Topic 16 Flashcards Preview

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Flashcards in Topic 16 Deck (86):
1

Anesthetic Agent=

any drug used to induce a loss of sensation with or without unconsciousness

2

Adjunt=

a drug that is not a true anesthetic, but that is used during anesthesia to produce other desired effects such as sedation, muscle relaxation, analgesia, reversal, neuromuscular blockade, or parasympathetic blockade

3

Route of administration (4)

Inhalant
Injectable
Oral
Topical

4

Time of administration (3)

Preanesthetic
Induction
Maintenance

5

Principal Effect (5)

Local vs. general
Sedatives and tranquilizers vs. analgesics
Neuromuscular blockers
Anticholinergic agents
Reversal agents

6

General Anesthesia=

Reversible
Produced by administration of one or more anesthetic drugs

7

General Anesthesia Characteristics (4) Know this

1) Unconsciousness (SPELL THIS CORRECTLY!)
2) Immobility
3) Muscle relaxation
4) Loss of sensation

8

Surgical Anesthesia=

A stage of general anesthesia
-Analgesia and muscle relaxation
-Eliminate pain and patient movement during the procedure

9

Sedation= (7)

CNS depression
Drowsiness
Drug-induced
Various levels
Slightly aware or unaware of surroundings
Aroused by noxious stimulation
Uses: minor procedures

10

Tranquilization= (3)

Calmness
Patient is reluctant to move
Aware of surroundings but doesn’t care

11

Hypnosis= (4)

Drug-induced
Sleeplike state
Impairs patient’s ability to respond to stimuli
Patient can be aroused with sufficient stimulation

12

Narcrosis= (3)

Drug-induced sleep
Patient is not easily aroused
Associated with narcotic drugs

13

Local anesthesia= (3)

Targets a small, specific area of the body
Loss of sensation to a specific area
Drug is infiltrated into the desired area

14

Topical anesthesia= (2)

Applied to body surfaces or a wound
Produces a superficial loss of sensation

15

Regional anesthesia= (3)

Loss of sensation to a limited area of the body
Nerve blocks
Epidural anesthesia

16

Balanced anesthesia= (4)

Using multiple drugs in smaller quantities
Maximizes benefits
Minimizes adverse effects
Gives anesthetist greater control

17

Agonists=

Bind to and stimulate target tissue
--Most anesthetic agents and adjuncts

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Antagonsits=

Bind to target tissue but don’t stimulate
--Reversal agents

19

Partial Agonists and Agonist-Antagonists=

Opioids
Partial agonists
Agonist-antagonists
Used to block pure agonists

20

Analgesia:
-Most general anesthetics are not _____
-Must provide analgesic ____ and _____
-No _____ perception while anesthetized
-True analgesics don’t provide ___________

-analgesics
-pre and postoperatively
-pain
-general anesthesia!

21

Don’t mix drugs in a single syringe unless they are

compatible

22

Don’t administer a drug combination if a ______ develops when the drugs are mixed

precipitate

23

Most anesthetic agents and adjuncts are ____ soluble
--The Exception is:

water
Diazepam (Valium) is not water soluble!!!

24

Opiods:
-Derivatives of _____
-Produce _____ and _____
-Anesthetic ______ when combined with other drugs
-Classified as (4)

-opium
-analgesia and sedation
-induction
-agonists, partial agonists, agonist-antagonists, or antagonists

25

Opiod Agonist Drug names

Morphine (Contin)
hydromorphone (Dilaudid)
oxymorphone (Oxycontin)
fentanyl (Actiq, Duragesic)
meperidine (Demerol)
remifentanil (Ultiva)
hydrocodone (Vicodin)

26

Opiod partial agonists drug names

Buprenorphine (Buprenex)

27

Opiod agonist-antagonists drug names

Butorphanol (Stadol)
nalbuphine (Nubain)
pentazocine (Talwin)

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Opiod antagonist drug names

Naloxone (Narcan)
naltrexone (Depade, Revia)
methynaltrexone (Relistor)

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Morphine

(Contin)

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hydromorphone

(Dilaudid)

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oxymorphone

(Oxycontin)

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fentanyl (2)

(Actiq, Duragesic)

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meperidine

(Demerol)

34

remifentanil

(Ultiva)

35

hydrocodone

(Vicodin)

36

Buprenorphine

(Buprenex)

37

Butorphanol

(Stadol)

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nalbuphine

(Nubain)

39

pentazocine

(Talwin)

40

Naloxone

(Narcan)

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naltrexone (2)

(Depade, Revia)

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methynaltrexone

(Relistor)

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Opiods: Controlled substances- Except for

antagonist and nalbuphine

44

Opiods: Administered how and margin of saftey

Administered IV, IM, SC, oral, rectal, intranasal inhalant,
transdermal, subarachnoid, and epidural
Wide margin of safety

45

Opioids—Pharmacodynamics:
1. Mimic endogenous opioid peptides=
2. Analgesia and sedative effects=

1. β-Endorphins, dynorphins, enkephalins (“Runner’s High”)
2. Result of action on the receptors in the brain and spinal cord

46

How opioids work:
They prevent nerves from

transmitting impulses.

47

How opioids work:
They prevent presynaptic release of

neurotransmitters, particularly excitatory afferent neurotransmitters

48

How opioids work:
Decrease critter’s “perception” of

pain

49

Opiod Agonists=

Bind to and stimulate mu and kappa receptors
Best for moderate to severe pain

50

Opiod Partial Agonists=

For moderate pain—they have lower efficacy

51

Opiod Agonists-Antagonists=

Typically bind to delta, mu, and kappa receptors, but typically stimulate only kappa receptors (Reversal agent/mild pain)

52

Opiod Antagonists=

Bind to but don’t stimulate delta, mu and kappa receptors (reversal agents)

53

______ are the BEST things we have for severe pain!

Pure opioid agonists
--Used as a premedication for painful surgery

54

Effects of opiods: cardiovascular system

Bradycardia except meperidine which has antimuscarinic effects that can produce tachycardia

55

Effects of opiods: respiratory system

Decreased rate and tidal volume (dose-related)
Cough suppression (codeine {usually}, morphine)

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Effects of opiods: eyes

Miosis (small pupil)

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Effects of opiods: GI system

Salivation and vomiting by stimulation of the chemoreceptor trigger zone (CTZ)
Initial diarrhea, vomiting, and flatulence
GI stasis follows initial GI stimulation

58

Effects of opiods: histamine release

Allergic rxns are very common with morphine use.
Avoid in asthmatics.
*Increased intraocular and intracranial pressure*

59

mixing opiods and tranquilizers such as Diazepam=

neuroleptanalgesia
--A profound state of sedation and analgesia induced by simultaneous administration of an opioid and a tranquilizer” So it’s a state of “tranquil dreaming

60

opiods are used in treatment of what?

Acute Pulmonary Edema, as in that seen with CHF.
--Multiple possible actions: Vasodilation and Reduce anxiety of “drowning

61

describe what Opioid Antagonists do

1. Reversal of effects of opioid agonists, partial agonists, and agonists-antagonists
2. Reversal can be complete in a few minutes
•Wake up patient following sedation
•Emergencies

62

Naloxone (Narcan) hydrochloride is given how?

IM—5 minutes to reversal
IV (slowly)—2 minutes to reversal
--Duration of action 30-60 minutes

63

what is Like Naloxone but longer-acting and has the potential for liver toxicity

Naltrexone

64

what drug is Like opioids in that it is a weak centrally-acting μ-receptor agonist providing moderately strong analgesia

Tramadol (Ultram)

65

what drug blocks serotonin release and reuptake of norepinephrine and is Prescribed for rheumatoid arthritis and fibromyalgia

Tramadol (Ultram)

66

Tramadol has aide effects similar to opioids (but generally milder EXCEPT for “Serotonin Syndrome” which can be fatal. describe serotonin syndrome

Agitation
Muscular tremors
Sweating
Hyperthermia
Seizures

67

Tramadol can be _____ reversed with opioid antagonists

partially

68

Ultrashort Barbiturates=

Thiopental sodium & methohexital
•Induce general anesthesia

69

short Barbiturates=

•Pentobarbital
•Induce general anesthesia
•Treat epilepsy

70

Oxybarbiturates=

Phenobarbital, pentobarbital, and methohexital

71

Thiobarbiturates=

Thiopental and thiamylal

72

Barbiturates Mimics the inhibitory neurotransmitter

GABA

73

describe Pharmacokinetics of Barbiturates

Protein binding (plasma proteins)
-Free (unbound) drug enters the brain
-Hypoproteinemia results in more free drug
-Increased drug amounts to brain

74

with barbiturates, “Normal” drug dose may produce prolonged unconsciousness or death in with what condition?

hypoproteinemia

75

what Barbiturate is Redistributed to muscle and fat and slowly released

Thiopental— (in ultra–short-acting category)
--Continuous or repeated dosing may lead to “full” muscle and fat and prolonged recovery, making it “seem” like a longer-acting drug (first order>> zero order kinetics)

76

what Barbiturate is Redistributed to muscle and fat but released faster

Methohexital—(in ultra–short-acting category)
--Muscle and fat don’t get “full” (saturated) so there is no prolonged recovery with continuous or repeated doses (zero order kinetics avoided)

77

what Barbiturate has a Sustained effect caused by slow uptake and release from the brain, therefore good for seizure disorders. Release is dependent on kidney excretion, which is slowest

Phenobarbital—long acting category

78

what Barbiturate has Brain levels decrease based on liver metabolism. Faster than kidney excretion

Pentobarbital—short acting category

79

main use for barbiturates is

Rapid anesthetic induction
--To allow intubation (thiopental and methohexital)
--Sustain with inhalation anesthetic (thiopental)
--Sustain with repeated doses or continuous infusion (methohexital)

80

So long-term barbituate users (such as epileptics) “chew up” drugs that are metabolized by the

liver MUCH faster.

81

The #1 “most used” drug for anesthetic induction in most of the world (including the U.S.)

Propofol (PropoFlo, Diprivan)

82

Propofol

(PropoFlo, Diprivan)

83

Although Propofol is both metabolized by the liver and excreted by the kidneys, the primary way Propofol’s action is terminated is by

redistribution

84

Propofol: Onset of action? Duration of action?

Onset of action—30-60 seconds
Duration of action—5-10 minutes

85

what drug has a Milky appearance

Propofol

86

In many ways, propofol is like a “better” short-acting

barbituate