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1390-59 Intro to Pharmacology > Chapter 18 > Flashcards

Chapter 18 Flashcards

1
Q

adipose tissue

A

tissue containing fat cells

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2
Q

akathesia

A

continuous body movement in which an individual is restless of constantly paces about

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3
Q

akinesia

A

loss of voluntary muscle movement restless leg movement

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4
Q

analgesia

A
  • lack of pain or feeling

- decreased response to pain; condition in which painful stimuli are not consciously interpreted (perceived as hurting

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5
Q

cation

A

positively charged ion

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6
Q

dehiscence

A

bursting open or separation of a would, usually along sutured line

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7
Q

dissociative anesthesia

A

form of general anesthesia in which patients do not appear to be unconscious

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8
Q

dyskineasia

A

uncontrollable involuntary repetitive movements; spastic

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9
Q

emetogenic

A

a substance that causes vomiting

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10
Q

euphoria

A

feeling of well-being or elation; feeling good

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11
Q

expectorate

A

eject from the mouth; split

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12
Q

extrapyramidal syndrome

A

movement disorders such as akathisia, dystonia, and parkinsonism caused by antipsychotic drug therapy

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13
Q

GABA (gamma-amino butyric acid)

A
  • the principal inhibitory neuro transmitter in the brain stem and spinal cord
  • inhibitory hyperpolarized the membrane. Barbiturates, benzodiazepines, etomidate, Propofol, and volatile anesthetics enhance GABAa
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14
Q

general anesthesia

A

deep state of unconsciousness in which there is no response to stimuli including painful stimuli

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15
Q

halogenated hyrocarbon

A

compound that contains halogen (chlorine, fluorine, bromine, iodine) combined with hydrogen and carbon

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16
Q

hyperpolarized

A

a change in the cell membrane potential that makes the inside of the cell even more negative so it cant respond to stimulations

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17
Q

hyperthermia

A

abnormally high body temperature

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18
Q

hypothalamus

A

center of the brain that influences mood, motivation, and perception of pain

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19
Q

hypotaxia

A

reduction of oxygen supply to tissues below the amount required for normal physiological function

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20
Q

induction of general anasthesisa

A

time required to take a patient from consciousness to Stage III of anesthesia

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21
Q

maintenance of general anesthesia

A

ability to keep a patient safely in stage III anesthesia

-monitoring of vital signs and ECG, EEG, and general observation

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22
Q

medullary depression

A

inhibition of automatic response controlled by the medulla, such as breathing or cardiac function

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23
Q

medullary paralysis

A

condition in which overdose of anesthetic shuts down cardiovascular and respiratory centers in the medulla, causing death

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24
Q

microcilia

A

tiny hairs that line the respiratory tract and continuously move, pushing secretions toward the mouth

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25
Q

minimal alveolar concentration (MAC)

A

standard reference for inhaled anesthetics indicating the lowest concentration of anesthetic in the alveoli (lungs) that keeps 50 percent of the patients from responding to stimuli (moving)

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26
Q

monitored anesthesia care (MAC)

A
  • intravenous sedation with midazolam, followed by Propofol and/or fentanyl
  • induces conscious sedation- patient can speak and answer questions but has altered state of awareness and minimal response to pain; can be light enough to permit interaction or heavy enough so patient cannot be aroused easily
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27
Q

neuroleptanalgesia

A

condition in which a patient is quiet and calm and has no response to pain after the combined administration of an opioid analgesic (fentanyl) and a tranquilizer (droperidol)

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28
Q

neuroleptanesthesia

A

state of unconsciousness plus neuroleptanalgesia produced by the combined administration of nitrous oxide, fentanyl and droperidol

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29
Q

neurotransmitter-gated ion channel

A

receptor-ion complex in the membrane that opens and allows rapid transmission of signal

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30
Q

NMDA (N-methyl D-aspartate) receptor

A

a glutamate receptor in the brain that causes excitation

  • depolarizes the membrane, ketamine, nitrous oxide, and Propofol antagonize glutamate action
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31
Q

preferred anesthetic

A

produces adequate anesthesia with minimal side effects

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32
Q

synergism

A

when the action resulting from a combination of drugs is greater than the sum of their individual drug effects

33
Q

therapeutic dose

A

dose at which the desired effect is produced

34
Q

what happens in the limbic system with Mild Inhibition?

A

reduces anxiety

35
Q

what happens in the limbic system with More Intense depression?

A

sleep (state of unconsciousness)

- can be awakened

36
Q

what happens in the limbic system with General Anesthesia?

A

a deeper state of unconsciousness

37
Q

Local Anesthesia

A

inhibits pain in a specific area of the body

38
Q

General anesthesia

A
  • causes complete loss of consciousness
  • balanced anesthesia
    • requires less absolute CNS depression because it uses other drugs such as anti anxiety and muscle relaxants that complement the action of anesthetic
39
Q

balanced anesthesia

A
  • requires less absolute CNS depression because it uses other drugs such as anti anxiety and muscle relaxants that complement the action of anesthetic
40
Q

Stage I

of Anesthesia with CNS Depression

A

analgesia/lack of pain or feeling

  • decreased response to pain
  • euphoria/giddiness
41
Q

Stage II

A

excitement (delirium)

  • cerebral cortex if fully depressed
  • achieved by the hypothalamus assuming control of body functions
  • increased sympathetic tone
  • elevated blood pressure and heart rate
  • hyper reaction to stimulation
  • cardiac erythema’s can occur in this stage
42
Q

Stage III (Surgical Anesthesia)

A
  • sleep
  • normal blood pressure and respiration
  • dilated pupils, loss of corneal reflex
  • skeletal muscle relaxation
  • paralysis of the diaphragm, hypotension occur
43
Q

Stage IV

A

medullary paralysis

-represents an overdose of general anesthetic in which respiratory paralysis leas to circulatory collapses and death

44
Q

What is the ideal state of General Anesthesia?

A

rapid induction and slow maintenance

45
Q

What is the Mechanism of Action of General Anesthetics?

A

neurotransmitter-gated ION channels

  • general anesthetics inhibit CNS activity by interacting with membrane ION channels
    • general anesthetics bind with the GABAa Receptors
      • hyperpolarized membranes
  • Excitatory NMDA receptor
    • antagonized by nitrous oxide, Propofol, and ketamine
    • blocks cation movement and depolarization
46
Q

Volatile Anestetics

A

liquid anesthetic that at room temperature volatilizes to a vapor, which, when inhaled, is capable of producing general anesthesia. Modulate excitatory and inhibitory synaptic transmissions

  • Minimal alveolar concentration
    • less when intravenous anesthetics enhance inhibitory receptors and antagonize excitatory receptors

ex- ether and halogenated hydrocarbons

47
Q

Channel Proteins

A

a channel protein that is constantly open and allows solutes to pass into and out of the cell

48
Q

Explain the Routes of Administration for General Anesthetics

A

inhalation or intravenous injection

  • provide rapid delivery of the drug in the blood
  • facilitates a smooth induction into anesthesia
49
Q

What are the Solubility Characteristics of Inhalation Anesthetics?

A
  • blood; gas partition coefficient
  • the greater the value of the coefficient, higher the solubility of the drug in the blood
  • volatile liquids - more soluble in the blood so like staying there
  • nitrous oxide, desflurane, sevoflurane are not very soluble in the blood, so cant wait to move out of the blood
50
Q

What does having a greater # of Coefficient mean?

What does having a less # of Coefficient mean?

A

-the more soluble the drug is in the blood.

51
Q

What does having a less # of Coefficient mean?

A

-have a quicker onset of action because the drugs are ready to cross the CNS as soon as the circulation gets them there.

52
Q

How does solubility effect the onset of action?

A

the more soluble the longer onset of action because they require more anesthetic to dissolve in the blood before enough drug molecules are available to cross into the brain

  • once into the CNS the anesthetics modulate neuronal membranes to produce a state on anesthesia
53
Q

Inhalation Anesthetic produce all stages of general anesthesia with the exception of what? Why?

A

nitrous-oxide

-its not potent enough to maintain stage III

(recently been re introduced in the US by manufacturer with updated delivery system for use in obstetrics

54
Q

Inhalation Anesthetic - Delivery and Potency

A
  • delivered to the alveoli and then to the blood for distribution to the tissues
  • potency is measured by the concentration of drug in alveoli
55
Q

What must be included in the Inhalation Anesthetic Mixture? Why?

A

air

  • patients will rapidly develop hypoxia
56
Q

Why are Intravenous Anesthetics given?

A

the are administered by IV because extravascular injections cause pain, swelling, and ulceration

57
Q

Barbiturates

Intravenous Anesthetic

A

example-methohexital (Brevital)(C-IV)

  • ultrashort-acting drug
  • does not produce analgesia at any does
  • may cause laryngospasm or bronchospasm
  • contraindication- evidence of status asthmaticus or porphyria )abnormally metabolized hbg)
58
Q

Benzodiazepines

Intravenous Anesthetic

A

example- midazolam (Versed)(C-IV)

  • short acting CNS depressant- administered through the IV or rectal routes
  • induces amnesia and sedation -used for induction of genera anesthesia- given with neuromuscular blocking drugs
  • Flumazenil- specific receptor antagonist (only anesthetic class to have specific receptor antagonist ) - reverses the sedative effects of benzos when an over dose has occurred
59
Q

Non Barbiturates- Propoful (Dipravan) not on the controlled substance list

(Intravenous Anesthetic)

A
  • most commonly used parenteral anesthetic in the US
  • used to initiate and maintain MAC sedation
  • possesses a narrow margin of safety-can cause death if the medulla is fully depressed
  • not regarded as an analgesic
    • depresses cardiovascular and respiratory activity
  • antiemetic anesthetic
  • dependence is mostly psychological- cravings, loss of control over the amount and frequency of drug required to achieve desired effects

-PHARMACOLOGIC DOSE IS VER CLOSE TO THE LETHAL DOSE

60
Q

Nonbarbiturates- etomidate (Amidate) no on the controlled substance list

(Intravenous Anesthetic)

A
  • not used for continuous of maintenance anesthesia, only induction
  • produces postoperative nausea and vomiting (PONV)
  • used in high-risk surgical patients
    • exerts less depressant effects on the heart and respiratory centers
61
Q

Nonbarbiturates-Ketamine (Ketalar)

Intravenous Anesthetic

A

-Short-acting dissociative anesthetic - patients don’t appear to be unconscious

  • Produces good analgesia
  • Does not relax skeletal muscles, actually increases muscle tone
  • Inhibits the excitatory pathway by a direct interaction with the NMDA receptor
  • Stimulates the sympathetic nervous system
  • Vivid dreams and hallucinations occur during the recovery period
62
Q

Nonbarbiturates- Dexmedetomidine (Precedex)

Intravenous Anesthetic

A
  • Potent alpha2 adrenergic agonist

- Produces analgesia, sedation, and reduced anxiety

63
Q

Nonbarbiturates- Opioids and droperidol

Intravenous Anesthetic

A
  • When administered together, the combination produces neuroleptanalgesia.
    • Ex., fentanyl (C–II)and droperidol together cause a state quietness and calmness with no response to pain
  • Extrapyramidal symptoms have been seen from the use of droperidol.
    • Parkinsonian syndrome may occur occasionally.
64
Q

CNS

Non- Anesthetic Effects of General Anesthetics

A
  • Regulation of cerebral blood flow
  • Change in intracranial pressure
  • Seizure induction
  • Nausea and vomiting
65
Q

Postoperative nausea and vomititng (PONV)

Non- Anesthetic Effects of General Anesthetics

A

Volatile anesthetics are emetogenic.
Anesthetic agents increase the sensitivity of the vestibular center of the inner ear.
Rapid position change or movement may lead to the development of PONV

-Propofol is the only anesthetic to have evidence of reducing PONV

66
Q

Respiratory System

Non- Anesthetic Effects of General Anesthetics

A

-Postoperative ventilatory failure and hypoxia

-Production of secretions
Muscle spasms along the respiratory tract

-inhalation anesthetics inhibit the microcilia that line the respiratory tract

67
Q

Cardiovascular System

Non- Anesthetic Effects of General Anesthetics

A
  • IV anesthetics increase in blood pressure and heart rate
  • Cardiovascular depression may occur following depression of the medullary vasomotor centers.
  • Higher doses may cause cardiovascular collapse.
68
Q

Skeletal Muscle

Non- Anesthetic Effects of General Anesthetics

A
  • Skeletal muscle relaxation occurs in Stage III.
  • Inhalation anesthetics facilitate muscle incision and manipulation.
  • Benzodiazepines interrupt excessive contractions in spasticity disorders and dyskinesias.
69
Q

Hepatic and renal systems

Non- Anesthetic Effects of General Anesthetics

A
  • Volatile anesthetics temporarily reduce renal and hepatic blood flow, glomerular filtration, and urine output -> usually no other significant effects other than temporary inhibition in urine output. Thus these drugs are used in patients with renal or hepatic disease.
  • Hepatitis can be associated with the volatile anesthetics.
  • Intravenous anesthetics are metabolized in the microsomal enzyme system of the liver.
70
Q

Management of non-anesthetic effects of general anesthetics

Adjuncts to General Anesthesia

A

Pre-anesthetic and post-anesthetic medications are given to:

  • Aid induction
  • Counteract side effects of anesthesia
  • Make recovery safe and more comfortable
  • Fear, anxiety and pain are often associated with surgery.
  • Anxiety and CNS stimulation tend to counteract a smooth induction into anesthesia
  • CNS depressants may be administered before surgery to assist in a smooth induction
71
Q

Examples of Adjunct Medications used with Anesthesia

A

analgesics
antianxiety
anitbiotics

72
Q

Antiemetic drugs
Droperidol

(Adjunct Medications used with Anesthesia)

A

-effective as a single agent antiemetic for prophylaxis and treatment

Serotonin (5HT3) antagonists – ondansetron; first line therapy effective 4-6 hours

Neurokinin (NK1) antagonists – aprepitant; prophylaxis

Propofol and dexamethasone – prevents PONV up to 72 hours

73
Q

Multimodal treatment for PONV

  • Dopamine (d2) receptor antagonists
  • antihistamines
  • anticholinergics

(Adjunct Medications used with Anesthesia)

A

Used alone or in combination with the first-line drugs, but alone these drugs don’t have the efficacy that serotonin antagonists offer

74
Q

Monitoring patients

A
  • Allergic reactions – many are not aware of allergies they have; anaphylacytoid reactions are rare with anesthetics
  • Black box warning
  • Vital signs – should be monitored before, during, and after administration
  • CNS depression – may experience a “hung over”or disoriented feeling
  • Malignant hyperthermia – occurs only in certain individuals; increase is body temp, acidosis, electrolyte imbalance and shock

Drug interactions

  • Droperidol – lengthen the QT interval in the heart
  • Propofol – special handling is needed
75
Q

Propofol handling technique

A
  • Instructions on handling and disposition are provided on the box.
  • Strict aseptic technique needs to be followed.
  • Should be used with caution in patients with lipid metabolism disorders
76
Q

Solution incompatibilities

A
  • Drug admixture - Adding solutions to an existing intravenous line or by mixing two or more drugs in the same syringe
  • Not all drugs are compatible.
77
Q

Preferred Intravenous anesthetics

A

Propofol is the most frequently used induction anesthetic.

For MAC, midazolam, propofol, ketamine, fentanyl, alfentinil, and lidocaine are used.

78
Q

Preferred Volatile anesthetics

A

Nitrous oxide, enflurane, sevoflurane, and isoflurane

1390-59 Intro to Pharmacology (17 decks)

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