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Clinical Med (Year 2) > Pharm Quiz 2 > Flashcards

Pharm Quiz 2 Flashcards

1
Q

What is the goal of general anesthesia?

A

absence of all perceived sensations

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2
Q

What is the purpose of general anesthesia?

A

Allow detailed surgical procedures with minimal harm to patient

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3
Q

What was the “anesthesia” before 1846?

A
  • Unconsciousness from strangulation or blow to head
  • Drugs for pain
  • Physical restraint
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4
Q

What was anesthesia after 1846?

A
  • First use of ether
  • Development of safer, less toxic drugs
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5
Q

What are the general requirements of general anesthesia?

A
  • Loss of consciousness (perceived sensation)
  • Amnesia
  • Inhibition of reflexes
  • Skeletal muscle relaxation
  • Safe, transient, predictable
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6
Q

What are the stages of general anesthesia?

A
  1. Analgesia
  2. Excitement/delirium
  3. Surgical anesthesia
  4. Medullary paralysis
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7
Q

What are the general anesthetics inhalation agents?

A
  • Halogenated liquids
  • Nitrous oxide
  • Other gases
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8
Q

What are the general anesthetic IV agents?

A
  • barbiturates
  • benzodiazepines
  • opioids
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9
Q

Injected anesthetic take effect (BLANK) but are (BLANK) to control level

A

quickly
more difficult

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10
Q

Inhaled anesthetic take effect (BLANK) but (BLANK) to control level

A

slowly
easier

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11
Q

What is the general protocol to how general anesthesia is administered?

A
  • Patient start with small dose of injected to get patient under quickly
  • Switch to inhaled agent for duration of procedure
  • Start to withdrawal inhaled agent ASAP
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12
Q

How is balanced anesthesia provided?

A

Use 2 or more agents

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13
Q

What is the mechanism of action for general anesthetics?

A

Increase inhibition or decrease excitation throughout CNS by directly effecting neuronal receptors or combo of lipid & receptor effects

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14
Q

What is the purpose of anesthetic adjuvants given pre/post op?

A
  • Relax & sedate patient prior to surgery
  • Reduce post-op nausea & vomiting
  • Reduce of there problems related to anesthesia
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15
Q

What do Neuromuscular junction blockers do?

A
  • Paralyze skeletal muscles to facilitate positioning on table, prevent spasms, allow easier mechanical ventilation
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16
Q

What are the 2 type of NMJ blockers?

A
  • Depolarizing
  • Nondepolarizing
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17
Q

How long do the effects of NMJ blockers last?

A

Short durations- lasting from a few minutes to an hour or so

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18
Q

What can NMJ blockers cause post op?

A

Muscle soreness

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19
Q

What is a very rare effect of NMJ blockers?

A
  • Some patients may lack certain metabolizing enzymes and remain paralyzed at end of surgery
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20
Q

What is dissociative anesthesia?

A

Patient remains conscious but indifferent to surroundings

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21
Q

How is dissociative anesthesia achieved?

A

Use of ketamine or combo of antipsychotic with opioid

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22
Q

When is dissociative anesthesia useful?

A

-Diagnostic/radiologic procedures
- Dressing changes
- Emergency surgeries

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23
Q

What are some residual effects of general anesthesia?

A

-Chills/shivering
- Nausea, vomiting
- Sore throat
- Cognitive effects

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24
Q

What short term cognitive effects can occur from general anesthesia?

A

-Confusion
- Lethargy

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25
Q

What populations will see some possible long-term cognitive effects of general anesthesia?

A

In older adults and patients with comorbidites

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26
Q

What is the Rehabilitation concerns of general anesthetics?

A
  • muscle soreness
  • respiratory hygiene
  • confusion, altered cognition
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27
Q

What is the goal of local anesthesia?

A

Interrupt nerve condition at site of application

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28
Q

What is the purpose of local anesthesia?

A

Prevent or relieve pain without loss of consciousness or systemic effects

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29
Q

What is the suffix of typical local anesthetics?

A

-Caine

30
Q

What is the mechanism of local anesthetics?

A

-Bind to sodium channels in nerve membrane
- Inactivate sodium channels, prevent action potential conduction

31
Q

How are local anesthesias administrated?

A

-Topical
- Transdermal
- Inflitration
- Nerve block
- Spinal/ epidural block
- Sympathetic block
- Intravenous regional anesthesia

32
Q

Where is topical local anesthesia applied?

A

surface of skin

33
Q

What is topical local anesthesia applied for?

A

Pain relief
Minor burns
Abraison
Prior to injections or IV insertion

34
Q

How is transdermal application enhanced by?

A
  • Electricity (iontophoresis)
  • Ultrasound (Phonophoresis)
  • other chemicals
35
Q

Where is infiltration local anesthesia applied?

A
  • Injected subcutaneously
  • Allowed to penetrate/infiltrate into selected area
36
Q

When is infiltration commonly used?

A

Before suturing wounds

37
Q

Where are peripheral nerve blocks injected and commonly used for?

A
  • Injected close to nerve or nerve plexus
  • Commonly used for dental procedures, other minor surgeries
38
Q

Where is an epidural administered?

A

Outside of dura

39
Q

Where is a spinal block administered?

A

Into subarachnoid space

40
Q

Where is a sympathetic block inserted to target UE?

A

Stellate ganglion

41
Q

Where is a sympathetic block inserted to target LE?

A

L4, L5 chain ganglia

42
Q

What is an intravenous regional anesthesia (bier block) and how does it remain in limb?

A

-Local anesthetic injected into venous system of affected arm or leg
- Tourniquet placed proximally to keep drug in limb

43
Q

How is a continuous nerve block administered and used?

A
  • Admin: Small catheter is implanted near peripheral nerves to a specific region
  • Local anesthetic dripped slowly/continuously onto nerve
44
Q

What is the pro and con of continuous nerve block?

A
  • Pro: excellent post-op pain control
  • Con: Loss of sensation, motor function, proprioception when block is in effect
45
Q

What does differential nerve block effect?

A

Smallest (unmyelinated fibers 1st) then largest myelinated fibers

46
Q

What is the typical order of functional loss with differential nerve block?

A

-Pain
- Temp
-Touch
- Proprioception
- Motor

47
Q

What does LAST stand for in the local anesthetics?

A

Local anesthetic system toxicity

48
Q

What are some symptoms of LAST with CNS toxicity?

A

-Ringing/buzzing in ears (tinnitus)
- Agitation, restlessness, seizures
- Decrease sensation in tongue and mouth, areas of skin
- Later stages: CNS depression (including respiratory depression/failure)

49
Q

What are some symptoms of cardio toxicity due to LAST?

A
  • Changes in heart rate (bradycardia)
  • Other ECG abnormalities
  • Clinical signs of cardiac depression (fatigue, dizziness)
  • Cardiac arrest
50
Q

What is the primary goal of muscle relaxants?

A

Selective decrease in skeletal muscle excitability

51
Q

What are muscle relaxants primarily used for?

A

Muscle spasm spasticity

52
Q

What is a muscle spasm?

A
  • Injury to muscle, peripheral nerve
  • Tonic contraction in paraspinals, traps
53
Q

What is spasticity?

A

CNS legion
Exaggerated stretch reflex

54
Q

What are some agents used to treat muscle spasm?

A
  • Centrally acting anti-spasm drugs
  • Diazepam
55
Q

What are centrally-acting Antispasmodic drugs?

A

-Diverse groups of drugs
- used commonly in back, neck spasm, other orthopedic injuries

56
Q

What is the mechanism of Central antispasm drug Carioprodol?

A

-Enhance GABA inhibition in brain

57
Q

What is the mechanism of Central antispasm drug cyclobenzaprine?

A

Increase serotonin in brainstem

58
Q

How does Diazepam work?

A
  • Works in CNS to increase inhibitory effects of GABA
  • Less excitation leads to muscle relaxation
59
Q

What is Baclofen?

A

Synthetic GABA
- Stimulates receptors in cord
- Decreases excitation of alpha motor neuron
- Administered intrathecally

60
Q

When is intrathecal baclofen used and how is it delivered?

A
  • Used in severe spasticity
  • Delivered by catheter and pump to deliver drug to subarachnoid space
61
Q

What are some signs of intrathecal baclofen overdose?

A
  • Decrease respiration
  • Decrease cardiac function
  • Stupor
  • Coma
62
Q

What are some signs of intrathecal baclofen withdrawal?

A
  • Fever
  • Confusion
  • Hallucination
  • Seizures
63
Q

What is the primary agent of Alpha- 2 agonists?

A

Tizanidine

64
Q

How do Alpha-2 agonist work?

A
  • Stimulates alpha 2 receptors located on spinal interneruon
  • Cause inhibition of interneurons (decrease excitatory input onto alpha neuron)
65
Q

How does Gabapentin work?

A
  • Inhibits Ca entry presynaptic terminals, decrease release of glutamate (other excitatory neurotransmitters)
66
Q

How does Dantrolene work?

A
  • Only direct- acting muscle relaxant
  • Inhibits release of calcium from skeletal muscle SR
67
Q

What is Botulinum toxin and where is it injected?

A
  • Muscle paralytic
  • Injected locally into skeletal muscle for severe spasms
68
Q

What is the mechanism of botulinum toxin?

A

Inhibits Ach release at skeletal NMJ

69
Q

When does relaxation occur and how long does it last after botulinum is injected?

A
  • Occur within 3-7 days
  • Lasts 2-3 months
70
Q

What are some signs of botulinum overdose?

A
  • Drooping eyes
  • Difficulty speaking/swallowing
  • General muscle weakness
  • Respiratory distress
71
Q

What are the agents used to treat spasticity?

A
  • Diazepam
  • Baclofen
  • Alpha 2 agonist
  • Gabapentin
  • Dantrolene
  • Botulinum toxin

Clinical Med (Year 2) (17 decks)

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