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Chapter 20 (anesthetics) Flashcards

1
Q

anesthesia

A

total or partial loss of awareness and sensation

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2
Q

topical, local, and regional anesthesia

A

all use same drugs, just administered differently

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3
Q

general anesthesia

A

numbs the brain by using centrally-acting drugs

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4
Q

LAs

A

local anesthetics; all are ‘caine’ drugs
Without affecting consciousness, they prevent propagation of nerve impulses by blocking Na channels along nerve axon to produce loss of sensation

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5
Q

tetrodotoxin

A

potent sodium channel blacker found in Japanese puffer fish, which causes muscle paralysis and death due to respiratory failure

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6
Q

pain relieving properties of anesthetics allows…

A

surgeries to be performed without patients going into shock from pain

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7
Q

topical anesthesia

A

accomplished using Na channel blocker creams, gels, ointments, or sprays to relieve pain, itching, and irritation due to bites, burns, scrapes, sunburn, or rash

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8
Q

EMLA cream

A

eutectic mixture of local anesthetic; topically applied LA used to numb skin over a vein for starting IVs in children

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9
Q

Zingo device

A

delivers lidocaine to skin of children undergoing venipuncture (IV) or line placement. Pressed against skin and pressurized helium gas and lidocaine painlessly numbs skin
*but each device costs $20 and can only be used once, so most people do not use them

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10
Q

topical anesthetics

A

applied to skin or mucous membranes. Can be used in nose/throat so doctors can do endoscopy or minor surgery.
Used often to intubate awake patients before you put them under to ensure you have the airway secured

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11
Q

Hurricaine spray

A

10-20% benzocaine spray; tastes very bad, but used to spray down throats/in mouth; Rx only

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12
Q

local anesthesia

A

produced with Na channel blockers (same drugs as with topical, but just in different formulations)

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13
Q

Novocain

A

procaine; original packaged and sold LA; not used much anymore b/c it causes more allergic reactions than other caines. Also used for regional blocks for regional anesthesia.

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14
Q

Xylocaine

A

lidocaine; LA that has less allergic reactions than procaine. Also used for regional blocks for regional anesthesia.
Short acting, lasts 1.5-2.5 hours

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15
Q

Marcaine

A

bupivacaine; LA that has less allergic reactions than procaine. Also used for regional blocks for regional anesthesia.
Longer acting; 0.5% injection will make numb for a day

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16
Q

local anesthetics

A

uses 1-2% concentration of caine drugs for injection, compared to like 10% for topical use
Often will add epinepherine to make it more like cocaine b/c then you get Na channel block combined with vasoconstriction, which makes drug last longer and less blood is lost in operation

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17
Q

RA

A

regional anesthesia; use various LAs to cause nerve block and lead to entire areas of body going numb

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18
Q

interscalene block

A

common RA approach for upper extremity surgery; use LA to block Na channels in brachial plexus

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19
Q

spinal or epidural blocks

A

can render insensate everything from ‘nipples down’

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20
Q

N2O

A

nitrous oxide; laughing gas that has pain-relieving properties, but does not put people to sleep

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21
Q

diethyl ether

A

original anesthetic gas used to put people to sleep
Not used on humans anymore
*used exclusively for 70 years, but replaced by halothane b/c it makes people vomit, sneeze, cough, gurgle, etc.

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22
Q

chloroform

A

anesthetic gas used to put people to sleep before ether; not used on humans anymore

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23
Q

softening people up

A

pre-anesthesia administered in holding room or pre-op area with a sedative hypnotic and/or opioid analgesic
Used to slowly start sedating person to relieve anxiety; usually it is easier on people and they recover more quickly when slowly eased into anesthesia

24
Q

drugs for pre-anesthesia

A

sedative hypnotics and/or opioid analgesics
Most common sedative hypnotic is benzodiazepine Versed (midazolam)
Most comomon opioid is mu rc agonist Sublimaze (fentanyl) and Sufenta (sufentanil)

25
Sublimaze
fentanyl; potent mu rc agonist used for pre-anesthesia
26
Sufenta
sufentanil; potent mu rc agonist used for pre-anethesia
27
Versed
midazolam; benzodiazepine used for pre-anesthesia
28
induction of anesthesia
In operating room GA is started with IV 'induction agent' uses same drugs as for pre-anesthesia (sedative hypnotics and opioid narcotics) as well as propofol to put someone to sleep
29
GA
general anesthesia
30
Pentothal
thiopental; barbiturate previously used to induce GA, but caused nausea and prolonged anesthesia and has now been replaced by Diprivan (propofol)
31
Diprivan
propofol; GA induction agent used by IV admin. Produces rapid loss of consciousness and prevent postoperative nausea (also helps counter nausea brought about from opioids) *very dangerous b/c can cause respiratory depression and death
32
maintenance of anesthesia
continued anesthesia achieved by potent inhaled anesthetics (given through vaporizer) or IV infusions of Diprivan (propofol) to keep patient asleep
33
halothane
inhaled anesthetic invented in 1940s/50s that replaced ether, but not used anymore on humans *still used in veterinary medicine b/c it is inexpensive
34
Ultane
sevoflurane; newer inhaled anesthetic that has tremendous advantages over ether
35
IV anesthetics
used in combination with inhaled anesthetics to: supplement GA, maintain GA, provide sedation, control BP, and protect brain
36
muscle relaxants
most people are referring to sedative hypnotic drugs that work centrally to relax brain and decrease motor activity going out to muscles, but when anesthesiologists use this term they are talking about NMBs
37
NMBs
neuromuscular blockers; paralytic agents; muscle relaxants derived from amazonian dart poison Antagonize nicotinic Ach rc at neuromuscular junction *have no sedative effect on brain
38
NMBs in operating room
used in anesthesia and ICUs to facilitate endotracheal intubation and in OR to allow less use of inhaled drugs and gives surgeon good operating conditions (relaxes belly muscles to make it easier to make cuts) Given by IV and all require ventilatory support
39
curare
original NMB that was used in amazonian dart poison
40
d-tubocurarine
NMB muscle relaxant like curare
41
Norcuron
vecuronium; NMB muscle relaxant
42
ventilated patients
paralytics (NMBs) are used with benzodiazepines, opioids, and propofol to prevent patients from 'fighting' mechanical ventilation (keep them immobile)
43
opioid sleep effects
in addition to treating pain, they bind to mu rc to produce 'narcotic', sleep inducing effects (especially if combined with benzodiazepines) Used with Diprivan (propofol) is very popular b/c it sedates patient, but also inhibits nausea caused by opioids
44
4% cocaine solution
very common topical anesthetic; Na channel blocker
45
ketamine
kappa rc agonist; most potent pain reliever we know of (besides general anesthesia)
46
atropine
congeners of this drug are used during general anesthesia to reduce secretions Atropine is used for dysrhythmias though, which its drying agent congeners are not used for
47
cyclopropane
inhaled anesthetic not used on humans anymore
48
Valium
diazepam; benzodiazepine sedative hypnotic used to sedate parts of brain and relieve muscle pain/spasm as a muscle relaxant
49
Soma
carisoprodol; muscle relaxant for pain/stiffness
50
Flexeril
cyclobenzaprine; muscle relaxant for pain/stiffness
51
paralytic agents
NMBs (neuromuscular blockers); used as strong, non-sedating muscle relaxants
52
most common drug administered to ventilated pts
oxygen; given to pretty much any pt. in emergency situation and in intensive care settings
53
ideal GA induction agent qualities
best given by IV, to produce a rapid loss of consciousness; any weakening of muscles would be a plus too b/c of the syngergism with actions of NMBs
54
benzodiazepines
sedative hypnotics that above all else in anesthesia, impart amnesia on pts., but also useful for inducing part of induction (but can't be used alone for inducing GA)
55
Robinul
glycopyrrolate; synthetic anticholinergic drug used as pre-operative antimuscarinic for drying agent. Reduces salivary, tracheobronchial, and pharyngeal secretions; reduces volume and free acidity of gastric secretions; and blocks cardiac vagal inhibitory reflexes during induction of GA and intubation *will cause some increase in HR, but not as much as atropine

Pre-pharmacology (27 decks)

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