Exam 2 Start: Week 4 - Surgical Meds Flashcards
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)
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
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
4
Q
What are the 3 types of Anesthetic Drugs and the 1 Adjunct Category
A
- Inhalation Anesthetics
- IV Anesthetics
- Local Anesthetics
1 Adjunct: Skeletal Muscle Relaxant
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
6
Q
2 Subtypes of Inhalation Anesthetics
A
- Gaseous
- Vaporous
7
Q
Classification of Nitrous Oxide
A
“Laughing Gas”
Gaseous (Inhalation) General Anesthetic
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
9
Q
How does gaserous general anesthetic cause its depression of CNS effect
A
it is a GABA receptor agonist / opioid agonist
10
Q
Narcosis
A
effects that narcotics / opioids cause
ex; Sedation, pain relief, sleepiness, less anxiety, etc.
11
Q
The big benefit of nitrous oxide is what
A
Analgesia
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
13
Q
Anesthesia is more than analgesia, it effects…
A
CNS, sensation, movement, etc
there are differing levels of anesthesia
14
Q
What is Nitrous Oxides potentcy
A
very potent - small amounts give the effect wanted
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)
16
Q
Nitrous Oxide does not…
A
cause complete loss of consciousness
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)
18
Q
Gaseous General Anesthesia (nitrous oxide) must be given with what?
A
- MUST be given in combination with oxygen (at least 30% oxygen)
- Must be given with other agents except in very short procedures
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
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
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
22
Q
Classification of Isoflurane (Forane)
A
Inhaled General Volatile Anesthetic
23
Q
What is the action of volatile asthetic
A
Progressive depression of CNS (exact action unknown); GABA (inhibition) and glutamate receptor agonist
24
Q
Suffix: “-ane”
A
General Volatile Anesthetics
25
Which inhalation classification is better for longer procedures
General Volatile Anesthetics
26
What is the important thing that general volatile anesthetics does in comparison to gaseous general anesthetics
Volatile Anesthetics will depress the CNS, but its not as good for Analgesia like gaseous general anesthesia
27
Why can Isoflurane be used in longer procedures
it can be titrated up or down depending on if it is going longer or if it is done quickly
28
What are some other effects (not ADR) that can occur from isoflurane (volatile general anesthesia)
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*
29
Why is the metabolism of isoflurane so important to know about?
It is minimal and since it crosses the blood brain barrier it has the intense CNS depressive effects
30
What is the typical method of excretion for inhaled anesthetics
respiratory (exhaled breaths)
31
ADR of Volatile General Anesthesia
1. Hypotension (from vasodilation)
2. Significant respiratory depression
3. can trigger malignant hyperthermia - especially in conjunction with succinylcholine
32
How does volatile general anesthesia (isoflurane) simplify tracheal intubation
relaxes the tracheal area and depresses the reflexes
33
If isoflurane (volatile general anesthesia) is given alone...
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
34
Patients may do what following coming out of volatile general anesthesia
they may shiver
35
Other Volatile General Anesthesia drugs (other than isoflurane) that are related
desflurane (Suprane)
sevoflurane (Ultane)
36
Intravenous Anesthetics
IV drugs
inhalation can be uncomfortable or claustrophobic so this may be used
37
Types of IV Anesthetics
Hypnotics
Narcotics
Neuroleptics
Benzodiazepine
38
Example Drug for Hypnotics
propofol (Diprivan)
39
Example Drug for Narcotics
fentanyl (Sublimaze)
40
Example Drug for Neuroleptics
like Ketamine
41
Example Drug for Benzodiazepine
midazolam (versed)
42
Advantages of IV Anesthetics
rapid pleasant induction
absence of explosive hazards
low incidence of postop N/V (but some still quite sensitive)
43
Disadvantages of IV Anesthetics
laryngospasm and bronchospasm (may need intubation)
hypotension
resp. depression
44
Uses for IV Anesthetics
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
45
What is the major difference between barbiturates and gaseous agents is ___
safety
46
Why is safety so different between barbiturates and IV meds compared to gaseous agents
inhalation - anesthetist controls minute by minute administration and removal
IV - once administered, course of events must continue until out of system
47
Another term for Barbiturates
Hypnotics
48
Classification of Barbiturates/Hypnotics
IV general anesthetic, ultra short acting
49
propofol (Diprivan)
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
What is important to know about the pharmacokinetics/distribution of propofol
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
ADRs of propofol
resp depression
hypotension from vasodilation
risk of bacterial infection (in lipid based emulsion)
propofol infusion syndrome (rare)
injection site pain
52
One bonus benefit of propofol
antiemetic properties - helps in anti vomiting
53
What is induction like for propofol
smooth, easy, and pleasant for the patient
54
propofol is not recommended for patients...
with severe heart disease or respiratory difficulties
55
propofol is NOT...
a controlled substance
56
Milk of Amnesia
another name for propofol as it is a milky white solution
57
propofol and michael jackson
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
2 Other Common IV Hypnotic Drugs
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
Narcotics/Opioids
IV Anesthetics
Used as anesthetic as well as preoperatively and for analgesia
mostly known for analgesia but does provide anesthesia and sedation
60
Prototype drug for Narcotics/Opioids
fentanyl (Sublimaze)
61
fentanyl (Sublimaze)
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
fentanyl is super __
potent
63
fentanyl is an opioid ___
agonist (binds to mu receptors and causes opioid activity - analgesia, sedation, etc)
64
ADR of fentanyl (Narcotics/Opioids)
euphoria
miosis
N/V
pruritis (may not even realize it)
constipation
hypotension
respiratory depression
bradycardia
BLACK BOX WARNING - Significant abuse potential
65
Miosis
pupil constriction/contraction - some degree of this occurs whether you take an opioid d/t addiction or prescribed
66
What schedule is fentanyl
II
67
What is important to know about rapid IV injection of fentanyl and other opioids/narcotics
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
How often should topical patches (duragesic - fentanyl /narcotic-opioid like) be changed
every 72 hours for pain control (but not surgical pain)
69
What pain is a topical opioid/narcotic patch for
chronic pain or cancer - not acute pain like in surgical
70
It is important to do what with topical opioid/narcotic patches
dispose carefully - people can get the drugs off the patches to use
71
Other than IV and Topical, what are other routes of narcotics/opioid administration
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
Neuroleptics
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
Is there loss of consciousness with neuroleptics
no - you appear awake but do not connect things to yourself
74
What types of procedures are neuroleptic ideal for
something that is uncomfortable BUT does not take long
75
What often needs to be given with a neuroleptic
nitrous oxide or an opioid
76
What is an important Neuroleptic Like Drug
ketamine (Ketalar)
77
ketamine (Ketalar)
"Dissociative anesthetic"
used to induce a trance like effect with analgesia, quietude and detachment from the environment
78
What is a unique new use for ketamine
it can be used in very resistent and persistent depression as the intense dissociative effect seems to fight major depression
79
What is a major issue with misuse of ketamine
it is used as a date rape drug
80
Neuroleptanesthesia
Effect produced by administering a neuroleptic agent, narcotic analgesic, and sometimes nitrous oxide with oxygen
81
Benzodiazepine
IV anesthetic drug class
ex: midazolam (Versed)
neuroleptic and skeletal muscle relaxant effect
82
What is the important Benzodiazepine IV Anesthetic to know
midazolam (Versed)
83
What is important to know about the half life of midazolam (Versed)
Its half life is 2.5 hours meaning it takes 10 hours for 4 half lifes and to fully wear off
84
ADRs of midazolam (Versed)
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
What is the amnesia like when taking midazolam
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
Examples of other Benzodiazepines
diazepam (Valium) and lorazepam (Ativan)
87
4 Types of IV Anesthetics
Hypnotics
Narcotics/Opioids
Ketamine
Benzodiazepines
88
Local Anesthetics
anesthesia drugs that vary in duration but change sensation transmission
89
All local anesthetics end in what suffix
-caine or -cain
90
What are the important prototype drugs for local anesthetics to know
1. Short duration mepivacaine (Carbocaine)
2. lidocaine (Xylocaine)
3. Long duration Bupivacaine (Marcaine)
91
How does local anesthetics (what is the action) cause their effects
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
What is important to know about the metabolism and excretion of local anesthetics
they will basically just stay in their location of absorption until removed/deleted
93
ADRs of Local Anesthetics
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
What is important to know about the sensation loss with local anesthetics
loss of all sensation occurs but pain fibers are AFFECTED FIRST - can still feel pressure though
95
If local anesthetics become systemic...
they can cause serious reactions (especially heart and brain)
96
Why are local anesthetics often given with vasoconstrictors
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
What sort of effect do we want with local anesthetics
numbing, but maintain awareness but lose pain (analgesia)
98
Skeletal Muscle Relaxants
Adjunct Anesthetics
Drug allows binding to ACh receptors to prevent further firing and relax muscles
99
2 Important Prototype Drugs for Skeletal Muscle Relaxants
rocuronium (Zemuron)
succinylcholine (Anectine)
100
rocuronium (Zemuron)
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
succinylcholine (Anectine)
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
What is important to keep in mind about the distribution and pharmacokinetics of recuronium (Zemuron)
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
Never use rocuronium unless...
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
Skeletal Muscle Relaxants should always be given with what
a sedative
105
ADRs of rocuronium (Zemuron)
Tachycardia, Muscle Weakness, Salivation, HTN - many from stress and awareness
106
Why can't recuronium cross membranes
it is positively charged/ionized so it cannot cross membranes, BBB, or placenta
107
What can reverse the effect of recuronium and other non depolarizing agents
Anticholinesterases like neostigmine that allow ACh accumulation
108
Both recuronium and succinylcholine do what
thesame effect (flaccid muscles) but in different ways
109
ADRs of succinylcholine
Muscle weakness
Bronchospasm
Apnea
Bradycardia
Hypotension
Arrhythmias
Increased Salivation
Postop Muscle Pain
Hyperthemia!!!
110
Despite ADRs, succinylcholine...
has low level toxicity
111
Why is post op muscle pain unique to succinylcholine
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
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 70 yo man with COPD
Reason: Do I want to use an anesthetic that is depressing the respiratory system on this guy
113
A local anesthetic like lidocaine is NOT useful during:
A. Suturing of a Deep Laceration
B. Regional Blocks
C. General Anesthesia
D. Opthalmic Anesthesia
C: General Anesthesia
We do not want local anesthetics going systemic
