TOpic 16: ANesthetic Agents and Adjucts Flashcards
Adjunct:
a drug that is not a true anesthetic, but that is used during anesthesia to produce other desired effects such as sedation, muscle relaxation, analgesia, reversal, neuromuscular blockade, or parasympathetic blockade
Anesthetic agent:
any drug used to induce a loss of sensation with or without unconsciousness
Route of administration anesthetics & adjucts
¬Inhalant
¬Injectable
¬Oral
¬Topical
Time of administration anesthetics & adjucts
¬Preanesthetic
¬Induction
¬Maintenance
General Anesthesia 4 Characteristics
1) Unconsciousness (SPELL THIS CORRECTLY!)
2) Immobility
3) Muscle relaxation
4) Loss of sensation
General Anesthesia - produced by what?
reversible?
Reversible
•Produced by administration of one or more anesthetic drugs
Surgical Anesthesia
about it?
- A stage of general anesthesia
- Analgesia and muscle relaxation
- Eliminate pain and patient movement during the procedure
Sedation characteristics (a bunch)
–CNS depression –Drowsiness –Drug-induced –Various levels –Slightly aware or unaware of surroundings –Aroused by noxious stimulation –Uses: minor procedures
Tranquilization characteristics (3)
–Calmness
–Patient is reluctant to move
–Aware of surroundings but doesn’t care
Hypnosis characteristics (4)
–Drug-induced
–Sleeplike state
–Impairs patient’s ability to respond to stimuli
–Patient can be aroused with sufficient stimulation
Narcosis characteristics (3)
–Drug-induced sleep
–Patient is not easily aroused
–Associated with narcotic drugs
Topical Anesthesia produces what?
Applied to body surfaces or a wound
Produces a superficial loss of sensation
Regional Anesthesia blocks what?
example of one?
Loss of sensation to a limited area of the body
Nerve blocks
Epidural anesthesia
Most general anesthetics are analgesics?
FALSE
most are not
True analgesics don’t provide what?
general anesthesia!
Dont mix drugs when? (2)
Don’t mix drugs in a single syringe unless they are compatible
Don’t administer a drug combination if a precipitate (what’s this?) develops when the drugs are mixed
Opioids produce what effects?
Derivatives of opium
Produce analgesia and sedation
Opiods classified as what?
Classified as agonists, partial agonists, agonist-antagonists, or antagonists
Opioids can be anesthetic inductions how?
Anesthetic induction when combined with other drugs
4 categories of Opioids
Agonist, Partial Agonist, agonist antagonist, antagonist
Opioids - what kind of substances?
- except for what?
Controlled substances
Except for antagonists and nalbuphine
Opioids Mimic what?
endogenous opioid peptides
β-Endorphins, dynorphins, enkephalins (“Runner’s High”)
Opioids have what effects? how are these effects caused?
Analgesia and sedative effects
Result of action on the receptors in the brain and spinal cord
They prevent nerves from transmitting impulses.
They prevent presynaptic release of neurotransmitters, particularly excitatory afferent neurotransmitters (?)
Decrease critter’s “perception” of pain
Opioid Agonists how do they work?
Bind to and stimulate mu and kappa receptors
Best for moderate to severe pain
Opioid Partial agonists - for what/efficacy?
For moderate pain—they have lower efficacy
Opioid Agonist-antagonists stimulate what receptors ?
Typically bind to delta, mu, and kappa receptors, but typically stimulate only kappa receptors (Reversal agent/mild pain)
Antagonists - bind to what?
Bind to but don’t stimulate delta, mu and kappa receptors (reversal agents)
Pure opioid agonists are the BEST things we have for what?
severe pain!
BEST things we have for severe pain?
Pure opioid agonists
Effects of Opioids on Cardiovascular system
Bradycardia except meperidine which has antimuscarinic effects that can produce tachycardia
Adverse Effects of Opioids on Gastrointestinal system
¬Salivation and vomiting by stimulation of the chemoreceptor trigger zone (CTZ)
Initial diarrhea, vomiting, and flatulence GI stasis follows initial GI stimulation
•“Oh, THAT’S why heroine addicts always look so constipated and cranky!
Adverse Effects of Opioids on GU system?
Urinary Retention
Opioids – cause release of what?
HISTAMINE RELEASE
Allergic Rxns are very common with morphine use.
Avoid in asthmatics.
*Increased intraocular and intracranial pressure
Use of Opioids (3)
Cough Suppressants (codeine, dextromethorphan)
Preanesthetic
Analgesia
Opioids used with tranquilizer produce what?
neuroleptanalgesia
Neuroleptanalgesia is what?
“A profound state of sedation and analgesia
induced by simultaneous administration of an opioid and a tranquilizer” So it’s a state of “tranquil dreaming”
How do Opioids used in Treatment of Acute Pulmonary Edema, as in that seen with CHF
Vasodilation
Reduce anxiety of “drowning”
Opioid Antagonists do what?
Reverse undesirable effects
–CNS and respiratory depression
Reversal of effects of opioid agonists, partial agonists, and agonists-antagonists
Reversal can be complete in a few minutes
Opioid Antagonists used for what? (3)
- Wake up patient following sedation
- Emergencies
- Overdoses
Tramadol can be *Can be partially reversed with what?
opioid
antagonists
Tramadol side effects
- Agitation
- Muscular tremors
- Sweating
- Hyperthermia
- Seizures
Barbiturates Subclasses based on what?
duration of action and chemical structure
Ultrashort, Short, Intermediate, long acting
Oxybarbiturates, Thiobarbiturates
Barbiturates Subclasses on chemical structure (2)
Oxybarbiturates
•Phenobarbital, pentobarbital, & Methohexital oxygen
Thiobarbiturates (•Thiopental and Thiamylal) (“thi… gives them away!) sulfur
Thiopental - acting time?
ultra–short-acting
Barbiturate
good for intubation
Methohexital - acting time?
ultra–short-acting
Barbiturate
good for intubation
Barbiturate can use for what short procedure?
INTUBATION
thiopental and methohexital
Barbs Increase what enzyme activity?
hepatic
Propofol (PropoFlo, Diprivan)
The #1 “most used” drug for what?
anesthetic induction in most of the world (including the U.S.)
Propofol
PropoFlo, Diprivan
nonbarbiturate anesthetic
Propofol (PropoFlo, Diprivan)
respiratory effects?
VERY potent respiratory depressant with possible (frequent) apnea upon induction
–Administer slowly to effect
Barbiturates Normal” drug dose may produce prolonged unconsciousness or death in what.!
hypoproteinemia
