chapter 19 drugs for local and general anesthesia – Flashcards
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what are the five techniques for applying local anethesia?
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topical infiltration nerve block spinal epidural
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what are topical anethesias?
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creams sprays suppositories drops lozenges
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where are the topical anethesias applied?
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mucous membranes
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how are topical anethesias not safe?
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only if they get in the systemic system
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how are infilitration anesthesia done?
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direct injection into tissue immediate surgical site
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how do infiltration anesthesia work?
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block specific nerves near site
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how are nerve block anethesia done?
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direct injection into tiusses that may distant from surgical site
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what do they affect?
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affects nerve bundles supplying surgical area
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what are they used for?
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to block sensation in a limb or large area of face
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where is spinal anesthesia injected?
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into csf
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what does spinal anethesia affect?
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large regional areasus such as lower abdomen and legs
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where is epidural anethesia injected into?
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injected into epidural space of spinal canal
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what is it used most often for?
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labor and delivery
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how does local anesthetics work?
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work by blocking sodium channels, temporarily suspending nerve conduction and preventing pain signal from reaching the cns
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how are local anethesia classified?
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by chemical structure
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what are the two major classes of local anesthesia?
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esters amides
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what does esters contain?
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an ester chemical linkage
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are allergic reactions high or low?
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low
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what ester was the first widely used anesthetic?
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cocain natural ester
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which ester is a topical otc agent?
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benzocaine
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has esters replaced amides or amides replace esters?
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amides replaced esters
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what does amide contain?
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containe amide chemical linkage
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how does it compare to esters?
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longer duration of action and fewer side effects than esters
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what is the most frequently used injectable anesthetic?
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lidocaine
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AMIDES DRUG LIDOCAINE moa use ae
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to stop axonal conduction by blocking sodium channels for brief medical dental procedures rarely has side effects, serious ones are convulsions, respiratory depression, and cardiac arrest
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what agents are sometimes added to increase duration or effectiveness of local anesthetics?
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epinephrine sodium hydroxide
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what does epinephrine do?
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constricts blood vessels increases duration of anesthetic
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what kind of agent is sodium hydroxide?
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alkaline agent
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what is sodium hydroxide used for?
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in areas of infection that may be acidic (from bacteria)
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what does local anesthestics have reactions to?
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sulfites methylparaben
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what are the signs of adverse effects? when do they occur
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cns stimulation with early adverse effects cns depression with later adverse effects cardiovascular effects
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how does general anesthetics work?
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clock flow of sodium into neurons, delay nerve impusles and reduce neural activity
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what is the mechanism known as?
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no known, but gaba receptors in the brain are activitaed
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what does general anesthetics produce?
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produce unconsciousness, lack of responsiveness to painful stimuli
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how are they given?
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inhalation and intravenous agents
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what are the stages of generanl anethesia?
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stage I: loss of pain stage II: excitement and hyperactivity stage III: surgical anesthesia stage IV: paralysis of the medulla
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how does inhalation agents work?
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prevent flow of sodium into nerurons cns, delay nerve impulses, produce reduction in neural ativity
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what is the primary use of inhalation agents?
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with iv agents to maintain loss of consciousneess; used alone for dental procedures
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what is the gas used for the gaseous agnet?
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nitrous oxide
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how does volatile luquid work?
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converted to a vapor to produce anesthetic effects
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VOLATILE LIQUID ISOFLURANE moa
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caused by suppression of pain mechanisms
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what are intravenous agents?
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opioids, benzodiazepines
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how fast do they induce unconsciousness
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rapidly
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what is intravenous agents combined with?
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inhalation agents
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when is it used alone?
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for procedures that take minutes or less
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what is a fentanyl?
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an opioid
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what is fentanyl given with?
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an antipsychotic agent to produce neuroleptanalgesia
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what happens to the patients who take this?
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are conscious, but insensitive to pain and unconnected with surroundings
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what is it called when its a premixed combination?
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innovar
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what are adverse effects of intravenous general anethesia?
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allergic reactions dysrhythmias respiratory depression cns depression shivering headache nausea and vomiting vital sign change
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what are the adverse effects of postoperative period?
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tohallucinations confusion excitability
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why are adjuncts medications given?
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to complement effects of general anesthesia treat anticipated side effects of anesthesia
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what are adjuncts agents?
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anticholinergic, benzodiazepine, cholinergic, dopmine blocker, neuromuscular blocker, opiods phenothiazine
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what are depolarizing neuromuscular blockers?
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binds with acetylcholine receptors at neuromuscular joints
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what are nondepolarizing neuromuscular blockers?
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compete with acetylcholine for cholinergic receptors at neuromuscular juntions
