Pharmacology pt. 1 Flashcards
What are the 6 types of anesthesia?
- local
- moderate sedation
- MAC
- nerve blocks
- neuraxial
- general anesthesia
What is unique about local cases?
you can be the circulator and the monitoring if it is straight local case with no IV sedation
What 2 things will be characteristic of a patient with moderate sedation?
- patient can maintain an airway
- easily arousable
Nurses can do what during moderate sedation?
they can monitor, but they cannot be circulator and monitoring nurse at the same time. You need 2 nurses
What is MAC?
higher doses of moderate sedation. You might also have propofol, which is not characteristic of moderate sedation.
Can patient control their airway in MAC?
not always, so you might have to have anesthesia
What is MAC also called?
TIVA
What are nerve blocks?
same medication used during locals it just in or around the nerve root for the temporary control of pain in the extremity or eye
What is neuraxial anesthesia?
spinals and epidurals
What is general anesthesia?
patient goes to sleep
What is ASA I?
normal healthy patient
What is ASA 2?
patient with mild systemic disease (they are not having other health issues related to their disease process)
What is ASA 3?
patient with severe systemic disease (they are having other health issues related to their disease process - diabetic with peripheral neuropathy, unhealed wounds)
What is ASA 4?
patient with severe systemic disease that is a constant threat to life
What is ASA 5?
Near-death patient who is not expected to survive
Being pregnant, obese, or a smoker makes you what ASA?
ASA 2
What is ASA 6?
declared brain-dead patient
If the procedure is followed by an E with ASA 6 what does that mean?
it is an emergency
What does echinacea in conjunction with propofol cause?
liver damage?
What does kava kava in conjunction with propofol cause?
liver damage
What does ginger in conjunction with propofol cause?
increased bleeding
What does gingko in conjunction with propofol cause?
increased bleeding
What does garlic in conjunction with propofol cause?
increased bleeding
What does fever few in conjunction with propofol cause?
increased bleeding
What does saw palmetto in conjunction with propofol cause?
increased bleeding
What does fish oil increase the liklihood of in surgery?
bleeding
How long should a patient be off their herbals?
1-2 weeks prior to surgery
What can goldenseal cause?
arrhythmias/hypertension
What can milk thistle cause?
arrhythmias/hypertension
What can licorice cause?
arrhythmias/hypertensionW
What can ginseng cause?
arrhythmias/hypertension
What can ephedra cuase?
arrhythmias/hypertension
What can ephedra cause in addition to arrhythmias/hypertension?
it acts like a beta 3, it is a fat burner. It turns fat into glucose, so it is going to increase glucose
What is an herbal that can drop your blood pressure?
black kohash
What are 3 herbals that can prolong emergence?
- gingko
- st. John’s wort
- valerian
What 3 things can help with anesthesia induction?
- inhalation
- barbiturates
- sedatives - hypnotics
It is not uncommon to do what kind of induction in children?
inhalation
What are the 2 sedatives that we use for induction?
- propofol
- etomidate
What is a positive of etomidate?
it can cause some adrenal suppression for 24 hours.
What is etomidate good for?
good for AAA (large vessel grafts) because there is not big blood pressure on new graft.
What is negative side effect of etomidate?
you need prophylactic antiemetic because it can cause emesis
What is the downside of brevital?
the therapeutic dose and toxic dose are next door neighbors, so small margin of error
What does brevital lower?
the seizure threshold
What will we still use brevital for?
ECT
Nurse needs to do what with patient during induction?
remain with the patient
The nurse needs to limit what kind of stimulation during induction?
sensory stimulation
The stress response of induction is what?
increase in BP and Heart rate
As the nurse, know where what are located during induction?
the emergency/difficult intubation cart and trach tray are located
MI’s occur during what phase of induction?
the excitatory phase
Nurses want to do slow what for induction? why?
slow deliberate positioning because of loss of compensatory vasoconstriction
Patients lose what during anesthesia?
compensatory vasoconstriction, which can cause venous pooling
What are 2 things to remember for asthmatics on induction?
- need to be deeper for intubation
- bronchodilator use prior to intubation
MH usually occurs when?
during induction, after given the triggering agents
MH has variable what? which means?
variable penetrance which means that it is dependent on dose and duration
do you still need to vigilant of MH throughout the procedure?
yes because of variable penetrance
During intubation patients are at risk for what?
aspiration
What 4 patients are most at risk for aspiration?
- GERD
- trauma
- awake intubation
- pregnancy/obesity
For patients who are at risk for aspiration what can you use to help with intubation?
cricoid pressure
Why do you do cricoid pressure?
to prevent vomiting and aspiration, so we don’t let go until the cuff is up
What is cricoid also known as?
SELLECK maneuver
What do you have to have as a nurse in order to do moderate sedation?
competency
What is important for pain post op?
pain goals so we can understand when we need to give meds
We control our own pain with what?
natural endorphins
We have what for our endorphins? so we can do what?
we have receptors for our endorphins so we can build muscle, move stuff and run from tigers
Sometimes the natural ability to ignore pain is a what
a big advantage?
What can cause a histamine release in some people?
synthetic opioids
The word endorphin derived from the words what?
endogenous morphine
Hydromorphone is also known as what?
dilaudid
We want to push hydromorphone what?
slowly
Hydromorphone is 7x more potent than what?
morphine
Meperidine is also known as what?
demerol
What are 2 naturally occurring opioids?
morphine and codeine
What is meperidine (demerol) used for?
shivering
Is meperidine (demerol) a strong opioid?
no it is weak
What receptor do we avoid with our synthetic opioids?
MU receptor because it makes people have N/V, that anxious nervous feeling
What receptors do we target with opioids?
kappa and delta receptors
If you push hydromorphone (dilaudid) or sublimaze (fentanyl) too quickly what can it cause?
chest wall rigidity (wooden chest syndrome) especially in elderly people that already have that non-compliant chest wall
Can demerol be given for pain control?
no not approved by AMA for pain control
Sublimaze (fentanyl) is 100 times stronger than what?
morphine
You want to push sublimaze (fentanyl) what?
slowly
Duramorph (morphine) has high incidence of what?
N/V
What are the 4 opioids we want to remember for the exam?
- hydromorphone (dilaudid)
- meperidine (demerol)
- sublimaze (fentanyl)
- duramorph (morphine)
What is the reversal agent for all opioids?
narcan (naloxone)
What kind of reversal agent is narcan (naloxone)?
competitive reversal agent; competes for the opiate receptors
What is the dose of narcan (naloxone)?
0.1 to 0.2 mg at 2-3 minute intervals
narcan (naloxone) is ordered as a what? we start at the what?
range. start at the low end and repeat the dose up until the high end
The onset of narcan (naloxone) is what?
1-2 minutes
The durate of narcan (naloxone) is what?
30-45 minutes
Monitor narcan (naloxone) for what?
return of respiratory depression
What are 2 benzos?
- versed (midazolam)
- valium (diazepam)
What are benzos for?
anxiety. Suppressing the limbic system or anxiety
What receptor do benzos work on?
GABA receptros
Versed (midazolam) is what?
short acting
Versed (midazolam) has what kind of effect?
amnesic/anti-anxiety
Valium (diazepam) burns on what?
IV admin
Valium (diazepam) is a potent what?
respiratory depresant
Limbic system is responsible for what 3 things?
- emotions
- processing memory
- arousal
Versed and valium are clinically effective for how many hours?
1-2 hours
Versed is completely metabolized after how much time?
2-6 hours
Valium is completely metabolized after how much time?
48-50 hours
Valium is sometimes used for what kind of surgery? why?
abdominal surgery because it is good at stopping spasms and seizures
Flumazenil (romazicon) reverses what?
benzodiazepines
Flumazenil (romazicon) is contraindicated in patients with what 2 things?
- seizures
- those taking tricyclic antidepressants
What are 7 things that act as complimentary therapy/holistic care to meds?
- music (shown to reduce use of pain meds post op)
- massage
- acupuncture/acupressure
- aromatherapy
- hypnosis
- reiki
- guided imagery
Complimenary therapy is used in surgery primarily with what?
local anesthesia
Who should perform complimentary therapy?
qualified practitioner within your state should perform the complimentary therapy
We want do what with patients regarding complimentary therapy?
shared decision making
We want a good history of what with complimentary therapy?
dietary and herbal supplements
What, in regard to complementary therapy, should not be given orally?
essential oils
