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Pharm Exam 2
Anesthesia, Analgesics, Anti-inflammatory, Anti-Infectives
| Term | Definition |
|---|---|
| Why do we use a variety of anesthetics, even for one patient? | No single anesthetic agent is ideal, so multiple medications are used together |
| What is balanced anesthesia? | Using various combinations of anesthetics for best results to provide sleep, analgesia, elimination of certain reflexes and good muscular relaxation |
| What are the 3 main categories of anesthetics? | Inhalation anesthetics (gaseous & volatile agents), IV anesthetics (hypnotics, narcotics, neuroleptic life), Local anesthetics |
| What are inhalation anesthetics? | Drugs administered through the respiratory tract - inhalation and exhalation -absorption is rapid and diffuses through alveoli |
| What is the classification and mains actions of Nitrous Oxide (aka laughing gas)? | Classification: Gaseous general anesthetic Action: -Produces narcosis (sleepiness or anesthetic state) -analgesia (↓ perception of pain) -amnesia (↓ memory of events) **causes progressive depression of CNS (GABA-receptor & opioid agonist) |
| What ADRs or special information are important for Nitrous Oxide (laughing gas)? | ADRs: -free of major toxicities when given with O2 (need >=30% O2) -toxic suppression of CNS if given for too long -post-op N/V Info: -greatest use is induction agent (begin anesthesia) -combined with other anesthetics unless procedure is short |
| What is the classification and main actions of Isoflurane (Forane)? | Classification: inhaled general anesthetic (volatile liquid) Action: -Progressive depression of CNS, GABA receptor agonist, ↓glutamate transmission -Resp: less efficient gas exchange (rapid & shallow) -muscle relaxation -depressed liver function |
| What are volatile anesthetics? | Anesthetics that are more soluble in the blood, intercellular fluid, and fatty tissue than gaseous anesthetics -longer to produce anesthesia, and stays in tissues longer, can build up if not monitored carefully |
| What ADRs is important for Isoflurane (Forane)? | ADRs -Hypotension (from vasodilation) -Significant resp. depression -malignant hyperthermia (esp. when used w/ succinylcholine ,rapid temp ↑; anecdote is dantrolene) |
| What special information should a nurse note when using Isoflurane (Forane)? | -helps facilitate intubation (depresses reflexes) -not a potent analgesic alone -mild skeletal muscle relaxant but is a UTERINE MUSCLE RELAXANT -Patient may shiver coming out of anesthesia |
| What are some advantages and disadvantages of Intravenous (IV) anesthetics? | Adv: rapid pleasant induction, absence of explosive hazards, low incidence of post-op N/V Disadv: laryngospasm & bronchospasm, hypotension, and resp arrest |
| What are some uses for IV anesthetics a nurse should notes? | -induce and maintain general surgical anesthesia, basal anesthesia and hypnosis -short or ultra-short acting barbiturates and narcotics |
| What is a major difference between barbituates and gaseous agents? | SAFETY -inhalation: anesthetist controls minute-by minute administration and removal -IV: once a dose is administered, it cannot simply be withdrawn from the body |
| What is the classification and main actions of propofol (Diprivan)? | Classification: barbiturate, IV general anesthetic, ultra-short acting Action: -promotes the release of GABA -Has short duration of anesthesia action |
| What are ADRs for propofol (Diprivan)? | -Resp. depression, -hypotension from vasodilation -risk of bacterial infection (in lipid-based emulsion) -Propofol infusion syndrome (rare) --> prolonged or high-dose propofol infusion -injection site pain -antiemetic properties |
| What is important special information for propofol (Diprivan)? | -smooth, easy, pleasant induction -NOT recommended for pt with severe heart disease or resp. difficulties -NOT a controlled substance -Milky-white solution (milks of amnesia) |
| What is Etomidate (Amediate) and when would you use it? | -Hypnotic agent for anesthesia induction -useful in pt with heart problems who may not tolerate propofol -minimal cardiac effects |
| What is fentanyl/droperidol combination (Innovar) and when would you use it? | an opioid and neuroleptic combination used for "neurolept analgesia" |
| What is the classification and main actions of fentanyl (Sublimaze)? | Classification: opioid/narcotic anesthetic Action: -morphine-like action (100x as potent as morphine) -opioid agonist -faster onset than morphine with short duration |
| What are ADRs for fentanyl (Sublimaze)? | -euphoria, -miosis (constricted/pinpoint pupils) -N.A -puritus (itching) -constipation -hypotension -respiratory depression -bradycardia -BLACK BOX warning - significant abuse potential |
| What is important information to note for fentanyl (Sublimaze)? | -Rapid IV injection or large doses may cause muscle rigidity & apnea -topical patches (Duraesic) used for analgesia; change q72 hrs for pain control - don't put patches where heating pad may go -lozenge on a stick (actiq) and buccal tablets (fentora) |
| What is dissociative anesthesia? Name a dissociative anesthetic. | -decreased perception of pain -calm quiet state, pt appears disconnected from their surroundings w/o loss of consciousness -trance-like effect Ketamine (Ketalar): neuroleptic-like anesthetic -used for treatment-resistant major depression |
| What is the classification and main actions of midazolam (Versed) | Classification: IV anesthetic, benzodiazepine Action: -neuroleptic effects -Acts on limbic system, thalamus, hypothalamus -causes CNS depression, skeletal muscle relaxation, prevention of seizure activity |
| What are some ADRs of midazolam (Versed)? | -resp depression (resp arrest) -BLACK BOX -decreased alertness and amnesia (rest of day) -hypotension, laryngospasm, loss of dexterity, muscle tremors, tachycardia, SOB |
| What important info about midazolam (Versed) should a nurse note? | -peak 30min-1hr, half-life = 2.5 hrs -produces anterograde amnesic effect (loss of memory about procedure) -↓anxiety -more prolonged post anesthetic recovery period than barbiturates |
| What do local anesthetics like mepivacaine (Carbocaine), lidocaine (xylocaine), bupivacaine (marcaine) do? | -prevent nerve impulses from traveling to the brain -causes loss of sensation in a particular area without necessarily causing unconsciousness -stabilize or elevate the threshold of excitation of the nerve cell membrane -prevents depolarization |
| What are ABRS when using local anesthetics? | -overdosage or systemic absorption may give ADRs in CNA --> excitement, convulsions, and then CNS depression -bradycardia, hypotension, cardiac arrest N/V, pallor, apprehension |
| What is important information to note with local anesthetics? | -loss of all sensation occurs but pain fibers affected 1st -if it becomes systemic, serious reactions occur esp. with heart and brain -vasoconstrictors are used with them to ↓systemic absorption topical ex. benzocaine |
| Why are skeletal muscle relaxants used? What are two major types? | -During surgery patient may need significant muscle relaxation to facilitate procedures and intubations -allow for lower dose of general anesthetics 1. Non-depolarizing neuromuscular blocking gents 2. Depolarizing neuromuscular blocking agents |
| What is the classification and major actions of rocuronium (zermuron)? | Classification: non-depolarizing (competitive) neuromuscular blocking agents Action: -prevents Ach from acting buy occupying cholinergic receptor sites -competitive antagonist -causes paralysis, but doesn't affect LOC or pain perception |
| What are some ADRS and other important info to know with rocuronium (Zermuron)? | ADRs: tachycardia, muscle weakness, salivation, HTN Reversal agents: anticholinesterases like neostigmine or sugammadex -inhibits the enzyme that breaks down ACh --> ACh accumulates and competes Related drug: vecuronium (nocuron) |
| What is the classification and main actions of succinylcholine (anectine)? | Classification: depolarizing neuromuscular blocking agents Action: -resemble ACh in body -prolonged depolarization of motor endplates -repolarization of the endplate doesn't occur normally -effects are partly r/t slower inactivation by cholinesterase |
| What are soem ADRs and important info seen with succinylcholine (anectine)? | ADRs: muscle weakness, bronchospasm, apnea, bradycardia, hypotension, arrythmias, ↑ salivation, post-op muscle pain, hyperthermia -Has low level toxicity -hydrolyzed by plasma cholinesterase (pseudocholinesterase) |
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