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Pharmacology > Chapter 12- General and Local Anesthetics > Flashcards

Chapter 12- General and Local Anesthetics Flashcards

1
Q

Anesthetics

A

Drugs that depress the central nervous system (CNS)

  • depression of consciousness
  • loss of responsiveness to sensory stimulation (including pain)
  • muscle relaxation
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2
Q

Anesthesia

A

A state of depressed CNS activity

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3
Q

Two types of anesthesia

A
  • General anesthesia

* Local anesthesia

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4
Q

General Anesthetics

A
  • Drugs that induce a state in which the CNS is altered to produce verying degress of:
  • analgesia
  • depression of consciousness
  • skeletal muscle relaxation
  • reflex reduction
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5
Q

General Anesthetics: Inhaled anesthetics

A

Volatile liquids or gases that are vaporized/mixed in oxygen and inhaled

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6
Q

General Anesthetics: Parenteral anesthetics

A

Administered intravenously

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7
Q

Inhaled Anesthetics

A

Inhaled gas:

-nitrous oxide

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8
Q

Inhaled volatile liquids:

A
  • desflurane
  • enflurane (Ethrane)
  • halothane (Fluothane)
  • isoflurane (Forane)
  • methoxyflurane (Penthrane)
  • sevoflurane
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9
Q

Injectable Anesthetics- Used:

A
  • To induce or maintain general anesthesia
  • To induce amnesia
  • As an adjunct to inhalation-type anesthetics
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10
Q

Injectable Anesthetics:

A
  • etomidate (Amidate)
  • ketamine (Ketalar)
  • methohexital (Brevital)
  • propofol (Diprivan)
  • thiamylal (Surital)
  • thiopental (Pentothal)
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11
Q

Sedative-hypnotics

A
  • Barbiturates (pentobarbital, secobarbital)
  • Benzodiazepines (diazepam, midazolam)
  • hydroxyzine
  • promethazine
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12
Q

Opioid Analgesics

A

fentanyl, sufentanil, meperedine, morphine

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13
Q

Neuromuscular blocking drugs (NMBDs)

A
  • depolarizing drugs (succinylcholine)

- nondepolarizing drugs (pancuronium, d-tubocurarine, vecuronium)

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14
Q

Anticholinergics:

A

atropine, glycopyrrolate, scopolamine

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15
Q

Mechanism of Action

A
  • Varies according to drug
  • Overton-Meyer theory
  • Overall effect
  • orderly and systematic reduction of sensory and motor CNS functions
  • progressive depression of cerebral and spinal cord functions
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16
Q

Indications

A
  • General anesthetics used during surgical procedures to produce:
  • unconsciousness
  • skeletal muscular relaxation
  • Rapid onset; quickly metabolized
  • Also used in electroconvulsive therapy treatments for depression
17
Q

Adverse Effects

A
  • Vary according to dosage and drug used
  • Sites primarily affected
  • heart, peripheral circulation, liver, kidneys, respiratory tract
  • Myocardial depression is commonly seen
18
Q

Adverse Effects: Malignant Hyperthermia

A
  • occurs during or after general anesthesia or use of the NMBD succinylcholine
  • sudden elevation in body temperature (greater that 104)
  • tachypnea, tachycardia, muscle rigidity
  • life threatening emergency
  • treated with dantrolene (skeletal muscle relaxant)
19
Q

Moderate Sedation

A
  • Also called conscious sedation, procedural sedation
  • combination of an IV benzodiazepine and an opiate analgesic
  • anxiety and sensitivity to pain are reduced, and patient cannot recall the procedure
  • preserves the patients ability to maintain own airway and to respond to verbal commands
20
Q

Moderate Sedation also used for:

A
  • diagnostic procedures and minor surgical procedures that do not require deep anesthesia
  • topical anesthetic may be applied also
  • Rapid recovery time and greater safety profile than general anesthesia
21
Q

Local Anesthetics

A
  • Also called regional anesthetics
  • used to render a specific portion of the body insensitive to pain
  • interfere with nerve impulse transmission to specific areas of the body
  • do not cause loss of consciousness
22
Q

Local Anesthetics: Topical

A
  • Applied directly to skin or mucous membranes

- creams, solutions, ointments, gels, ophthalmic drops, lozenges, suppositores

23
Q

Local Anesthetics: Parenteral

A

-injected parenterally or into the CNS by various spinal injection techniques

24
Q

Types of Local Anesthesia

A
  • Spinal or intraspinal
  • Intrathecal
  • Epidural
  • Infiltration
  • Nerve block
  • Topical
25
Q

Parenteral Anesthetics

A
  • procaine (Novocain)
  • tetracaine (Pontocaine)
  • lidocaine (Xylocaine)
  • mepivacaine (Carbocaine)
  • bupivacaine
26
Q

Drug Effects: Paralysis

A
  • First, autonomic activity is lost
  • Then pain and other sensory functions are lost
  • Last, motor activity is lost
  • As local drugs wear off, recovery occurs in reverse order (motor, sensory, then autonomic activity are restored)
27
Q

Indications: Local anesthetics are used for-

A
  • Surgical, dental, and diagnostic procedures
  • Treatment of certain types of chronic pain
  • Spinal anesthesia: to control pain during surgical procedures and childbirth
28
Q

Local anesthetics are given by:

A
  • Infiltration anesthesia

- Nerve block anesthesia

29
Q

Infilitration anesthesia

A
  • Minor surgical and dental procedures
  • injection of the anesthetic solution intradermally, subcutaneously, or submucosally across the path of nerves supplying the target area
  • May be given in a circular pattern around the operative area
30
Q

Infilitration anesthesia and epinephrine

A
  • Some local anesthetics used for infiltration or nerve block are combined with vasoconstrictors
  • to prevent systemic absorption of anesthetic
  • to help confine local anesthetic to injected area
  • to reduce local blood loss during procedure
  • epinephrine, phenylephrine, norepinephrine
31
Q

Nerve block anesthesia

A
  • Used for surgical, dental, and diagnostic procedures
  • also used for therapeutic management of pain
  • the anesthetic drug is injected directly into or around the nerve trunks or nerve ganglia that supply the area to be numbed
32
Q

Adverse Effects:

A
  • usually limited
  • adverse effects result if:
  • inadvertent intravascular injection occurs
  • excessive dose or rate of injection is given
  • slow metabolic breakdown occurs
  • “spinal headache,” treated with an epidural blood patch
33
Q

Neuromuscular Blocking Drugs:

A
  • Also known as NMBDs
  • Prevent nerve transmission in certain muscles, resulting in muscle paralysis
  • Used with anesthetics during surgery
34
Q

Neuromuscular Blocking Drugs: When used during surgery

A 
Artificial mechanical ventilation is required
-these drugs paralyze respiratory and skeletal muscles 
-patient cannot breathe on is or her own
-do not cause sedation or pain relief
-patient may be paralyzed yet conscious
-depolarizing drugs
-Nondepolarizing drugs
short acting
intermediate acting
long acting
35
Q

NMBAs: depolarizing drug

A

Succinylcholine

  • works similarly to neurotransmitter acetylcholine (Ach), causing depolarization
  • metabolism is slower than Ach, so as long as succinylcholine is present, repolarizing cannot occur
  • Result: flaccid muscle paralysis
36
Q

NMBAs: nondepolarizing drugs

A
  • Short acting
  • mivacurium (Mivacron)
  • Intermediate acting
  • atracurium (Tracrium), vecuronium (Norcuron)
  • rocuronium (Zemuron)
  • Long acting
  • pancuronium (Pavulon), doxacurium (Nuromax)
  • d-tubocurarine
37
Q

Nodepolarizing NMBAs

A
  • prevent Ach from acting at neuromuscular junctions
  • muscle fibers are not stimulated
  • skeletal muscle contraction does not occur
38
Q

Neuromuscular Blocking Drugs

A
  • first sensation is muscle weakness
  • followed by total flaccid paralysis
  • Small, rapidly moving muscles affected first (fingers, eyes) then limbs, neck, trunk
  • finally, intercostal muscles and diaphragm affected,

Pharmacology (14 decks)

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