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Pharm Test 2
Pharm Test 2 Ch. 11 General Anesthetics
| Questions | Answers | |
|---|---|---|
| General anesthetics | administered for more extensive surgical procedures | |
| local anesthetics | relatively small, well defined area or when a Pt needs to remain conscious through the procedure | |
| What are the requirements for general anesthesia? | 1) rapid onset 2) skeletal muscle relaxation 3) inhibition of sensory & autonomic reflexes 4) easy to adjust 5) minimum toxic side effects 6) rapid recovery 7) no recollection of what happened in surgery | |
| How many stages are there in general anesthesia? | 4 | |
| What are the stages? | analgesia, excitement (delirium), surgical anesthesia and medullary paralysis | |
| How do they get to stage 3 the fastest? | IV and inhaled anesthetic agents | |
| Balanced anesthesia | use of both Iv and inhaled agents throughout the surgery | |
| Inhalation Anesthetics consists of: | gases or volatile liquids | |
| most IAs end in | -rane or -thane | |
| which are the most preferred IAs | desflurane and sevoflurane | |
| Intravenous anesthetics | barbiturates, benzos and opioids | |
| Ketamine is a | dissociative anesthesia | |
| dissociative anesthetics makes the Pt | appear awake but is sedated and no recall of affects | |
| When is ketamine useful? | relatively short diagnostic or surgical procedures or invasive procedures w/ kids or certain high-risk Pt | |
| Neuroleptanesthesia | w/ or w/o loss of consciousness but disassociation from what was happening | |
| propofol (diprivan) | a short acting hypnotic that takes effect rapidly and is often the drug of choice from inducing GAs | |
| Etomidate is what kind of drug? | hypnotic like drug rapid onset w/ min. cardiopulm side effects maybe used with Pts w/ cardio and resp functions | |
| Fospropofol does what? | converts to propofol in the body used in minor surgeries | |
| Dexmedetomidine is a short or long term sedative? | short term sedation mechanically ventilated in Pts in ICU can be used as an adjacent drug during surgeries stimulates certain alpha receptors in brain | |
| pharmokinetics of GAs are nonlipid soluble, lipid soluble, or very lipid soluble? | very lipid soluble gets redistributed by washout period in CNS -older ppl need less than younger elimination is by the lung, biotransformation in the liver or a combo | |
| Mechanism of Action | look at notes!! | |
| Adjuvant drugs are used to do what? | help give comfort & safety to the Pt - can be used in preop &/or neuromuscular blockers | |
| adjuvant as preoperatives can be given when? what drugs are these? | 1-2 hours before GA Table 11-2 orally or IM barbs, opioids or benzos may be continued during or after surgery | |
| Do antihistamines offer sedation and reduce vomiting during or after surgery? | yes | |
| Steroids can help do what? | reduce pain afterwards | |
| Does Zofran and Kytril work at reducing n/v in postop? if so how? | yes and by blocking CNS serotonin receptors associated w/ GI tract | |
| Do anticholinergics reduce n/v? | yes | |
| Neuromuscular blockers (NMB) do what? | helps w/ mechanical inflation and deflation in the chest w/ diaphragm relaxxed | |
| can these be given in conjunction w/ GAs? | yes | |
| T/F Neuromuscular blockers can produce anesthesia or analgesia affects if given alone | false | |
| where do they work and what do they block? | skeletal neuromuscular junctions by blocking ACh postsynaptic receptors | |
| LOOK at TABLE 11-3 | ||
| can these cause tachycardia, increase histamine release, increased plasma K+ levels (hyperkalemia) residual muscle pain and strength? | no; everything else is right but strength - it causes weakness | |
| are these given in small or large doses? | small | |
| Neostigmine and edrophonium do what? | reverse the effects of NMB - inhibit acetylcholineterase | |
| Sugammadex | deactivates 2 common NMB by encapsulating them and terminating their abilities - works fast w/ less side effects; not approved in USA | |
| can electrical stimulation be used to determine if the drug has worn off? | yes | |
| Nondepolarizing blockers are what? | competitive antagonist of the postsynaptic receptor | |
| Where no nondepolarizing blockers work? | happens at neuromuscular junction | |
| What do nondepolarizing blockers do? | paralysis of muscle | |
| An example of nondepolarizing blocker is? | curare | |
| Depolarizing blockers work by? | initially acting as ACh by binding to & stimulating the receptor | |
| Do depolarizing blockers break down as fast as ACh? | no; slower | |
| How many phases of depolarizing fblockers? | 2; not breaking down fast causing depolarization and then staying in the synapse but allowing muscle cell to eventually repolarize but stay unresponsive | |
| What are signs of depolarizing blockers? | muscle tremors followed by flaccid paralysis | |
| An example and the only one used in clinics? | Succinylcholine |
Created by:
hfillingim
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