anesthetics

centrally-acting muscle relaxants

diazepam

diazepam tx

relieve discomfort associated w/ acute, painful msk conditions; should not be the only intervention

diazepam CI

CAUTION: seizure hx, cardiac dysfunction, conditions w/ muscle weakness, hepatic/renal

• spasms r/t rheumatic disorder or when spasms help movement, posture, or fx

• preg/lact

diazepam AE

• GI/GU effects

• hypotension

• arrhythmias

• possibility of physical dependence

diazepam DI

ETOH

peripherally-acting muscle relaxants

dantrolene

dantrolene tx

• manage muscle spasticity of various severe/chronic disorders

• antidote for malignant hyperthermia

dantrolene CI

CAUTION: females, age >35, hx prior hepatic dz, respiratory depression, cardiac dz, preg

• spasticity that helps movement, posture, or fx

• active hepatic dz

• lact

dantrolene AE

• GI/GU effects

• hepatic cell damage/hepatitis

• skin effects

dantrolene DI

• estrogens

• ETOH

barbiturate anesthetics

methohexital

methohexital MoA

depress CNS to produce hypnosis & anesthesia w/out analgesia; induces rapid anesthesia

methohexital tx

• induction or maintenance of anesthesia

• induction of hypnotic state

methohexital CI

• silicone

• preg/lact

methohexital DI

• narcotics

• many other meds

nonbarbiturate anesthetics

midazolam

midazolam tx

• produce amnesia or sedation for procedures

• pre-procedure anxiety

• induce anesthesia

• provide continuous sedation

midazolam CI

respiratory depression/respiratory arrest

propofol CI

egg & soy allergies

midazolam CI

CAUTION: pt could be compromised by vomiting

midazolam AE

• skin breakdown

• respiratory depression

midazolam DI

• ketamine & NMJ blockers

• midazolam

midazolam antidote

flumazenil

anesthetic gases

nitrous oxide

nitrous oxide tx

• induction & maintenance of anesthesia

• common in dental surgery

• newer agents have mostly replaced this

nitrous oxide CI

• hypoxia

• preg/lact

nitrous oxide AE

• skin integrity

• decreased vit b12 lvls

• sinus/ear effects

• bowel obstruction

• pneumothorax

volatile liquids

desflurane

desflurane tx

induction & maintenance of general anesthesia

desflurane NC

unstable at room temp

desflurane CI

CAUTION: pts w/ risk for malignant hyperthermia

• respiratory disorders

• pediatrics

• preg/lact

desflurane AE

• respiratory

• hypotension

• hypercapnia

local anesthetic agents

lidocaine

lidocaine tx

• relief of local pain

• infiltration anesthesia

• peripheral nerve block

• spinal anesthesia

• central nerve block

• topical anesthesia

lidocaine CI

CAUTION: preg/lact

• heart block

• shock

lidocaine AE

• GI effects

• cardiovascular effects

lidocaine DI

• succinylcholine

• epinephrine

nondepolarizing NMJ blockers

pancuronium

pancuronium tx

muscle paralysis is required or desired

pancuronium CI

CAUTION: hx malignant hyperthermia, pulmonary or cardiac dysfunction, fluid & electrolyte imbalance, respiratory dz, lact

• myasthenia gravis

• renal or hepatic dz

• preg

pancuronium AE

• histamine release occurs

• hypotension/cardiac arrhythmias

• GI effects

• hyperkalemia

pancuronium DI

• volatile liquids

• aminoglycoside

• CCBs

• cholinesterase inhibitors

• xanthines

• barbiturates

depolarizing NMJ blockers

succinylcholine

succinylcholine CI

CAUTION: fractures, eye considerations, paraplegia or SCI

• conditions causing low plasma cholinesterase lvls

succinylcholine AE

• muscle pain

• malignant hyperthermia

• hyperkalemia

• histamine release occurs

• hypotension/cardiac arrhythmias

• GI effects

succinylcholine DI

• cholinesterase inhibitors (increased effects)

• volatile liquids

• aminoglycoside

• CCBs

• cholinesterase inhibitors

• xanthines

• barbiturates