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Pathopharm III > Chapter 19: Drugs for Local and General Anesthesia - Prototype Drugs > Flashcards

Chapter 19: Drugs for Local and General Anesthesia - Prototype Drugs Flashcards

1
Q

What is the prototype drug for Amides

A

lidocaine

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2
Q

What is the MOA of lidocaine?

A

Acts by stopping axonal conduction by blocking sodium channels

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3
Q

What is lidocaine used for?

A
  • used for brief medical or dental procedures
  • may be injected as a nerve block for spinal and epidural anesthesia
  • patches may be admin to relieve pain
  • may be given topically before painful procedures
  • may be given IV, IM or SubQ to treat dysrhythmias
  • mouthwashes and rinses can be compounded to help ease pain associated with mouth and throat infections
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4
Q

are lidocaine side effects common when used for anesthesia?

A

No

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5
Q

What is an early symptom of lidocaine toxicity?

A

CNS excitement leading to irritability and confusion

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6
Q

What are serious adverse effects of lidocaine?

A
  • convuslions
  • respiratory depression
  • cardiac arrest
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7
Q

how might a patient injure themselves after dental procedures where lidocaine was used?

A

pts may injure themselves by biting or chewing areas of the mouth that have no sensation following a dental procedure until the effect of the anesthetic diminishes

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8
Q

What is the route of lidocaine?

,

A

IV, IM, SubQ, topical

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9
Q

What are some adverse effects of lidocain?

A
  • solutions of lidocain containing preservatives or epinephrine are intended for local anaesthesia only and must never be given parenterally for dysrhythmias
  • do not appy topical lidocaine to large skin areas or to broken or abraded areas - significant absorptrion may occur
  • do not allow it to come into contact with the eyes
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10
Q

What pregnancy category is lidocaine?

A

Pregnancy category B

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11
Q

Lidocaine black box warning

A
  • use of 2% oral viscous lidocaine products, especially among infants, may lead to ingestion that cannot be predicted or controlled.
  • when excessive amounts of lidocain are administered to infants and young children, or they accidentally swallow too much, it can induce seizures, brain injury, cardiac abdormalities, and death
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12
Q

what are lidocaine contraindications

A
  • avoided in cases of sensitivity to amide-type local anaesthetics
  • in presence of severe trauma or sepsis, blood dyscrasias, dysrhythmias, sinus bradycardia, and sever degrees of heart block
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12
Q
A
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13
Q

which drug may decrease the activity of lidocaine?

A

Barbiturates

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14
Q

What drugs may increase the effects of lidocaine?

A

cimetidine, quinidine, and beta blockers

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15
Q

What are lidocaine lab testes

A

increased creatine phosphokinase (CPK)

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16
Q

what are symptoms of lidocaine OD

A
  • breathing difficulty
  • swelling of the lips
  • chest pain
  • irregular hearbeat
  • N/V
  • treamors
  • seizure activity
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17
Q

What therapy is given for lidocaine OD

A

Lipid infusion therapy (LipidRescue) - an intravascular infusion of lipid emulsion to treat severe, systemic drug toxicity or poisoning

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18
Q

inhalation agents: gaseous Agent prototype drug

A

Nitrous Oxide

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19
Q

What is the MOA of Nitrous Oxide

A
  • acts by suppressing pain mechanisms in the CNS
  • has low potency and does not produce complete loss of consciousness or profound relaxation of skeletal muscle
  • because nitrous oxide does not induce surgical anesthesia (stage 3), it is commonly comvined with other surgical anesthetic agents
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20
Q

What is Nitrous oxide used for?

A

ideal for short surgical or dental procedures because the patient remains conscious and can follow instructions while experiencing full analgesia

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21
Q

what adverse effects of nitrous oxide to patients experience at higher doses

A
  • anxiety
  • excitement
  • combativeness
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22
Q

what are other adverse effects of nitrous oxide?

A
  • as it is exhaled, the patient may temporarily have some difficulty breathing at the end of a procedure
  • N/V following the procedure are more common with nitrous oxide thatn with other inhalation anesthetics
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23
Q

what is the route of nitrous oxide

A

inhalation

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24
Q

what is the onset of nitrous oxide?

A

less than 5 minutes

25
Q

what is nitrous oxide always combined with

A

oxygen (25-30%)

26
Q

what should be established with nitrous oxide in the case of an emergency?

A

an IV

27
Q

Nitrous oxide has the potential to be abused. True or False?

A

True

28
Q

What is contraindicated with nitrous oxide?

A
  • impaired LOC
  • head injury
  • inability to comply with instructions
  • decompression sickness (nitrogen narcosis)
  • clients with decreased oxygen status
29
Q

what drugs may exacerbate dysrhythmias when taken with nitrous oxide?

A

sympathomimetics and phosphodiesterase inhibitors

30
Q

what herbal/food product may lower the potential risk of liver damage when taken with nitrous oxide?

A

milk thistle

31
Q

What is the treatment of nitrous oxide OD?

A

metoclopramide may help reduce the symptoms of N/V

32
Q

general anesthetics: volatile liquid prototype drug

A

isoflurane

33
Q

what is the MOA for isoflurane?

A

produces a potent level of surgical anesthesia that is rapid in onset

34
Q

What is isoflurane used for?

A

provides excellent muscle relaxation and may be used off-label as adjuvant therapy in the treatment of status asthmaticus

35
Q

other actions and uses of isoflurane?

A
  • Isoflurane with oxygen or with an oxygen and nitrous oxide mixture may be used
  • compared to other inhaled general anesthetic, cardiac output is well maintained
36
Q

What are common adverse effects of isoflurane

A

mild N/V, and treamor

37
Q

What are some other adverse effects of isoflurane?

A
  • does-dependent respiratory depression and a reduction in blood pressure
  • malignant hyperthermia with elevated temperature has been reported
38
Q

What is the route of isoflurane?

A

inhalation

39
Q

What is the pregnancy category of Isoflurane?

A

pregnancy category C

40
Q

What is the onset and duration of isoflurane?

A

onset is 7-10 minutes and duration is less than 1 hour after drug discontinued

41
Q

What are the contraindications of Isoflurane?

A
  • known hx of genetic predisposition to malignant hyperthermia
  • caution when treating patients with head trauma or brain neoplasms –> possible increases in intracranial pressure
  • older adult patients are more susceptible to hypotension
42
Q

What may occur when isoflurane is used with nitrous oxide?

A

coughing, breath holding and laryngospasms

43
Q

What may happen with aminoglycosides are admin with isoflurane?

A

skeletal muscle weakness, respiratory depression, or apnea may occur

44
Q

What may occur if Isoflurane is administered with other skeletal muscle relaxants

A

additive effects

45
Q

What may happen when isoflurane is taken concurrently with antihypertensive such as betablockers

A

additivite hypotension

46
Q

What drugs should be administered with caution when given concurrently with Isoflurane, d/t the possibility of dysrhythmias

A

Epinephrine, norepinephrine, dopamine, other adrenergic agonist

47
Q

What herbal/food products should be discontinued 2-3 weeks prior to admin d/t the possible risk of hypotension

A

St. Johns wort

48
Q

What is the treatment of OD for Isoflurane?

A

since isoflurane causes profound respiratory depression, patients are treated symptomatically until effects of the drug diminish

49
Q

What is the prototype drug for neuromuscular blockers?

A

Succinylcholine

50
Q

What is the MOA of succinylcholine?

A

acts to cholinergic receptor sites at neuromuscular junctions

51
Q

What is succinylcholine used for?

A

used for skeletal muscle paralysis

52
Q

What is succinylcholine rapidly broken down by?

A

enzyme cholinesterase

53
Q

What effects are noted when taking succinylcholine

A

muscle weakness and spasms

54
Q

What are the adverse effects of succinylcholine

A
  • can cause complete paralysis of the diaphragm and intercostal muscles
  • bradycardia and respiratory depression are expected adverse effects
  • if doses are high, the ganglia are affected, causing tachycardia, hypotension, and urinary retention
  • use cautiously with fractures or muscle spasms - initial muscle fasciculations may cause addition trauma
  • malignant hyperthermia can result

-

55
Q

What is the route of succinylcholine and what is the pregnancy category

A
  • IV
  • preg cat C.
56
Q

what is the black box warning for succinylcholine

A
  • should be administered in a facility with trained personal to monitor, assisk, and control respirations
  • cardiac arrest has been reported resulting from hyperkalemic rhabdomylosis most frequently ininfants or children with diagnosedskeletal muscle myopathy or Duchenne muscluar dystrophy.
  • This drug is reservfed for use in children in cases of emregency intubation or in instance when immediat securing of air is necessary
57
Q

What is contraindicated with succinylcholine

A
  • use with extreme caution in patients with severe burns or trauma, neuromuscular diseases, or glaucoma
  • in patients with a family hx of malignant hyperthermia or conditions of pulmonary, kidney, cardiovascular, metabolic, or liver dysfunition
58
Q

What are interactions of succinylcholine

A
  • additive skeletal muscle blocade will occur if succinylchole is given concurrently with clindamycin, aminoglycosides, furosemide, lithium, quinidine or lidocaine
  • effects may be increased if given concurrently with phenothiazines, oxytocin, promazine, tacrine, or thiasie diuretics
  • effects may be decreased if given with diazepam
  • increased risk of bradycardia, dysrhythmias, sinus arrest, apnea, and malignant hypertherma exists
  • if given with cardiac glycosides, tehre is increased risk of cardia dysrhythmias
  • if given with narcotics, there is increasd risk of braddcar and sinsu arrest
59
Q

What is the treatment of Osuccinylcholine OD

A
  • may invovle drug therapy for the follwoing symptoms: weakness, lack of coordination, watery eyes and mouth, tremors and seizures
60
Q
A

Pathopharm III (9 decks)

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