lignocaine,Prilocaine,Bupivacaine
  • Esters –CO.O-
  • Cocaine , Amethocaine
28
Q

Mechanism of local anaesthetic action

A

· Na Channel Blockade
· Un- ionized Drug Through Membrane into axoplasm
· Protonated
· Blocks Channel thus blocking action potential

29
Q

Where to put local anaesthetics

A 
· Anatomy Local Blocks /Ultrasound
· Spinal Epidural Caudal
· Skin 
· Aerosol/Nebulised
· Combination with GA  Part of Triad
30
Q

Side effects of local anaesthetics

A 
· Skin/Subcutaneous
· Brachial Plexus
· Epidural
· Caudal
· Intercostal
· VESSELS AND NERVES FOLLOW EACH OTHER

Toxicity -

· CARDIOVASCULAR
· Dysrythmias,Cardiac Depression
· CENTRAL NERVOUS SYSTEM
· Fitting/Anxiety/Lossof Consciousness
· Circumoral numbness
· Ref Paper Mask 1990
31
Q

Side effects of NSAIDS

A

Side Effects

  • Gastric Irritation
  • Bronchospasm
  • Renal Impairment
  • Platelet function ASPIRIN

Year 2 - Theme 1 (30 decks)

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