Pharm Ch. 19 local and General Anesthesia – Flashcards
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What is the difference between local and general anesthesia?
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-Local anesthesia (patient does not lose consciousness) use drugs that produce a rapid loss of sensation to a limited part of the body. They produce their therapeutic effect by blocking the entry of sodium ions into neurons -General anesthesia (patient DOES lose consciousness due to utilizing a different class of drugs) the goal is to provide a rapid and complete loss of sensation.
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What are the 5 techniques for applying local anesthesia ?
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1. Topical 2. Infiltration (field block- direct injection into tissues that you will be cutting into- blocks specific nerves near the site) 3. Nerve block (direct injection that can be DISTANT from surgical site- inject into nerve that "feeds" the nerve at the site of surgery- can be used to block sensation of a limb or large portion of face) 4. Spinal (injected in cerebral spinal fluid - can effect a large regional area such as lower abdomen or legs) 5. Epidural (injected in epidural space of the spinal canal and is most often used in labor and delivery - but also used in surgery and post op to decrease pain
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What is the mechanism of action of Local Anesthetics?
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It temporarily blocks sodium channels
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What are the 2 classifications of local anesthetics? (classified by their chemical structures)
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1. Esters 2. Amides (3. Miscellaneous drugs)
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What chemical classification are these drugs ? - benzocaine (Americaine, Anbesol, Solarcaine, others) - chloroprocaine (Nesacaine) - procaine (Novacain) - proparacaine (Alcaine, Ophthetic) - tetracaine (Pontocaine) And what are the general adverse side effects?
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Esters (one of the classifications of local anesthetics) Adverse effects include respiratory arrest , circulatory failure, anaphylactoid reaction
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What chemical classification are these drugs? - lidocaine (Xylocaine) - articaine (Septocaine, Zorcaine) - bupivacaine (Exparel, Marcaine, Sensorcaine) - debucaine (Nupercainal) - mepivacaine (Carbocaine, Isocaine, Polocaine) - prilocaine - ropivacaine (Naropin) And what are the general adverse side effects?
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Amides (classification of local anesthetics) Adverse effects include Difficulty breathing or swallowing, respiratory depression and arrest, convulsions, anaphylactoid reaction, burning, contact dermatitis
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Of esters and amides, which one has a longer duration of action and fewer side effects?
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Amides
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The main prototype drug of Amides is _______
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lidocaine (Xylocaine)
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What is the mechanism of action of Amides?
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to stop nerve conduction blocking sodium channels
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What is the primary use of Amides?
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brief medical or dental procudures
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There is a drug-drug interaction of Lidocaine with __________
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Barbiturates
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What are some other agents of local anesthetics sometimes added to increase duration or effectiveness
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- Epinephrine (be careful with this in fingers, vasoconstricts and could block off blood flow) - Sodium bicarbonate (alkaline solution, decrease burning sensation when admin. lidocaine
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Adverse effects of local anesthetics are generally uncommon. Occasionally you can have an allergic reaction. What are some of these uncommon adverse effects?
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- CNS stimulation with EARLY adverse effects - CNS depression with LATER adverse effects - Cardiovascular effects (especially of patients with past heart complications)
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General Anesthetics block to flow of _______ into the neurons and delay nerve impulse
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sodium
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What is the mechanism of General Anesthetics? How can it be given?
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-It is not known but we think that GABA receptors in the brain are activated - IV, or inhalation (can be combination of the 2)
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What are examples of IV general anesthetics?
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Benzodiazepines Opioids Miscellaneous agents (used in combination with inhalation agents)
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What are these examples of : - alfentanil (Alfenta) - remifentanil (Ultiva) - sufentanil (Sufenta) - fentanyl
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Opioids
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What are these examples of? - diazepam (Valium) - lorazepam (Ativan) - midazolam (Versed)
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Benzodiazepines
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What are these examples of ? - etomidate (Amidate) - ketamine (Ketalar) --> commonly given to kids - propofol (Diprivan)**** Prototype drug
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Miscellaneous IV General Anesthetics
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What are these examples of? -Gaseous agents or volatile liquids And what is their primary use? What is an example of each?
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-General Anesthetics: Inhaled Drugs -can be used to dental procedures - Gas --> nitrous oxide (laughing gas) Volatile liquid --> desflurane (Suprane)
