Anesthesia Pharmacology Flashcards

Question

Thiopental Half Life

Answer 1

Induce Unconsiousness

Answer 2

Decreased cerbral oxygen demand Decreased myocardial function Possible decrease in vascular tone which will lead to hypotension

Answer 3

Due to it association with an **increased airway reactiveness** this is **not used with asthmatics**

Answer 4

Widely used tranquilizer Causes pain at peripheral injection site Better to infuse through a central line

Answer 5

0.3 to 0.6 mg/kg dose can achieve induction Metabolized by the liver and excreted by the kidney (70%) & bile/feces (30%). Prolonged effect due to first metabolites having nearly as strong an effect as the original drug.

Answer 6

Pre anesthetic sedation Mild muscle relaxant and anti-convulsant

Answer 7

Can cause the loss of airway reflexes at high doses and a decrease in tidal volume at lower doses

Answer 8

0.1 to 0.3 mg/Kg dose. Metabolized by liver---excreted by kidneys Duration of action is 15 minutes---longer than thiopental but less than valium.

Answer 9

Cardio-version Intubation Bronchoscopy

Answer 10

Little effect on RR ## Footnote Can cause the loss of airway reflexes at high doses and a decrease in tidal volume at lower doses

Answer 11

A stronger cousin of Diazepam (X2-3) Will have the **same pharmacological action as diazepam,** but also has **anterograde amnesia effects.** The patient will appear awake but will have no memory of the event afterwards Little effect on BP, cerebral blood flow, ICP No pain at injection site

Answer 12

Given IV or IM in 1-2 mg/kg dose over 1 minute Duration of action is 5-10 minutes Converted in liver and exreted by kidneys

Answer 13

Will Create a dissociative mental state Used in burns, pediatrics, etc

Answer 14

Catalepsy-Trance like state with muscle rigidity Sedation Amnesia Analgesia

Answer 15

Increased BP (20-40 mmHg) Increased HR Increased ICP

Answer 16

Patient can maintain airway

Answer 17

Pts need dark, quiet room to recover as can cause hallucinations/bad dreams (emergence delirium)

Answer 18

Loading dose: 0.2 to 0.3 mg/kg

Answer 19

2.9-5.3 Hour

Answer 20

Some adrenal suppression, (which may be advantageous in some pts). Potent cerebral vasoconstrictor.

Answer 21

No Analgesia effects Minimal cardio vascular effects Possible alternative to Propofol or Thiopental

Answer 22

Ultra short acting pentothal Being phased out

Answer 23

Cousin of thiopental Faster hepatic extraction therefore less residual drowsiness and less cumulative effect

Answer 24

Cousin of valium Long Duration and Action and Half-Life

Answer 25

Major role is the **maintance of anesthesia** after the patient has been induced through another means (ex. IV Thiopental) **Induction can be indicued by these agents** when there is contraindications (ex. small children) These agents are introduced to the body via the respiratory tract and distributed by normal circulation As vapours these agents will behave according to normal gas laws

Answer 26

Ptotal = P1 + P2 + P3 + P4 etc. ## Footnote The total pressure in a gas mixture is equal to the sum of all the partial pressures. The partial pressure of each gas is proportional to the volumetric percentage of each gas. The partial pressure of each gas is the pressure it would exert if it were alone in the container. Eg. A gas mixture of 10 litres total, containing 100 mL of Halothane vapour is a 1% concentration. (FiHalothane= 0.01) At BTPS, that 1% in a gas would exert a pressure equal to; (760-47) \* 0.01) = 7.13 mmHg.

Answer 27

Compartments can be considered as the different spacesagents need access to, to achieve their desired effect. For inhaled agents the first compartment is the lung. Agents need to traverse the A/C membrane to get to the second compartment --- the blood. The blood--brain barrier needs to allow agents in to get to the usual site of action in the brain (CNS) --- the third compartment. Partial pressure is the primary determinant of diffusion. If pressure equilibrium is achieved, and therefore no pressure gradient exists, movement of agent will stop.

Answer 28

A measure of a drugs **potency** and is the minimum concentration that is needed in order to prevent the movement of 50% of pt when an incision is made ## Footnote **The lower the MAC, the more potent the agent.**

Answer 29

2% in 100% O2 1.1 in 70% N2O B/G Sol CoEf 0.69

Answer 30

1. 70% in 100% O2 0. 57% in 70% N2O B/G Sol CoEf 1.9

Answer 31

1. 15% in 100% O2 0. 5% in 70% N2O B/G Sol CoEf 1.4

Answer 32

0. 77% in 100% O2 0. 29% in 70% N2O B/G Sol CoEf 2.4

Answer 33

0. 16% in 100% O2 0. 07% in 70% N2O B/G Sol CoEf 1.9

Answer 34

6% in 100% O2 3.50% in 70% N2O B/G Sol CoEf 0.6

Answer 35

104% Sol CoEf 0.47

Answer 36

The different MACs of agents can be combined for greater effects, but combing them is not precise and there can be a range of reactions

Answer 37

Hyperthermia Drug use Chronic alcohol abuse Amphetamines CNS stimulants

Answer 38

Advanced age Hypothermia Severe hypotension Other agents; opiates,valium Acute drug or ETOH intox. Pregnancy High PCO2, Low PO2

Answer 39

Gender Duration of anesthesia Mild hypercapnia Hypocapnia Mild anemia Mild acid-base imbalance Hypertension.

Answer 40

Patient may well have been given: * Pre-operative sedation. * Induction agent---Propofoletc. * Intra operative opioids. * Muscle relaxants. * Halogenated hydrocarbons. All agents can contribute to the depth of anesthesia. Repeated assessment of the depth of anesthesia is mandatory. Vital signs, tearing, obvious movement, etc.

Answer 41

* Inspired concentration ( [] effect) * Washout of alveolar gas * Alveolar ventilation * Functional residual capacity * Uptake by pulmonary blood flow * Solubility of agent in blood * Cardiac output * Alveolar-mixed venous tension gradient

Answer 42

The more soluble the gas the more potent it is

Answer 43

Because nitrous oxide has a low blood solubility it will equlilbrate very fast, it also has a large MAC meaning you can use a lot of it before you will ever see the affects. Due to this we can combine nitrous oxide with other inhaled drugs to help them equalibrate faster Solubility is related to the speed at which a drug will enter the blood/brain Potency is how much you need of a drug to see effect So second gas effect is combining drugs with low solubility (nitrous oxide) with drugs with high potency allowing for quicker induction and less quantity of any particular component.

Answer 44

Different drugs will have different affinities for one type of receptor OR the same drug may have different affinities for similar but different receptors. ## Footnote Drugs can be active on enzyme function and not receptors. General anesthetic inhaled agents seem to have no specific receptor site but are highly lipid soluble and cause some CNS cell membrane changes. Generally speaking, drugs that excite the CNS (amphetamines), will increase the MAC; drugs that depress the CNS (sedatives/hypnotics, tranquilizers, narcotics) will decrease the MAC. If a drug like valium was to decrease the MAC by 20% it could be said to contribute a MAC fractionof 20%.

Answer 45

Critical volume hypothesis, cell membrane volume swelling or expansion may obstruct ion channels and therefore electrical activity.

Answer 46

Lipids surrounding an ion channel that are normally a semi-rigid gel, may liquefy and block the channel.

Answer 47

GABA = gamma-aminobutyric acid A neurotransmitter that binds to receptors on CNS neurons, to inhibit their action may be potentiated by anesthetic agents. The GABA binding/blocking is strengthened.

Answer 48

Blue Tank Shoulder ## Footnote Mac of 104%. Very lowsol CoEf. Often used as a 70% strength with balance O2. **Weak anesthetic, good analgesic.** ‘Entonox’ 50/50. Used in combination with a narcotic analgesic and muscle relaxant, and a stronger anesthetic. Some respiratory and myocardial depression

Answer 49

Orange Tank Color ## Footnote Pleasant odor Good muscle relaxant Muscle relaxant properties similar to IsoF.

Answer 50

Purple Tank Color ## Footnote Dose related decrease CNS, slight increase ICP (Tx w/hypervent) Potentiates non-depolmuscle relaxants ( decreased by 1/3).

Answer 51

Blue Tank Shoulder ## Footnote **Least potent (MAC 6%)** **Least soluble (rapid induction and recovery)** **Sympathomimetic Properties:** Dose related tachycardia / hypertension, very resistant to biodegradation therefore little chance of systemic toxicity.

Answer 52

Yellow Tank Color ## Footnote Non pungent odor, (is used for induction)

Answer 53

**BP:** Increase **CO:** No Change **SVR:** Increase **HR:** Increase

Answer 54

**BP:** Decrease **CO:** No change **SVR:** Decrease **HR:** Increase No PVC’s.

Answer 55

Mild Cardiac Depressant Few PVR, will not cause MI but may contribute to "coronary steal"

Answer 56

Although PVCs are less common, circulatory depression is greater than others.

Answer 57

Decrease Vt Increase RR Bronchodilation Coughing and breath hold if given quickly

Answer 58

Decrease Vt Increase RR Bronchodilation Dose related resp depression of both central and peripheral chemoreceptors.

Answer 59

Decrease Vt Small Increase RR Decrease MV Good Bronchodilation

Answer 60

Decrease Vt Increase RR Increase Upper Airway Irritability Potent respiratory depressant

Answer 61

CO Decrease Abnormal EEG and may cause seizures during hypocapnia Potential nephro-toxic to pts with kidney disease.

Answer 62

Uterine relaxant, may incidence of and severity of post-partum hemorrhage.

Answer 63

Decrease dose of muscle relaxant needed

Answer 64

Decrease dose of muscle relaxant needed

Answer 65

Decrease dose of muscle relaxant needed

Answer 66

Decrease dose of muscle relaxant needed

Answer 67

Potential nephron toxic to kidney patients

Answer 68

Good for neuro-surgery, stable ICP, low Sol CoEf

Answer 69

Plesant smell Low Sol-Coef

Answer 70

Irritating smell Low sol-coef, boils at 23.5oC Dispensed as a gas from a heated vaporizer.

Answer 71

HE IS Dumb N2O Halothane Enflurane Isoflurane Sevoflurane Desflurane Nitrous Oxide

Answer 72

Both hypercapnic and hypoxic systems are depressed (EnFl is worst) Bronchodilationis caused by all, best with Halo. Hypoxic vasoconstriction is depressed by IsoFl. Halo and EnFlcan cause decreased cilliary function.

Answer 73

All will reduce liver perfusion, Halo the most. Renal blood flow is decreased by all High concentrations of EnFl has caused nephro-toxicity.

Answer 74

Halothane undergoes the most extensive reductive metabolization (up to 40%) ---- Isoflurane+ Des the least. TOXIC in high doses: Halo---hepato, EnFl---nephro Avoid all inhaled agents where the pt may be in the first trimester of pregnancy. (TIVA)

Answer 75

Paralyzers Muscle relaxants must NEVER, EVER, be given without sedation.

Answer 76

Profound muscle relaxation is necessary during intubation and many operative procedures. Neuromuscular blocking agents have occasionally been used as a substitute for adequate anesthesia or for pharmacological restraints for combative patients. It should be remembered that these drugs can cause total muscle paralysis and therefore the ability to intubate and ventilate the patient must be available before indiscriminant use is contemplated.

Answer 77

**Natural Agonists:** Noreepinephrine (no effect), Epinephrine (no effect), and Acetylcholine (strong effect) **Artifical Agonists:** Muscarine Pilocarpine **Heart and Blood Vessel Effect:** Decrease HR and Force vasodilation **Antagonists:** Atropine and Scopolamine **Degradation Blockers:** Anti-cholineresterase

Answer 78

**Natural Agonists:** Noreepinephrine (weak effect), Epinephrine (strong effect), and Acetylcholine (no effect) **Artifical Agonists:** Isoproterenol (B1 and B2) **Heart and Blood Vessel Effect:** Increased HR and Force vasodilation **Antagonists:** Propranolol **Degradation Blockers:** Monoamiine Oxidase Inhibitros and CCMT Inhibitors

Answer 79

**Natural Agonists:** Noreepinephrine (strong effect), Epinephrine (Weak effect), and Acetylcholine (no effect) **Artifical Agonists:** Phenylephrine **Heart and Blood Vessel Effect:** Constriction **Antagonists:** Phentolamine **Degradation Blockers:** Monoamiine Oxidase Inhibitros

Answer 80

-\>Action potential travels to synaptic end bulb ►ACh(or other) neurotransmitter spills out ► Post synaptic receptor takes up ACh, yields an action potential which

Answer 81

Non-depolarizing:Blocks action potential without depolarizing post-synaptic neuron. Depolarizing:Blocks action potential by depolarizing post-synaptic neuron and preventing effective re-polarization.

Answer 82

d-Tubocurarine Pancuronium

Answer 83

Original Gold Standard Quick onset Last 30-45 min Loading dose 0.4 mg/Kg, depolarizing and anesthetic agents will potentiate effect. Histamine release and sympathetic block result in hypotension Caution with asthma

Answer 84

**Trade Name:** Pavulon® **Duration of Affect:** Quick acting, lasting 45-60 minutes **Loading Dose:** 0.08 mg/kg Depolarizing and anesthetic agents will potentiate effect. Small histamine release Action on vagus nerve (**parasympatholytic**) and catecholamine reuptake depression causes tachycardia and perhaps BP.

Answer 85

Metocurine Pipecuronium Doxacurium Alcurnium

Answer 86

Similar to d-tubo 0.2 mg/kg no histamine release Can cause hypotension Avoid renal failure

Answer 87

Derivative of pabcuronium 0.05 mg/kg Minimum cardiac effect

Answer 88

Gallamine Atracurium Vecuronium Cisatracuriumaka NimBex

Answer 89

Strength = d-Tubox 0.2, 2.0 mg/Kg Quick acting, lasts 20+ minutes, little or no histamine release, cardiac vagal blockade causes sinus tachycardia. Contraindicated in renal failure.

Answer 90

0.4 mg/Kg Quick acting Lasts 20+ minutes Relative cardiac stability

Answer 91

0.08 mg/Kg Quick acting Last 25+ minutes

Answer 92

4-5 times more potent than Rocuronium Rocuronium has a faster onset, shorter duration, and faster recovery when compared to cisatracurium.

Answer 93

**Trade Name:** Zemuron **Loading Dose:** 0.3-0.5 mg/min **Onset Time:** 60-90 seconds (ideal for RSI) **Intermediate Duration of Action:** 35-45 min **Continuous Infusion** (seldom done): 4-16 mcg/kg/min

Answer 94

Used with atropine to end the effects of non-depolarizing neuromuscular blocking medications

Answer 95

10 – 20 mg given with a half dose of Atropine Slower onset but longer duration

Answer 96

Dose 0.15 mg/kg Very short acting (15 min) May cause hypotension due to histamine release

Answer 97

* How long a drug works for will depend upon amount used, distribution throughout the body, and metabolic and excretion pathways

Answer 98

Neostigmine Pyridostigmine Edrophonium

Answer 99

Using anticholinesterase allow concentration of ACh to build up which will complete with the drug at the neuromuscular junction If the block is severe, the clinician will wait until some degree of muscle function has returned.

Answer 100

Tensilon® 1 mg / Kg (Small doses are ineffective in that they may allow relaxation to return) Quicker onset and less muscarinic side effects. (like bradycardia, salivation etc

Answer 101

**Reversal of neuro bloackade without inhibition of acetycholinesterase** meaning it will **not cause autonomic instability** **Atropine do not need to be co-administered** **Greater cardiovascular and autonomic stability than the traditional reversal agents**

Answer 102

Priming Age Hypothermia Acid-Base Status Electrolyte Imbalance Renal Failure Myasthenia Gravis Eaton-Lambert (myasthenic-Oat Cell CA) Other Drug Interactions

Answer 103

A 10% dose of MR given prior to the actual need for anesthesia allows a much smaller dose to be given later. This will cause some paralysis in a small number of patients but allow easier reversal in the majority.

Answer 104

The very young (neonates and premies) have underdeveloped synaptic architecture. The very old may have decreased muscle mass and slower renal function. These conditions may dictate less MR needed to gain desired effect therefore less reversal agent.

Answer 105

Although cooler tissue is somewhat resistant to MR (more needed), the renal function is also slowed (more retained). Net result is a prolonged duration of action.

Answer 106

Acute onset hypokalemia, potentiates MR action and depresses Neostigmines’ ability to reverse.

Answer 107

Respiratory acidosis, metabolic alkalosis potentiate the MR, but metabolic acidosis seems to decrease the action of MR.

Answer 108

Drugs whose primary detoxification pathway is renal, will obviously stay in relatively high concentration in the patient with renal failure. The counterbalance is that the reversal drugs like neostigmine will also have a prolonged effect. Drugs with a high hepatoclearance pathway will not be as effected and the clinician may need less reversal agent if its’ main clearance route is nephro.

Answer 109

There will be antibodies that compete with ACH and will block or depress the action of ACH

Answer 110

Impaired Ach release mechanisms. More susceptible to both depolarizing and non-depolarizing agents.

Answer 111

All inhaled agents will potential non depl MR

Answer 112

Succinylcholine can before intubation to potentiate MRs by up to 20%. Therefore pts hould be showing signs of recovery from ‘Succs’ before more MRs are given.

Answer 113

Magnesium Sulfate (for seizures) antagonizes the action of calcium at the motor end plate therefore enhancing the blockade.

Answer 114

Calcium channel blockers like verapamil will enhance the neuromuscular block.

Answer 115

Aminoglycosides (streptomycin and others) potentiate non-depolMRs.

Answer 116

Anti-convulsants like phenytoin and carbamazepine will actually depress the action of non-depol MRs.

Answer 117

Normally all muscles have some tension. They will increase tension if stretched. Peripheral surgery may require little relaxation. Deeper procedures need complete muscle flaccidness.

Answer 118

**Dose:** 1-2 mg/kg **Duration of Action:** 3-5 min Produces a constant depolarization resulting in isotonic contractions and fasciculations Rapid paralysis and vagal stimulation may lead to cardiac arrhythmias Broken down by plasma (or pseudo)-cholinesterase.

Answer 119

Arrhythmia Salivation Muscle pain and spasm Increased pressures (ex. gastric, ICP, ocular) Increased potassium which is why it is not used with burns

Answer 120

◦Pre-curarization, small pre-dose of NonDepol ◦Self-taming,small pre-dose of Succs ◦Myotonia, succsmay aggravate, see next slide ◦Myasthenia Gravis, IgG antibodies block site ◦Atypical Plasma Cholinesterase, ↓breakdown ◦Others

Answer 121

Fainting Goats The inability to relax a muscle group, common to MD pts.

Answer 122

Morphine and derivatives allow good hemodynamic stability (but reduced ventilatory drive) and have been used as sole agents in anesthesia. Analgesics are generally used to relieve pain with no loss of consciousness. (normal dosages)

Answer 123

Triggers a recpetor on a CNS neuron which will activate a G protein and become an inhibitory force The action of Ca ion channels will become depressed Substance “P” from sensory neurons in the spinal cord is involved in sending painful sensations to the brain. Opioids inhibit this transfer. There are changes in nociception in the forebrain as well.

Answer 124

**Effects:** Analgesic effects in CNS & spinal cord, changes in affective behavior, no sedation, some ventilatorydepression **Agonists:** Enkephalins

Answer 125

**Effects:** Analgesic effects in CNS & spinal cord, miosis(small & possibly unequal pupil size), sedation, littleventilatorydepression **Agonists:** Dynorphins

Answer 126

**Effects:** Analgesic effects in CNS & spinal cord, respdepression, constipation, N&V, euphoria, physical dependence, bradycardia **Agonists:** Endorphins, Morphine, Synthetic Opioids

Answer 127

Naloxone (Narcan) Naltrexone (Revia; used in morphine and alcohol dependence therapies.)

Answer 128

•Morphine and other opiates are very well absorbed by the lungs, mucosa, subQ tissue or muscular injection and less well through the GI tract.

Answer 129

Morphine’s main action is in the CNS, but transport across the blood brain barrier is relatively slower than other lipid soluble narcotics. Dependent on the site of injection.

Answer 130

* For relief of pain during and after surgery. * Subcutaneous injection; 10–15 mg. * IV 1 –2 mg (dose, titration against analgesia). * Can be used to induce anesthesia in larger doses. * As a premedication with atropine (vagolytic).

Answer 131

* Both a stimulant and a depressant. * Stimulation—pupils constrict, N & V, spinal reflexes (muscle rigidity), convulsions. * Depression---analgesia, sedation, mood changes (tranquil, drowsy), hypoventilation. * Possible miosisin high doses. * Other Effects: No direct action on cerebral circulation if PCO2is controlled. Depressedneuro-function and pupillary constriction hampers neuro-assessment.

Answer 132

* The Mu effect will depress the respcenters in the brain stem. * Vtseems preserved but RR decreases. Overdose causes death by hypoventilation. * Use with great caution in asthmatic or COPD pts.

Answer 133

•Dose dependent bradycardia, contractility preserved. Decreased SVR due to peripheral vasodilation (resistance and capacitance vessels) and peripheral histamine release. Little worry with healthy, supine pt. in usual dosages

Answer 134

* Stimulates the smooth muscle of the GI tract leading to ineffective peristalsis, increased transit time and constipation. * Spasm of Oddi’ssphincter (liver) and biliary backup can cause acute angina like pain. * Relieved by nitro-glycerin (relieves both biliary pain and angina) or naloxone (Narcanâ) •

Answer 135

* After repeated use, toleranceto these drugs requires increasing dose for the desired effect. * Usually reversible with 2-3 week abstinence. * Addictionis psychological and physical ---- after 8 or more hours of abstinence, dependence presents as; Restlessness, anxiety, tearing, rhinorrhea, N&V, diarrhea, hypertension, tachycardia, cramps and muscle ache.

Answer 136

•Potency refers to the amount of drug (usually expressed in milligrams) needed to produce an effect, such as relief of pain or reduction of blood pressure. For instance, if 5 milligrams of drug A relieves pain as effectively as 10 milligrams of drug B, drug A is twice as potentas drug B.

Answer 137

* refers to the potential maximum therapeutic response that a drug can produce. * For example, the diuretic LASIX eliminates much more salt and water through urine than does the diuretic DIURIL. Thus, LASIX has greater efficacythan DIURIL.

Answer 138

* , greater potency or efficacy does not necessarily mean that one drug is preferable to another. * When judging the relative merits of drugs for a patient, clinicians consider many factors, such as side effects, potential toxicity, duration of effect (which determines the number of doses needed each day), and even cost.

Answer 139

* "Responsiveness"of a particular patient to therapy with opioids would then refer to the success of therapy (regardless of dose) in terms of reducing pain to an acceptable level with acceptable side effects. * Therefore the differences in potencies between different opioids becomes much less important than which drug produces the right balance between analgesia and side effects. * The relative potencies of various opioids becomes important only when trying to switch opioids while maintaining equipotent analgesic effects.

Answer 140

* The standard accepted ratio of the relative potency of IM to PO Morphine is 1:6. * Interestingly, this ratio seems to change with chronic dosing such that the ratio of IM to PO becomes 1:2-3. * The ratio of potency of immediate release morphine to sustained or controlled-release of morphine remains 1:1.

Answer 141

Meperidine (Dermerol) Fentanyl Papaveretum Alfentanil **Remifentanil** **Carfentanil**

Answer 142

•Demerol 10-15mg IV, 75-125 mg IM * Synthetic morphine, dry mouth and blurred vision. * Less constipation, less pupillary constriction. * May¯myocardial function in high dose. * Shorter period of action than morphine.

Answer 143

•Fentanyl 100 times stronger than morphine (or Sufentanil which is 5x-10 stronger than fentanyl). Short duration of effect, severe respdepression.

Answer 144

50% Morphine

Answer 145

reduced potency---rapid elimination ---- quicker recovery

Answer 146

= Fentanyl x 100 200 ug is fatal.

Answer 147

Naloxone (Narcan) * Respiratory depression to the point of apnea is a hallmark of morphine overdose. * This opioid antagonist causes RR to increase, pupils to dilate, blood pressure to normalize and the patient to awake. * The adult dose of 100 mg IV, starts immediately and effects can be seen in 1 to 2 minutes. Short acting, repeat dose until desired effect is obtained, (ptcan return to lalaland). * Overdose of Narcanmay cause hypertension and agitation. Naltrexone is an oral version given to addicts to blunt morphine euphoria and therefore desire.

Answer 148

* natural opium alkaloid. * 10 to 15% the strength of morphine parenterally. * Low first pass hepatic clearance allows for oral delivery, liver converts some to morphine. * Eventual conjugation in liver and excretion by kidneys. * Usually used topically, IM or subQ. Has been used IV, in neurocases and ambulatory patients but is seldom used parenterally. Semi synthetic derivatives: Oxycodone with ASA or acetaminophen----orally; hydrocodone is also used with antitussive medications

Answer 149

When using the pharmacological approach please keep in mind the following recommendations: Use the simplest dosage schedules and least invasive pain management modalities first. For mild to moderate pain, use (unless contraindicated) aspirin, acetaminophen, or non-steroidal anti-inflammatory drug (NSAID; WHO ladder, Step 1). When pain persists or increases, add an opioid (WHO ladder, Step 2). If pain increases, increase the opioid potency or dose (WHO ladder, Step 3). Schedule doses regularly (i.e., "by the clock") to maintain the level of drug that will help prevent recurrence of pain. Ask for patient and family cooperation in establishing the effective level. Administer additional doses "as needed" for breakthrough pain NSAIDs reduce the production of prostaglandin E2 (PGE2) and prostacyclin (PGI2), which mediate pain and inflammation.

Answer 150

Used off label in conjunction with opioids ◦Anti-depressants ◦Anti-seizure meds ◦Muscle relaxants ◦Sedatives ◦Anxiolytics ◦Marijuana (what label?) ◦Botulinum Toxins

Answer 151

When **injected in small amounts**, it can effectively **weaken a muscle for a period of three to four months**. It is used in the **treatment of spasms and dystonias**. Botulinum is the most acutely lethal toxin known. LD50 = 1-2 ng/kg IV-IM

Answer 152

First plasma will have the highest concentration Next the viscera will reach peak concentration and the plasma concentration rapidly drops Muscle mass takes longer to reach peak concentration and when it does the concentration in both the plasma and viscera will have dropped As the muscle concentration begins to decrease adipose tissue will begin to gain concentration

Answer 153

Megan Has Isolated Evil Serious Dream Nightly Methexyfluane (0.0016) Halothank (0.0077 Isoflurane (0.115) Enfluurance (0.0170) Servo (0.02) Des (0.06) Nirtrous Oxide (1.04)

Answer 154

Dose related depression Increased ICP which is the brains’ response to high PaCO2 (increased RR decreased Vt) is preserved.

Answer 155

Ability to feel pain, caused by stimulation of a nociceptor. Composed of four processes: transduction, transmission, modulation, andperception.

Answer 156

Post operative fever, eosinophilia and liver dysfunction (elevated enzymes) is very rare. Pts with four of: age, femaleness, sepsis, obesity, biliary surgery, drug dependency, long procedures, multiple procedures, multiple allergies----should be given another agent.