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NURS 365 - Pharmacology in Nursing > Exam 2 Start: Week 4 - Surgical Meds > Flashcards

Exam 2 Start: Week 4 - Surgical Meds Flashcards

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1
Q

Prototype Drugs for Medicaitons r/t to Surgery

A

Nitrous Oxide

Isoflurane (Forane)

Propofol (Diprivan)

Fentanyl (Sublimaze)

Midazolam (Versed)

Procaine and Lidocaine

Rocuronium (Zemuron)

Succinylcholine (Anectine)

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2
Q

Balanced Anesthesia

A

Use of various combinations of medications for the best results to provide sleep, analgesia, elimination of certian reflexes and good muscular

No one drug can do all these things alone

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3
Q

What sort of effects do we want from anesthesia

A

Analgesia

Decreased LOC (Coma) / Amensia

Decrease Anxiety

Decrease Muscle Activity

Decrease Secretions / N/V

Get into system quickly and leave the system quickly

no one magic drugs all of these at the same time

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4
Q

What are the 3 types of Anesthetic Drugs and the 1 Adjunct Category

A
  1. Inhalation Anesthetics
  2. IV Anesthetics
  3. Local Anesthetics

1 Adjunct: Skeletal Muscle Relaxant

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5
Q

Inhalation Anesthetics

A

Anesthesia Drugs administered through the respiratory tract - dosage is dependent of many things, but can be controlled by anesthetist – both inhalation and exhalation

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6
Q

2 Subtypes of Inhalation Anesthetics

A
  1. Gaseous

2. Vaporous

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7
Q

Classification of Nitrous Oxide

A

“Laughing Gas”

Gaseous (Inhalation) General Anesthetic

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8
Q

Gaseous General Anesthetic

A

Type of Inhalation Anesthetics

ex: NO

Causes ANALGESIA, narcosis, and amnesia by depressing the CNS via GABA - however does not depress the CNS well like volatile anesthetics

GABA receptor agonist, opioid agonist

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9
Q

How does gaserous general anesthetic cause its depression of CNS effect

A

it is a GABA receptor agonist / opioid agonist

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10
Q

Narcosis

A

effects that narcotics / opioids cause

ex; Sedation, pain relief, sleepiness, less anxiety, etc.

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11
Q

The big benefit of nitrous oxide is what

A

Analgesia

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12
Q

Why is nitrous oxide enver used for long procedures?

A

It does not last lone, but it does have a HIGHLY ANALGESIC EFFECT

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13
Q

Anesthesia is more than analgesia, it effects…

A

CNS, sensation, movement, etc

there are differing levels of anesthesia

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14
Q

What is Nitrous Oxides potentcy

A

very potent - small amounts give the effect wanted

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15
Q

ADRs of Gaseous General Anesthesia (Nitrous Oxide)

A

Suprisingly free of major toxicities when given WITH OXYGEN

Does compress normal tissue oxygenation if balance between NO and O2 is not adequate

Toxic Suppression of CNS can occur

Post op N/V can occur (more so than other drugs)

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16
Q

Nitrous Oxide does not…

A

cause complete loss of consciousness

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17
Q

Gaseous General Anesthesia (Nitrous Oxides) greatest use?

A

An induction agent - gets a person to the state where you can do the procedure / induce the effects (analgesia in this case)

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18
Q

Gaseous General Anesthesia (nitrous oxide) must be given with what?

A
  1. MUST be given in combination with oxygen (at least 30% oxygen)
  2. Must be given with other agents except in very short procedures
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19
Q

Important Points about Nitrous Oxide (General Gaseous Anesthesia)

A

Strong Analgesic, Poor Anesthetic (Depressing CNS)

Some N/V

Better to give with O2 in good balance

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20
Q

General Volatile Anesthesia

A

Type of Inhalation Anesthetics

Not a gas, it is a liquid that is more soluble in blood, ICF, and fat tissue than gas

Not explosive

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21
Q

What does the high solubility of General Volatile Anesthesia mean

A

There is slower onset in induction and slower recovery

High solubility will allow tissues and blood concentrations to build up unless carefully titrated

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22
Q

Classification of Isoflurane (Forane)

A

Inhaled General Volatile Anesthetic

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23
Q

What is the action of volatile asthetic

A

Progressive depression of CNS (exact action unknown); GABA (inhibition) and glutamate receptor agonist

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24
Q

Suffix: “-ane”

A

General Volatile Anesthetics

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25
Q

Which inhalation classification is better for longer procedures

A

General Volatile Anesthetics

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26
Q

What is the important thing that general volatile anesthetics does in comparison to gaseous general anesthetics

A

Volatile Anesthetics will depress the CNS, but its not as good for Analgesia like gaseous general anesthesia

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27
Q

Why can Isoflurane be used in longer procedures

A

it can be titrated up or down depending on if it is going longer or if it is done quickly

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28
Q

What are some other effects (not ADR) that can occur from isoflurane (volatile general anesthesia)

A

Hypotension (from vasodilation, not cardiac output effects)

Respiration - less efficient exchange of gas - rapid and shallow respirations; respiratory depression

Muscle - some relaxation by central depression

Liver - depressed function

Stronger CNS depression leads to this stuff

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29
Q

Why is the metabolism of isoflurane so important to know about?

A

It is minimal and since it crosses the blood brain barrier it has the intense CNS depressive effects

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30
Q

What is the typical method of excretion for inhaled anesthetics

A

respiratory (exhaled breaths)

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31
Q

ADR of Volatile General Anesthesia

A
  1. Hypotension (from vasodilation)
  2. Significant respiratory depression
  3. can trigger malignant hyperthermia - especially in conjunction with succinylcholine
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32
Q

How does volatile general anesthesia (isoflurane) simplify tracheal intubation

A

relaxes the tracheal area and depresses the reflexes

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33
Q

If isoflurane (volatile general anesthesia) is given alone…

A

it is NOT a potent analgesic

Has some mild skeletal muscle relaxant effects (but IS uterine muscle relaxant)

So if you need an agent for quick induction and one for muscle relaxant - if used alone, however, you could see the patient going through the stages of anesthesia because of the slow onset

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34
Q

Patients may do what following coming out of volatile general anesthesia

A

they may shiver

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35
Q

Other Volatile General Anesthesia drugs (other than isoflurane) that are related

A

desflurane (Suprane)

sevoflurane (Ultane)

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36
Q

Intravenous Anesthetics

A

IV drugs

inhalation can be uncomfortable or claustrophobic so this may be used

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37
Q

Types of IV Anesthetics

A

Hypnotics

Narcotics

Neuroleptics

Benzodiazepine

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38
Q

Example Drug for Hypnotics

A

propofol (Diprivan)

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39
Q

Example Drug for Narcotics

A

fentanyl (Sublimaze)

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40
Q

Example Drug for Neuroleptics

A

like Ketamine

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41
Q

Example Drug for Benzodiazepine

A

midazolam (versed)

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42
Q

Advantages of IV Anesthetics

A

rapid pleasant induction

absence of explosive hazards

low incidence of postop N/V (but some still quite sensitive)

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43
Q

Disadvantages of IV Anesthetics

A

laryngospasm and bronchospasm (may need intubation)

hypotension

resp. depression

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44
Q

Uses for IV Anesthetics

A

induce and maintain general surgical anesthesia

basal anesthesia (low start and add on top of it

usually use short acting and ultra short acting barbiturates (sedating meds)

Narcotic use

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45
Q

What is the major difference between barbiturates and gaseous agents is ___

A

safety

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46
Q

Why is safety so different between barbiturates and IV meds compared to gaseous agents

A

inhalation - anesthetist controls minute by minute administration and removal

IV - once administered, course of events must continue until out of system

47
Q

Another term for Barbiturates

A

Hypnotics

48
Q

Classification of Barbiturates/Hypnotics

A

IV general anesthetic, ultra short acting

49
Q

propofol (Diprivan)

A

IV Anesthesia

like IV isoflurane

can use in short procedures like a colonscopy, ultra short acting

excites release of GABA (inhibitory NT) - promotes the release of GABA . Has short duration of anesthesia action

50
Q

What is important to know about the pharmacokinetics/distribution of propofol

A

onset = 60 seconds; length of action - 3-5 minutes

have to shift to something inhaled or a longer drug after this not just keep giving it

51
Q

ADRs of propofol

A

resp depression

hypotension from vasodilation

risk of bacterial infection (in lipid based emulsion)

propofol infusion syndrome (rare)

injection site pain

52
Q

One bonus benefit of propofol

A

antiemetic properties - helps in anti vomiting

53
Q

What is induction like for propofol

A

smooth, easy, and pleasant for the patient

54
Q

propofol is not recommended for patients…

A

with severe heart disease or respiratory difficulties

55
Q

propofol is NOT…

A

a controlled substance

56
Q

Milk of Amnesia

A

another name for propofol as it is a milky white solution

57
Q

propofol and michael jackson

A

physician prescribed this hypnotic as a sleep aid and mixed with other meds it was acting in its CNS depressant capacities and killed him

58
Q

2 Other Common IV Hypnotic Drugs

A

etomidate (Amidate) - for induction of those with heart issues and cannot handle the cardiac effects

fentanyl/droperidol combination (Innovar) - an opioid and neuroleptic combo used for neurolept analgesia

59
Q

Narcotics/Opioids

A

IV Anesthetics

Used as anesthetic as well as preoperatively and for analgesia

mostly known for analgesia but does provide anesthesia and sedation

60
Q

Prototype drug for Narcotics/Opioids

A

fentanyl (Sublimaze)

61
Q

fentanyl (Sublimaze)

A

a common street drug mixture, and why many overdose

It is like super charged morphine - 100x more powerful and measured in mcg rather than morphine’s mg

62
Q

fentanyl is super __

A

potent

63
Q

fentanyl is an opioid ___

A

agonist (binds to mu receptors and causes opioid activity - analgesia, sedation, etc)

64
Q

ADR of fentanyl (Narcotics/Opioids)

A

euphoria

miosis

N/V

pruritis (may not even realize it)

constipation

hypotension

respiratory depression

bradycardia

BLACK BOX WARNING - Significant abuse potential

65
Q

Miosis

A

pupil constriction/contraction - some degree of this occurs whether you take an opioid d/t addiction or prescribed

66
Q

What schedule is fentanyl

A

II

67
Q

What is important to know about rapid IV injection of fentanyl and other opioids/narcotics

A

large doses or rapid IV injection may cause muscle rigidity and apnea - observe closely!

(if it says push over certain time than push over that time)

68
Q

How often should topical patches (duragesic - fentanyl /narcotic-opioid like) be changed

A

every 72 hours for pain control (but not surgical pain)

69
Q

What pain is a topical opioid/narcotic patch for

A

chronic pain or cancer - not acute pain like in surgical

70
Q

It is important to do what with topical opioid/narcotic patches

A

dispose carefully - people can get the drugs off the patches to use

71
Q

Other than IV and Topical, what are other routes of narcotics/opioid administration

A
  1. lozenge on a stick (actiq) - not a lollipop, but can be used to give kids to get an IV in with order
  2. buccal tablets (Fentora) - between gums and cheeks - maybe for cancer pain or issues swallowing
72
Q

Neuroleptics

A

Group of drugs that are called “Dissociative drugs” because they give a sort of out of body experience, no pain and you are detached from the environment.

If it is a painful procedure you may not even associate the pain or procedure with yourself and it leaves you unbothered

73
Q

Is there loss of consciousness with neuroleptics

A

no - you appear awake but do not connect things to yourself

74
Q

What types of procedures are neuroleptic ideal for

A

something that is uncomfortable BUT does not take long

75
Q

What often needs to be given with a neuroleptic

A

nitrous oxide or an opioid

76
Q

What is an important Neuroleptic Like Drug

A

ketamine (Ketalar)

77
Q

ketamine (Ketalar)

A

“Dissociative anesthetic”

used to induce a trance like effect with analgesia, quietude and detachment from the environment

78
Q

What is a unique new use for ketamine

A

it can be used in very resistent and persistent depression as the intense dissociative effect seems to fight major depression

79
Q

What is a major issue with misuse of ketamine

A

it is used as a date rape drug

80
Q

Neuroleptanesthesia

A

Effect produced by administering a neuroleptic agent, narcotic analgesic, and sometimes nitrous oxide with oxygen

81
Q

Benzodiazepine

A

IV anesthetic drug class

ex: midazolam (Versed)

neuroleptic and skeletal muscle relaxant effect

82
Q

What is the important Benzodiazepine IV Anesthetic to know

A

midazolam (Versed)

83
Q

What is important to know about the half life of midazolam (Versed)

A

Its half life is 2.5 hours meaning it takes 10 hours for 4 half lifes and to fully wear off

84
Q

ADRs of midazolam (Versed)

A

RESPIRATORY DEPRESSION (EVEN ARREST) - do not give too quickly! (1-3 m push)

Decreased alertness and amensia (can last rest of day)

Hypotension

Hiccups

Laryngospasm

Loss of Dexterity

Muscle Tremors, Tachycardia, SOB

85
Q

What is the amnesia like when taking midazolam

A

anterograde - meaning there is loss of memory about the proecdure and after until it wears off

May not remember what was said to them or even discharge instructions

Does allow decreased anxiety though

86
Q

Examples of other Benzodiazepines

A

diazepam (Valium) and lorazepam (Ativan)

87
Q

4 Types of IV Anesthetics

A

Hypnotics

Narcotics/Opioids

Ketamine

Benzodiazepines

88
Q

Local Anesthetics

A

anesthesia drugs that vary in duration but change sensation transmission

89
Q

All local anesthetics end in what suffix

A

-caine or -cain

90
Q

What are the important prototype drugs for local anesthetics to know

A
  1. Short duration mepivacaine (Carbocaine)
  2. lidocaine (Xylocaine)
  3. Long duration Bupivacaine (Marcaine)
91
Q

How does local anesthetics (what is the action) cause their effects

A

they stabilize or elevate threshold of excitation of nerve cell membrane preventing depolarization

so, NO SENSATION TRANSMISSION OCCURS BY ELEVATING THE THRESHOLD - cannot fire nerve impulses

92
Q

What is important to know about the metabolism and excretion of local anesthetics

A

they will basically just stay in their location of absorption until removed/deleted

93
Q

ADRs of Local Anesthetics

A

Overdosage or systemic absorption gives general body effects and excites (excitement, convulsion) or depresses the CNS (bradycardia, hypotension, cardiac arrest) - we want it staying local

NV, pallor, apprehension

94
Q

What is important to know about the sensation loss with local anesthetics

A

loss of all sensation occurs but pain fibers are AFFECTED FIRST - can still feel pressure though

95
Q

If local anesthetics become systemic…

A

they can cause serious reactions (especially heart and brain)

96
Q

Why are local anesthetics often given with vasoconstrictors

A

something like EP is given to constrict blood vessels in the area in order to keep the anesthetic in that tissue so it does not go systemic

97
Q

What sort of effect do we want with local anesthetics

A

numbing, but maintain awareness but lose pain (analgesia)

98
Q

Skeletal Muscle Relaxants

A

Adjunct Anesthetics

Drug allows binding to ACh receptors to prevent further firing and relax muscles

99
Q

2 Important Prototype Drugs for Skeletal Muscle Relaxants

A

rocuronium (Zemuron)

succinylcholine (Anectine)

100
Q

rocuronium (Zemuron)

A

NON DEPOLARIZING AGENT - Skeletal Muscle Relaxant

A ACh competitive drug that will cause neuromuscular blocking to cause “paralytic” effects

Does so by taking the space on the receptor ACh would attempt to take (Competitive Antagonist)

101
Q

succinylcholine (Anectine)

A

DEPOLARIZING NEUROMUSCULAR BLOCKING AGENT - Skeletal Muscle Relaxant

Also resembles ACh so it fits into thre receptors and causes depolarization like ACh would but its more twitchy and seizure like - but then it sits on the receptor and does not allow repolarization (reset) –> more prolonged depolarization occurs and it is slowly inactivated –> leads to flaccid muscles that cannot move (just like a non depolarizing agent)

102
Q

What is important to keep in mind about the distribution and pharmacokinetics of recuronium (Zemuron)

A
  1. It works 20-40 minutes only so its good for only short procedures like intubation
  2. Only effects muscles so they can be conscious and terrified
103
Q

Never use rocuronium unless…

A

it is given with a sedative as well to prevent trapping them in their body since it does not hinder pain perception or consciousness

104
Q

Skeletal Muscle Relaxants should always be given with what

A

a sedative

105
Q

ADRs of rocuronium (Zemuron)

A

Tachycardia, Muscle Weakness, Salivation, HTN - many from stress and awareness

106
Q

Why can’t recuronium cross membranes

A

it is positively charged/ionized so it cannot cross membranes, BBB, or placenta

107
Q

What can reverse the effect of recuronium and other non depolarizing agents

A

Anticholinesterases like neostigmine that allow ACh accumulation

108
Q

Both recuronium and succinylcholine do what

A

thesame effect (flaccid muscles) but in different ways

109
Q

ADRs of succinylcholine

A

Muscle weakness

Bronchospasm

Apnea

Bradycardia

Hypotension

Arrhythmias

Increased Salivation

Postop Muscle Pain

Hyperthemia!!!

110
Q

Despite ADRs, succinylcholine…

A

has low level toxicity

111
Q

Why is post op muscle pain unique to succinylcholine

A

because it causes initial seizure or twitching activity that is very intense and causes pain in the muscles similar to that of a post workout

112
Q

Which person has an increased risk for adverse effects with isoflurane (Forane)?

A. A 70 yo man with COPD

B. 66 yo woman with hypothyroidism

C. 80 yo woman with Parkinsons disease

D. A 16 yo girl with anorexia nervosa

A

A. a 70 yo man with COPD

Reason: Do I want to use an anesthetic that is depressing the respiratory system on this guy

113
Q

A local anesthetic like lidocaine is NOT useful during:

A. Suturing of a Deep Laceration

B. Regional Blocks

C. General Anesthesia

D. Opthalmic Anesthesia

A

C: General Anesthesia

We do not want local anesthetics going systemic

NURS 365 - Pharmacology in Nursing (15 decks)

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