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NURS 1064 - Pharm > Chapter 19 > Flashcards

Chapter 19 Flashcards

1
Q

What is anesthesia?

A

Loss of feeling or sensation through administration of a drug or drugs

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2
Q

What are the three characteristics of general anesthesia?

A
  1. State of unconsciousness
  2. Analgesia
  3. Amnesia
    - all three states must be present
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3
Q

When and how does regional anesthetics occur?

A

When sensory transmission from a specific area or region of the body to the CNS is blocked

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4
Q

What are the three ways that regional anesthetics can be administered?

A
  1. Epidural block
  2. Spinal block
  3. Peripheral nerve block
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5
Q

When is regional anesthesia drugs used?

A

To perform minor surgeries

- for a conscious patient or used with general anesthesia

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6
Q

How is local anesthetics different than regional anesthetics?

A

Similar to regional anesthetics, but on a smaller region of the body

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7
Q

What do neuromuscular blocking agents do?

A

Cause paralysis

- loss of motor function

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8
Q

What are the two different groups of neuromuscular blocking agents?

A
  1. Non-depolarizing

2. Depolarizing

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9
Q

What is the action of non-depolarizing NMBAs?

A

Bind to acetylcholine receptors and function as competitive antagonist

  • preventing the binding of Ach
  • end plate is unable to depolarize
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10
Q

What is the action of depolarizing NMBAs?

A

Closely resemble acetylcholine, binding to the receptor and functioning as an agonist
- cause continuous muscle depolarization and prevent repolarizing

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11
Q

What does PACU stand for?

A

Post-anesthesia Care Unit

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12
Q

What is the prototype drug for inhaled anesthetics?

A

Isoflurane (Forane)

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13
Q

What is the prototype drug for intravenous anesthetics?

A

Propofol (Diprivan)

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14
Q

What is the prototype drug for local anesthetics (that are used as regional anesthetics)?

A

Lidocaine (Xylocaine)

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15
Q

What is the prototype drug for non-depolarizing NMBAs?

A

Vecuronium (Norcuron)

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16
Q

WHat is the prototype drug for depolarizing NMBAs?

A

Succinylcholine (Anectine)

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17
Q

What is the most likely explanation for how general anesthesia works (since it’s unknown)?

A
  1. May provoke a decreased release of neurotransmitters

2. Increased re-uptake and inhibition of the post-synaptic enzymes

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18
Q

What is the action of local anesthetics (how do they work)?

A

Reversibly block all nerve impulses by disrupting membrane permeability to sodium during an action potential
- stopping the generation and propagation of nerve impulses

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19
Q

When will muscle fasciculation be present, with the use of depolarizing or non-depolarizing drugs?

A

Use of depolarizing drugs

- muscle is constantly contracting

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20
Q

Why are anesthetics called functional drugs?

A

Are not used to treat a pathologic disease

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21
Q

What are the 4 levels of sedation?

A
  1. Minimal sedation
  2. Moderate sedation and analgesia (conscious sedation)
  3. Deep sedation and analgesia
  4. Anesthesia
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22
Q

The goal of general anesthesia is to achieve, what 3 things?

A
  1. Akinesia (loss of voluntary movement)
  2. Analegsia (inability to feel pain)
  3. Amnesia (loss of memory)
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23
Q

What is balanced anesthesia?

A

When a combination of drugs are used rather than 1 single agent

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24
Q

What happens during Stage I, analgesia?

A
  • loss of pain sensation

- still responsive until the end of the stage

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25
Q

What happens during Stage II anesthesia?

A

Delirium/excitement

  • systolic pressure rises
  • pt experiences excitation, agitation, restlessness, increase RR
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26
Q

What are potentially dangerous responses to Stage II anesthesia?

A

Vomiting, laryngospasm, tachycardia, uncontrolled movement

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27
Q

What happens during Stage III anesthesia?

A

Surgical anesthesia

  • there are 4 stages within surgical anesthesia
  • by stage IV, respiration ceases
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28
Q

What happens during Stage IV anesthesia?

A

Medullary depression

  • Respiratory and vasomotor centres are depressed
  • spontaneous respiration has ceased
  • unless rapid intervention and support occur – death follows
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29
Q

What are the 2 drug classes of general anesthetic agents?

A
  1. Inhalant agents (like Isoflurane)

2. Parenteral agents (like Propofol)

30
Q

Describe the pharmacodynamics of Isoflurane (inhaled anesthetic agent).

A

Unknown
- likely that the effects are mediated through physicochemical properties of the gases (lipid solubility, oil-gas, and blood-gas partition coefficients

31
Q

What is the minimum alveolar concentration (MAC)?

A

A measure of potency
- concentration of anesthetic gas required to eliminate movement in 50% of patients challenged by a standardized skin incision

32
Q

What does it mean if an agent has a small MAC? A large MAC?

A

The smaller the MAC, the more potent the agent

The larger the MAC, the less potent the agent

33
Q

What is the MAC of Isoflurane administered alone? Administered with nitrous oxide?

A

Alone = 1.17%

With nitrous oxide = 0.56%

34
Q

How does Isoflurane interact with NMBAs that are non-depolarizing?

A

Potentiates the effects of NMBAs and prolongs the blockade.

35
Q

How are inhaled anesthetics administered and absorbed?

A

Administered through the lungs and absorbed across the alveolar membrane

36
Q

What is Isoflurane (Forane) used for?

A

Anesthesia; induction, maintenance

37
Q

What is the most serious adverse effect of Isoflurane?

A

Respiratory depression

38
Q

What are intravenous (IV) anesthetics also known as?

A

Induction agents

39
Q

What are some examples of classes of drugs that are IV anesthetics used as balanced anesthesia and total intravenous anesthesia (TIVA)?

A

Barbiturates
Benzodiazepines
Opioid analgesics
Non-barbiturate hypnotic agents

40
Q

What is Propofol and what is it used for?

A

Intravenous anesthetic agent

- used for induction and maintenance of general anesthesia and maintenance of sedation in the ICU

41
Q

How quickly will a patient loose consciousness after being administered Propofol?

A

Within 40 seconds and continues for 3-5 minutes after a bolus injection

42
Q

What is the most serious adverse effect of Propofol?

A

Apnea and anaphylaxis

43
Q

What are three examples of benzodiazepines that are used in balanced anesthesia?

A
  • Diazepam
  • Lorazepam
  • Midazolam
44
Q

What is fentanyl and what is it used for?

A

Opioid analgesic

- used in general anesthesia and conscious sedation

45
Q

What are the 2 different groups that local anesthetic agents are divided into?

A
  1. Esters

2. Amides

46
Q

What is the difference between esters and amides?

A 
Esters = rapidly hydrolyzed in the body by plasma cholinesterase and other esterases
Amides = slowly degraded in the liver by P-450 enzymes
47
Q

What do local anesthetics do to the body?

A

Produce local or regional anesthesia and analgesia by blocking electrical transmission of pain along nerve fibres and abolishing sensations in a limited and well-defined area of the body
- WITHOUT loss of consciouss

48
Q

In what order are the nerve fibres affected in local anesthesia?

A
  1. Autonomic
  2. Sensory
  3. Motor
49
Q

What clinical manifestations are lost by the result of local anesthetics and in what order?

A
  1. Temperature
  2. Pain
  3. Touch
  4. Proprioception
  5. Skeletal muscle tone
50
Q

What is the prototype drug for local anesthetic agents?

A

Lidocaine (Xylocaine)

- amide local anesthetic agent

51
Q

When is Lidocaine used?

A 
Regional blocks
Peripheral nerve blocks
Ophthalmic anesthesia
Dental anesthesia
Infiltration anesthesia
52
Q

When Lidocaine is applied topically, what is it used for?

A

Dental pain
Neuropathic pain
Skin disorder (inflammation and irritation)

53
Q

When Lidocaine is administered intranasally, what is it used for?

A

Migraine headaches

54
Q

If Lidocaine is administered intravenously, what is it used for?

A

Ventricular tachycardia and ventricular fibrillation

55
Q

What is the most serious adverse effect of Lidocaine?

A

Allergic reactions

56
Q

What is the action of neuromuscular blocking agents?

A

Interrupt transmission of nerve impulses at the NMJ causing paralysis

57
Q

Specifically, what is the action of NMBAs that are non-depolarizing?

A

They are competitive antagonists preventing the binding of acetylcholine to the cholinergic receptor

58
Q

What happens if acetylcholine is unable to bind to the receptor (as seen in non-depolarizing NMBAs)?

A

End plate is unable to depolarize

59
Q

How are depolarizing drugs different than non-depolarizing drugs?

A

Depolarizing drugs cause continuous muscle depolarization and prevents repolarization

60
Q

What are some examples of non-depolarizing NMBAs?

A

Vecuronium
Rocuronium
Pancuronium
Cisatracurium

61
Q

What is the prototype drug for non-depolarizing NMBAs?

A

Vecuronium

- an anesthesia adjunct

62
Q

What is Vecuronium used for?

A
  • to provide skeletal muscle relaxation
  • facilitate intubation and mechanical ventilation
  • improve surgical conditions during surgical procedures
63
Q

How is Vecuronium excreted?

A

Kidneys

- watch renal function

64
Q

How can Vercuronium be reversed?

A

By using anticholinersterases

  • such as neostigmine, pyridostigmine, and edrophonium
  • block the normal breakdown of acetylcholine at the motor end plate, causing the neurotransmitter to accumulate and returning muscle stimulation
65
Q

How is NMBAs different than all other drugs discussed so far?

A

DO NOT affect consciousness or produce sedation!

  • patients will be paralyzed
  • unable to spontaneous ventilate
66
Q

What is the most serious adverse effect of Vecuronium?

A

Prolonged paralysis and apnea

67
Q

What is the action of depolarizing NMJ blockers?

A

By causing the muscle cell membrane to depolarize or become excited, which causes muscle contraction
- this leads to paralysis after repeated excitation

68
Q

What is the prototype drug for depolarizing NMJ blockers?

A

Succinylcholine

69
Q

What is succinylcholine used for?

A

Rapid endotracheal intubation

- other procedures that need a very short acting paralysis

70
Q

Which receptors does Succinylcholine act as an agonist to?

A

Cholinergic nicotinic receptors of the motor end plate

71
Q

Why do patients experience post-operative muscle pain when depolarizing NMJ blockers are used?

A

Because the muscles have been contracting rapidly, followed by flaccid paralysis

72
Q

How is nitrous oxide used?

A

Used to increase the effectiveness of halogenated agents (Isoflurane) without severely depressing the depth of coma

NURS 1064 - Pharm (9 decks)

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