Chapt. 19/Drugs for Local and General Anesthesia – Flashcards
Unlock all answers in this set
Unlock answersquestion
amide
answer
type of chemical linkage found in some local anesthetics involving carbon, nitrogen and oxygen
question
balanced anesthesia
answer
use of multiple medications to rapidly induce unconsciousness, cause muscle relaxation and maintain deep anesthesia
question
ester
answer
type of chemical linkage found in some local anesthetics involving carbon and oxygen
question
general anesthesia
answer
medical procedure that produces unconssciousness and loss of sensation throughout the entire body
question
local anesthesia
answer
loss of sensation to a limited part of the body without loss of consciousness
question
neuroleptanalgesia
answer
type of general anesthesia that combines fentanyl with droperidol to produce a state in which patients are conscious through insensitive to pain and unconncected with surroundings, similiar state is produced with ketamine
question
neuromuscular blocker
answer
drug used to cause total muscle relaxation
question
surgical anesthesia
answer
stage 3 of anesthesia, in which most major surgeries occur
question
Five major routes for applying local anesthetics
answer
Topical, Infiltration, Nerve block, Spinal, Epidural
question
How do local anesthetics act?
answer
by blocking sodium channels, called sodium channel blockers
question
What is added to the anesthetic to constrict blood vessels?
answer
epinephrine, keeps anesthetic in the area longer, extending duration of the drug, increases 20-60 minutes(dental or surgical)
question
Why is sodium hydroxide sometimes added?
answer
increases effectiveness of anesthetic in regions that have extensive local infection or abscesses
question
What neutralizes a region to make a more favorable environment for anesthesia?
answer
sodium hyroxide or sodium bicarbonate
question
Epidural anesthesia
answer
inject into epidural space of spinal cord, most common in labor and delivery
question
Infiltration (field block) anesthesia
answer
injection into tissue immediate to the surgical site, diffuses into tissue to block a specific group of nerves
question
Nerve block anesthesia
answer
direct into tissue that may be distant from the operation site, drug affects nerve bundles serving the surgical area, used to block sensation in a limb or large area of the face.
question
Topical (surface) anesthesia
answer
Cream, sprays, suppositories, drops and lozenges, applied to mucous membranes including the eyes, lips, gums, nasal membranes, and throat
question
Lidocaine (Xylocaine)
answer
anesthetic, sodium channel blocker, amide, injectible local anesthetic, blocks neuronal pain impulses, used as a nerve block or for spinal and epidural anethesia, IV, IM, subcutaneously
question
Amides
answer
bupivacaine, lidocaine
question
Side effects of amides
answer
difficulty breathing, swallowing, respiratory depression and arrest, convulsions, anaphylactoid reaction, burning, contact dermatitis
question
Esters
answer
benzocaine, procaine
question
Side effects of esters
answer
respiratory arrest, circulatory failure, anaphylactoid reaction
question
Natural substance used for tooth pain?
answer
oil of clove
question
What plane leaves did cocaine come from?
answer
Erythroxylon coca, Andes Mountains of Peru
question
What was cocaine routinely used for?
answer
eye surgery, nerve blocks & spinal anesthesia
question
When allergies occur to amides, what is it usually caused from?
answer
due to sulfites, added as preservatives
question
What are patients with cardiovascular disease given?
answer
forms of local anesthetics that contain no epinephrine to reduce potential effects of this sympathomimetic on the heart and blood pressure.
question
What is the goal of general anesthesia?
answer
to provide a rapid and complete loss of consciousness, memory and body movement
question
Stage I- general anesthesia
answer
loss of pain: patient loses general sensation but my be awake, this stage proceeds until the patient loses consciousness
question
Stage II-general anesthesia
answer
excitement and hyperactivity, patient delerious and trys to resist treatment, heart rate, breathing irregular, blood pressure increase, IV agent given to calm patient
question
Stage III anesthesia
answer
Surgical anesthesia, skeletal muscles become relaxed, delirium stablizes, cardiovascular & breathing stabilize, eye movements slow, patient becomes still and remains until procedure ends
question
Stage IV anesthesia
answer
Paralysis of the medulla region in brain,if breathing or heart stops death could result, this stage avoided during general anesthesia
question
Gas- Nitrous Oxide
answer
inhalation gaseous agent, general anesthetic, side effects dizziness, drowsiness, nausea, euphoria, vomiting, malignant hyperthermia, apnea, cyanosis
question
Volatile liquids
answer
enflurane, isoflurane (children, sweet smelling), isoflurane (most commonly used), side effects: myocardial depression, marked hypotension, pulmonary vasconstriction, hepatotoxicity
question
How are general anesthetics usually administered?
answer
IV or inhalation
question
Nitrous Oxide
answer
general anesthetic, inhalation gaseous agent, combined with other surgical anesthetic agents
question
What is the only gas used routinely?
answer
nitrous oxide (laughing gas)
question
What is nitrous oxide used for?
answer
dental procedures, brief obstetric and surgical procedures
question
Most commonly used volatile liquid?
answer
halothan (Fluothane)
question
Halothane (Fluothane)
answer
General anesthetic, Inhalation volatile liquid
question
What happens when you combine the opioid fentanyl with the antipsychotic agent droperidol?
answer
neuroleptanalgesia
question
Thiopental (Pentothal)
answer
general anesthetic, I.V. short-acting barbiturate
question
deplarizing blockers
answer
neuromuscular blocking agent is succinylcholine, binds receptors at neuromuscular junction to cause total skeletal muscle relaxation, used in surgery for ease of tracheal intubation
question
Nondepolarizing blocker
answer
Mivacurium-shortest acting nondepolarizing blocker, cause muscle paralysis by competing with acetylcholine for cholinergic receptors at neuromuscular junctions, once attached to the receptor, the nonpolarizing blockers prevent muscle contraction.
question
Succinylcholine (Anectine)
answer
skeletal muscle paralytic agent: neuromuscular blocker, depolarizing blocker; acetylcholine receptor blocking agent, at bedside for emergency bronchial-spasms, SIDE EFFECTS: respiratory depression, malignant hyperthermia, apnea, circulatory collapse, bradycardia
question
What is the mechanism of nitrous oxide?
answer
suppresses pain mechanisms within the CNS, causing analgesia, does not produce complete loss of consciousness or profound relaxation of skeletal muscles. Does not induce stage 3 analgesia or cause a loss of consciousness.
question
Succinylcholine (Anectine) can cause?
answer
complete paralysis of the diaphragm and intercostal muscles. Bradycardia and respiratory depression are expected.
question
Neuroleptanaglesia drugs......
answer
ex; ketamine, do not result in full loss of consciousness but cause disconnection from events occurring, confusion, anxiety, fear of panic may occur postprocedure....keep sensory stimulation to a minimum
question
What does a depolarizing drug have the potential to increase?
answer
potassium release
question
Why are the advantages of lidocaine (Xylocaine) over the older anesthetics?
answer
Amides have fewer side effects than esters Amides tend to last longer than esters
question
Stage 3 of general anesthesia?
answer
Relaxation, stable respiration and slow eye movements
question
What is the correct use of a topical anesthetic?
answer
Wash hands before touching eyes, use on small areas of skin
question
What is the most dangerous side effect of inhalation anesthesia?
answer
Malignang hyperthermia
question
What would be a priority assessment of a patient taking succinylcholine(Anectine)
answer
Respiratory paralysis
question
How does succinylcholine (Anectine) work?
answer
patient will need assistance with breathing, it paralyzes respiratory muscles
question
Why use epinephine with a local anesthetic?
answer
constricted blood vessels will extend the duration of action in the drug
question
What is the action of infiltration anesthesia?
answer
blocks a specific group of nerves close to the operative area
question
What is a common side effect of spinal anesthesia?
answer
headache
question
What medications can not be given IV?
answer
solutions of lidocaine containing preservatives or epinephrine only for local anesthesia
question
What is the main action of nitrous oxide?
answer
Causes analgesia by suppressing the pain mechanism in the CNS? Does not produce complete loss of consciousness or profound relaxation of skeletal muscles.
question
What side effects might occur after takine thiopental (Pentothal)
answer
emergence delirium which can cause hallucinations, confusion and excitability
question
What side effects should the nurse assess for if the patient has been given (Anectine) succinylcholine?
answer
Bracycardia and respiratory depression
question
Because local anesthesia is not always applied to small areas of the body, some local anesthetic treatments are more accurately called ______ anesthesia.
answer
surface or regional
question
The direct injection of a local anesthetic into tissue immediate to a surgical site is called _______ anesthesia.
answer
infiltration (or field block)
question
The two major ways to induce general anesthesia are by using ____agents and ____agents
answer
IV, inhaled
question
Opioids are sometimes given as preoperative medications to counteract ____ _____ _____.
answer
pain following surgery
question
Local anesthesia is loss of ______ to a small area without loss of _______.
answer
sensations, consciousness
question
In applying local anesthesia the method employed depends on ______ and _____ ____ ______ ______.
answer
location, extent of desired anesthesis
question
In the area where the local anesthetic is applied ______ and _____ _______. will temporarily diminish.
answer
sensations, muscle activity
question
Drug classes used as adjuncts to anesthesia include ____, ____, _____ and _____.
answer
opiates, anxiolytics, barbiturates, neuromuscular
question
With _____ anesthesia, the dose of inhalation anesthetic can be ____ thus making the procedure safer for the patient.
answer
balanced, lowered
question
What type of anesthetic is droperidol (Inapsine)
answer
adjunct to anesthesia
question
What type of anesthetic is benzocaine (Anbesol)
answer
ester-type anesthetic
question
What type of anesthetic is bupivacaine (Marcaine)
answer
amide-type local anesthetic
question
What type of anesthetic is enflurane (Ethrane)
answer
inhaled anesthetic
question
What type of anesthetic is diazepam (valium)
answer
intravenous anesthetic
question
What type of anesthetic is lidocaine (Xyclocaine)
answer
amide-type local anesthetic
question
What type of anesthetic is prilocaine (Citanest)
answer
amide-type local anesthetic
question
What type of anesthetic is fentanyl (Duragestic, Actiq, others)
answer
adjunct to anesthesia
question
What type of anesthetic is promethazine (Phenergan, others)
answer
adjunt to anesthesia
question
What type of anesthetic is ketamine (Ketalar)
answer
intravenous anesthetic
question
What type of anesthetic is isoflutane (Forane)
answer
inhaled anesthetic
question
What type of anesthetic is pentobarbital (Nembutal)
answer
adjunct fo anesthesia
question
What type of anesthetic is thiopental (Pentothal)
answer
intravenous anesthetic
question
What prolong duration of local anesthetic agents?
answer
epinephrine
question
What is most commonly used as a topical anesthetic?
answer
benzocaine
question
What may be prescribed for cardiac dysrhythmias?
answer
lidocaine
question
What type of anesthesia is most commonly used in OB during labor and delivery?
answer
epidural
question
What is the most commonly used injectable local anesthetic?
answer
lidocaine
question
What is the most abused anesthetic agent?
answer
nitrous oxide
question
What is the major depolarizing neuromuscular blocker?
answer
succinylcholine (Anectine)
question
What is the most widely used inhalation anesthesia?
answer
isoflurane (Forane)
question
Epinephrine is often added to a local anesthetic. The nurse must monitor for what factors for the patient who is due to receive epinephrine in his anesthetic?
answer
Side effects of increased heart rate and BP history of cardiac conditions vital signs
question
In administering general anesthetics using balanced anesthesia, the nurse would expect what medication to be adminstered first?
answer
IV anesthesia
question
Nitrous oxide can be administered safely in patients with?
answer
increased anxiety related to pain or procedures
question
Why is alkaline substance such as sodium hydroxide sometimes added to a vial of anesthetic solutions?
answer
To increase the effectiveness of the anesthetic in regions that have extensive local infection or abscesses
question
What is a potential early adverse effect from local anesthetics?
answer
restlessness or anxiety
question
Which stage of general anesthesia is called surgical anesthesia because it is the stage in which most surgery occurs?
answer
Stage 3
question
The primary reason the nitrous oxide is used in denistry is that it provides?
answer
Sedation/relaxation
question
Inhaled general anesthetics produce their effect by preventing the flow of which of the following into neurons of the CNS?
answer
Sodium
question
Which of the following is a potential early adverse effect from nitrous oxide?
answer
Restlessness or anxiety
question
What is the major depolarizing neuromuscular blocker used during surgery?
answer
Succinylcholine (Anectine)
question
Bethanechol (Urecholine)
answer
parasympathomimetic administered to stimulate the smooth muscle of the bowel and the urinary tract following surgery
question
Halothane hepatitis can be prevented by using halothane?
answer
at least 21 days apart
question
The patient received lidocaine viscous before a gastroscop was performed. Priority nursing assessments include?
answer
1. return of gag reflex 2. ability to urinate 3. abdominal pain 4. ability to stand
question
The nurse observes a coworker preparing to administer a solution of intravenous lidocaine and epinephrine to a patient with multiple ventricular contractions. The appropriate action is to?
answer
Prevent the administration and discuss the need for a solution of lidocaine without epinephrine in this situation.
question
The nurse recognizes that the main action of nitrous oxide is to?
answer
Cause analgesia by suppressing the pain mechanism in the CNS
question
Regional loss of sensation is achieved by administering?
answer
local anesthetics
question
What are the routes of administering local anesthetics?
answer
topically, infiltration, nerve block, spinal, epidural
question
Local anesthetics work by?
answer
blocking sodium channels which suspends nerve conduction and prevents pain signals from reaching the CNS
question
What other agents are added to local anesthetics to increase duration or effectiveness?
answer
epinephrine and sodium hydroxide
question
Sodium Hyroxide
answer
alkaline agent increases effectiveness of anesthetic used in areas of infection that my be acidic (from bacteria)
question
How does general anesthetics work?
answer
blocks flow of sodium into neurons delays nerve impulses and reduces neural activity produces unconsciousness produces lack of responsiveness to painful stimuli
question
Stage I anesthesia
answer
loss of pain
question
Stage II anesthesia
answer
excitement and hyperactivity
question
Stage III anesthesia
answer
surgical anesthesia
question
Stage IV anesthesia
answer
Paralysis of the medulla
question
Action of amides?
answer
to stop axonal conduction by blocking sodium channels
question
Primary use of amides?
answer
brief medical or dental procedures
question
Action of esters?
answer
to stop axonal conduction by blocking sodium channels,replaced amides
question
Adverse effects of local anesthetics?
answer
CNS stimulation with early adverse effects CNS stimulation with later adverse effects Cardiovascular effects
question
Mechanism of action of inhalation agents?
answer
prevent flow of sodium into CNS; reduce neural activity
question
Primary use of inhalation agents?
answer
with IV agents fo maintain loss of consciousness; used alone for dental procedures
question
Side effects of inhalation agents?
answer
nausea, vomiting, CNS depression, respiratory difficulty, vital-signs changes
question
General anesthetic intravenous agents?
answer
barbiturate, barbiturate like agents, opioids, benzodiazepines
question
Adverse effects of general anesthetics
answer
allergic reactions, dysrhythmias, respiratory depression, CNS depression, shivering, headache, nausea, vomiting Postoperative period: hallucinations, confusion, excitability may occur
question
Adjuncts to anesthesia
answer
neuromuscular blockers depolarizing-Succinylcholine (Acectine-tracheal intubatuib nonpolarizing- mivacurium (short acting) tubocuraine-long acting
question
What does succinylcholine have the potential to increase?
answer
potassium
