Exam #4 Flashcards
4 stages of anesthetics?
- Analgesia
- Excitement
- Surgical Anesthesia
- Medullary paralysis
Define Induction
Time from administration of anesthetic to reach stage 3 dependent upon uptake from lungs and distribution to CNS
Minimum Alveoli Concentration
Concentration of inhaled anesthetic that results in 50% of patients failing to move in response to surgical incision
Greater the MAC =?
Lower the POTENCY
LOW MAC=?
High Potency like Halothane
name a low potent anesthetic
Nitrous Oxide
Define Recovery
Reverse of induction, dependent upon export of inhalation anesthetic in the expired breath
MOA of inhalation anesthetics?
Enhance effects of GABA, while suppressing actions of Glutamate
Adverse effects of Inhalation Anesthetics?
↬ Respiratory depression ↬ Cardiac Depression ↬ Sensitization of heart to catecholamines ↬ Malignant hyperthermia ↬ Aspiration of gastric contents ↬ Hepatotoxicity
Types of inhalation anesthetics?
- Volatile Liquids
2. Gases
Volatile liquid anesthetics
↬ Halothane
↬ Isoflurane
name a gas anesthetic
↬ Nitrous Oxide
Pre-anesthetic drugs you can give
↬ Benzodiazepines
↬ Opioids for pre-op pain
↬ Anti-cholinergic drugs - atropine (decreases secretions) and maintains HR up
↬ Neuromuscular blockers
Post-anesthetic meds you give?
↬ Anelgesics
↬ Anti-emetic
↬ Muscurinic Agonists (bethanecol - increases GI, urinary motility)
How are intravenous anesthetics used?
Either alone or to supplement the effects of inhalation anesthetics
Two potential benefits of IV agents when combined with inhaled anesthetics?
- Permit dosage of inhaled agents to be reduced
2. Produced effects that cannot be achieved with an inhaled agent alone
Types of IV anesthetics
- Barbiturates
- Benzodiazepines
- Miscellaneous
Name a Barbiturates
Thiopental
Name a Benzodiazepine
Midazolam
What is Ketamine
A tasteless, odorless, amnesia inducing drug. Date rape drug. Distorts sounds and sensations and makes patients feel detached from reality.
Action of Propofol
Induces and maintains anesthesia, sedates during mechanical ventilation and during non-invasive procedures.
Adverse effects of Propofol
↬ Resp. depression
↬ Hypotension
↬ Bacterial infection
Use of local anesthetics
To get rid of pain prior to procedures and also found in OTC meds.
MOA of local anesthetics
Inhibits sensory neurons that carry painful stimuli to CNS, by blocking influx of NA+ in nerve cell
Classes of local anesthetics
- Esters - Short duration of action, metabolized by enzyme esterase’s present in blood & skin
- Amide - Long duration of action, metabolized in liver
Ester local anesthetics
- Procaine
- Cocaine
- Benzocaine
- Tetracaine
Amide local anesthetics
- Lidocaine
- Mepivacaine
- Bupivacaine
- Prilocaine
Local Anesthetics ROA?
Topically and Injection
Local Anesthetics adverse effects?
↬ Systemic effects when given frequently & at high does or in areas of open injury ↬ Cardiovascular& CNS disturbances ↬ If patient has hypersensitivity switch class of anesthetic
Define Opioids
Drug produces same pharmacological effects as opium same pharmacological effects as endogenous neuropeptides (ENKEPHALINS, ENDORPHINS, DYNORPHINS) → work on 3 receptors MU, KAPPA, DELTA
What receptors do Opioids work on?
MU, KAPPA
Classifications of Opioids
- Opioid agonist
- Opioid antagonist
- Opioid agonist/antagonist (morphine)
Physiological actions of Morphine?
Histamine release
Emesis
Contraction of smooth muscle in biliary & urinary tract
Cardiovascular changes (orthostatic hypotension)
Decreases cough reflex, GI motility, Uterine tone, Mental fx
Respiratory depression
Euphoria
Analgesia
Myosis
Indications for Morphine
- Pain
- Diarrhea
- Relief of cough
- Relief of acute pulmonary edema
Adverse effects of Morphine
↬ N&V
↬ Respiratory depression
↬ Constipation
↬ Urinary retention
↬ Elevation of intracranial pressure caused by rep. depression
↬ Tolerance to analgesic, sedative & euphoria effects needing an increased dosage
↬ Tolerance also develops to resp. depression
↬ No tolerance to myosis or constipation
↬ Physical dependency rarely a problem if its taken for less than 2 weeks, if taken longer physical and psychological dependency increases.
↬ No cross tolerance w/ CNS depressants
↬ Cross tolerance w/ other opioids
↬ Cross placenta & cause resp. depression in newborn
Morphine drug-drug interaction
↬ CNS depressants ↬ Anticholinergics ↬ Hypotensive drugs ↬ MAO inhibitors ↬ Agonist/Antagonist drugs like Pentazocine
Codeine action
similar to morphine, but milder
Indication of Codeine
Anti-tussive & treatment of mild to moderate pain
Pentazocine classification
partial agonist, antagonist. Works @ Kappa as agonist and @ MU as antagonist
What happens if Pentazocine is given with morphine?
If given for a long period of time withdrawal syndrome can occur.
Pure Opioid Antagonists
Narcan & Naltrexone
Narcan MOA
Competitive antagonist
Narcan Indications
Reverses opioid OD, and post-op opioid effect
Narcan onset of action & duration
Within 30 secs of admin & brief
Narcan adverse effects
Tachycardia
Cardiac Dysrhythmias
Withdrawal
Naltrexone MOA
Competitive antagonist
Naltrexone Indication
Benefit to patients with opioid dependency because it can be given orally & has a longer duration of action 48hrs
Adverse effects of Naltrexone
Similar to Narcan but also Hepatotoxicity
Strong opioid agonists list
▸ Morphine
▸ Meperidine
▸ Methadone
▸ Fentanyl
Moderate to strong opioid agonists list
▸ Codeine
▸ Oxycodone
▸ Hydrocodone
Combination Opioid Agonists list
▸ Hydrocodone + Acetaminophen = Vicodin
▸ Oxycodone + Aspirin = Perocodan
▸ Oxycodone + Acetaminophen = Percocet
Agonist/Antagonist opioids list
▸ Pentazocine
Opioid antagonist list
▸ Narcan
▸ Naltrexone
