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test 2 - surgical medications Flashcards

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1
Q

medications related to surgery

A 
nitrous oxide 
isoflurane 
propofol
fentanyl
midazolam
procaine and lidocaine 
rocuronium
succinylcholine
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2
Q

balanced anesthesia

A

using a variety of anesthetics for the best results… to provide sleep, analgesia, elimination of certain reflexes and good muscular relaxation

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3
Q

inhalation anesthetics

A

gaseous

volatile agents

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4
Q

intravenous anesthetics

A

hypnotics - barbiturates, short acting
narcotics
other – neuroleptic like

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5
Q

local anesthetics

A

esters and amides

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6
Q

adjunct anesthetics

A

skeletal muscle relaxant

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7
Q

how can the dosage of inhalation anesthetics be controlled

A

controlled by anesthetist

both inhalation and exhalation

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8
Q

type of gaseous general anesthetic

A

nitrous oxide “laughing gas”

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9
Q

action of nitrous oxide

A

produce narcosis
analgesia
amnesia to varying degrees (through causing progressive depression of CNS; GABA-receptor agonist, opioid agonist

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10
Q 
pharmacokinetics of nitrous oxide 
absorption 
distribution 
metabolism 
excretion
A

A: rapid and diffused through alveoli
D: readily passes BBB
M: not metabolized
E: rapid and complete through lungs

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11
Q

ADRs of nitrous oxide

A
  • mostly free of toxicity effects when given WITH OXYGEN
  • compromises normal tissue oxygenation if balance not adequate
  • toxic suppression of CNS can occur
  • post-op nausea and vomiting can occur
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12
Q

special information for nitrous oxide

A
  • greatest use as induction agent
  • must be given in combination with oxygen (AT LEAST 30%)
  • must be given with other agents, except in very short procedures
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13
Q

volatile anesthetic agents classification

A

inhaled general anesthetic (volatile liquid)

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14
Q

volatile anesthetic agents overview

A

more soluble in blood, intercellular fluid and fatty tissue than gaseous anesthetics
slower onset in induction and slower recovery
high solubility can allow tissue and blood concentrations to build up unless carefully titrated

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15
Q

prototype volatile drug

A

isoflurane (forane)

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16
Q

action of isoflurane

A

progressive depression of CNS (exact action is unknown)

GABA and glutamate receptor agonist

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17
Q

other effects of isoflurane

A

hypotension from vasodilation, not cardiac output effects
resp – less efficient exchange of gas; rapid and shallow resp; respiratory depression
muscle – some relxation by central depression
liver – depressed function

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18
Q

pharmacokinetics of isoflurane

A 
A = rapid
D = throughout body; crosses BBB
onset = 7-10 mins, duration = 7-19 mins 
M = minimal 
E = via respiratory (exhaled breath)
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19
Q

ADR of isoflurane

A

hypotension (from vasodilation)
significant respiratory depression
can “trigger” malignant hyperthermia; especially in conjunction with succinylcholine

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20
Q

special information about isoflurane

A

relaxes the tracheal area and depresses the reflexes – which simplify tracheal intubation
if alone – is not a potent analgesic… has some mild skeletal muscle relaxant effects… THEREFORE need an agent for quick induction and one for muscle relaxant. If used alone, however, you can see the pt going through stages of anesthesia because of slow onset
PT may shiver coming out of anesthesia

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21
Q

related drugs to isoflurane

A

desflurane (suprane)

sevoflurane (ultane)

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22
Q

IV anesthetics overview

ADV

A

rapid, pleasant induction, absence of explosive hazards and low incidence of postop N/V

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23
Q

IV anesthetics overview

DISADV

A

laryngospasm
bronchospasm
hypotension
respiratory arrest

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24
Q

IV anesthetics overview

uses!!

A

induce and maintain general surgical anesthesia, basal anesthesia and hypnosis
usually use short-acting and ultra-short acting barbiturates and also narcotics

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25
MAJOR DIFFERENCE BETWEEN BARBITURATES AND GASEOUS AGENTS IS...
SAFETY!!! inhalation anesthetist controls minute by minute administration and removal IV once administered, course of events must continue until out of the system
26
barbiturates classification
IV general anesthetics, ultra short acting
27
prototype drug for barbiturates:
Propofol (diprivan)
28
action of propofol (diprivan)
promote the release of GABA | has short duration of anesthesia action
29
pharmacokinetics of propofol
A: rapid D: onset = 60 seconds; length of action = 3-5 mins M = hepatic excretion = kidney
30
ADRs for propofol
Respiratory depression, hypotension from vasodilation risk of bacterial infection (in lipid-based emulsion) propofol infusion syndrome (rare); injection site pain. Actually has antiemetic properties.
31
special information for propofol
Induction is smooth, easy, & pleasant for patient. Not recommended for patients with severe heart disease or respiratory difficulties. NOT a controlled substance. Is a milky-white solution (“milk of amnesia”)
32
commonly used IV anesthetics
etomidate (amidate) | fentanyl/droperidol combination (innovar)
33
etomidate (amidate) uses
hypnotic agent used for induction of anesthesia; useful for those with heart issues who cannot tolerate propofol since minimal cardiac effects
34
fentanyl/droperidol combination (innovar) uses
an opioid and neuroleptic combination used for “neurolept analgesia” anesthetic dissociative
35
narcotics use
used as anesthetic as well as preoperatively, and for analgesia
36
what is fentanyl sublizamaze
- narcotic anesthetic | - prototype drug!
37
action of fentanyl
Morphine-like action (100 times as potent as morphine) (See opioid analgesic section of supplement listing Morphine Sulfate) – opioid agonist ** remember not used to help someone sleep, moreso for pain**
38
pharmacokinetics for fentanyl
A = for surgery, usually IV so absorption is bypassed *used often in surgery/post surgical care* D = diffuse. factor onset than morphine, with short duration M = liver E = kidney RAPID ONSET! VERY SHORT DURATION
39
how to remember that fentanyl only takes a small amount
think about when people get drugs but they're laced with fentanyl since it only takes a little amount --> OD
40
why is absorption bypassed with fentanyl
it is bypassed when given IV since it is going straight into the bloodstream
41
ADRs of fentanyl
euphoria miosis (pin-point pupils, might indicate if an unconscious person ODed) N/V pruritus (itching) constipation (key for all opioids) hypotension respiratory depression, bradycardia (when people are having surgery, need to pay close attention to resp/cardiac)
42
what is the black box warning for fentanyl
SIGNIFICANT ABUSE POTENTIAL!!
43
special information for fentanyl
Rapid IV injection or large doses may cause muscle rigidity & apnea - observe closely! 2. Topical patches (Duragesic) used for analgesia; change q 72 hours for pain control. 3, Also lozenge on a stick (Actiq) and buccal tablets (Fentora)
44
other neuroleptic like... ex KETAMINE (ketalar)
Categorized as “dissociative” anesthetics. They induce a trance-like effect characterized by analgesia, quietude, and detachment from the environment without loss of consciousness. Neuroleptanesthesia is often produced by administration of a neuroleptic agent, a narcotic analgesic, and sometimes nitrous oxide with oxygen. *Also being used for treatment of Major Depression now
45
midazolam (versed) classification
IV anesthetic, benzodiazepine
46
action of midazolam
neuroleptic effect, exact action unknown. Acts on limbic, thalamic, and hypothalamic regions to cause CNS depression and skeletal muscle relaxation. Also prevents seizure activity. (Probably potentiates GABA (inhibitory neurotransmitter)
47
pharmacokinetics of midazolam
Absorption- Only given parenterally Distribution- Diffuse. Does cross the blood-brain barrier and placenta. Peak-half-hour to one hour; half-life 2.5 hrs. Metabolism- liver Excretion- kidney
48
ADRs of midazolam
Respiratory depression (even respiratory arrest)-BLACK BOX, decreased alertness and amnesia (which may last rest of day after administration), hypotension, hiccups, laryngospasm, loss of dexterity. Have reported muscle tremors, tachycardia, shortness of breath.
49
what is the black box warning for midazolam
RESPIRATORY DEPRESSION, EVEN RESPIRATORY ARREST
50
special information for midazolam
Usually produces an anterograde amnesic effect (loss of memory about the procedure). Also decreases anxiety. 2. Has a more prolonged post anesthetic recovery period than barbiturates. 3. Other benzodiazepines = diazepam (Valium), lorazepam (Ativan), etc.
51
types of local anesthetics
short duration - mepivacaine (carbocaine) lidocaine (xylocaine) long duration - bupivacaine (marcaine)
52
action of local anesthetic
Unknown, but is known to stabilize or elevate threshold of excitation of nerve cell membrane without affecting resting potential. This prevents depolarization & transmission of nerve impulses.
53
pharmacokinetics of local anesthetics
A: VARIES D M: procaine by plasma esterase; lidocaine and Marcaine by liver E
54
ADRs of local anesthetics
Overdosage or systemic absorption may give ADR’s in CNS = excitement, convulsions, and then CNS depression. Cardiac = bradycardia, hypotension, cardiac arrest; Others = N/V, pallor, apprehension
55
special information of local anesthetics
1. Loss of all sensation occurs, but pain fibers affected first. 2. If it becomes systemic, can have serious reactions--especially heart and brain. 3. *Vasoconstrictors are used with them to decrease systemic absorption. 4. Topical example – Benzocaine
56
types of skeletal muscle relaxants
Usually administered to allow for lower dose of general anesthetic to be used. Two major types: A. Non-depolarizing neuromuscular blocking agents B. Depolarizing neuromuscular blocking agents
57
classification for skeletal muscle relaxants
Non-depolarizing (competitive) neuromuscular blocking agents.
58
prototype drug for muscle relaxants
rocuronium (zemuron)
59
action of rocuronium
prevents acetylcholine from acting by occupying cholinergic receptor sites. competitive antagonist
60
pharmacokinetics for rocuronium
Absorption: Is intravenous. Rapid onset of action Distribution: Does not cross blood-brain barrier or placenta. Length of action 20 – 40 min. Metabolism: None Excretion: Largely unchanged by kidney
61
ADRs of rocuronium
tachycardia, muscle weakness, salivation, hypertension
62
related drug to rocuronium
vecuronium (norcuron)
63
how is rocuronium reversed
by anticholinesterase like neostigmine (allows accumulation of ACh) or a newer agent called sugammadex
64
what classification is succinylcholine (anectine)
REMEMBER THIS IS PROTYPE DRUG! | - depolarizing neuromuscular blocking agents
65
action of succinylcholine
Repolarization of end-plate does not occur after discharge. Resembles acetylcholine - but produces more prolonged depolarization of motor endplates--partially due to slower inactivation by cholinesterase.
66
pharmacokinetics of succinylcholine
hydrolyzed by plasma cholinesterases (pseudocholinesterase) | excreted by kidney
67
ADRs of succinylcholine
Muscle weakness, bronchospasm, apnea, bradycardia, hypotension, arrhythmias, increased salivation, postop muscle pain, hyperthermia. However, has low level toxicity.

Pharmacology (3 decks)

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