Week 1 chapter 19 & 35 Flashcards Preview

Pharmacology II: term 4 > Week 1 chapter 19 & 35 > Flashcards

Flashcards in Week 1 chapter 19 & 35 Deck (75):
1

Major clinical technique for administering local anesthetics:

Administered via creams, sprays, suppositories, drops and lozenges. Applied to mucous membranes such as eyes, lips, gums, nasal membranes and throat. Generally safe unless absorbed.

Topical (surface) anesthesia

 

2

Major clinical technique for administering local anesthetics:

Administered by direct injection into tissue immediate to the surgical site. The drug diffuses into the tissue and blocks a specific group of nerves near the surgical site.

Infiltration (field block) anesthesia

 

3

Major clinical technique for administering local anesthetics:

Directly injected into tissues that may be distant from the surgical site. Affects the nerve bundles supplying the surgical area and is used to block sensation in a limb or large area of the face.

Nerve-block anesthesia

 

4

Major clinical technique for administering local anesthetics:

Injected into the cerebral spinal fluid (CSF) and affects large regional areas such as the lower abdomen and legs.

Spinal anesthesia

5

Major clinical technique for administering local anesthetics:

Injected into the epidural space of the spinal canal and is used most often in obstetrics during labor and delivery. 

Epidural anesthesia

6

Two primary ways that general anesthesia may be induced:

Administered by inhalations. These agents may be gases or volatile liquids.

General anesthesia

(Gases exist in a gaseous state at atmospheric pressure. The only gas currently in use is nitrous oxide. Volatile liquids can exist in a liquid state at atmospheric pressure and can easily be volatilized for admnistration by inhalation)

7

Two primary ways that general anesthesia may be induced:

May be used alone, usually for procedures that take 15 minutes or less, or in combination with inhalation agents. 

Intravenous anesthetics

(drugs employed as IV anesthetics include opioids, benzodiazepines, and miscellaneous drugs.)

8

IV agents allow dosages of inhalation agents to be reduced, and they produce effects that cannot be achieved with an inhalation agent alone. This is called _______ ______.

Balanced anesthesia. 

 

9

Four Stages of general anesthesia:

What is Stage I of general anesthesia?

Loss of pain:

patient loses general sensation and proceeds until loss of consciousness

10

Four Stages of general anesthesia:

What is Stage II of general anesthesia?

excitement and hyperactivity:

patient may be delirious, heart rate and breathing may be irregular, and blood pressure increases. 

11

Four Stages of general anesthesia:

What is Stage III of general anesthesia?

Surgical anesthesia:

Skeletal muscles become paralyzed, cardiovascular and breathing activities stabilize, eye movement slows, patient becomes still. 

12

Four Stages of general anesthesia:

What is Stage IVof general anesthesia?

Paralysis of the medulla region in the brain, which can result in death.

 

**This stage is usually avoided. **

13

Chemical classes of local anesthetics:

________ anesthetics work by stopping axonal conduction, thereby blocking sodium channels in the axonal membrane. This stops sodium influx, which brings conduction to a halt.  

Local

(adverse effects of local anesthetics are not common, allergy is rare. when it does occur it is often due to sulfites, which are added as preservatives to prolong the shelf life of the anesthetic or to methlyparaben, which may be added to retard bacterial growth in anesthetic solutions. CNS and cardiovascular side effects are not expected unless the local anesthetic is absorbed rapidly or is accidentally injected directly into a blood vessel. )

14

Chemical classes of local anesthetics:

_______ are a group of local anesthetics that contain an ester chemical linkage in their structure. 

Esters

(an adverse effect of esters is CNS depression)

15

Chemical classes of local anesthetics:

______ are a group of local anesthetics that contain an amide chemical linkage in their structure. 

Amides

(incidence of allergic reactions is very low, and the method of metabolism is hepatic enzymes. Amides have replaced most esters becuase amides have a longer duration of action and fewer side effects)

16

A small amount of ______ is sometimes added to local anesthetics in order to constrict blood vessels in the immediate area being anesthetized.

Epinephrine

(the anesthetic is kept in the area longer, which increases the duration of the anesthetic)

17

_______ ______ is an  alkaline agent, is sometimes added to increase the effectiveness of an anesthetic in areas that have extensive local infection because bacteria acidify the area. 

Sodium Hydroxide

(anesthetics do not work as well in acidic environments)

18

Identify the actions of general anesthetics on the CNS

General anesthetics act by preventing the flow of sodium into neurons in the CNS. This delays nerve impulses and reduces neural activity. This action rapidly produces unconsciousness and lack of responsiveness to all painful stimuli. the exact mecheanism is not exactly known, although it is likely that gamma-aminobutyric acid (GABA) receptors in the brain are activated. 

19

For each drug know class, mechanism of action and adverse effects:

Prototype: Lidocaine (Xylocaine)

[Local anesthetic]

 

Class: Sodium channel blocker, an amide

Mechanism of action: to block sodium channels located within the membranes of neurons and thereby block neuronal pain impulses. it is used primarily for brief medical or dental procedures. 

Adverse Effects: uncommon, an early symptom of toxicity is CNS excitedmement 

Rare serious adverse effects: convulsions, respiratory depression, and cardiac arrest. 

20

For each drug class  know representative drug example, mechanism of action, primary actions and adverse effects:

Prototype: Nitrous  oxide

[Gaseous general anesthetics]

Class: inhalation gaseous agent

Mechanism of action: Suppress pain mechanisms in the complete loss of consciousness or profound relaxation of skeletal muscle. it is usually used in conjunction with IV agents to maintain loss of consciousness. It can be given alone for short surgical or dental procedures

Adverse Effects: Low to moderate doses: few effects, High doses: signs of stage 2 anesthesia. after procedure nausea and vomiting may occur. 

21

For each drug class  know representative drug example, mechanism of action, primary actions and adverse effects:

Prototype: Isoflurane (Forane)

[Volatile liquid general anesthetics]

Class: GABA and glutamate receptor agonist

Mechanism of action: To depress cardiovascular and respiratory function. Because it has less effect on the heart and does not damage the liver, isoflurane is one of the widely used inhalation anesthetics

Adverse Effects: mild nausea, vomiting, and tremors. produces a dose-dependent respiratory depression and reduced BP, Malignant hyperthermia with elevatted temp has been reported

22

For each drug class  know representative drug example, mechanism of action, primary actions and adverse effects:

Prototype: Propofol (Diprivan)

[Miscellaneous IV general anesthetics]

Class: N-methyl-D-aspartate (NMDA) receptor agonist

Mechanism of action: indicated for the induction and maintenance of general anesthesia. it has almost an immediate onset of action and is used effectively for conscious sedation. Emergence is rapid. Has an antiemetic effect that can prevent N/V.

Adverse Effects: Pain at injection site, apnea, respiratory depression, hypotension. 

*propofol has been associated with a collection of metabolic abnormalities and organ system failures, referred to as propofol infusion syndrome (PIF). The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipidemia, rhabdomyolysis, hepatomegaly, and cardiac failure. 

23

For each drug class  know representative drug example, mechanism of action, primary actions and adverse effects:

Prototype: Succinylcholine (anectine)

[Neuromuscular blocking drugs]

Class: Depolorizing blocker, acetylcholine receptor blocking 

Mechanism of action: Act  on cholinergic receptor sites at neuromuscular junctions. At first depolarization occurs, and skeletal muscles contract. After repeated contractions, however, the membrane is unable to repolarize as long as the drug stays attached to the receptor, eventually leadin to paralysis. Use of succinylcholine can cause complete paralysis of the diaphragm and intercostal muscles, thus mechanical ventilation is necessary during surgery

Adverse Effects: Bradycardia, repiratory depression. High doses: the ganglia are affected, causing tachycardia, hypotention and urinary retention. 

24

Preoperative Drugs are given to relieve anxiety and to provide mild sedation. 

Opioids such as ________ may be givent to counteract pain that the patient will experience after surgery

Morphine

25

Preoperative Drugs are given to relieve anxiety and to provide mild sedation. 

Anticholinergics such as _______ may be administered to dry secretions and to suppress the bradycardia caused by some anesthetics. 

Atropine

26

Preoperative Drugs are given to relieve anxiety and to provide mild sedation. 

________-_______ drugs help reduce the fear, anxiety or pain associated with the surgery. 

Sedative-hypnotic 

27

During surgery, the primary adjuncts are the neuromuscular blockers, which cause paralysis without loss of consciousness, which means that without a general anesthetics patients would awake and without the ability to move. Administration of these drugs also allows a reduced amount of general anesthetic. 

Neuromuscular blocking agents are classified as _______ blockers and nondepolarizing blockers. 

Depolarizing

28

During surgery, the primary adjuncts are the neuromuscular blockers, which cause paralysis without loss of consciousness, which means that without a general anesthetics patients would awake and without the ability to move. Administration of these drugs also allows a reduced amount of general anesthetic. 

The only depolarizing blocker is ________ (Anectine), which works by binding to acetylcholine receptors at neuromuscular junctions to cause total skeletal muscle paralysis. 

Succinylcholine

29

During surgery, the primary adjuncts are the neuromuscular blockers, which cause paralysis without loss of consciousness, which means that without a general anesthetics patients would awake and without the ability to move. Administration of these drugs also allows a reduced amount of general anesthetic. 

The ___________ blockers cause muscle paralysis by competing with acetylchoine for cholinergic receptors at the neuromuscular junctions. Once attached to the receptor, the ___________ blockers prevent muscle contraction.

nondepolarizing; nondepolarizing

30

Postoperative drugs include analgesics for pain and antiemetics.

___________ (phenergan, others) for the nausea and vomiting that sometimes occur during recovery from anesthetic. 

Promethazine

31

Postoperative drugs include analgesics for pain and antiemetics.

Occasionally following surgery, a parasympathomimetic such as ________(Urecholine) is administered to stimulate the urinary tract and smooth muscle of the bowel to begin peristalsis. 

Bethanechol

32

Use the nursing process to care for a patient who are receiving anesthesia:

____________: the nurse should collect information regarding allergies to anesthetics. Obtain complete health and drug history. Presence or history of any severe respiratory, cardiac, renal or liver disorders. obtain baseline VS and lab results. Patients knowledge of procedure and level of anxiety for local anesthetics. check for skin intactness, infection or wounds. 

Assessment

33

Use the nursing process to care for a patient who are receiving anesthesia:

Nursing Diagnosis: possible nursing diagnoses that would apply to the patient receiving a LOCAL anesthetic:

1._________

2. _________

3.__________

1. Risk for Aspiration

2. Risk for injury

3. Deficient knowledge 

(related to drug use)

34

Use the nursing process to care for a patient who are receiving anesthesia:

Nursing Diagnosis: possible nursing diagnoses that would apply to the patient receiving GENERAL anesthetic:

1._________

2. ________

3._________

4._________

5._________

6._________

  1. Anxiety r/t surgical procedure
  2. impaired gas exchange 
  3. nausea r/t drug side effect
  4. disturbed sensory perception
  5. ineffective breathing pattern
  6. decreased cardiac output

35

Use the nursing process to care for a patient who are receiving anesthesia:

Planning: during the planning phase possible goals for the patient receiving an anesthetic would be for the patient to experience ___ _____ during the procedure, experience ___ _____ ______ or adverse reactions to the anesthetic, and experience adequate anesthesia during the procedure. 

No pain; no side effects

36

Use the nursing process to care for a patient who are receiving anesthesia:

Implementation: interventions that may be implemented in order to meet the patients needs when receiving anethesia could include monitoring for _________ and respiratory side effects, monitoring for length of anesthetic effectiveness, providing for patient safety, monitoring ____ _____, and monitoring _____ from anesthesia

Cardiovascular; vital signs; recovery

37

Use the nursing process to care for a patient who are receiving anesthesia:

Evaluation: the nurse should ensure that the __________of the drug therapy as evidence by patient goals and expected outcomes is being met. 

Effectiveness

38

Pathogens are microbes that can cause disease by bypassing the body's defenses. 

What are 5 examples of pathogens?

  1. bacteria
  2. viruses
  3. fungi
  4. intracellular organisms
  5. multicellular animals

39

Pathogens are microbes that can cause disease by bypassing the body's defenses. 

Pathogens generally cause disease by one of two basic mechanisms:

1._________

2. ____   _______

1. Invasiveness: is the ability of pathogens to grow extremely rapidly and cause direct damage  to surrounding tissues by their sheer numbers. 

2. Toxin production: even very small amounts of some bacterial toxins may disrupt normal cellular activity and in extreme cases, result in death. 

40

Pathogens are microbes that can cause disease by bypassing the body's defenses. 

___________is the ability of an organism to cause infection.

Pathogenicity

41

Pathogens are microbes that can cause disease by bypassing the body's defenses. 

 __________ is the ability of a microbe to produce disease when present in minute numbers. 

Virulence

42

Bacteria are classified by the size of the cell wall. 

Bacteria with thick walls are called ___-_______. 

gram-positive

43

Bacteria are classified by the size of the cell wall. 

Bacteria with thin cell walls are called ______-_______. 

Gram-negative

44

Bacteria are describes by their shape:

What shape are the following:

1. Bacilli

2. cocci

3. spirilla

1. rod shaped

2. spherical

3. spiral

45

Bacterial are classified based on their ability to utilize oxygen.

Some organisms have the ability to change their metabolism and survive in either aerobic or anaerobic conditions.

Those that thrive in an _______-_____ environment are called aerobic bacteria. 

oxygen-rich

46

Bacterial are classified based on their ability to utilize oxygen.

Some organisms have the ability to change their metabolism and survive in either aerobic or anaerobic conditions.

Those that grow best ________ oxygen are called anaerobic bacteria. 

without

47

Anti-infective drugs are known as antibacterial, antimicrobial, or antibiotic. They are classified by their chemical structures (e.g. aminoglycoside) and by their mechanism of action      (e.g. cell-wall inhibitor).  The primary goal of antimicrobial therapy is to assist the body's defenses in eliminating a pathogen

Medications that accomplish this by killing bacteria are called ________. 

Bactericidal

48

Anti-infective drugs are known as antibacterial, antimicrobial, or antibiotic. They are classified by their chemical structures (e.g. aminoglycoside) and by their mechanism of action      (e.g. cell-wall inhibitor).  The primary goal of antimicrobial therapy is to assist the body's defenses in eliminating a pathogen.

Medications that slow the growth of the bacteria, allowing the body's natural defenses to eliminate the microorganisms, are called _________.

Bacteriostatic

49

When a bacteria population grows, many mutations occur spontaneously.

Antibiotics kill populations of bacteria that are sensitive to the drug, but leave behind _______ that possess random mutations that make them insensitive to the effects 

Microbes

50

When a bacteria population grows, many mutations occur spontaneously.

These drug-resistant bacteria are then free to grow, unrestrained by their neighbors that were killed by the antibiotic and the patient soon develops an infection this is resistant to conventional drug therapy. This phenomenon is called ______ ________

Acquired resistance

 

51

Overprescribing of antibiotics has worsened the problem because it results in loss of antibiotic effectiveness. Practitioners should only prescribe when necessary. 

True or false

Long-time use of antibiotics decreases resistant strains. 

False:

Long-time use INCREASES resistant strains. 

52

Overprescribing of antibiotics has worsened the problem because it results in loss of antibiotic effectiveness. Practitioners should only prescribe when necessary. 

Nosocomial infections are often resistant. _________use is sometimes appropriate. The nurse should instruct the patient to take the full dose. 

Prophylactic

(Definition: a medicine or course of action used to prevent disease.)

53

The widespread and sometimes unwarranted use of antibiotics has lead to a large number of resistant bacterial strains. 

The majority of _________ _______ microbes are now resistant to penicillin

Staphylococcus Aureus

54

The widespread and sometimes unwarranted use of antibiotics has lead to a large number of resistant bacterial strains. 

Name 3 resistant strains that have become a major clinical problem: 

 

1. Enterococcus faecalis

2. Enterococcus faecium

3. Pseudomonas aeruginosa

55

Careful selection of the correct antibiotic, through the use of culture and sesitivity testing, is essential for effective pharmacotherapy and to limit adverse effects. 

_______-spectrum antibiotics are effective for a wide variety of bacteria. 

Broad

56

Careful selection of the correct antibiotic, through the use of culture and sesitivity testing, is essential for effective pharmacotherapy and to limit adverse effects. 

_______- spectrum antibiotics are effective for a narrow group of bacteria. 

Narrow

57

Culture and sensitivity testing is examination of a specimen for microorganisms. The specimen is grown in the lab and identified. It is tested for sensitivity to different antibiotics.

_______ may take several days to identify. _____ may take several weeks to identify. 

Bacteria; viruses

58

Broad-spectrum antibiotics may be started before the lab culture is completed.

After laboratory testing is completed the drug may be changed to a ______-spectrum antibiotic, one that is effective against a smaller group of microbes or only the isolated species

Narrow

( in general, Narrow-spectrum antibiotics have less effect on normal host flora, thus causing fewer side effects)

59

Skilled health care providers are often able to make an accurate diagnosis based on a patients symptoms. 

True or False

For mild infections, lab identification is not always necessary. 

True

60

In most cases, antibacterial therapy is conducted using a single drug. 

Combining two antibiotics may actually decrease each drug's efficacy, a phenomenon known as ________. 

antagonism

61

Unless an infection is highly localized, the antibiotic alone may not be enough. The patients immune system and phagocytic cells will be needed to completely rid the body of the infectious agent. 

Patients with suppressed immune systems may require aggressive antibiotic therapy with _______ agents

Bacteriocidal

62

Local conditions at the infection site should be considered when selecting an antibiotic because factors that hinder the drug from reaching microbes will limit therapeutic success.

Infections of the central nervous system are particularly difficult to treat because many drugs cannot cross the _____-_____ ______. 

Blood-brain barrier

63

Local conditions at the infection site should be considered when selecting an antibiotic because factors that hinder the drug from reaching microbes will limit therapeutic success.

Injury or inflammation can cause tissues to become _____ and anaerobic and to have poor circulation. 

acidic

64

Local conditions at the infection site should be considered when selecting an antibiotic because factors that hinder the drug from reaching microbes will limit therapeutic success.

Excessive pus formation or ________ can block drugs from reaching their targets. 

hematomas

65

Allergy history

Severe allergic reactions to antibiotics, while not common may be _____. 

Fatal

66

Other patient variables:

What are 3 other host factors that should be considered for the success of anti-infective therapy?

1. age

2. pregnancy status

3. genetics

67

For each drug know  mechanism of action, primary actions  and important adverse effects:

Prototype: Penicilin G.

[penicillins]

Mechanism of action: to kill bacteria by weakening their cell walls, allowing water to enter, and thus killing the organism

Primary action: as the drug of choice against streptococci, pneumococci, and staphylococci organisms that do not produce penicillinase; medication of choice for gonorrhea and syphilis 

Important adverse effects: few serious adverse effects are noted  although superinfections and anaphylaxis are possible. Diarrhea nausea, and vomiting are the most common adverse effects. 

68

For each drug know  mechanism of action, primary actions  and important adverse effects:

Prototype:  Cefazolin (Ancef, kefzol)

[cephalosporins]

Mechanism of action:to act as a first-generation cephalosporin, a beta-lactam antibiotic.

Primary action: prophylaxis of bacterial infections, particularly those that are caused by susceptible gram-positive organisms. 

Important adverse effects: rash, diarrhea. superinfections, seizures, and allergic reaction are possible. 

69

For each drug know  mechanism of action, primary actions  and important adverse effects:

Prototype: tetracycline (sumycin)

[tetracyclines]

Mechanism of action: to inhibit bacterial protein synthesis, exerting a bacteriostatic effect. 

Primary action: it is effective against a broad range of gram-positive and gram-negative organisms, including Chamydia, Rickettsiae, Mycoplasma, and H. pylori. it is used topically and orally for Acne. 

Important adverse effects: It affects the vaginal, oral and intestinal flora and can cause superinfections. They irritate the GI mucosa and may cause N/V, epigastric burning, diarrhea, discoloration of the teeth, and photosensitivity

70

For each drug know  mechanism of action, primary actions  and important adverse effects:

Prototype: 

Mechanism of action:

Primary action:

Important adverse effects:

71

For each drug know  mechanism of action, primary actions  and important adverse effects:

Prototype: 

Mechanism of action:

Primary action:

Important adverse effects:

72

For each drug know  mechanism of action, primary actions  and important adverse effects:

Prototype: 

Mechanism of action:

Primary action:

Important adverse effects:

73

For each drug know  mechanism of action, primary actions  and important adverse effects:

Prototype: 

Mechanism of action:

Primary action:

Important adverse effects:

74

For each drug know  mechanism of action, primary actions  and important adverse effects:

Prototype: 

Mechanism of action:

Primary action:

Important adverse effects:

75

For each drug know  mechanism of action, primary actions  and important adverse effects:

Prototype: 

Mechanism of action:

Primary action:

Important adverse effects: