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Pharmacotherapeutics > General Anesthetics, Local Anesthetics & Muscle Relaxants > Flashcards

General Anesthetics, Local Anesthetics & Muscle Relaxants Flashcards

1
Q

General Anesthesia

A

Used for more extensive surgeries/procedures
Reversible state of unconsciousness

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2
Q

Local Anesthesia

A

Small, defined surgery
Patient remains conscious

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3
Q

Anesthetic agents must be able to…

A
  1. Have a rapid onset
  2. Cause skeletal muscle relaxation
  3. Inhibit sensory/autonomic reflexes
  4. Easily adjustable
  5. Minimal toxic side effects
  6. Rapid, uneventful recovery
  7. Amnesia
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4
Q

General Anesthesia - Stage I

A

Analgesia
Patient begins to lose sensation but is still conscious

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5
Q

General Anesthesia - Stage II

A

Excitement or Delirium
Patient is unconscious and amnesiac, may also be agitated and restless

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6
Q

General Anesthesia - Stage III

A

Surgical Anesthesia
Level is desirable for surgery
Onset of regular, deep respirations

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7
Q

General Anesthesia - Stage IV

A

Medullary Paralysis
Cessation of spontaneous respiration due to inhibition of respiratory control systems
Cardiovascular collapse + altered BP regulation
AVOID this stage at all costs due to risk of death

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8
Q

Order of Administration - General Anesthesia

A

Initially given through IV until patient achieves stage III, then inhaled anesthesia to maintain appropriate level
“Balanced anesthesia”

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9
Q

What is the only inhaled general anesthetic?

A

Nitrous Oxide - Short term procedures (dental work)

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10
Q

Classes of Intravenous Anesthetics (5)

A
  1. Barbiturates
  2. Benzodiazepines
  3. Opioid Analgesics
  4. Ketamine
  5. Propofol (Diprivan)
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11
Q

What happens with the administration of Ketamine Anesthesia?

A

Dissociative anesthesia causing patient to become detached from surrounding environment - appears awake, but is actually sedated and will not recall events

Likely to experience hallucinations, strange dreams, or delusions

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12
Q

What is the drug of choice for general anesthesia?

A

Propofol (Diprivan) - Rapid recovery, good for short term invasive procedures

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13
Q

Mechanism of Action - Anesthetics

A

Inhibit neuronal activity throughout CNS, decrease activity of neurons in RAS (sedation, hypnosis, amnesia), inhibit neuronal function in SC (immobility/inhibit pain response), and bind to receptors in CNS to enhance inhibition

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14
Q

What are anesthetic adjuvants?

A

Drugs administered with general anesthesia to enhance effects

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15
Q

What are the 2 types of adjuvants?

A
  1. Preoperative medications
  2. Neuromuscular blockers
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16
Q

Preoperative Adjuvant

A

Given 1-2 hours before general anesthesia to relax patient and reduce anxiety
Includes barbiturates, benzos, and opioids

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17
Q

Neuromuscular Blocker Adjuvant

A

Ensure skeletal muscle paralysis when used with general anesthetics by blocking post-synaptic ACh receptors. Allows a smaller dose of general

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18
Q

Adjuvant side effects include:

A

Tachycardia, increased histamine release, increased plasma potassium levels, residual muscle pain/weakness, immunological reactions (anaphylaxis)

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19
Q

Rehab Implications for Neuromuscular Blockers

A

Residual paralysis can persist after surgery and depress skeletal muscle contractions for several hours
Long term detrimental effects on memory, attention & cognition (older adults)
Perform early mobilization & breathing exercises for those experiencing bronchial secretions

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20
Q

Mechanism of Action - Local Anesthetics

A

Produce a loss of sensation to specific body parts by inhibiting the opening of sodium channels & blocking afferent nerve transmission (APs) along peripheral nerve.
Used for minor surgeries, painless
(+) Rapid recovery, little residual effects, no post-op lethargy
(-) Length of time require to establish anesthetic effect

21
Q

Examples of Local Anesthetics

A

Ending in “-caine”
Lidocaine, Procaine, Benzocaine

22
Q

How do you prevent washout for local anesthetics?

A

Administer it with a vasoconstrictor

23
Q

When does toxicity result from local anesthetics?

A

When drug reaches systemic circulation

24
Q

Administration of Local Anesthetics

A

Topically, transdermally, peripheral nerve block, central nerve block, sympathetic blockade & IV regional blockade

25
Q

What are topical anesthetics used for?

A

Wound cleaning, circumcision, cataracts surgery

26
Q

What are transdermal anesthetics used for?

A

Localized musculoskeletal pain - OA, LBP, fractures, neuropathic pain

27
Q

What are peripheral nerve blocks used for?

A

Dental procedures and foot/hand surgeries
Major vs Minor nerve blocks

28
Q

What are central neural blockades used for?

A

Obstetric operations and chronic pain relief
Epidural vs Subarachnoid - Administered L3-4 or L4-5

29
Q

What are sympathetic blockades used for?

A

Complex regional pain syndrome

30
Q

What is a Differential Nerve Block?

A

Local anesthetics that blocks specific nerve fiber groups based on size/diameter. Small diameter fibers (Type C pain fibers) are the most sensitive and first affected by anesthesia
*Clinically significant that sensory pain fibers can be blocked without affecting motor fibers

31
Q

Local Anesthetic Systemic Toxicity (LAST)

A

When local anesthetics are absorbed into the general circulation and cause toxic effects on organs/tissues. Can disrupt cardiac and CNS excitability

32
Q

Early S/S of “LAST”

A

Ringing in ears, agitation, restlessness, decreased sensation in tongue/mouth/skin

Can be counteracted by lipid compounds that soak up the molecules to limit their effect

33
Q

Rehab Implications for Local Anesthetics

A

Be aware of patients with transdermal patch - Do not disturb it during exercise. NO heat over patches.
Be cautious of central nerve blocks - LE may buckle
May be diminished sensation below level of anesthesia

34
Q

What conditions are Skeletal Muscle Relaxants used for?

A

Spasticity & Muscle Spasms (Hyperexcitable muscle)

35
Q

What is the goal of Skeletal Muscle Relaxants?

A

Normalize muscle excitability without decreasing muscle function. They do NOT prevent muscle contractions

36
Q

Types of Antispasm Drugs

A

Diazepam & Centrally Acting Antispasm Drugs

37
Q

Types of Antispasticity Drugs

A

Baclofen, Intrathecal Baclofen, Dantrolene Sodium, Diazepam & Tizanidine

38
Q

Diazepam (Valium)

A

Antianxiety drug, Skeletal muscle relaxant
Increase inhibitory effects of GABA on AMN activity in SC

39
Q

Centrally Acting Antispasm Drugs

A

Mechanism of action not well defined
Inhibit neurons in polysynaptic pathways to decrease AMN excitability and cause relaxation. Short term relief.

40
Q

Baclofen

A

Derivative of GABA - Inhibitory effect on AMN activity causing relaxation of skeletal muscle.

Side effects: Transient drowsiness, fatigue, nausea, dizziness, weakness, headache, hyperthermia, hallucinations, and seizures

41
Q

Intrathecal Baclofen

A

Administered directly into subarachnoid space in smaller doses for greater effect (reduced pain and improved function) on severe spasticity. Can be administered via implantable pump - common for SCI, MS, CP, CVA, and TBI patients

42
Q

Dantrolene Sodium

A

Effects skeletal muscle cells directly - NOT used to treat spasms caused by musculoskeletal injury.

Side effects: Weakness, hepatotoxicity, fatal hepatitis, drowsiness, dizziness, nausea, and diarrhea

43
Q

Gabapentin

A

Decrease spasticity associated with SCI & MS. Also used for seizure management and neuropathic pain.

Side effects: Sedation, fatigue, dizziness and ataxia

44
Q

Tizanidine

A

Controls spasticity as a result of spinal lesions (SCI, MS) and cerebral lesions. Do NOT use them acutely (slow recovery). Milder side effects and less muscle weakness than baclofen and diazepam

Side effects: Sedation, dizziness, dry mouth

45
Q

Botulinum Toxin

A

Control localized hyperexcitability and decrease muscle excitation by disrupting synaptic transmission at NMJ. Injection needs to be specific to a certain muscle; NOT systemically administered (paralysis with loss of respiratory function)

Used for dystonias, torticollis, and strabismus

46
Q

Types of Botulinum Toxin

A

Type A: Botox
Type B: Myobloc

47
Q

Reducing spasticity can improve facilitation of…

A

Volitional motor function - Improved gait and other functional activities

48
Q

Rehab Implications for Skeletal Muscle Relaxants

A

Therapy should be AGGRESSIVE so that the patient can discontinue medication ASAP - Address strength, flexibility, posture, lifting techniques, body mechanics, etc to help decrease potential for recurrence

Be aware of patients that rely on their spasticity (LE extensor pattern)

Pharmacotherapeutics (13 decks)

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