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Pharm Test 2

Pharm Test 2 Ch. 11 General Anesthetics

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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