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60 Cards in this Set

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uses for neuromuscular blockers, muscle relaxants
intubation
muscle paralysis during surgery, aid in mechanical ventilation
brand

tracrium
generic:

atracurium



depolarizing NMBA
brand

nimbex
generic

cisatracurium

depolarizing NMBA
brand

mivacron
generic

mivacurium

depolaring NMBA
brand

norcuron
generic

vercuronium

depolarizing NMBA
trade

pavulon
generic

pancuronium
trade

zemuron
generic

rocuronium
trade

raplon
generic

rapacuronium
trade

nuromax
generic

doxacuruium
effects are dose related when it comes to NMBA's?? T or F
true they are dose related
max time of paralysis for NMBA? Duration of Action???
2-10 minutes of paralysis

35-60 DOA
NONdepolarizingng NMBA MOA?
bind to receptor site that acetylcholine would occupy stoping ACh from stimuating muscle causing paralysis.
adverse SE for NMBA's?
increase HR, BP

(ESPECIALLY IN CURARE PAVULON)
newer NMBA's have less SE on HR and BP. name a few
vecuronium
atracurium,
doracurium
pepecuronum
and mivacurium in lower BP
what does histamine release cause??
transient hypotension
worst histamine release NMBA?
pancuronium curare

atracurium also have histamine release, rapacuronium does at higher doses
neostigmine and pyridostigmine and edrophonium are cholinesterase inhibitors MOA?
inhibit enzyme acetylcholinesterase which breaks down acetylcholine.More Ach avail.
Cortex
Responsible for ?
muscle control
Intellect
Memory and senses
Midbrain:
Thalamus responsible for?

Hint: OUCH!
relays pain
Midbrain:
hypothalumus reponsible for?
Endocrine gland function
Vasomotor reflex
Reticular Formation
RAS: Reticular Activating System
awakes cortex and responsible for concentration
Limbic System reponsible for?
Control & display of emotion
cerebellum/Extra-pyramidal
Control coordination and balance
How do CNS drugs work thru your bangin brain??
Beginning with the cortex, proceeding to the brain stem,
then the RAS,
and on to the spinal cord
muscle relaxants MOA?
central work directly on CNS. interferes with nerve pathway in spinal cord

perpheral work on muscles. (stop calcium release)
comomon muscle relaxants
central
cyclobenzaprin (flexerial)
chlorzoxazon (parafon forte)

perpheral
dantrolen (dantrium)
def
sedative?
reduces CNS arousal
def

hypnotic
induces sleep
def

anxiolytic
reduces anxiety
sedatives are needed with analgesics...the pt can still feel with out the analgesic? t or f
True! make sure you give them a analgesic
benzodiazepines MOA

non barbituate/dose dependant
enhances the inhibitory effect on the receptor
benzodiazepines used for?

side effects?
muscle relaxation,anti anxiety,anticonvulsant

SE:resp & cv depression especially w/opiates, may cause amnesia
generic benzodiazepines:
alprazolam
chloriazepoxide
diazepam
midazolam

name trade?

hint:lams and ium
trade benzodiazepines:
xanax
librium
valium
versed
def local anesthesia?
stops sensation from area being worked on
def general anesthesia?
pt will nnot respond to any stimuli. Pt totally under
factors determining anesthetic meds?
age,organ function,dx being treated
stages of anesthesia (4)

NOT LOSS OF CONSCIOUSNESS
stage 1:pt awake w/o pain

stage 2:pt has number of reflexes

stage 3:loss of bling reflex and eye movement, resp depression

stage 4: complete loss of resp drive,and muscle tone
4 charecteristics of general anesthesia
unconsciousness,analgesia,muscle relaxation,depression of reflexes
inhaled anesthetics SE?
increase in tissue blood flow
decrease in vessel and cardia response and conduction. Decrease in ventilatory response, Depth and RR. Rise in CO2 level
intravenous anestheics SE?
resp depression,cardiac conduction and arterial BP
def analeptic?
ventilatory stimulate
ketamine (ketalor)
IV admin
low doses
analgesic (conscious pain) and sedative
higher doses
anesthetic (sensory pain) at higher doses
SE assoc w. aspiration and ventilatory compromise.
drugs used for ventilatory stimulants?
doxapram)dopram, caffenine, theophylline, protiptyline (vivactyl), medroxprogesterone(depo-provera)
analeptics used for??
sleep apnea,postanesthesia resp depression, acute hyper capnea,pts weaned off vents.
ANELGESIA DECREASES?
THE PTS PERCEPTION OF PAIN
Non Barbiturate Anesthetics
Uses:
General anesthesia
Twilight anesthesia
Conscious sedation
Ketamine does produce analgesia but no muscle relaxation
Barbiturate Anesthetics
Produce a rapid & profound loss of consciousness when given in adequate doses
No analgesia
Fentanyl roo and DOA

non barb anesthetic and opiod analgesic
ROO: 30 sec
Peak: 5 – 15”
DOA: 30 – 60”
After continued use it may cause prolonged sedation due to peripheral accumulation.
Versed (midzolam) DOA,dosage,used for?

non barb anesthetic
Widely used in bronchs
Short DOA
Dosage 2.5 mg can produce conscious sedation
ROO: 3-5”IV, 15”IM
Lorazepam
Less lipid soluble
Slower ROO
Longer DOA
Dipravan ( propofol)
Rapid ROO – 40 sec, short DOA
produces loss of consciousness
dose related
SE: resp depression, hypotension, bradyarrhythmias, hyperlipidemia, sepsis.

The lipid emulsion is a potential growth medium mandating strict asepsis.

High doses with steroids may precipitate an acute myopathy
Inapsine (droperidol)
Sedative, tranquilizer, anti-emetic
Innovar = Inapsine & Fentany(a narcotic analgesic)
Psychotherapeutics
Minor tranquilizers or anxiolytics group? adv over barb?
Belong to Benzodiazepine group
2 advantages over barbiturates:
No resp depression in sedative doses
Higher T.I.
neuroleptics

Modify psychotic behavior by blocking dopaamine receptor sites.
Effects: Sedation, anti-emetic & analgesic. Indicated in those with delirium and in those with whom Respiratory depression must be avoided
Thorazine, Haldol
Side Effects: CNS depression, hypotension, decreased contractility & conduction abnormalities
Meprobamate (Equanil, Miltown

(antianxiety)
anti anxiety med, muscle relaxant,od can cause coma
Buspirone (antianxiety)
antiaxiety doesn't cause muscle relaxation or sedation
Others: Utarax, Sinequan, Trancopal & Inapsine
Analgesics
Narcotics, derivatives of opium

Morphine, codeine, demerol

*demerol can cause tremors in high doses
Narcotics
At low doses are analgesics
Not anxiolytics
At high doses = sedatives
Lipid soluble
Synergistic with Benzodiazepines &Propofol
Morphine opiod analgesic
depress the CNS & increase bowel tone to the point of constipation,
depress respiratory center,
(pinpoint pupils)
Peripheral vasodilation due to histamine release
Slower ROO – 20”,
increased DOA – 2-7 hr

Requires dose adjustment with renal failure patients
Narcotic antagonists
Narcan & Trexan
Narcan inactivates opiate receptors
if someone is addicted it will illicit immediate withdrawal sx.
Short DOA