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Pharm Test 6 > Lecture Anesthesia and Headaches > Flashcards

Lecture Anesthesia and Headaches Flashcards

1
Q

Types of headaches

A

sinus
pain is usually behind the forehead and/or cheekbones

Cluster
pain is in and around one eye; often a series of headaches

Tension
pain is like a band squeezing the head

Migraine
pain, nausea, and visual changes are typical of classic form; unilateral
2 types: w aura and without aura (more common)

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2
Q

Migraine triggers:

A

A LOT!!

Emotions
Foods
(1)	Tyramines - aged cheese, red wine
(2)	Nitrates - cured meats
(3)	Phenylethylamine – chocolate
(4)	monosodium glutamate (MSG) - canned soups, Chinese food
(5)	aspartame - diet sodas
(6)	yellow food coloring
drugs
(1)	EtOH
(2)	Analgesics - too often / withdrawal
(3)	Caffeine - too much / withdrawal
(4)	Cimetidine
(5)	Cocaine
(6)	Estrogens - i.e. oral contraceptives
(7)	Nitroglycerin
carbon monoxide
hormonal changes
flickering lights
weather
(1)	low temp + low humidity
(2)	high temp  + high humidity
(3)	major change over 1-2 days
(4)	high or low barometric pressure
glare
loud noises
hypoglycemia
altitude change
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3
Q

Prevention is recommended for patients with ___ headaches a month.

A

three or more

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4
Q

headaches are treated with:

A

nonspecific analgesics - ASA-like drugs, opioids

migraine-specific - triptans and ergot alkaloids

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5
Q

sumatriptan [Imitrex]

A

vasoconstriction of intravascular vessels & vascular inflammation

used to abort ongoing migraine, relieve HA & symptoms

PO or intranasal

AEs
Chest (50%) – feeling of heavy arms or chest pressure
coronary vasospasm (angina)
teratogenesis
vertigo, malaise, fatigue, tingling sensations, bad taste (intranasal)

Interactions – with Ergot alkaloids and other triptans

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6
Q

Ergotamine

A

2nd line for migraine – unresponsive to triptan

risk for dependence with regular use

Toxicity – ergotism (too much vasoconstriction)
Convulsive
S/S: N/V/D, itching, spasms, paresthesias, HA, mania, psychoses, seizure

gangrenous
excessive vasoconstriction of fingers/toes
S/S: peeling, weak peripheral pulse, loss of peripheral sensation, edema, death/loss of tissue

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7
Q

General anesthesia

A

Produce unconsciousness & lack of responsiveness to all painful stimuli

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8
Q

Local anesthesia

A

Loss of sensation to limited body area, no LOC changes

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9
Q

Regional anesthesia

A

Similar to local; Loss of sensation encompasses larger body area, such as entire limb

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10
Q

Monitored anesthesia care (MAC)

A

Responsive, respirations without assistance

3 levels
(1) Minimal sedation (anxiolysis)
Patient responds to verbal commands.
(2) Moderate (conscious) sedation
Patient responds to verbal or light tactile prompting.
Pt may not remember
(3) Deep sedation/analgesia
Patient aroused by repeated or painful stimulation
Airway, ventilation interventions
Cardiovascular functions usually adequate

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11
Q

Balanced anesthesia

A

Combination of medications

(1) Neuromuscular blockers
(2) Short-acting benzodiazepines
(3) Opioids
(4) General anesthetics
(5) Order of IV medications, then general anesthetic, then inhaled anesthetics

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12
Q

Anesthesia staging

A

Stage I

(1) Analgesia
(2) Lose sensation, but may remain awake

Stage II

(1) Excitement and hyperactivity
(2) May have irregular pulse and respirations with increased BP

Stage III

(1) Surgical anesthesia
(a) Want to get to this stage with surgical pts
(2) Skeletal muscle relaxation

Stage IV

(1) Paralysis of medulla
(2) Death could result.
(3) Too much!! Don’t want to get to this stage!

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13
Q

IV anesthetics

A

Rapid progression through stages I and II

Commonly used classes
Benzodiazepines
Opioids
Miscellaneous agents - Propofol and ketamine

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14
Q

The primary indication for benzodiazepine use is ___.

A

to treat symptoms of anxiety.

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15
Q

Benzodiazepines

A

-pam / -lam
diazepam, midazolam, lorazepam

used in anesthesia to produce relaxation, sedation, unconsciousness, and amnesia

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16
Q

diazepam [Valium]

A

IV – anesthesia induction

Unconsciousness within 1 minute

Little muscle relaxation, no analgesia**

moderate CV/Respiratory depression

17
Q

midazolam [Versed]

A

IV – anesthesia induction, conscious sedation*

Unconsciousness within 80 seconds

sedation, analgesia, amnesia, lack of anxiety

Can cause dangerous cardiorespiratory effects

18
Q

propofol [Diprivan]

A

most widely used IV anesthetic (90%)*

induction & maintenance of anesthesia, no analgesia

Unconsciousness in 60 sec, lasts 3-5 min

also for sedation
mechanical ventilation, radiation, procedures

Can cause
1. profound respiratory 
2. depression
3. hypotension
4. ***bacterial infection (high risk)***
lipid based so ideal for bacteria; once opened, must be discarded within 6 hours

Risk for abuse
Widely used, not controlled – not monitored closely
no “high” – instant/brief sleep – awake refreshed & euphoric
Low therapeutic index – OD/death common

19
Q

ketamine

A

dissociative anesthesia, sedation, immobility, analgesia, amnesia

Rapid action, last 10-15 min (full recovery hours)

Adverse psychologic reactions
hallucinations, disturbing dreams, delirium
(so want to provide a soothing environment for pt)

Drug of abuse – “K”, “Special K”
(a) High dose – “K-hole”, out-of-body or near-death experience

20
Q

Minimum Alveolar Concentration (MAC)

A

measure of inhalation anesthetic potency

Concentration of drug vapor in alveoli that prevents a motor response in 50% of subjects when exposed to painful stimulus

low MAC = high potency

21
Q

inhalation anesthetics

A

2 types
volatile liquids - fluranes
gas - nitrous oxide

22
Q

what are the adverse effects of inhalation anesthetics?

A

Respiratory & cardiac depression (so often intubated/mechanical ventilation/ET tube)

Sensitization of heart to catecholamines (epi and norepi which cause dysrhythmias)

Aspiration of gastric contents (again ET tube!)

Malignant Hyperthermia
muscle rigidity & profound temperature elevation ( up to 109*F!)

23
Q

Malignant hyperthermia

A

muscle rigidity & profound temperature elevation ( up to 109*F!)

also unstable BP, metabolic acidosis, cardiac dysrhythmias, and electrolyte abnormalities)

all inhalation anesthetics (except nitrous oxide)
and increased risk with succinylcholine

Treatment

  1. Stop succinylcholine
  2. COOL patient- IV cool saline and ice packs
  3. IV Dantrolene
24
Q

succinylcholine

A

a neuromuscular blocking agent that is often combined with an inhalation anesthetic

the combo increases the risk for malignant hyperthermia

it reduces the amount of anesthesia needed and relaxes the skeletal muscles (including diaphragm and respiratory muscles)

25
Q

to avoid systemic toxicity with local anesthetics:

A

(1) apply smallest amount needed
(2) avoid applying to large areas
(3) avoid applying to broken/irritated skin
(4) avoid strenuous exercise, wrapping or heating site

AE of local anesthetics include CNS excitation/depression, CV, allergic rxn, methemoglobinemia (hemoglobin can’t release O2)

26
Q

What are the two major classes of local anesthetics?

A

Esters and Amides

Amides have a lower incidence of allergic reactions

Esters: cocaine, procaine, benzocaine, and tetracaine

Amides: lidocaine, debucaine

27
Q

What are local injection anesthetics?

A

procain [Novocain] - ester type

lidocaine - amide type

28
Q

What are topical local anesthetics?

A

benzocaine- ester type

lidocaine - amide type

29
Q

treatment for cocaine OD

A

(1) IV diazepam or lorazepam,
(2) nitroprusside,
(3) sodium bicarb,
(4) ASA,
(5) external cooling
v) addiction treatment – anticocaine vaccine, disulfiram [Antabuse]

30
Q

5 A’s model for treating tobacco use & dependence

A

(1) Ask - screen all patients for tobacco use
(2) Advise tobacco users to quit
(3) Assess willingness to make a quit attempt
(4) Assist with quitting; offer medication and provide or refer to counseling
(5) Arrange follow-up contacts beginning within the first week after the quit date

Pharm Test 6 (21 decks)

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