Module 6 - Sedatives, Anesthetics, Analgesics Flashcards
What are Sedatives?
Sedatives reduce CNS arousal
What are Hypnotics?
Hypnotics induce sleep
What are Anxiolytics?
Anxiolytics reduce anxiety
What are Barbiturates?
Some of the oldest drugs used to treat seizures, sleep and anxiety disorders.
Cause drowsiness and can cause respiratory depression in overdose.
Mainly used for patients with seizures, but tolerance build up is common so this drug class is not used frequently.
Phenobarbital - good choice for sedation it the ICU
What are Anesthetics
Anesthesia means "without sensations" Two categories: Local - at the site General - patient will not respond to any stimuli Lidocaine (Xylocaine) is a local.
What are Analgesics?
Analgesia refers to the reduction in the sensation of pain
Pain is relative, but almost all ICU patients are in pain, which can impair ventilatory function and effective cough mechanism.
Several types:
opioids
steroidal anti-inflammatory agents
nonsteroidal anti-inflammatory drugs (NSAID’s)
What are Benzodiazepines
Most common drug class with all effects (sedative, hypnotic, and anxiolytic)
List 3 common Benzodiazepines
Diazepam (Valium) Midazolam (Versed) Lorazepam (Ativan) Alparazolam (Xanax) Chordiazepoxide (Librium)
What are Nonbenzodiazepines?
Name three.
Sedative hypnotics that may cause fewer side effects then Benzodiazepines. Fewer daytime residual effects Sometimes called the Z compounds: Zolpidem (Ambien) Eszopiclone (Lunesta) Zaleplon (Sonata)
What are Ventilatory Stimulants?
Directly stimulate the respiratory centers in the medulla to increase the rate and depth of ventilation Also called analeptic stimulants Medroxyprogesterone Protriptyline Doxapram Caffeine See pg 236 for indications
What are drug Cocktails?
Drug combinations used in surgical and office procedures to decrease the level of consciousness and produce retrograde amnesia.
Goal is to make patient feel comfortable yet still able to respond to commands.
List and describe 3 Anesthesia Terms
Induction - time it takes to create the appropriate level of anesthesia.
Maintenance - continuation of the anesthetic state.
Termination - time it takes a patient to recover from anesthesia.
Describe the 4 stages of Anesthesia
Stage 1
Conscious sedation - patient is awake but can not feel pain frequently used for scopes and minor procedures
Stage 2
Loss of consciousness but patient still has reflexes, such as a cough
Stage 3
surgical anesthesia that progresses to respiratory depression
Stage 4
Complete loss of respiratory drive, and patient may have loss of cardiovascular tone.
Describe how Specific General Anesthetics function.
Can create surgical anesthesia with inhaled or intravenous route
Inhaled anesthetics work by binding to a protein-binding site in the neurons of the CNS
Intravenous anesthetics are commonly used as adjuncts to inhaled agents or as primary agents for maintaining a state of anesthesia
Common Inhaled Anesthetics
Nitrous Oxide N2O - laughing gas Nitric NO vasodilation Halothane (Fluothane)* Enflurane (Ethrane) Isoflurane (Forane) Sevoflurane (Ultane)* Desflurane (suprane) *used by RT's
Common IV Anesthetics
Barbiturates
Thiopental (Pentothal)
Methohexital (Brevital)
Miscellaneous
Propofol (Diprivan)
Etomidate (Amidate)
Ketamine (Ketalar) - Special K
Benzodiazepines
Midazolam (Versed)
Describe what Common Local Anesthetics used for and list one of each.
Used for suturing, skin biopsies, dental work, bronchoscopies, and intubations
Also injected in joints for sports injuries and used as sore throat sprays
Ester
Benzocaine (Anbesol)
Amide
Lidocaine (Xylocaine)
See pg 234 for more
List several Opioid Analgesics
Morphine (Many) Hydromorphone (dilaudid) Levorphanol (Levo-Dromoran) Oxymorphone (Numorphan) Fentanyl (Sublimaze) Codeine (Many) Meperidine (Demerol)
Side Effects of Opioid Analgesics
Major Concern:
Respiratory depression, apnea circulatory depression, shock, respiratory arrest, cardiac arrest
CNS:
Light-headedness, dizziness, syncope, seizures, dysphoria, hallucinations
Respiratory:
Depression, decreased rate and depth of breathing
Cardiovascular:
Reduction in venous and arterial pressures
Skin: histamine release resulting in vessel dilation, flushing, sweating, pruritus
GI, nauseant:
Inhibition of peristaltic waves, leading to constipation
What are Opioid Antagonist?
Opioid antagonist can reverse the CNS and ventilatory depression caused by opioid administration.
Naloxone (Narcan) is an example of such a drug.
Where’s off quicker than the narcotic does
Must give multiple treatments
Does not work with propofol
Describe what Steroidal Anti-Inflammatory Drugs are and what they may be used for.
Short-term systemic corticosteroids can be used for pain but have many long-term side effects, such as peptic ulcer disease, bone demineralization, altered blood glucose, and muscle atrophy.
Corticosteroids are used as local injections into painful joint to reduce pain and inflammation.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
One of the most commonly used classes of analgesic medications
Consider the drug of choice for tissue destruction pain
Have antipyretic (fever reducing) properties
Inhibit cycloxygenase pathway, which produces prostaglandins.
Can trigger asthmatic reactions
Common Nonsteroidal Anti-Inflammatory Medications
Aspirin (Bayer, et al) Ibuprofen (Mortrin, et al) Ketoprofen Naproxen HCI (Aleve, Naprosyn, et al) Naproxen sodium (Anaprox, et al) Indomethacin (Indicin, et al) Sulindac (Clinoril) Piroxicam (Feldene) Cetorolac Celecoxib (Celebrex)
What are neuromuscular blocking agents (NMBA’s)
1) Reduce spontaneous breathing
2) Prevent movement that can dislodge chest tubes
3) Reduce oxygen consumption in patients with poor cardio pulmonary function and
4) Improve patient ventilator synchrony there by reducing the pressures needed for mechanical ventilation
Name a depolarizing neuromuscular blocking agent
Generic Name Trade Name
Succinylcholine Anectine
Name five nondepolarizing neuromuscular blocking agents
Generic Name Trade Name Pancuronium Pavulon Vecuronium Norcuron Rocuronium Zemuron Cisatracurium Nimbex Atracurium Tracrium
Name a neuromuscular blocking agent with ultra short duration
Succinylcholine
Category: ultra short duration
Onset: 30-60 seconds
Duration: 4-6 minutes
Name a neuromuscular blocking agent with intermediate duration
Rocuronium
Category: intermediate duration
Onset: 1-2 minutes
Duration: 30-60 minutes
Name a neuromuscular blocking agent with long duration
Pancuronium
Category: long duration
Onset: 3-5 minutes
Duration: 60-120 minutes
What are some cautions with succinylcholine
Patients with genetic muscle weakness disorders are prone to hyperkalemia when they are given succinylcholine, inhalation anesthetics or the combination. Patients with burns, polio or Guillain Barre syndrome are also at higher risk of hyperkalemia, so it should be not used for such patients
Succinylcholine has also been associated with malignant hyperthermia. This is a life-threatening autosomal dominant inherited Pharmacogenetic disorder
Triggering events can include volatile anesthetics and depolarizing muscle relaxants
It is characterized by a spasm of the jaw muscles, skeletal muscle damage, hyperthermia, rapid breathing, and death if not treated properly. Metabolic and respiratory acidosis are commonly associated with it
