PHARM TEST 3 - general anesthetics

General anesthesia goals

Amnesia: Memory loss

Analgesia: Absence of pain

Hypnosis: unconsciousness

Immobility: Muscle relaxation

balanced anesthesia

using several drugs to reach the anesthetic goal

Phases of general anesthesia

Induction - pt becomes unconscious

maintenance - during procedure, may reiceive anti-emeitcs, opiods, or neuromuscular blocking agents

Emergence

- procedure ends. Medication wears off or reversal agent given.

Anesthetic drug classes

5 classes for balanced anesthesia

1. Benzodiazepines: Amnesia

◦Midazolam

2. Analgesics: Pain Relief

◦Opioids like Fentanyl

3. Inhaled Anesthetics: Hypnosis

◦Isoflurane

4. IV Anesthetics: Hypnosis

◦Propofol

5.Neuromuscular Blocking Agents: Muscle relaxation

◦Vecuronium

Inhaled anesthetics example

Isoflurane

Inhaled anesthetics : Isoflurane action

Diffuses from the lungs, effecting neurotransmitters systemically

Inhaled anesthetics : Isoflurane use

Induction or maintenance of anesthesia

Amnesia, muscle relaxation, hypnosis

Inhaled anesthetics : Isoflurane adverse effects

CV and respiratory depression

airway irritation

malignant hyperthermia (dantrolene antidote)

Inhaled anesthetics : Isoflurane contraindications

Hx/ Family Hx malignant hyperthermia

Inhaled anesthetics : Isoflurane nursing considerations

monitor BP and resp status closely, depression may last 30 minutes

have dantrolene available if needed

Intravenous anesthetics example

Propofol

Intravenous anesthetics : propofol action

causes depression of the CNS.

Block perception of pain

Intravenous anesthetics : propofol use

Rapid induction of anesthesia < 1 minute

Amnesia

Euphoria

Hypnosis

10 minute recovery time

can be used in mechanical ventilation

Intravenous anesthetics : propofol adverse effects

pain and burning at IV site

Intravenous anesthetics : propofol contraindications

Allergies to soy, eggs, and preservatives

Intravenous anesthetics : propofol nursing considerations

Nurse may be managing drip in ICU

Can be given IVP for procedures

have airway equipment nearby

rapid onset (<1 min)

Short duration (10 mins)

Neuromuscular blocking agents example

vecuronium

succinylcholine

Neuromuscular blocking agents : Vecuronium action

suspends nerve impulses, leading to paralysis

Neuromuscular blocking agents : Vecuronium use

Anesthetic paralysis

muscle relaxation

intubation and mechanical ventilation

Neuromuscular blocking agents : Vecuronium adverse effects

allergic reactions

Neuromuscular blocking agents : Vecuronium contraindications

allergy

Neuromuscular blocking agents : Vecuronium nursing considerations

Maintain airway and ventilation

can be given as drip or IVP

onset 3-5 mins

action 25-40 mins

risk for return of weakness after presumed recovery monitor closely

Migraine treatment : ergotamine tartrate action

stimulates vascular smooth muscle to constrict cranial blood vessels

Migraine treatment : ergotamine tartrate use

treat migraine headaches

Migraine treatment : ergotamine tartrate adverse effects

Cardiac effects

musculoskeletal effects

vertigo

n/v

Migraine treatment : ergotamine tartrate contraindications

Vascular disease

Azole antifungals and macrolide antibiotics

Migraine treatment : sumatriptan action

produces cranial vascular constriction

also relieves nausea, vomiting, and photophobia

Migraine treatment : sumatriptan use

treat migraine headaches

Migraine treatment : sumatriptan adverse effects

Dizziness

anxiety

malaise

Migraine treatment : sumatriptan contraindications

vascular disease

Drug therapy for migraine headaches nursing considerations

Available in multiple routes : SQ, SL, PO, Nasal

Give at onset of headache

may take up to 2 hours to work

monitor BP

safety precautions

Migraine treatment : sumatriptan patient education

Ensure patient knows how to take medications

take at onset of headache

do not drive after taking

may take up to 2 hours to work