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Pharmacology > DRUGS FOR LOCAL & GENERAL ANESTHESIA > Flashcards

DRUGS FOR LOCAL & GENERAL ANESTHESIA Flashcards

1
Q

what is local anesthesia?

A

loss of sensation to a limited body region, w no loss of consciousness

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2
Q

what is regional anesthesia?

A

loss of sensation to a larger body area, w no loss of consciousness

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3
Q

what is general anatheisa?

A

loss of sensation throughout entire body, accompanied by loss of consciousness

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4
Q

what is monitored anatheisa care?

A

sedation, client remains responsive, used during diagnostic procedures, or in combination with local anesthetic for minor surgeries

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5
Q

what is the method of a topical route?

A

creams, sprays, lozenges, drops, suppositories

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6
Q

what is the method of infiltration (field block) route?

A

direct injection into tissue immediate to the surgeries call site

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7
Q

what is the method of nerve block route?

A

direct injection into tissue that may be distant from operation site

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8
Q

what is the method of a spinal route?

A

injection into the cerebrospinal fluid (CSF)

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9
Q

what is the method of an epidural route?

A

injection into epidural space of spinal cord
- always a higher dose then spinal

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10
Q

to improve a local anesthetics duration of action, it can be co administered with?

A

epinephrine

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11
Q

what is the mechanism of action for a local anesthetic?

A

-block voltage gated sodium channels
-blocks action potentials
-inhibit both motor an sensory neuronal signalling
-bind to open sodium channels
-active neurons ate the most susceptible

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12
Q

what is an ester anesthetic?

A

-rapidly metabolized in the bloodstream
-don’t need to be metabolized by liver
-short half life (1-2 mins)
-pKa ranges from 8.6-8.9

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13
Q

what is an amide anesthetic?

A

-metabolized in the liver (CYP 450)
-longer half lives (60-240 mins)
-pKa ranges from 7.5-8.0

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14
Q

what is Bupivaccaine (marcaine)?

A

anesthetic drugs, affects more visceral (C fibres)/somatic pain fibres (A& fibres) rather than motor fibres (Alpha fibres)

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15
Q

when a local anesthetic is administered into the epidural space, how is it different than an intrathecal (spinal) administration?

A

more anesthetic is required

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16
Q

is the epidural space a vascularized area?

A

yes. highly vascularized

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17
Q

if a local anesthetic is properly applied, what should happen?

A

the drug should predominately affect the nerve roots passing through the epidural space (somatosensory)

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18
Q

when administering a local anesthetic directly into the CSF, is it a clear end point? And when do you know you’ve reached the spinal cord?

A

Yes
- when pulling back syringe there is CSF fluid

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19
Q

when is a local anesthetic generally administered?

A

during scheduled surgical procedure (c section)

20
Q

what is the difference between a local anesthetic and an epidural?

A

local anesthesia has a higher rate of efficacy, but requires less anesthetic than an epidural
CANNOT inject epidural in the wrong place

21
Q

what is the function of opioids?

A

-bind to presynaptic receptors in the dorsal horn of the spinal cord (substantia gelatinous), inhibits release of pain signalling neurotransmitters
-bind to postsynaptic receptors in the brain; decreasing neuronal excitability
-NO ACTIVITY on motor neurons; mobility, proprioception and sense of touch are maintained
-very effective in controlling visceral pain

22
Q

why can opioids be administered with local anesthetics?

A

lowers the dose of local anesthetic required

23
Q

what are adverse effects local anesthetics?

A
  • pruritus (itching) is common and can be treated with antihistamines
    -nausea an vomiting may occur if drug reaches the area postrema in the brain stem
    -respiratory depression (very rare) in cases of epidural regional anesthesia
24
Q

what are adverse effects of epidural and intrathecal anesthesia?

A

-inadequate anesthesia
-backache (20%)
-infection (1%)
-arachnoiditis
-spinal headache (1-5%) - CSF leak, causing traction on the brain from the meninges - treated with a blood patch, 15-20 ml autologous blood transfusion to the puncture site

25
Q

what are the 4 stages of a general anesthetic?

A
  1. analgesia
  2. disinhibition
  3. surgical anesthesia
  4. medullary depression
26
Q

what occurs in stage 1 of general anesthetic (analgesia - loss of pain)?

A

client loses general sensation but may be awake. this stage proceeds until client loses consciousness

27
Q

what occurs in stage 2 of general anesthetic (disinhibition - excitement and hyperactivity)?

A

the client may be delirious and try to resist treatment. HR an breathing may become irregular and BP can increase. IV agents are administered to stay calm

28
Q

what occurs in stage 3 of general anesthetic (surgical anesthesia)?

A

skeletal muscles become relaxed and delirium stabilizes. cardiovascular an breathing activities stabilize. eye movements slow an the client becomes still. surgery is performed during this stage

29
Q

what occurs in stage 4 of general anesthetic (medullary depression - paralysis of the medulla region in the brain)?

A

responsible for controlling respiratory and cardiovascular activity. if breathing or the heart stops, death could result. this stage is usually avoided during general anesthesia

30
Q

what are the 6 steps that must happen under general anesthesia?

A
  1. analgesia
  2. sedation
  3. relaxation
  4. hypnosis (sleep)
  5. amnesia
  6. loss of reflexes
31
Q

No single drug can safely accomplish all 6 steps of general anesthesia. What combination of drugs are used?

A

short acting benzodiazepines, general anesthetics (IV an inhaled), opioids, neuromuscular blocking agents

32
Q

what are the effects of intravenous anesthetics?

A

-used to induce analgesia, sedation, muscle relaxation and LOC
-allows pt to quickly move through stages 1 and 2 of analgesia
-IV anesthetics decrease the dose of inhaled anesthetic required to maintain anesthesia
-can be used alone (propofol) if surgical procedures requires less than 15 minutes anesthesia

33
Q

what is propofol?

A

hypnotic, muscle relaxation, amnesia

34
Q

what is midazolam?

A

sedation, relaxation

35
Q

what are opioids and ketamine?

A

hypnotic, nociception

36
Q

what are the effects of inhaled general anesthetics?

A

-used to maintain anesthesia, highly lipid soluble
-prevent flow of sodium ions into neurons in the CNS - REDUCING NEURAL ACTIVITY

37
Q

what are volatile liquids (sevoflurane)?

A

low MAC, poor analgesic properties, high safety profile, does not induce the same respiratory/cardiovascular depression as other drugs in this class

38
Q

what are gaseous inhaled anesthetics (nitrous oxide)?

A

hight MAC (no LOC), but strong analgesic properties, used in dental procedures, during labour and minor/brief surgical procedures

39
Q

what should pt be monitored for postoperatively?

A

nausea an vomiting, CNS depression, respiratory depression, changes in vital signs

40
Q

during surgery, what is the function of neuromuscular blockers?

A

induce relaxation of skeletal muscles

41
Q

what are anticholinergics used for preoperatively?

A

dry respiratory and oral secretions

42
Q

what is histamine (H2) receptor antagonists used for preoperatively?

A

decrease gastric fluid volume

43
Q

what is used for pain management postoperatively?

A

opioids (multiple routes), NSAIDS

44
Q

what are antiemetics used for postoperatively?

A

reduce nausea an vomiting associated with general anesthetics

45
Q

what are cholinergics used for postoperatively?

A

stimulate smooth muscle contraction in the GI tract and bladder to induce peristalsis and urination

Pharmacology (20 decks)

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