Opiods Lecture

Question 1

Halothane

Answer 1

• inhaled anesthetic
• slower but more control

Question 2

Barbiturates

Answer 2

IV anesthetic
Long half life
Increases time Cl channels are open

Question 3

Benzodiazepines

Answer 3

Valium
Lorazepam
- more selective
Increases frequency that CI channels are open

Question 4

Propofol

Answer 4

• most common anesthetic for surgery
• faster clearance
• less hangover effect

Question 5

Ketamine

Answer 5

Causes dissociative amnesia
CV stimulant

Question 6

Etomidate

Answer 6

Produces hypnotic anesthesia without SE

Question 7

Opioids

Answer 7

Fentanyl and morphine
- used more post op for pain control

Question 8

Post op meds

Answer 8

Barbiturates
Benzodiacepinas
Antihistamines
Antacids
- Valium most common
All to relax the patient

Question 9

Neuromuscular blockers

Answer 9

Cause skeletal muscle paralysis to keep patient from moving during the procedure
- anti cholinergic — curare
- Depolarizing blocker — succinylcholine

Question 10

Goal of local anesthetics

Answer 10

Block afferent neuro transmission at level of peripheral nerve or spinal cord

Question 11

Advantages of local anesthetic

Answer 11

Rapid recovery
Absence of cog problems after surgery
Minimal effects on Cv, respiratory or renal function
- most have -Caine suffix

Question 12

Lidocaine

Answer 12

Rapid onset
Intermediate duration
Used for infiltration, peripheral nerve block, epidural, spinal, transdermal, topical

Question 13

Procaine

Answer 13

Novacaine
Slow onset
Short duration
Used for infiltration, peripheral nerve block, spinal

Question 14

What is the mechanism of action of local anesthetics

Answer 14

Inhibit sodium channel opening
STOP the depolarization

Question 15

Side effects of local anesthetics

Answer 15

• systemic effects —> anesthetic diffuses throughout the body
• CNS effects —> initial excitation , latent effects like CNS depression
• CV effects —> CV depression, decreased HR and BP

Question 16

What are the physical therapy concerns

Answer 16

• local anesthetics may be useful when applied transfermally with ionto or phono
• patients with complex regional pain syndrome —> schedule PT after the patient has received ganglionic or nerve block to be maximally effective. Maximize use of the involved extremity

Question 17

What are the endogenous opioids

Answer 17

Enkephalin
Dynorphin
Endorphins
Endogenous receptors are Mu, Kappa, and delta

Question 18

Mu receptors.

Answer 18

Most portent for pain releif and in highest concentration in periaqueductal gray
- fentanyl
- meperidine
- morphine
Also have the most side effects

Question 19

Effects of strong opioids

Answer 19

• binds primarily to Mu receptors
• greatest analgesic effect but greatest potential for OD
• oral, IM, SQ, IV, Intrathecal

Question 20

Adverse side effects of opioids

Answer 20

Sedation, drowsiness, mental slowing.
Euphoria and confusion
Respiratory depression
OH
N+V
Constipation
Addiction
Dependence
Tolerance

Question 21

Opioid withdrawal symptoms

Answer 21

Body aches
Diarrhea
Fever
Gooseflesh
Insomnia
Irritability
Loss of appetite
N+V
Shivering
Stomach cramps sweating
Tachy
Uncontrollable yawning
Weakness/fatigue