Pathopharmacology 2 Exam 1

What is your priority action if your pt tells you they have a medication allergy

apply bracelet

Goals of anesthesia

amnesia, analgesia, reflex depression, muscle relaxation, etc.

Types of anesthesia

general, local, regional, moderate

monitored care anesthesia; conscious sedation

moderate

General anesthesia can be

volatile gases, IV agents, muscle relaxants

If you give a muscle relaxant as anesthesia you must also provide ___, due to the lack of diaphragm use

vent support

Stages of general anesthesia

Induction, Maintenance, Emergence

During the induction phase of general anesthesia should you give the hypnotic and amnesic before or after muscle relaxant

before

Before removing ventilation after general anesthesia, you should ensure the ___ has worn off

muscle relaxant

How many stages do anesthetic effects have

4

What stage of anesthetic effects includes the stage where muscles are relaxed and sensations and reflexes are lost

3

What stage of anesthetic effects includes toxic patients receiving reversal agents

4

Examples of a toxic pt on general anesthesia

suppressed vital organs, respiratory/cardiac failure, fixed pupils

For volatile agent, the smaller the concentration the ___ the potency of that gas

high

isoflurane

volatile agent

sevoflurane

volatile agent

desflurane

volatile agent

nitrous oxide

volatile agent

MoA volatile agents

unknown (thought to inhibit CNS synaptic transmission)

Volatile agents are examples of ___ anesthesia

general

Nitrous oxide is most used for

minor suregeries

A higher MAC for a volatile agent would mean it needs a ___ concentration

lower

IV agents

barbiturates, benzos, opioids, propofol, ketamine

Barbiturates are an

IV agent

Thiopental solution (Pentothal)

barbiturate

Thiopental solultion (Pentothal) is ___ acting

short

SE Thiopental solution (Pentothal)

laryngospasm and apnea

2 main things to remember before giving Thiopental solution (Pentothal)

Weight based, monitor RR

AE Thiopental solution (Pentothal)

respiratory depression

Why should you get an accurate weight upon admission before administering Thiopental solution (Pentothal)

weight specific

You should give an extra injection of Thiopental solution (Pentothal) whenever the pt ___

moves

You give your pt Thiopental solution (Pentothal) and after an injection there is momentary apnea, is this something to be concerned about?

No (normal, but monitor RR)

Thiopental solution (Pentothal) is ___

hypnotic (CNS depressant)

Propofol (diprivan) is

hypnotic and amnesic

Propofol is ___ acting

short

What is propofol used for

general anesthesia induction and maintenance

SE propofol

hypotension, apnea

Propofol contraindications

eggs, soybean, soy allergy

What vitals should you monitor when giving propofol

BP and RR

Benzos are

amnesic

Diazepam (Valium)

Benzo

Midazolam (Versed)

Benzo

Benzo MoA

enhance GABA in CNS

Diazepam (Valium) is a

hypnotic/amnesic

Diazepam (Valium) is usually given in ___ to help with sedation

preop (5-10 min before procedure)

Midazolam is a

hypnotic, amnesic, anxiolytic

AE of benzos (valium and versed)

respiratory depression

You are about to give your pt a benzo when you notice their RR is 11, what should you do next

alert and hold

Benzo (Valium and Versed) key points

given in preop, can cause resp depression, hold if RR < 12, SA

Morphine Sulfate

opioid analgesic

Morphine TU

preop and periop pain

High doses of morphine or fentanyl can cause

sedation

Morphine SE/AE

hypotension, sedation

Fentanyl (Sublimaze)

surgical analgesia

What vital signs should you monitor when giving morphine

BP

What vitals should you monitor when giving fentanyl

RR (if have not been intubated yet)

Fentanyl is great for ___ stability

cardiovascular

Fentanyl is used for

surgical analgesia

Two categories of muscle relaxants

depolarizing and nondepolarizing

What category of muscle relaxant works by occupying the Ach binding sites at the neuromuscular junction

depolarizing

What category of muscle relaxant has an extremely quick onset and quick paralysis and must wear off

depolarizing

Sign that means onset of muscle relaxant is about to begin

twitching

What category of muscle relaxants compete with native Ach for binding at the neuromuscular junction

nondepolarizing

What category of muscle relaxants is progressive and can be reversed

nondepolarizing

Reversal agent for nondepolarizing muscle relaxants

cholinergics

succunylcholine

depolarizing muscle relaxant

SE succinylcholine

fasciculations, myalgia postop, dysrhythmias, hyperkalemia

AE succinylcholine

MH trigger

Vitals you need to monitor when giving succinylcholine

ECG, CO2, SpO2

Antidote for MH

dantrolene

Muscle relaxants are often given for

airway intubation

Cisatracurium (Nimbex)

Nondepolarizing muscle relaxant

Rocuronium (zemuron)

Nondepolarizing muscle relaxant

Vecuronium (norcuron)

Nondepolarizing muscle relaxant

Panuronium (pavulon)

Nondepolarizing muscle relaxant

Nondepolarizing muscle relaxants are ___ based

weight

SE of nondepolarizing MRs

hypersensitivity

What vitals should you monitor when giving a nondepolarizing MR

SpO2, ECG, CO2

How to monitor nondepolarizing MR effect

stimulate ulnar or facial nerve

neostigmine (prostagmin)

cholinergic agent

Neostigmine is typically given to

reverse a nondepolarizing MR

Neostigmine is typically given with ___ to avoid bronchospasms

atropine

Atropine SE

tachycardia, suppress salivation

Local anesthetic used to block or asynthesize a nerve or nerve fiber

regional

Spinal regional anesthesia pt position

flat HOB (to avoid headache)

asynthesizing a nerve in an extremity is done to allow surgery in a specific area

nerve block

numbs a specific area of the body without causing a loss of consciousness by causing a reversible conduction blockade of nerve impulses

local anesthetic

What fibers are affected first by local anesthetics

pain

Lidocaine

amide local anesthetic

TU of lidocaine

rapid onset and excellent spreading

Bupivacaine

amide local anesthetic

Bupivacaine TU

slow onset, post-op

SE of amide local anesthetics

HEADACHE, NV, dizziness, tingling, pain, allergic rxn

Why should you give an amide local anesthetic with epi?

control bleeding, delay absorption

Cocaine

ester local anesthetic

Why is cocaine used in some nasal surgeries

vasoconstriction

Novocaine

ester local anesthetic

Novocaine is used for dental procedures as it

blocks sodium from nerve

Administration of sedatives and/or hypnotics and opioids to the point where the client is relaxed enough that the surgeon can perform a procedure on the patient without discomfort

monitored anesthesia care

Client can respond to verbal stimuli, has a gag reflex, is easily aroused, and maintains an airway

monitored anesthesia care