Chapter 6 – Anesthetics, Analgesics, and Narcotics – Flashcards
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Central Nervous System
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evaluates incoming information and determines responses
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Brain
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evaluates information and sends out a response
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Spinal Cord
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receives information and sends to brain
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Afferent system
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brings information to the CNS; from body to brain; nerves, sense organs
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Efferent system
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dispatches information from the CNS; from the brain to the body
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Autonomic nervous system
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regulates involuntary control (respiration, circulation, digestion, body temperature); part of the efferent system
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Sympathetic
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fight or flight response (epinephrine or norepinephrine)
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Parasympathetic
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returns body back to normal (acetylcholine)
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Somatic nervous system
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controls voluntary activities; controls skeletal muscles; Acetylcholine is the only neurontransmitter between CNS and skeletal muscles
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Acetylcholine (Ach)
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acts on smooth muscle (GI tract), cardiac muscle, and exocrine glands; acts to stimulate parasympathetic nervous system;
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Anticholinergics
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block acetylcholine
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Dopamine
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acts on receptors in the kidneys and CNS; pleasure chemical
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Seratonin
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acts on smooth muscle, gastric mucosa and CNS. It is involved in emotional responses of depression and anxiety
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Epinephrine
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adrenaline; acts on cardiac receptors and bronchodilator receptors; heart rate increases and allows more air into the lungs
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Norepinephrine
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acts on alpha and beta receptors; increases blood pressure and is involved in the anger response
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Beta 1 Receptors
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increase heart rate, contractile force of heart
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Beta 2 Receptors
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skeletal muscle vasodilation; increase muscle contraction; relax bonchiole smooth muscle, GI smooth muscle, uterine smooth muscle; Albuterol and epinephrine attach here
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General anesthesia
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a condition of reversible unconscious and absence of painful stimuli; Causes unconsciousness, analgesia, skeletal and muscle relaxation, amnesia on recovery
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Malignant Hyperthermia
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Side effect of anesthesia that results in a large increase of intracellular calcium, rapid rise in body temperature, arrhythmias, rapid breathing, and muscle rigidity
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Dantrium
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(dantrolene) a muscle relaxant used for MS, treats and prevents malignant hyperthermia
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Narcotics
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pre-anesthetic; alleviate pain and depress respiration
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Barbituates
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pre-anesthetic; depress respiration similar to normal sleep;
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Benzodiazepines
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pre-anesthetic; relieve anxiety, convulsions; most commonly given; Schedule IV
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Nitrous oxide
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inhaled anesthetic; not potent, usually used with other agents; rapid elimination; used alone in dental procedures
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Forane
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(isoflurane); known for causing malignant hyperthermia
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Barbituates
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injectable anesthetic; rapid induction; short acting; less post emesis (vomiting)
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Brevital
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(methohexital); shortest acting barbituate
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Pentothal
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(thiopental); "truth serum"; used in capital punishment
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Versed
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(midazolam); injectable anesthetic; preferred for shortest onset and rapid elimination
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Ketamine
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"Special K"; quick onset, short acting; dissociative amnesia, cat tranquilizer, frequently abused; not used much outside of a veterinary office; injectable
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Propofol
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maintains anesthesia by sedation (keeps you under); treats agitation in ICU patients; white emulsion to be mixed only with 5% dextrose by slow infusion in glass containers; changes urine to green
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Etomidate
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used to supplement nitrous oxide; used during short gynecological procedures; causes nausea and vomiting
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Romazicon
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used for benzodiazepine overdoses
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Narcan
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used for opiate overdoses
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Novocain
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local anesthetic
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Lidocaine
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available OTC; also available in a patch which is by prescription only
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Pain
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the activation of electrical activity in afferent neurons in peripheral tissue with a high firing threshold ; part of the healing process; warns of damage and presence of disease; stimulates inflammation which will result in repair
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Acute
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associated with trauma or surgery; easier to manage by treating the cause; disappears when body heals; has beginning and end
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Chronic Nonmalignant
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3 months or more; undiagnosed or diagnosed disease; symptoms of depression; may respond poorly to treatment; fibromyalgia or arthritis
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Chronic Malignant
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malignant disease; often increases in severity with disease progression; cancer pain
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Neuropathic
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treated with anticonvulsants, antidepressants; shingles
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Narcotics
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analgesics derived from opium or synthetic opiate; used for analgesia and sedation; euphoria or dysphoria; potential for tolerance and dependence; opiods may cause constipation
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Analgesic ladder
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a guideline for selecting pain relieving medications according to the severity of the pain and whether agents lower on the ladder have been able to control the pain
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Mild to moderate pain
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NSAID (non-steroidal anti-inflammatory drug) and adjuvant analgesic
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Moderate pain
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Weak opioid
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Severe pain
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Strong opioid
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Pantient Controlled Analgesia (PCA) pump
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a means of pain control whereby the patient can regulate within certain limits the administration of pain medication
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Combination Drugs
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combine a non-narcotic and narcotic for synergistic effect; watch for aspirin and acetaminophen toxicity
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Addiction and Dependence
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Subutex (buprenorphine) CIII sublingual use 3-4 days; Suboxone (burprenorphine/naloxone) CIII used as maintenace drug after Subutex has been completed; doctor must have 2 DEA numbers to prescribe
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Methadone
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CII; concentrated tablet and solution should be mixed with water; can only be dispensed by pharmacy other than a methadone clinic if used to treat pain
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Narcotic Analgesics Properties
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depress respiration, constipation, emesis or nausea, ATC dosing is best, morphine is most effective
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Codeine
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Combined with tylenol or aspirin. CII if alone CIII combined
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Hydrocodone
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combined with tylenol - vicodin, lortaab, lorcet, norco; Combined with ibuprofen - vicoprofen; anything with hydrocodone is CIII
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Hydromorphone
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CII; brand name Dilaudid
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Stadol
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(butorpharnol) IV or IM; stadol NS nasal spray; can be addictive; CIV
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Morphine Sulfate
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CII
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Oxymorphone
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CII; brand name Opana
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Tri
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name brand Ultram; not scheduled; non-addictive; non-narcotic; usually combined with an NSAID
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Nubain
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IM injection commonly used during labor; not scheduled
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Oxycodone
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CII; extended release
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Fentanyl
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CII
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Actiq
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lollipop; CII
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Duragesic
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transdermal patch; CII
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Oralet
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lozenge; CII
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Sublimaze
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injection: CII
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Migraine Headache
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a severe throbbing, unilateral headache, usually accompanied by nausea, photophobia, phonophobia, hyperesthesia
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Migraine Prophylactic Therapy
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anticonvulsants, beta blockers, NSAID's, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRI), estrogen
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Selective 5-HT Receptor Agonists
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Class of drugs that work by binding to serotonin receptors and causing vasoconstriction for the treatment of migraines
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Imitrex
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(sumatriptan); first on the market, originally a SC injection; tablet and nasal spray are now available; injection effective in 15 minutes; second dose may be adminstered in one hour
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Zomig
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(zolmitriptan); dose may be repeated in two hours but no more than 10 mg in 24 hours
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Maxalt
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MLT (sublingual)
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Relpax
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(eletriptan); many drug interactions
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Migranal
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nasal spray - one spray in each nostril, repeat in 15 minutes; ergot preparationn
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Wygraine and Cafergot
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ergotamine suppository
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Ergomar
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sublingual ergotamine
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Midrin
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DESI drug (Drug efficiency standard index) potentially ineffective
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Excedrin Migraine
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OTC; 250mg APAP, 250mg ASA; 60mg caffeine
