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Pharm: Drug Therapy with General Anesthetics
Terms in this set (17)
inhalation general anesthetic: prototype
a) Think -ANE = inhalation
IV general anesthetic: prototype
a) Think -fol = IV
Isoflurane (Forane): action
(1) produces amnesia, skeletal muscle relaxation, and hypnosis - blocks pain - exact mechanism of action UNKNOWN.
(a) As concentrations increase:
(i) BP decreases and HR may increase. Resp. Rate may increase but the tidal volume (the amount of air which enters the lungs during normal inhalation at rest) diminishes.
(ii) Progressive skeletal muscle relaxation (likely due to the effect on spinal cord glycine receptors)
Isoflurane (Forane): Use
(1) can be used for people of all ages regardless of health status. It can be used alone or with a combo of other agents to create balance
(a) Renal impairment: isoflurane reduces renal blood flow and decreases urinary output. HYDRATION IS IMPORTANT if the patient remains hydrated during the period phase the patient maintains normal renal function
(b) Hepatic impairment: isoflurane is associated with very mild and brief postop hepatic dysfunction, but the incidence of hepatotoxicity is rare so it is considered safe
Isoflurane (Forane): Adverse effects:
(a) cardiovascular and resp. depression
(b) airway irritation which can progress to coughing, laryngospasm, bronchospasm in suceptable patients such as smokers and asthmatics.
(c) Vomiting (~ 2 hrs or more after exposure)
(d) malignant hyperthermia: (treatment: dantrolene sodium)is a genetic disorder that is potentially fatal hypermetabolic response after exposure to volatile inhalation ane. Or to the neuromuscular blocking agents. Response can be immediate or delayed and s/s include tachycardia, elevated temp, body rigidity, sweating, ridged jaw, mix or metabolic and resp. acidosis
Isoflurane (Forane): Contradictions and nursing Implications
(1) Contradictions: any history of Malignant Hyperthermia, patient history of hepatic dysfunction after exposure of inhalation ane., if history of PONV (postop n/v), therefore TIVA "total IV anesthesia" replaces the inhalation agent.
(2) Nursing Implications:
(a) Monitor blood pressure and temperature to detect residual hypotension and the possibility of malignant hyperthermia. HR over 100 BP over 160/90
(b) Maintain adequate respiratory support and manage shivering and tremors. And the room should be quiet
(c) Provide preoperative teaching, and postoperatively, instruct patients to avoid no prescribed CNS depressants.
(d) If person has dependency to alch or other drug they would be using a higher dose of the medication that they are giving to them.
IV general anesthetic: Propofol (Diprivan): Action
(1) Action: provides smooth hypnosis in the time it takes the drug to travel for the injection site to the brain. It is chiefly metabolized in the liver to water soluble inactive metabolites which are then excreted by the kidneys. Propofol is very liquid soluble easily crossing the B-B barrier (which means the patient is unconscious). Propfol produces amnesia, euphoria and hypnosis therefore blocking pain. IT DOES NOT PROVIDE ANAGESIA. It causes depression of the CNS (by amplifying the inhibitory neurotransmitter GABA (which promotes relaxation in the CNS)). Propofol has anticonvulsant properties. It produces a dose dependent change in several organs which is exacerbated in hypovolemia, critically ill, significate cardiac disease or elderly patients. There is reduction in cardiac output and BP. Tidal volume and resp rate decrease and it may be necessary for assisted ventilation
IV general anesthetic: Propofol (Diprivan): Use
(1) can be used for people of all ages regardless of health status. It can be used alone or with a combo of other agents to create balance. It causes bronchodilation which is good for patients with asthma and COPD. Propofol suppresses laryngeal reflexes (which makes is a suitable choice when inserting an airway device)
(a) Children: can be used for short term sedation for infants and children
IV general anesthetic: Propofol (Diprivan):Adverse effects
(1) rapid IV administration can be unplesent because of the emulsion formula. On injection pain, burning, or stinging at the IV site may occur. Nausea, vomiting, involuntary movements and apnea and anaphylaxis.
Contraindications: hypersensitivity to soybean or egg products
IV general anesthetic: Propofol (Diprivan): Contraindications and nursing Implications
(1) Contraindications: hypersensitivity to soybean or egg products.
(2) Nursing Implications: see inhalation
neuromuscular blocking agent: prototype
Prototype: Vercuronium (Norcuron)
Think -ium = neuromuscular blocking agent (which relaxes the skeletal muscles)
Does not cross the blood brain barrier so the patient is still awake
neuromuscular blocking agent: Vercuronium (Norcuron) : Action
i) Max. blockade occurs within 3-5 min and the duration is 25-40 min. The onset and duration are dependent (ie larger dose results in faster onset and longer duration). Excreted in the bile (unchanged Vercuronium are excreted through the urine). Large repeated dosing can result in accumulation of Vercuronium and active metabolites. It acts by temporarily suspending nerve impulses at the neuromuscular junction. It can be titrated to produce weakness through complete paralysis. It causes skeletal muscle paralysis. It has no abnormal effects on the cardiovascular system. temporarily suspending nerve impulses at the neuromuscular junction - inhibition of Ach, preventing normal function, producing skeletal muscle paralysis.
neuromuscular blocking agent: Vercuronium (Norcuron) : use
i) Use: Helps facilitate tracheal intubation and mechanical ventilation. Children have higher clearance rates requiring higher initial doses and increased frequencies.
neuromuscular blocking agent: Vercuronium (Norcuron) : Adverse effects and Contraindications
i) Adverse effects: allergic reactions during ane. Such as anaphylaxis or skin irritation, prolonged paralysis and apnea
ii) Contraindications: in the case of a patient who reports a known hypersensitivity or allergy to Vercuronium or nondepolarizing neuromuscular blocking agents, the ane. Provider modifies the ane. plan
neuromuscular blocking agent: Vercuronium (Norcuron) : Nursing Implications:
(1) maintenance of a pts airway and respiratory function are the MOST important
(2) remind the patient that he/she will be constantly monitored
(3) medical vent. Is necessary during surgery
adjunctive medication: Midazolam (Versed):
ii) produce amnesia, anxiolysis, sedation, and have anticonvulsant properties - short-acting IV med - helps maintain sedation - can be administered in flavored syrup PO or IM, valuable adjunct in pediatric anesthesia.
iii) USES: to produce amnesia or sedation for many diagnostic therapeutic, and endoscopic procedures.
iv) BLACK BOX - profound respiratory depression that may result in hypoxia, brain damage, or death. Flumazenil (Romazicon) is the antagonist that reverses effects
adjunctive medication: Fentanyl (Sublimaze):
i) opioid analgesic,
ii) 100x more potent than morphine sulfate, used to supplement sedation, regional techniques, and general anesthesia.
iii) Adverse effects of ALL OPIOIDS: respiratory depression, nausea and vomiting, altered mentation, urinary retention, and itching. Naloxone (Narcan) reverses the effects of opioids.
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