Drugs for Pain Flashcards
List 3 types of anesthesia.
- General: inhaled or intravenous
- Local: administered through injection or by topical administration
- Regional: involves numbing a large area of the body - spinal anesthesia
Novacane is an example of a _____ anesthetic.
Local
List 7 characteristics of an IDEAL general anesthetic .
- Loss of consciousness/ sensation
- Analgesia
- Amnesia
- Skeletal muscle relaxation
- Inhibition of sensory/ autonomic reflexes
- Rapid onset
- Non-toxic
An ideal general anesthetic should achieve desired effect WITHOUT producing what 4 conditions?
- Hypoxia
- Laryngospasm
- Excessive tracheobronchial secretions
- Depressed respirations
True or False: There is a single anesthetic that can achieve the desired anesthetic effect on its own.
FALSE
There is no one drug that can achieve the desired effect on its own. NEED BALANCED ANESTHESIA
What is balanced anesthesia?
Involves giving several different medications in small amounts to produce desired effects while minimizing toxic effects.
What are the 4 stages of anesthesia?
- Analgesia
- Delirium
- Surgical anesthesia
- Cardiovascular/ respiratory collapse
______ can occur as a result of a patient falling too deep into surgical anesthesia.
Cardiovascular and respiratory distress
List 6 drugs/considerations given as premedication prior to anesthesia.
- Sedation-benzodiazepine/ barbiturate
- Analgesia: opioids
- Antiemesis: promethazine (anti-vomiting drug)
- Infection control: usually a single injection within an hour of the start of surgery
- Disease-modifying agents: e.g. pretreatment with bronchodilators for COPD
- Withhold certain drugs like oral diabetic drugs to avoid hypoglycemia
What are 2 theories that may explain the mechanism of action of inhaled anesthetics?
- Molecules of gas dissolve in the neuronal membrane causing the membrane to expand impeding the opening of ion channels (so no AP can occur)
- Probably act differently in different neural tissues and affect a variety of ion channels. Anesthetic-sensitive potassium (K+) channel is understudy
What 2 effects can inhaled anesthetics have on the cardiovascular system?
- Most decrease arterial pressure
2. Depress contractility producing reflex tachycardia
What 2 effects can inhaled anesthetics have on the pulmonary system?
- Decrease RR
2. Decreased mucociliary function
What 2 effects can inhaled anesthetics have on the central nervous system?
- Decrease metabolic rate
2. Increased cerebral blood flow
What 2 effects can inhaled anesthetics have on the renal and hepatic systems?
- Renal: decrease glomerular filtration rate
2. Hepatic: decrease blood flow
Inhaled anesthetics can induce ________.
Malignant Hyperthermia
What are 4 symptoms associated with malignant hyperthermia?
- Excessive muscular rigidity
- Producing high BP
- Tachycardia
- Fast rise in fever
List 3 treatments used to treat malignant hyperthermia.
- Dantrolene
- Lidocaine
- Cooling blanket
_____ is an ultra-short acting barbituate (IV anesthesia). This drug is often replaced with ____.
Thiopental
Propofol
What is the MOA of IV anesthesia? (4)
Binds to GABAa gated Chloride Channels
- Induce anesthesia
- Produce hypnosis
- Anesthesia without analgesia.
What is the dosing of IV anesthesia?
- IV injection
2. Rapidly taken up by brain (30 sec) short duration (10 min) due to redistribution in fat
List 5 ADRs associated with IV anesthesia.
- Hangover due to lipid solubility
- Respiratory depression
- Bronchospasm
- Laryngospasm
- Reflex tachycardia
IV anesthetic drugs may need to be given with _____. Why?
Opioids
Why?: Anesthetics may not produce analgesia, which is why you need an opioid to relieve the pain.
Large doses of _____ can induce anesthesia while maintaining a good _____ but impairing ______.
IV Opioids
Cardiovascular profile
Ventilation (depress RR)
____ are too slow in onset but can provide basal level of sedation for maintenance of anesthesia
Benzodiazepines
What drug, given 30-60 min before surgery, can be used to produce anterograde amnesia?
Midazolam with an anxiolytic
______ may be given to inhibit any movement especially for delicate surgical procedures.
Neuromuscular blocker
List 3 TRUE IV anesthetics.
- Etomidate
- Ketamine
- Propofol
List 4 characteristics of Etomidate.
- Min. changes in CVS/ respiratory function
- Rapid induction(within 60 seconds)
- Can produce skeletal muscle movements
- Produces nausea and vomiting
List 4 ADRs associated with the use of ketamine.
- Dissociative anesthesia
- HTN
- Tachycardia
- Emergence phenomena
What 3 symptoms make up emergence phenomena ?
- Visual hallucinations
- Vivid dreams
- Thrashing
Propofol causes global CNS _____ through agonist actions on _____.
Depression
GABAa
List 4 characteristics of Propofol.
- Lowers BP without myocardial depression
- Lowers intracranial pressure
- Good anti-emetic action
- Used for same day surgery and examinations (colonoscopy)