pharm ch 11, kilgore lvl1
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| anesthetics | drugs that depress the central nervous system (CNS)
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| effects of anesthetics | -depression of consciousness
-loss of responsiveness
-muscle relaxation
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| anesthesia | a state of depressed CNS activity
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| General anesthesia | type of anesthetics that affects entire body (puts you to sleep)
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| Local anesthesia | type of anesthetic that only affects the part of body being worked on
-general conscience
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| balanced anesthesia | combination of anesthetic drugs
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| effects of general anesthetics | -pain relief
-depression of consciousness
-skeletal muscle relaxation
-reflex reduction
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| Inhaled anesthetics | volatile liquids or gases that are vaporized in O2 and inhaled
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| inhaled gas | nitrous oxide- (laughing gas)
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| Inhaled volatile liquids | -enfulrane (Ethrane)
-halothane (Fluothane)
-isoflurane (Forane)
-methoxyflurane (Penthrane)
-others
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| Injectable anesthetics | administered intravenously
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| effects of injectable anesthetics | -induce or maintain general anesthesia
-induce amnesia
-used as adjunct to inhalation-type anesthetics
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| Type of injectable anesthetics | etomidate (Amidate)
ketamine (Ketalar)
methohexital (Brevital)*
propofol (Ciprivan)*
thiamylal (Surital)
thiopental (Pentothal)*
* may also be used as adjunctive drugs at lower dosages
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| sedative-hypnotics | -used as adjunctive drugs
-barbiturates (secobarbital, thiopental)
-benxodiazepines (Diazepam, midazolam)
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| opioids (narcotics) | used as adjuctive drugs
-morphine, fentanyl, sufentanil
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| NMBAs (neuromuscular blocking drugs/agents | used as adjunctive drug to relax skeletal muscles
depolarizing and nondepolarizing drugs
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| Depolarizing drugs | type of NMBAs
-succinylcholine
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| Nondepolarizing drugs | type of NMBAs
-pancuronium, d-tubocurarine, vecuronium
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| anticholinergics | used as adjunctive drug
-atropine, glycopyrrolate, scopolamine
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| Overton-Meyer theory | anesthetics have high lipid soluability and therefore have a high potency
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| How anesthetics work | -orderly and systematic reduction of sensory and motor CNS functions
=progressive depression of cerebral and spinal cord functions
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| Effects of general anesthetics | -unconsciousness
-skeletal muscular relaxation
-visceral smooth muscle relation
-rapid onset and quickly metabolized
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| Adverse effects (AEs) of anesthetics | -vary btwn different drugs
-esp watch for Malignant hyperthermia- idiopathic
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| malignant hyperthermia- idiopathic | a severe AE of anesthetics that:
-occurs during or after general anesthesia
-sudden elevation in body temp over 104 F
-tachypnea, tachycardia, muscle rigidity
-life-threatening emergency
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| Local anesthetics/regional anesthetics | -renders a specific portion of body insensitive to pain
-interferes w/ nerve impulse transmission to specific areas of body
-do not cause loss of consciousness
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| Topical anesthetics | applied directly to skin or mucous membranes
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| Parenteral anesthetics | injected IV or into the CNS by various spinal injection techniques (Epidural)
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| Spinal or intraspinal anesthetics | type of local anesthesia
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| Intrathecal | anesthetics injected into the spinal cord (spinal tap)
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| Epidural | type of local anesthetic
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| Nerve block | type of local anesthetic injected diretly into the nerve area (Dental work)
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| Lidocaine (Xylocaine) | parenteral anesthetic drug that is a blocker and is injected
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| steps to paralysis via anesthetics | -autonomic activity is lost
-pain and other sensory functions are lost
-motor activity is lost last
wears off in reverse order
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| surgical, dental, diagnostic procedures, treatment of certain types of chronic pain | what local anesthetics are used for
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| inflitration anesthesia & Nerve block anesthesia | types/routes of local anesthetics given
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| infiltration anesthesia | used in/for:
-minor surgical and dental proceduress
-injection ID, subcut, or submucosally across the path of nerves supplying the target area
-may be given in a circular pattern around the operative area
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| Nerve block anesthesia | -can cause problems if too high concentration in body
-injected directly into or around the nerve trunks of nerve ganglia that supply the target area
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| Major AEs of infiltration and Nerve block anesthesia | "spinal headache" and epidural blood patch
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| Uses of NMBAs | -to prevent nerve transmission, resulting in paralysis
-used with anesthetics during surgery
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| Special considerations for NMBAs when used during surgery | -cause paralysis of respiratory and skeletal muscles
-client unable to breathe w/o mechanical respiration
-does not cause sedation or pain relief
-client may be paralyzed AND conscious
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| types of NMBAs-nondepolarizing drugs | -short acting (mivacurium-Maacacron)
-intermediate acting (atracurium-Tracrium, vecuronoim-Norcuron, rocuronium-Zemuron)
-long acting (pancuronium-Pavulon, doxacurium-Nuromax, d-Tubocurarine-dTC)
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| Succinylcholine | NMBA- depolarizing drug
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| function of Succinylcholine | -similar to ACh in causing depolarization
-slower metabolism than ACH, repolarization cannot occur while present
-causes flaccid muscle paralysis
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| function of nondepolarizing NMBAs | -prevent ACh from acting at neuromuscular junctions
-muscle fibers are not stimulated bc nerve cell membrane is not depolarized
-skeletal muscle contraction does not occur
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| sequential effects of NMBAs | -muscle weakness initially followed by total flaccid paralysis
-small, rapidly moving muscles 1st affected
-then larger muscles
-finally intercostal muscles and diaphragm are affected resulting in cessation of respiration
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| main uses of NMBAs | -maintaining controlled ventilation during surgical procedures
-endotracheal intubation (short acting)
-reduction of muscle contraction in target area
-diagnostic drugs for myasthenia gravis
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| AEs of NMBAs | Serious:
-Hypotension (blockade of autonomic ganglia
-Tachycardia (Blockade of muscarinic receptors
-Hypotension (release of histamine
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| Overdose of NMBAs symptoms | -Cardiovascular collapse
-conscious sedation, moderate sedation, procedural sedation, a semi-conscious effect
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| Moderate sedation (conscious sedation, procedural sedation) | used for diagnostic/minor surgical procedures that do not require deep anesthesia
-recovery time better than gen. anesthesia
-greater safety profile than gen. anesthesia
-client may have no memory of experience
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| vital assessment during pre-, intra- and postoperative phases | -vital signs
-baseline labwork, ECG
-Pulse oximeter (PO2)
-ABCs
-all body systems
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| what to watch for during recovery | cardiovascular depression, respiratory depression and Major complications of anesthesia
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| propofol | -IV general anesthetic drug
-used in ICU and other critical care settings for induction and maintenacne of anesthesia/sedation
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| succinylcholine | -only depolarizing NMBA available
-ultra-short-acting, but is more slowly metabolized than ACh
-adjunct to general anestehsia for flaccid paralysis of muscle
-stimulates motor endplate to ongoing depolarizing, repolarization cannot occur and muscles ca
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| vecuronium | -intermediate-acting NONdepolarizing NMBA
-adjunct to gen. anesthesia
-most useful in procedures requiring mechanical ventilation
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