Chapter 19: Drugs for Local and General Anesthesia - Prototype Drugs Flashcards
1
Q
What is the prototype drug for Amides
A
lidocaine
2
Q
What is the MOA of lidocaine?
A
Acts by stopping axonal conduction by blocking sodium channels
3
Q
What is lidocaine used for?
A
- used for brief medical or dental procedures
- may be injected as a nerve block for spinal and epidural anesthesia
- patches may be admin to relieve pain
- may be given topically before painful procedures
- may be given IV, IM or SubQ to treat dysrhythmias
- mouthwashes and rinses can be compounded to help ease pain associated with mouth and throat infections
4
Q
are lidocaine side effects common when used for anesthesia?
A
No
5
Q
What is an early symptom of lidocaine toxicity?
A
CNS excitement leading to irritability and confusion
6
Q
What are serious adverse effects of lidocaine?
A
- convuslions
- respiratory depression
- cardiac arrest
7
Q
how might a patient injure themselves after dental procedures where lidocaine was used?
A
pts may injure themselves by biting or chewing areas of the mouth that have no sensation following a dental procedure until the effect of the anesthetic diminishes
8
Q
What is the route of lidocaine?
,
A
IV, IM, SubQ, topical
9
Q
What are some adverse effects of lidocain?
A
- solutions of lidocain containing preservatives or epinephrine are intended for local anaesthesia only and must never be given parenterally for dysrhythmias
- do not appy topical lidocaine to large skin areas or to broken or abraded areas - significant absorptrion may occur
- do not allow it to come into contact with the eyes
10
Q
What pregnancy category is lidocaine?
A
Pregnancy category B
11
Q
Lidocaine black box warning
A
- use of 2% oral viscous lidocaine products, especially among infants, may lead to ingestion that cannot be predicted or controlled.
- when excessive amounts of lidocain are administered to infants and young children, or they accidentally swallow too much, it can induce seizures, brain injury, cardiac abdormalities, and death
12
Q
what are lidocaine contraindications
A
- avoided in cases of sensitivity to amide-type local anaesthetics
- in presence of severe trauma or sepsis, blood dyscrasias, dysrhythmias, sinus bradycardia, and sever degrees of heart block
12
Q
A
13
Q
which drug may decrease the activity of lidocaine?
A
Barbiturates
14
Q
What drugs may increase the effects of lidocaine?
A
cimetidine, quinidine, and beta blockers
15
Q
What are lidocaine lab testes
A
increased creatine phosphokinase (CPK)
16
Q
what are symptoms of lidocaine OD
A
- breathing difficulty
- swelling of the lips
- chest pain
- irregular hearbeat
- N/V
- treamors
- seizure activity
17
Q
What therapy is given for lidocaine OD
A
Lipid infusion therapy (LipidRescue) - an intravascular infusion of lipid emulsion to treat severe, systemic drug toxicity or poisoning
18
Q
inhalation agents: gaseous Agent prototype drug
A
Nitrous Oxide
19
Q
What is the MOA of Nitrous Oxide
A
- acts by suppressing pain mechanisms in the CNS
- has low potency and does not produce complete loss of consciousness or profound relaxation of skeletal muscle
- because nitrous oxide does not induce surgical anesthesia (stage 3), it is commonly comvined with other surgical anesthetic agents
20
Q
What is Nitrous oxide used for?
A
ideal for short surgical or dental procedures because the patient remains conscious and can follow instructions while experiencing full analgesia
21
Q
what adverse effects of nitrous oxide to patients experience at higher doses
A
- anxiety
- excitement
- combativeness
22
Q
what are other adverse effects of nitrous oxide?
A
- as it is exhaled, the patient may temporarily have some difficulty breathing at the end of a procedure
- N/V following the procedure are more common with nitrous oxide thatn with other inhalation anesthetics
23
Q
what is the route of nitrous oxide
A
inhalation
24
what is the onset of nitrous oxide?
less than 5 minutes
25
what is nitrous oxide always combined with
oxygen (25-30%)
26
what should be established with nitrous oxide in the case of an emergency?
an IV
27
Nitrous oxide has the potential to be abused. True or False?
True
28
What is contraindicated with nitrous oxide?
- impaired LOC
- head injury
- inability to comply with instructions
- decompression sickness (nitrogen narcosis)
- clients with decreased oxygen status
29
what drugs may exacerbate dysrhythmias when taken with nitrous oxide?
sympathomimetics and phosphodiesterase inhibitors
30
what herbal/food product may lower the potential risk of liver damage when taken with nitrous oxide?
milk thistle
31
What is the treatment of nitrous oxide OD?
metoclopramide may help reduce the symptoms of N/V
32
general anesthetics: volatile liquid prototype drug
isoflurane
33
what is the MOA for isoflurane?
produces a potent level of surgical anesthesia that is rapid in onset
34
What is isoflurane used for?
provides excellent muscle relaxation and may be used off-label as adjuvant therapy in the treatment of status asthmaticus
35
other actions and uses of isoflurane?
- Isoflurane with oxygen or with an oxygen and nitrous oxide mixture may be used
- compared to other inhaled general anesthetic, cardiac output is well maintained
36
What are common adverse effects of isoflurane
mild N/V, and treamor
37
What are some other adverse effects of isoflurane?
- does-dependent respiratory depression and a reduction in blood pressure
- malignant hyperthermia with elevated temperature has been reported
38
What is the route of isoflurane?
inhalation
39
What is the pregnancy category of Isoflurane?
pregnancy category C
40
What is the onset and duration of isoflurane?
onset is 7-10 minutes and duration is less than 1 hour after drug discontinued
41
What are the contraindications of Isoflurane?
- known hx of genetic predisposition to malignant hyperthermia
- caution when treating patients with head trauma or brain neoplasms --> possible increases in intracranial pressure
- older adult patients are more susceptible to hypotension
42
What may occur when isoflurane is used with nitrous oxide?
coughing, breath holding and laryngospasms
43
What may happen with aminoglycosides are admin with isoflurane?
skeletal muscle weakness, respiratory depression, or apnea may occur
44
What may occur if Isoflurane is administered with other skeletal muscle relaxants
additive effects
45
What may happen when isoflurane is taken concurrently with antihypertensive such as betablockers
additivite hypotension
46
What drugs should be administered with caution when given concurrently with Isoflurane, d/t the possibility of dysrhythmias
Epinephrine, norepinephrine, dopamine, other adrenergic agonist
47
What herbal/food products should be discontinued 2-3 weeks prior to admin d/t the possible risk of hypotension
St. Johns wort
48
What is the treatment of OD for Isoflurane?
since isoflurane causes profound respiratory depression, patients are treated symptomatically until effects of the drug diminish
49
What is the prototype drug for neuromuscular blockers?
Succinylcholine
50
What is the MOA of succinylcholine?
acts to cholinergic receptor sites at neuromuscular junctions
51
What is succinylcholine used for?
used for skeletal muscle paralysis
52
What is succinylcholine rapidly broken down by?
enzyme cholinesterase
53
What effects are noted when taking succinylcholine
muscle weakness and spasms
54
What are the adverse effects of succinylcholine
- can cause complete paralysis of the diaphragm and intercostal muscles
- bradycardia and respiratory depression are expected adverse effects
- if doses are high, the ganglia are affected, causing tachycardia, hypotension, and urinary retention
- use cautiously with fractures or muscle spasms - initial muscle fasciculations may cause addition trauma
- malignant hyperthermia can result
| -
55
What is the route of succinylcholine and what is the pregnancy category
- IV
- preg cat C.
56
what is the black box warning for succinylcholine
- should be administered in a facility with trained personal to monitor, assisk, and control respirations
- cardiac arrest has been reported resulting from hyperkalemic rhabdomylosis most frequently ininfants or children with diagnosedskeletal muscle myopathy or Duchenne muscluar dystrophy.
- This drug is reservfed for use in children in cases of emregency intubation or in instance when immediat securing of air is necessary
57
What is contraindicated with succinylcholine
- use with extreme caution in patients with severe burns or trauma, neuromuscular diseases, or glaucoma
- in patients with a family hx of malignant hyperthermia or conditions of pulmonary, kidney, cardiovascular, metabolic, or liver dysfunition
58
What are interactions of succinylcholine
- additive skeletal muscle blocade will occur if succinylchole is given concurrently with clindamycin, aminoglycosides, furosemide, lithium, quinidine or lidocaine
- effects may be increased if given concurrently with phenothiazines, oxytocin, promazine, tacrine, or thiasie diuretics
- effects may be decreased if given with diazepam
- increased risk of bradycardia, dysrhythmias, sinus arrest, apnea, and malignant hypertherma exists
- if given with cardiac glycosides, tehre is increased risk of cardia dysrhythmias
- if given with narcotics, there is increasd risk of braddcar and sinsu arrest
59
What is the treatment of Osuccinylcholine OD
- may invovle drug therapy for the follwoing symptoms: weakness, lack of coordination, watery eyes and mouth, tremors and seizures
60
