Exam I Flashcards
1
Q
What are drugs that reduce or eliminate pain by depressing nerve function in the central nervous system (CNS) and peripheral nervous system?
A
Anesthetics
2
Q
What two systems are depressed by anesthetics?
A
Central nervous system and peripheral nervous system.
3
Q
Do anesthetics enhance, depress or repress the central nervous system and peripheral nervous system?
A
Depress.
4
Q
What is a state of reduced neurologic function?
A
Anesthesia
5
Q
What are the three types of anesthesia?
A
General, local and balanced.
6
Q
General, local and balanced are three types of what?
A
Anesthesia.
7
Q
What is general anesthesia?
A
Complete loss of consciousness, loss of body reflexes including paralysis of respiratory muscles.
8
Q
General anesthesia is a complete loss of _____________ and loss of body _______________, including paralysis of _________________ muscles.
A
Consciousness, reflexes, respiratory…
9
Q
T/F: General anesthesia results in decreased function of respiratory muscles.
A
False. General anesthesia results in total paralysis of respiratory muscles.
10
Q
In what type of anesthesia is respiratory function not paralyzed?
A
Local
11
Q
What causes elimination of pain in local anesthesia?
A
Anesthetized nerves feel no pain.
12
Q
What type of anesthesia uses a combination of drugs to produce optimum desired effect and minimized undesirable effects?
A
Balanced anesthesia.
13
Q
What is balanced anesthesia?
A
A type of anesthesia that uses a combination of drugs to produce optimum desired effect and minimized undesirable effects.
14
Q
What type of anesthesia induces a state in which the DNS is altered to produce varying degrees of pain relief, depression of consciousness, skeletal muscle relaxation and reflex reduction?
A
General anesthesia
15
Q
Which type of anesthesia eliminates pain and work fast?
A
General anesthetics
16
Q
In what ways are general anesthetics administered?
A
Inhaled, IV or adjunct
17
Q
How ar parenteral anesthetic administered?
A
IV
18
Q
What are adjunct anesthetics?
A
Drug that enhances clinical therapy when used simultaneously with another drug.
19
Q
What is the Overton-Meyer theory?
A
Potency of all anesthetics varies directly with lipid solubility.
20
Q
What is the theory that states that the potency of all anesthetics varies directly with lipid solubility.
A
Overton-Meyer theory
21
Q
Are fat-soluble or water-soluble anesthetics stronger
A
Fat-soluble.
22
Q
Lipid-soluble anesthetics can cross B/B barrier to concentrate in nerve cell membranes because nerve cell membranes have what?
A
High lipid content
23
Q
The mechanism of action of general anesthetic varies according to what?
A
To drug
24
Q
An orderly and systematic reduction of sensory and motor CNS functions is called what?
A
Mechanism of action of general anesthetic
25
General anesthetics are used during surgical procedures to produce what?
Unconsciousness, skeletal muscular relaxation, visceral smooth muscle relaxation.
26
Which type of anesthetics have rapid onset and are quickly metabolized?
General anesthetics
27
Adverse effects of general anesthetics varies according to what?
Dosage and drug used
28
Sites primarily affected by adverse effects of general anesthesia are...
Heart, peripheral circulation, liver, kidneys, respiratory tract.
29
Heart, peripheral circulation, liver, kidneys, respiratory tract are sites primarily affected by the adverse effects of what?
General anesthesia.
30
What adverse effect is commonly seen with general anesthesia?
Myocardial depression
31
T/F: Even in large doses, anesthetics are not life threatening.
False. In large doses, anesthetics are potentially life threatening.
32
In an overdose of general anesthesia, what are ultimately the causes of death?
Cardiac and respiratory arrest.
33
T/F: General anesthesia is administered in a controlled environment.
True
34
What is malignant hyperthermia
It's a genetic disorder that occurs during or after volatile inhaled general or local anesthesia or use of the neuromuscular blocking drug (NMBD) succinylcholine.
35
What is the symptom of malignant hyperthermia?
Life threatening, sudden elevation in body temp (> 104°). Also, tachypnea, tachycardia, muscle rigidity (opposite of what anesthesia should do).
36
What is the treatment for malignant hyperthermia?
Cardiorespiratory supportive care and dantrolene.
37
What is the antidote for malignant hyperthermia?
Dantrolene.
38
What does dantrolene do?
Causes skeletal muscle relaxation and is the antidote for malignant hyperthermia.
39
What to do in the case of malignant hyperthermia?
Stop whatever is going in
Give 100% O2
Give dantrolene, bicarb, glucose or insulin, IV fluids (also for seizures), cooling blanket
Monitor output
40
What condition are the following interventions appropriate for?
- Stop whatever is going in
- Give 100% O2
- Give dantrolene, bicarb, glucose or insulin, IV fluids (also for seizures), cooling blanket
- Monitor output
Malignant hyperthermia ("Some hot dude better give iced fluids fast."
Stop triggering agent
Hyperventilate
Dantrolene
Bicarbonate
Glucose and insulin
IV fluids and cooling blanket
Fluid output monitory/furosemide
Fast heart (Tachycardia)
41
What drugs interact with general anesthetics?
Antihypertensives
Beta blockers
42
What can antihypertensives and beta blockers cause when used with general anesthetics?
Antihypertensives - increased hypotensive effects
Beta blockers - increased myocardial depression
43
When used with general anesthetics, which drugs cause increased hypotensive effects
and which cause increased myocardial depression?
Antihypertensives - increased hypotensive effects
Beta blockers - increased myocardial depression
44
How does the pneumonic "Michael Jackson Likes Kats" apply to anesthetics?
Sent email to Amy
45
What drug are the following associated with?
- Intravenous administration use for both general anesthesia and moderate sedation
- Rapid onset of action
=- Low incidence of reduction of cardiovascular, respiratory, and bowel function
- Adverse effects: disturbing psychomimetic effects, including hallucinations
Ketamine
46
What drug is associated with the following?
- Called “Laughing gas”
- Only inhaled gas currently used as a general anesthetic
- Weakest of the general anesthetic drugs
- Used primarily for dental procedures or as a supplement to other, more potent anesthetic
- No residuals from this.
Nitrous oxide
47
What are the side effects of inhaled anesthetics?
Apnea
Bradycardia
Bronchospasm
Laryngospasm
48
The following are side effects of what drug/administration route?
Apnea
Bradycardia
Bronchospasm
Laryngospasm
Inhaled anesthetics
49
What drug is the Michael Jackson drug?
Propofol (diprivan)
50
Propofol is the generic name for what drug?
Diprivan
51
What drug is commonly used for amnesia effect with colonoscopies?
Propofol (diprivan)
52
With what route of administration is propofol(diprivan) used?
Parenteral (IV)
53
What drug is used for induction and maintenance of general anesthesia?
Propofol (Diprivan)
54
What drug is used for mechanical ventilation in ICU settings?
Propofol (Diprivan)
55
Another name for conscious sedation or procedural sedation?
Moderate sedation
56
Moderate sedation is another name for what two states?
Conscious sedation and procedural sedation
57
What type of sedation does not cause complete loss of consciousness and does not normally cause respiratory arrest?
Moderate (conscious/procedural) sedation
58
What three drugs are used in combination for moderate (conscious/procedural) sedation?
- IV benzodiazepine (e.g., midazolam) or propofol
- Opiate analgesic (e.g., fentanyl or morphine – both with short half-lives, morphine gives bad headache so give Tylenol with it)
59
What do you give with morphine to alleviate the headache?
Tylenol
60
What type of sedation provides the following:
- Anxiety and sensitivity to pain reduced
- The patient cannot recall the procedure
Moderate (conscious/procedural) sedation with IV benzodiazepine or propofol with an opiate analgesic (fentanyl or morphine).
61
With what type of sedation can a patient maintain own airway, has rapid recovery time, requires no intubation?
Moderate (conscious/procedural) sedation
62
Another name for local anesthetics
Regional anesthetics
63
What type of anesthetic is used to render a specific portion of the body insensitive to pain?
Local anesthetics
64
What type of anesthetic interferes with nerve impulse transmission to specific areas of the body?
Local anesthetics
65
What type of anesthetics do not cause loss of consciousness?
Local anesthetics
66
What type of local anesthetics are applied directly to skin or mucous membranes?
Topical
67
What type of local anesthetics are injected IV or into the DNS by various spinal injection techniques?
Parenteral
68
Creams, solutions, ointments, gels, ophthalmic drops, powders, and suppositories are examples of what type of local anesthetics?
Topical
69
A spinal block or intraspinal injection is an example of what type of anesthesia?
Local
70
What type of local anesthesia is delivered via a big needle into lower spine?
Epidural
71
With what type of local anesthesia does the puncture cause a bad headache instantly?
Epidural
72
The Trendelenburg position instantly is the response to what side effect of anesthesia?
Bad headache from an epidural
73
When a bacteria invades the body through a source is called what?
Infection
74
What is harder to locate, a bacteria or virus?
Virus
75
What is the best way to identify a virus or bacterial source of infection?
Cultures
76
What are antivirals and antibiotics used to treat?
Viruses and bacterial infections
77
What is resistance?
When a virus or bacteria does not respond to an antibiotic or antiviral.
78
What causes c. diff?
Antibiotic treatment
79
If you have a heart issue, what type of antibiotics will be given before dental procedures?
prophylaxic
80
What are tested with cultures?
Blood and sputum
81
With what 2 drugs are peaks measured?
Vancomycin and digoxin
82
What are two spectrums of antibiotics?
Narrow and broad
83
What do you treat an organism with to have most effect with least amount of medicine?
The most narrow spectrum.
84
T/F: You should dousche to clean the bad flora in your vagina.
False" Floura is in everything. Mouth, body, vagina (don’t dousche), just your normal functioning of the body.
85
What is an antibiotic?
A manmade chemical that can harm microbes (kill and suppress microorganisms).
86
When a microbe does the following, this is called what?
- Decrease the concentration of a drug at its site of action
- Inactivate a drug
- Alter the structure of drug target molecules
- Produce a drug antagonist
Acquired resistance to antimicrobial drugs
87
What are the effects of antibiotic resistance?
Increase infection, inactivate drug, increase concentration.
88
What is the rule for antibiotic treatment?
Least amount of drug for maximum effect.
89
How does normal flora help the body?
Helps fight infection.
90
T/F: Pair appropriate antibiotic to bacteria after culture.
True
91
What are two ways to misuse antibiotics?
Diagnose yourself and take self-prescribed antibiotics
92
Bacteriostatic vs. bactericidal
Bacteriostatic: Suppress growth of bacteria
Bactericidal: Kill bacteria (Aminoglycosides)
93
What antibiotics were made from mold.
Penicillan
94
What is a problem with penicillin?
Allergies
95
Antibiotics derived from penicillin
Amoxicillin, augmentum, ampicillin, penicillin G
96
For ear infections, what is used when amoxicillin doesn't work?
Augmentum
97
-What is the mechanism of action of penicillin?
Mechanism of action:
- Inhibits cell wall synthesis, causing bacteria to take up excessive water and rupture (penicillin has 2 LL's like "cell wall")
- Active only against bacteria undergoing growth and division
98
Is penicillin bacteriostatic or bactericidal?
Bactericidal
99
With what type of infections do you prescribe penicillin
Use for moderate to severe infections.
100
Side effects of penicillin.
Will be specific antibiotics with same exact side effects: diarrhea, allergies, resistance, N/V, all cause stomach upset, yucky GI side effect,
- Severe side effects: red man syndrome, Steven-Johnson syndrome.
101
What is the abbreviation for penicillin?
PCN
102
What is an allergic rx to penicillin?
Usually rash. Rare anaphylaxis.
103
T/F: Anaphylaxis is only seen with penicillin/
False: anaphylaxis can be seen with any drug
104
The following are signs of what:
- Itchy rash
- Tingling in skin
- Nauseous
- Not feeling right.
Allergic reaction
105
What is an altered bodily state in which an exaggerated response occurs with exposure to an antigen?
Allergy
106
Which one: Subsequent exposures to the drug (allergen) does/does not cause an allergic reaction.
Does. The initial exposure to the drug (allergen) is the sensitizing does and does not cause a reaction. Subsequent exposures do cause a reaction.
107
A patient's initial exposure to a drug that does not cause an allergic reaction.
Sensitizing dose.
108
After the sensitizing dose, when can an allergic reaction occur?
Anytime after the sensitizing dose.
109
If patient has a history of mild reaction to penicillin, consider what antibiotic?
cephalosporin
110
If a patient has a history of anaphylaxis, avoid administration of penicillin and what other antibiotic?
Cephalosporin
111
What is the action of cephalosporin?
Inhibits the synthesis of bacterial cell wall.
112
This type of medication usually has "cef" of "ceph" in the word.
Cephalosporins
113
Why would you not switch from Z-pack if it wasn't immediately working?
Because it's extended release so it will take a bit longer to work.
114
What antibiotic is designed to be a shorter dose?
Z-pack
115
What antibiotic is first for ear infections?
Amoxicillin
116
Are cephalosporins used for periop prophylaxis for surgery?
Yes, it's run in the preop or operating room, if longer surgery will need more than one dose and possibly after surgery. Open heart surgery or transplant will be longer dose and will be IV.
117
When will prophylactic antibiotic be oral?
Dentistry
118
Can the prophylactic antibiotic used for dentistry cause resistance?
Yes.
119
T/F: Bone marrow suppression would be one dose of cephalosporin.
False, people undergoing bone marrow suppression will be on antibiotics for a long time.
120
Do you take cephalosporins with food?
Yes. They cause GI upset
121
Why is GI upset a problem with patients on antibiotics?
Because they won't be compliance with their medication.
122
Side effects of cephalosporins...
G - GI upset (vomiting, diarrhea)
I - Increase in glucose values
A - Anaphylaxis, Alcohol may cause vomiting
N - Nephrotoxicity
T - Thromocytopenia
123
What is thrombocytopenia and what drug is it a side effect of?
Low platelet count; cephalosporins
124
With what antibiotic do you check kidney function first?
Cephalosporins
125
What is the action of vancomycin?
Cell wall inhibitor
126
What is the antibiotic of choice for MRSA and c. diff?
Vancomycin
127
What is a vesicant?
Caustic to veins
128
What antibiotic is a vesicant?
Vancomycin
129
If vancomycin infiltrates, what can it do to tissue?
Eats tissue.
130
Why switch tubing with vancomycin every 2 days?
It will eat through the tubing too. Normally change tubing q 4 days.
131
How to tell if vancomycin infiltrated?
Site will be red, painful.
132
What to do if vancomycin has infiltrated the IV
Get it out ASAP.
133
Is the damage from vancomycin infiltrating considered reversible?
No, it's usually irreversible.
134
What do you do with an IV site that has been infiltrated by vancomycin?
Elevate, heat packs.
135
What gauge of catheter should you use with vancomycin?
20 or lower, preferably 18 if giving it over a long time. Given 3x/day. Never through 22 or higher.
136
How often do you change the tubing with vancomycin?
q 2 days
137
How often is vancomycin administered IV?
3x/day
138
What is an adverse reaction to vancomycin?
Red Man Syndrome
139
What are the symptoms of Red Man Syndrome?
Little rash, feeling that you have to clear your throat. If it's not a big rash, you're not even looking for it. Or the patient is feeling so bad from the infection, they don't realize this is going on.
140
What is the outcome of Red Man Syndrome?
Skin will peel off. Can have scars like a burn or total recovery.
141
What are examples of macrolides?
Erythromycin
Azithromycin
Cleocin (Clindamycin)
142
How to remember action of macrolides?
MaCrolide where M = "Membrane" and C = "Cell" (Binds to cell membrane to change protein function.)
143
Uses of Macrolides
- Acute infections (URI's): Whooping cough, diphtheria, chlamydia, group A strep.
- Alternative to penicillin in those with penicillin allergy
- Acne
- Prophylaxis before dental procedure
144
Adverse effects of macrolides include...
Diarrhea, N/V
GI upset
Superinfections
Confusion
Hepatotoxicity
145
Nursing considerations for macrolides
- Take with full glass of water
- Do not take with fruit juice
- Take before or after meals
- Will affect liver - know this
Can have prolonged QT - wouldn't give to pts with heart condition, pacemaker, etc.
146
What antibiotic do you not give to patients with heart condition or pacemaker?
Macrolides (Erythromycin, Azithromycin, Cleocin (Clindamycin))
147
Why do you not give macrolides to patients with heart conditions or pacemakers?
Can have prolonged QT interval, will aggravate heart condition
148
If zithromax is being administered IV, where is the patient?
In the hospital.
149
What is the dosage of zithromax?
5-day pack: 2 on day 1 and then 1 pill each day after.
150
Are macrolides bacteristatic or bactericidal?
Bacteristatic - Stop translocation in protein synthesis.
151
Biggest adverse effect of vancomycin
Red Man Syndrome
152
What antibiotic can heal c. diff and MRSA that other drugs can't.
Vancomycin
153
What antibiotic is a vesicant?
Vancomycin
154
What antibiotic must be taken with food because it's more hard on the GI system?
Cephalosporins
155
How is Z-pack dosed?
Take two on the first dose, one each day after that for 4 days. 5 days total. It stays in the system longer.
156
What are tetracyclines used for?
Infections, acne, prophylaxis
157
What is the mechanism of action of tetracyclines?
Inhibits protein synthesis
158
Types of tetracyclines
Tetracycline
Doxycycline
159
Off label use of doxycycline
Acne, malaria prophylaxis
160
What happened in the 60s and 70s with tetracyclines and pregnant women?
Doesn't mix well with milk & breast milk. Turns babies teeth black.
161
Kids under 8 should not be subscribed what antibiotics?
Tetracyclines
162
Side effects of tetracyclines
- Discoloration of teeth (for those who take while pregnant)
- Glossitis
- Phototoxic reactions (some cause photosensitivity but these cause phototoxicity)
163
Nursing considerations for tetracyclines
- Phototoxic
- Take 1 hour before or after meals.
- Do not take with milk or iron (take 3 hours apart)
- Don't take expired meds, might be toxic
- Monitor renal function
164
Uses for tetracycline
Chlamydia
Syphilis
Gonorrhea
Rocky Mountain Spotted Fever
Off-label: acne
165
What antibiotic treats the following conditions:
Chlamydia
Syphilis
Gonorrhea
Rocky Mountain Spotted Fever
Off-label: acne
Tetracyclines
166
Action of aminoglycosides
Inhibits protein synthesis in gram negative bacteria
167
What antibiotic Inhibits protein synthesis in gram negative bacteria?
Aminoglycosides
168
Aminoglycosides
Gentamycin
Neomycin
Steptomycin
Tobramycin
169
Side effects of amonoglycosides
Ototoxicity (tinnitus, deafness)
Nephrotoxicity
GI effects
(One easy way to remember is: Mice [mycin] have big ears [ototoxicity], and ears look like kidneys [nephrotoxicity].)
170
How to test the kidney function when administering aminoglycosides
Kidney – check BUN and creatine, GFR. May be only drug that will work for them, but if have to give it, monitor kidney function, take with lots of water, checking labs. Also, take blood work before next dose because can have toxicity.
171
Two major side effects of amonoglycosides
Kidneys and ears
172
How to dose aminoglycosides
Do loading dose – one large bolus, decrease over next few days.
173
Peak levels of aminoglycosides must be high enough to what?
To kill bacteria, low enough to avoid toxicity.
174
What's the common rule for levels of medication?
Lowest dose for maximum effect for every single drug.
175
How do you test for peak and trough levels?
Peak should be taken 30 minutes after giving an IM injections or after completing a 30-minute IV infusion.
Trough depends on dosing schedule
176
The way I remember this: Sulfonamides –> folic acid
Ulcerative colitis, crohn’s disease.
Sulfa drugs – smelly, will taste icky sulfur taste in mouth.
Along with GI syndromes, will not want to take because leave metallic taste in mouth and stuff tastes bad. Anyone allergic to sulfur can’t take
GI upset, neuropathy, photosensitivity, take with food.
Brush your teeth, clean your mouth because of taste.
