chapter 11 pharm 343

Question 1

*lidocaine (xylocaine)

Answer 1

local. amide drug. alone or with epinephrine used for infiltration and nerve block. topical form.

Question 2

*propofol (diprovan)

Answer 2

parenteral general anesthetic used for the induction and maintenance of general anesthesia and also for sedation for mechanical ventilation in ICU settings. it can also be used as a sedative-hypnotic for moderate sedation. well tolerated, producing few undesirable effects.

Question 3

*succinylcholine (Anectine)

Answer 3

depolarizing group. same stimulants as ACh and produces the same response. metabilzed slowly. repolarization can not occur. the muscle loses its ability to contract and flaccid muscle paralysis results just as long as sufficient succ concentrations are present. it has a quick onset and used to help endotracheal intubation. cause muscular fiscicutations (spasms). contraindications for history of hyperthermia, skeletal muscles myopathies, and hypersensitivity to the drug. only injectables.

Question 4

*vecuronium (norcuron)

Answer 4

intermediate acting nondepolar nmbd. used as an adjunct to general anesthesia to help tracheal intubation and to provide skeletal muscle relaxation during surgery. commonly used. long term use resulted in prolonged paralysis and difficulty weaning off ventilation. only injectables.

Question 5

anesthesia

Answer 5

the loss of the ability to feel pain resulting from the administration of an anesthetic drug.

Question 6

anesthetics

Answer 6

drugs that depress the CNS or peripheral nerves to produce decreased or loss of consciousness or muscle relaxation.

Question 7

balanced anesthesia

Answer 7

the practice of using combinations of different drug classes rather than a single drug to produce anesthesia.

Question 8

general anesthesia

Answer 8

a drug-induced state in which the CNS nerve impulses are altered to reduce pain and other sensations throughout the entire body. it normally involves complete loss of consciousness and depression of normal respiratory drive.
achieved by one or more drugs. often a synergistic combination of drugs is used, which allows for smaller doses of each drug and better control of the pts anesthized state.
inhalational anesthetics are volatile liquids or gases that are vaporized or mixed with O2 to induce anesthesia.
relaxation of skeletal and visceral smooth muscles for surgical procedures as well as in electoconvulsive therapy for severe depression.

Question 9

local anesthesia

Answer 9

a drug-induced state in which peripheral or spinal nerve impulses are altered to reduce or eliminate pain and other sensations in tissues innervated by these nerves. 
second major class. reduce pain. regional anesthetics bcuz they render a specific portion of body insensitivity to pain. 
they are used by interfering with nerve transmission in specific areas, blocking nerve conduction only in the area in which they are applied without losing consciousness. 
ester and amides-they are classified as parenterl or topical anesthetics. 
Nerve block (large body region) or infiltration anesthesia (multiple small injections to make a more limited area). 
motor activity returns first, then sensory functions, and finally autonomic activity. 
blocks the two neurotransmitters=noreepinephrine and epinephirne.

Question 10

malignant hyperthermia

Answer 10

a genetically linked major adverse reaction to general anesthesia characterized by a rapid rise in body temperature as well as tachycardia, tachypnea, and sweating.
associated with the use of volatile inhalational anesthetics as well as the depolarizing NMBD succinylcholine.
rapid rise in body temp, tachycardia, tachypnea, and muscular rigidity.
treated with cardiorespiratory supportive care as needed to stabilize heart and lung function along with the skeletal muscle relaxant dantrolene.

Question 11

moderate sedation

Answer 11

a milder form of general anesthesia that cause partial or complete loss of consciousness but does not generally reduce normal respiratory drive.
allows pt to relax and have markedly reduced or no anxiety, yet still maintain his/her own open airway and response to verbal commands.
most commonly used include benzo, usually midazolam, with an opioid usually fentanyl or morphine. propofol also used.

Question 12

overton-meyer theory

Answer 12

theory that describes the relationship between the lipid solubility of anesthetic drugs and their potency.
fat soluble drugs are stronger than water soluble drugs.

Question 13

spinal anesthesia

Answer 13

local induced by injectable of an anesthetic drug near the spinal cord to anesthize nerves that are distal to the site of injection.
does not depress CNS at a level that causes loss of consciousness , it can be thought of as a large-scale type of local rather than general anesthesia.

Question 14

parenteral anesthetics

Answer 14

are given intravenously and are used for induction and/or maintenance of general anesthesia, induction of amnesia, and as adjuncts to inhalation-type anesthetics. (etomidate and propofol).

Question 15

adjuncts

Answer 15

used dimultaneously with general anesthetics for anesthesia initiation (induction), sedation, reduction of anxiety, and amnesia. also inculde neuromuscular blocking drugs, sedative-hypnotics or anxiolytics.

Question 16

contraindications of anesthetics

Answer 16

may also include preggo, glaucoma, and malignant hyperthermia.

Question 17

adverse effects anesthetics

Answer 17

dose dependent and vary with individual drug. heart, peripheral circulation, liver, kidneys, and resp track are the sites that are affected. myocardial depression is common.

Question 18

toxicity and overdose of anesthetics

Answer 18

large doses are potentially life threatening with cardiac and resp arrest as the ultimate causes of death. very quickly metabolized. medullary center area of brain is affected and the first to regain function.

Question 19

interactions of anesthetics

Answer 19

drugs that interact with general are antihypertensives and beta blockers.

Question 20

effects of anesthetics

Answer 20

depends on where and how the drug is administered.

high plasma concentration, spinal headache, skin rash, itchy, and edema to anaphylactic shock.

Question 21

toxicity of anesthetics

Answer 21

epinephrine is given with local anesthetic to maintain localized drug activity.

Question 22

neuromuscular blocking drugs

Answer 22

prevent nerve transmission in skeletal and smooth muscles leading to paralysis. they are also used as adjuncts with general anesthesia. NMBD also paralyze the skeletal muscles required for breathing: the intercostal muscles and the diaphragm.
depolarizing and nondepolarizing. depolorizing works similarly to the neurotransmitter acetylcholine. they are competitive agonists. phase 1 depolorizing, the muscles twitch. phase 2 is desensitized. nondepolorizing also bind to ACh receptors ar the neuromuscular junction they block its actions. competitive antagonists. short-acting, intermediate, and long-acting drugs.
the first sensation is muscle weakness, flaccid paralysis, small muscles around fingers and eyes are first to be paralyzed, limbs, neck, and trunk, and then intercostal muscles and diaphragm.
when used alone do not cause sedation or relieve pain or anxiety. diaphragm is first to regain function.

Question 23

indications of nmbd

Answer 23

is to maintain skeletal muscle paralysis to help controlled ventilation during surgeries. shorter-acting is often used to help intubation with an endotracheal tube. they are frequently combined with anxiolytics, analgesics and anesthesia.
nonsurgical- reduction of laryngeal or muscle spasms, reduction of spasticity from tetanus and neurologic diseases such as MS and prevention of bone fractures.

Question 24

contraindication of nmbd

Answer 24

includes history of malignant hyperthermia, eye injuries and glaucoma.

Question 25

adverse effects of nmbd

Answer 25

preceded by muscle spasms which may damage muscles. muscles of hands, feet, and face. release of potassium resulting in hyperkalemia. increase in BP and HR, cause release of histamine which results in bronchospasm, hypotension, excessive bronchial and salivary secretion.

Question 26

toxicity and overdose of nmbd

Answer 26

it is prolonged paralysis requiring mechanical ventilation.
antidotes-neostigmine, pyridostigamine, and endrophonium are used to reverse muscle paralysis. prevent enzyme cholinesterase from breaking down ACh. displaces te nondepolarizing molecule and return to its normal state. malignant hyperthermia can also occur.

Question 27

interactions of nmbd

Answer 27

either synergistic or opposing effects. aminoglycoside antibiotics can have additive effects. calcium channel blockade enhances neuromuscular blockade.