Pharm exam 4 pt. 2 Flashcards


Set Details Share
created 1 year ago by halseyforster
6 views
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:

1

the goal of local anesthesia is

To interfere with sensory nerve endings in the operative area

2

When local anesthesia is used without an anesthesia care provider present,

an RN needs to be assigned to monitor the patient’s vital signs during the procedure.

3

Tumescent anesthesia

Specialized type of local infiltration requiring MAC

Widely used in aesthetic surgery for liposuction

4

Local agents are chemically classified as either:

Aminoesters

Aminoamides

5

Aminoesters

  • Topical cocaine; injectable procaine (Novocain)
  • Benzocaine (topical)
  • Tetracaine (local anesthetic; long-acting)

6

Aminoamides

  • Lidocaine (Xylocaine)
  • Bupivacaine (Marcaine; Sensorcaine)
  • Ropivacaine (Naropin)
  • Mepivacaine (Carbocaine) Less commonly used

7

Lidocaine

Most common local anesthetic

8

bupivicane binds to

cardiac muscle

9

bupivacaine is

Approximately four times as potent as lidocaine

Longer duration

10

Ropivacaine

Similar in duration to bupivacaine but less cardiotoxic

11

Mepivacaine

Similar potency to lidocaine

12

Adverse reactions to amide local anesthetics are primarily

dose related.

13

Systemic toxicity of local anesthetics is most commonly due to

inadvertent intravascular injection during peripheral nerve infiltration.

14

Regional anesthesia

It blocks nerves—not just nerve endings—at specific locations.

15

How are local and regional alike?

Many of the same agents are used.

The same vital signs are monitored.

Sedatives may be given by IV.

The patient remains awake.

16

Regional anesthesia is used when the surgical procedure dictates both

both sensory and motor block.

17

Most common agents used for spinals

Tetracaine

Bupivacaine

Ropivacaine

18

In obstetric anesthesia, concentrations of

0.125% plus very low doses of fentanyl are used to provide “walking epidurals.”

19

________ is preferred over spinal anesthesia when the surgical procedure duration is variable or extended or when prolonged postoperative analgesia is necessary.

Epidural

20

Epidural anesthesia has reduced risk of

hypotension.

21

Epidural anesthesia has less incidence of

postdural puncture headache.

22

Epidural anesthesia may be administered at levels

above L3 to L4.

23

Caudal anesthesia is a type of epidural block that

is injected into the epidural space via the sacral canal.

24

_______ is used in combination with general anesthesia for lower-extremity procedures in children

Caudal

25

Peripheral Nerve Block is also known as

Peripheral Nerve Block

26

Peripheral Nerve Block is used in what surgeries

Distal arms and legs

Hand and fingers

Feet and toes

27

Precise location of the nerve(s) to be blocked is necessary to avoid:

Penetration of the nerve sheath

Damage to nearby blood vessels

Unintended intravascular administration of the agent

28

Biggest disadvantage with peripheral nerve block is

time required to take effect; delays surgery

difficult to time correctly

29

One of the most common extremity blocks is

IVRA, also called Bier block.

30

Bupivacaine is contraindicated for IVRA because

toxicity is most closely associated with intramuscular administration.

31

contraindication to IVRA is

traumatic laceration, which may allow uncontrolled release of the agent from the limb.

32

Retrobulbar Block

Injected behind the eye into the muscle cone

33

Retrobulbar Block Typical injection

0.5% to 0.75% bupivacaine and 2% lidocaine with 150 units of hyaluronidase

34

Anesthesia

Literally, “without sensation”

A drug-induced temporary loss of consciousness

35

what happens in the emergence phase?

anesthetic agents are discontinued and allowed to wear off and the patient gradually awakens. The emergence phase ends when the patient is transported to the postanesthesia care unit (PACU).

36

Emulsion

A mixture of two liquids not mutually soluble

37

Endotracheal (ET) tube

An airway catheter inserted in the trachea to ensure patency of the upper airway and provide ventilation

38

Extubation

Process of removing a previously inserted ET tube

39

Fasciculation

Small involuntary muscle twitches just under the skin

40

what happens in the Induction phase?

Begins when medications are administered to initiate general anesthesia and concludes when an adequate depth of anesthesia is reached and the patient’s airway is secured

41

Lacrimation

The production of tears

42

Laryngeal masked airway (LMA)

An airway that is placed over the larynx

43

what happens in the maintenance phase

Begins as the patient’s airway is established and secured and continues until the surgical procedure has been completed

44

MAC stands for

Minimum alveolar concentration

45

A measurement of the concentration of an inhalation anesthetic agent that, at one atmosphere of pressure, stops the motor response to incision in 50% of patients is?

MAC

46

Opioids

Drugs (natural and synthetic) that produce morphine-like effects

47

what happens in the Preinduction phase?

Begins as the patient is admitted to the preoperative holding area and continues up to the point of administration of anesthetic agents

48

RSI

Rapid sequence induction; used for patients at greater risk for pulmonary aspiration

49

general anesthesia is

Systemic state of anesthesia

50

general anesthesia Interferes with

the brain’s ability to interpret pain impulses coming from anywhere in the body

51

general anesthesia is Used when

there are multiple operative sites, or for a procedure that is on an area that is difficult to block regionally

52

Patient Factors for General Anesthesia

Patient age

Cognitive ability

Mental or emotional state

Patient preference (when possible)

53

˜Components of an anesthesia workstation

Manual/automatic ventilation systems

Breathing circuits

Oxygen and nitrous oxide central pipeline hoses and backup tanks

Vaporizers

Pressure regulators and gas-mixing components

Gas-scavenging systems

54

Unconsciousness

Unaware; does not respond to stimuli

55

Analgesia

Does not experience pain

56

Amnesia

retains no memory of the event

No explicit recall

No awareness under anesthesia

57

Immobile

Muscles relaxed

Old term: “paralyzed”

58

Intravenous, inhalation, and a combination of the two—balanced—are

the common methods of giving general anesthesia

59

LMA

Sits on top of larynx

Administers oxygen and inhalation agents

60

Contraindications for LMA

  • Oral procedures
  • Obesity
  • Hiatal hernia
  • Gastroesophageal reflux disease (GERD)
  • Low pulmonary compliance

61

ET tube Used for:

  • Maximum airway control
  • Administer gases and inhalation agents
  • Longer procedures
  • When deep muscle relaxation is necessary
  • When patient is in prone or lateral position

62

ET tube Variations

  • Rapid sequence induction (RSI)
  • Nasal intubation
  • Awake intubation

63

cricoid pressure

Applied in emergent situations where the NPO status cannot be verified

Reduces the risk of aspiration

64

Sedatives-Benzodiazepines include

  • Valium
  • Versed
  • Ativan

65

Hypnotics-Barbiturates include

  • thiopental (Pentothal); methohexital (Brevital)
  • Ketamine (Ketalar)
  • Etomidate (Amidate)
  • Propofol (Diprivan)

66

Natural opioids include

Morphine

Codeine

67

Synthetic opioids include

Fentanyl (Sublimaze)

Alfentanil (Alfenta)

Sufentanil (Sufenta)

Remifentanil (Ultiva)

68

_______ is the most widely used inhalation anesthetic in clinical practice.

Nitrous oxide

69

3 most common liquid Volatile Agents

Isoflurane (Forane)

Desflurane (Suprane)

Sevoflurane (Ultane)

70

Disadvantages of inhalation agents

Øncrease potential for cardiovascular depression

Lack of postoperative analgesia

71

Selection of an inhalation agent is influenced by factors such as

solubility of the gas and the patient’s cardiac output.

72

For a muscle to contract, it must be stimulated by a

motor nerve.

73

Depolarizing- neuromuscualr agents

Succinylcholine (Anectine)

74

Nondepolarizing neuromuscular agents

Pancuronium bromide (Pavulon)

Atracurium besylate (Tracrium)

Vecuronium bromide (Norcuron)

Cisatracurium besylate (Nimbex)

Rocuronium bromide (Zemuron)

Mivacurium chloride (Mivacron)

75

reversal agents for opioids

ØNaloxone (Narcan)

ØNalmefene (Revex)

ØNaltrexone (ReVia, Trexan)

76

reversal agents for benzodiazepines

Flumazenil (Mazicon)

77

reversal agents For nondepolarizing muscle relaxants

Neostigmine (Prostigmin)

Edrophonium (Tensilon)