Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medical Screening II > Lecture 3 > Flashcards

Lecture 3 Flashcards

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

General Anesthesia

A
  • Reversible state of unconsciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Induction Stages of general anesthesia

A

Stage 1: Analgesia - lost somatic sensation
Stage 2: Excitement (delirium) - patient unconscious
Stage 3: Surgical anesthesia
Stage 4: Medullary paralysis - too much anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Inhaled anesthetics

A
  • easily be mixed with air or oxygen
  • endotracheal tube or a mask
  • easy adjustment of rate and concentration
  • advanced tracking / feedback systems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Barbiturates

A

fast onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Benzodiazepines

A

“Pam” endings - to induce or maintain general anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ketamine

A
  • Dissociative anesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Propofol

A
  • Short acting hypnotic that takes effect rapidly
  • maintain anesthesia
  • recovery may be most rapid, good for early mobilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Symptoms of recovering from anesthesia

A
  • confusion
  • disorientation
  • lethargy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Elimination and biotransformation primarily though?

A

elimination through the lungs and biotransformation in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mechanism of action

A
  • Widespread CNS inhibition through binding to 1 or more neuronal receptors in the CNS
  • influenced by receptor selectivity / location
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Antihistamines

A
  • sedation and antiemesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anti inflammatory steroid

A
  • to improve post-op pain and vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is essential for surgical procedures? and how does it work?

A
  • Skeletal muscle paralysis is essential
  • work by blocking postsynaptic acetylcholine receptor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Side effects of Neuromuscular blockers include

A
  • cardiovascular problems (tachycardia)
  • Increased histamine release
  • residual muscle pain and weakness
  • immunological reactions such as anaphylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Residual effects

A

In-patient PTs
Post-op in out-patient
Pre-op in out-patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Post-op effects of anesthesia

A
  • confusion/delirium post-op
  • muscle weakness
  • airways, bronchial secretions and muscle issues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Local anesthesia

A
  • loss of sensation in a specific body part or region
  • rapid recovery and lack of residual effects
  • Disadvantages: takes longer to have an effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Local anesthesia with use of topicals/ patches should be careful during

A
  • Exercise
  • Manual therapy
  • No heat agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Scheduling sessions while anesthetic is in effect

A
  • reestablish normal sympathetic function and blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Local anesthetics is chosen based on

A
  • location
  • nature of procedure
  • patient health
  • patient size
  • duration of action
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Spinal anesthesia can be

A

a single peripheral nerve block

22
Q

Routes of administration of local anesthesia

A
  • Topical
  • Transdermal
  • Peripheral nerve block
  • Central neural blockade
  • Sympathetic blockade
23
Q

Pharmacokinetics of local anesthetics

A
  • can be cardiotoxic in the bloodstream
  • sometimes used with vasoconstricting agent
  • metabolized in the liver
  • kidneys excrete metabolites
24
Q

Differences of local anesthetics lie in?

A

administration routes

25
Q

Topical administration

A
  • Symptomatic relief of minor surface irritation / injury
  • Applied directly to skin / mucous membranes
26
Q

Transdermal administration

A
  • Iontophoresis / Phonophoresis
  • Transdermal Patch
  • No heat agents!
27
Q

Peripheral nerve block

A
  • Anesthetic is injected close to the nerve trunk
  • The higher up the more it blocks
  • can be used postoperatively with join replacements
28
Q

For peripheral nerve block, what do PTs need to know?

A
  • what a specific nerve block means for the session
  • need to report excessive muscle pain and signs of infection
29
Q

Central neural blockade

A
  • injected into the spaces surrounding the spinal cord
  • Epidural nerve block: into the epidural space
  • Caudal block: Lumbar epidural space through the sacral hiatus
  • Spinal nerve block: subarachnoid space
30
Q

Where can you do Central neural blockade

A
  • could be done anywhere in the spine but usually lumbar levels
31
Q

Sympathetic block

A
  • riskier block
  • especially useful in complex regional pain syndrome (CRPS)
  • reduce sympathetic outflow to affected extremity
  • block usually occurs with peripheral and central blocks
32
Q

Local anesthetics inhibit?

A
  • the opening of sodium channels located on nerve membranes
  • blocking action potential propagation along neuronal axons
33
Q

Anesthetic needs to affect?

A
  • Just one specific segment to prevent sensory or motor information from being transmitted through the blocked point
34
Q

The ability of a local anesthetic dose to block specific nerve fibers groups depend on?

A
  • size (diameter) of the fibers
35
Q

Fiber sensitivity to anesthetic effects

A
  • Smaller: most sensitive
  • Larger: least sensitive
  • Different sizes transmit different information
36
Q

What is the intent of a local anesthetic?

A

produce a regional effect on specific neurons

37
Q

Local anesthetics can sometimes be absorbed into?

A

general circulation and can be toxic

38
Q

Systemic effects of local anesthetics

A
  • Local anesthetic systemic toxicity (LAST)
  • Mostly CNS and cardiac issues
  • More likely to occur with high doses, increased absorption, drug injected into systemic circulation
39
Q

Skeletal muscle relaxants

A
  • Treat hyperexcitable skeletal muscle - spasticity and muscle spasms
  • normalize muscle excitability without a decrease in muscle function
40
Q

Long term muscle relaxant use is not?

A
  • practical due to addictive properties, tolerance, and physical dependence
41
Q

Spasticity

A
  • exaggerated muscle reflex and neurological tone
  • usually related to CNS injuries
  • Abnormal reflex activity that is velocity dependent
42
Q

Spasm

A
  • Increased muscle tension which is involuntary
  • usually an orthopedic or nerve root issue
43
Q

Antispasm drugs: Diazepam (Valium)

A
  • likely works by interacting in both the spinal cord and the brain
  • More sedative effect
  • used for both spasm and spasticity
  • can cause tolerance and physical dependence
44
Q

Antispasm drugs: other

A
  • Polysynaptic inhibitors: work in the spinal cord to reduce pain
  • Increase sedation in the CNS → generalized sedation → Skeletal muscle relaxation
  • Short term relief of muscle spasms
  • Controlled substances
45
Q

Antispasticity drugs: Baclofen

A
  • Does not penetrate blood-brain barrier
  • Inhibitory effect on alpha motor neurons in the spinal cord
  • Decreased firing of the alpha motor neuron with subsequent relaxation of the skeletal muscle
  • Used orally for spasticity associated with lesions of the spinal cord
  • Less generalized muscle weakness than dantrolene
  • can also be used to treat alcohol abuse
46
Q

Intrathecal baclofen

A
  • severe, intractable spasticity
  • specific level of the spinal cord
    • increased effectiveness, smaller doses
  • fewer systemic side effects
  • May also interrupt chronic pain pathways
47
Q

Antispasticity drugs: Dantrolenen sodium (Dantrium)

A
  • only muscle relaxant that exerts effect directly on the skeletal muscle
  • inhibits channel opening, reduces muscle contraction, enhances relaxation
  • not used to treat MSK injury / related spasms or tension
  • side effects → generalized muscle weakness, hepatotoxicity, drowsiness, dizziness, nausea, diarrhea
48
Q

Antispasticity drugs: Gabapentin (neurontine)

A
  • Effective in decreasing the spasticity associated with SCI and MS
  • neuropathic pain
  • side effects → sedation, fatigue, dizziness, and ataxia
49
Q

Tizanidine

A
  • Pre and postsynaptic inhibition of alpha-2 receptors in the CNS
  • Used to control spasticity resulting from spinal lesions, sometimes in cerebral lesions
  • Treat chronic headaches and chronic pain
  • Side effects → sedation, dizziness, dry mouth, but less cardiac side effects
50
Q

Botulinum Toxin ( Botox)

A
  • Controls localized muscle hyperexcitability
  • Loss of presynaptic acetylcholine release results in paralysis of the muscle fiber → disrupting synaptic transmission at the NMJ
  • Help to reestablish a more reasonable level of excitation at the cord level
  • Treat muscle Dystonias
  • Symptoms may return in 2 to 3 months

Medical Screening II (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions