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pharmacology > Drugs for Local and General Anesthesia > Flashcards

Drugs for Local and General Anesthesia Flashcards

1
Q

what is general anesthesia?

A
  • a loss of sensation/movement throughout the body, accompanied by a loss of consciousness
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2
Q

what is local anesthesia

A
  • a loss of sensation to a limited body region, with no loss of consciousness
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3
Q

what is regional anesthesia

A
  • a loss of sensation to a larger body area, with no loss of consciousness
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4
Q

what is monitored anesthesia care?

A
  • sedation; client remains responsive

- used during diagnostic procedures, or in combination with local anesthesia for minor surgeries

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5
Q

what are the 5 routes of administration ?

A
  • topical, infiltration, nerve block, spinal, epidural
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6
Q

topical?

A
  • applied to mucus membranes including the eyes, lips, and gums
  • creams, sprays, drops, suppositories
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7
Q

infiltration ?

A
  • drug is diffused into tissue to block a specific group of nerves in a small area close to the surgical site
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8
Q

nerve block?

A

-drug affects nerve bundles serving the surgical area, used to block sensation in a limb or larger area of the face

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9
Q

what is spinal administration? where is it injected to?

A
  • drug affects large, regional area such as the lower abdomen and legs
  • injection into the CSF
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10
Q

where is an epidural administered?

A
  • used in obstetrics during labour and delivery

- injection into the epidural space of the spinal cord

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11
Q

what are the mechanisms of action for local anesthetics?

A
  • block voltage-gate sodium channels
  • inhibit motor and sensory neuronal signalling
  • bind to open sodium channels
  • active neurons are most susceptible
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12
Q

to improve duration of action, local anesthetics are sometimes co-administered with what & why?

A
  • epinephrine

- causes vasoconstriction so the local anesthetic cannot leave the area and therefore is metabolized

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13
Q

ester anesthetics

A
  • rapidly metabolized in the bloodstream
  • short half-life of 1 to 2 minutes
  • pKa ranges from 8.6-8.9
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14
Q

amide anesthetics

A
  • metabolized in the liver
  • longer half-life of 60 to 240 minutes
  • pKa ranges from 7.5-8.0
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15
Q

what form of anesthesia is an epidural? where is it administered?

A
  • a form of regional anesthesia

- injection of drug into fat-filled epidural space

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16
Q

What is the mechanism of action for an epidural?

A
  • exerts an effect on any nerve that comes into contact with the drug
  • some drug will diffuse into the arachnoid space
17
Q

what form of anesthesia is intrathecal anesthesia? where is it administered?

A
  • a form of regional anesthesia
  • injection of a local anesthetic directly into CSF
  • administered: surgical scheduled procedure, rarely used during labour
18
Q

rate of efficacy between epidural and intrathecal anesthetics

A
  • intrathecal has a higher rate of efficacy compared to epidural, requires less anesthetic than epidural
19
Q

how are opioids used in regional anesthesia?

A
  • administered in the epidural space
  • bind to presynaptic receptors in the substantial gelatinosa, inhibiting the release of pain signalling neurotransmitters in the spinal cord
  • bind to postsynaptic receptors in the brain decreasing neuronal excitability
20
Q

do opioids have an effect on motor neurons?

A
  • no: mobility, proprioception, and sense of touch are maintained
21
Q

what kind of pain do opioids control?

A

-visceral pain

22
Q

what are some adverse effects of opioids?

A
  • itchiness
  • nausea and vomiting
  • respiratory depression
23
Q

what are some adverse effects of spinal and epidural anesthesia?

A
  • backache
  • infection
  • inadequate anesthesia
  • arachnoiditis
  • spinal headache
24
Q

what are the four stages of general anesthesia?

A
  1. analgesia
  2. disinhibition
  3. surgical anesthesia
  4. medullary depression
25
Q

step 1: analgesia

A
  • loss of pain; client loses general sensation but may be awake
26
Q

step 2: disinhibition

A
  • excitement and hyperactivity; patient may be delirious and try to resist treatment.
  • heart rate and breathing may become irregular and blood pressure may increase
27
Q

stage 3: surgical anesthesia

A
  • skeletal muscle becomes relaxed and delirium stabilizes

- cardiovascular and breathing activities stabilize, eye movements slow and the patient becomes still

28
Q

stage 4: medullary depression

A
  • paralysis of the medulla region in the brain
29
Q

what is intravenous anesthesia co-administerd with and what does it induce?

A
  • co administered with inhaled general anesthetics once the client loses consciousness
  • induces analgesia, sedation, muscle relaxation, and LOC
30
Q

mechanism of action of inhaled general anesthetics

A
  • prevent flow of sodium ions into neurons in the CNS, reducing neuronal activity
31
Q

gaseous inhaled anesthetics (nitrous oxide)

A
  • high minimum alveolar concentration, but strong analgesic properties
  • used in dental procedures, during labour
32
Q

volatile liquids (isoflurane)

A
  • low mean alveolar concentration to be knocked out, poor analgesic properties
33
Q

what should patients be monitored for post-op?

A
  • nausea/vomiting
  • CNS depression
  • resp depression
  • changes in vital signs
34
Q

what drugs are available for patient pre-op?

A
  • benzodiazepines: anti-anxiety and mild sedative effects
  • anticholinergics: dry resp and oral secretions
  • histamine (H2) receptor antagonists: decrease gastric fluid volume
35
Q

what drugs are available for patients during surgery?

A
  • neuromuscular blockers: induce relaxation of skeletal muscle
36
Q

what drugs are available for patient post-op?

A
  • pain management: opioids and NSAIDS
  • antiemetics: reduce nausea and vomiting associated with anesthesia
  • cholinergic: stimulate smooth muscle contraction in the GI tract and bladder to induce peristalsis and urination
37
Q

the purpose of general anesthesia is to induce..

A
  • analgesia
  • sedation
  • relaxation
  • hypnosis
  • amnesia
  • loss of reflexes
38
Q

what is balanced anesthesia?

A

-no single drug can safely accomplish all 6 effects , thus balanced anesthesia is used

39
Q

what drugs classes are used in balanced anesthesia?

A
  • neuromuscular blockers, short acting benzodiazepines, opioids, and general anesthetics

pharmacology (14 decks)

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