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133 Cards in this Set

  • Front
  • Back
Ether based anestheitcs were replaced with...
Halogenated volatile anesthetics.
What are the two broad groups of inhales anesthetics?
The volatile or potent anesthetics, and nitrous oxide.
How should you transport patients to the PACU if you are worried about aspiration?
In the lateral position.
What is the most common cause of post operative airway obstruction ?
Pharyngeal obstruction, from a relaxed tongue in an unconscious patient.
What is the best way to deal with a pharyngeal obstruction from a relaxed tongue?
Backward tilt of the head + anterior displacement of the mandible.
An increase in the R to L intrapulmonary shunt, which is the most common cause of post op hypoxemia is most commonly caused by...

Other causes include...
Pulmonary atelectasis, from segmental lung collapse and a loss of alveolar volume.

Bronchial obstruction,
what is the best way to treat a bronchial obstruction?
Humidification of the inspired gases.
Coughing, deep breathing, chest physical therapy, and postural drainage.
Usual treatment of a pneumothraces?
Chest tube insertion, and drainage with a one way underwater seal.
Treatment for tension pneumo?
a 14 gauge needle immediately inserted in to the second intercostal space in the mid clavicular line of the chest wall to relieve the thoracic tesnion before formal chest tube insertion.
When does pulmonary edema occur after surgery?
With in the first hour.
3 big reasons for pulmonary edema
1. high hydrostatic presssure in the pulmonary capillaries.

Usually secondary to ischemic or valvular heart injury.

2. Increased capillary permeability.

3. sustained reductions in the interstitial hydrostatic pressure.

Called "negative pressure pulmonary edema"
4 symptoms of PE?
Sudden
1. Pleuritic chest pain
2. Dyspnea
3. Pleural effusion
4. Tachypnea
Who are good candiates for mask or nasal CPAP?
Patients with severe hypoxemia requiring more than 80% oxygen to acheive a PaO2 higher than 60mm Hg.

Must have a normal or low PaCo2.

Should not have sever respiratory distress.

Be awake and alert
What are the causes of hypoventilation in the post operative period?
1. Poor respiratory drive.

Narcotics, treatment involves repeated small doses of antagonists.

2.Poor respiratory muscle function.

Greatest reduction in vital capacity occures after abdominal surgery.

Failure of neuromuscular reversal blockade.

obesity, gastric dilation, tight wound dressing, body casts.

3. High production rate of CO2.

Sepsis, shivering.


4. Acute or chronic lung disease.
What can cause the failure of reversal of neuromuscular blockade?
1. Inadequate excretion of the drug ( Renal failure)

2. Other drugs that accentuate the NM blockade.
Gentamycin, Neomycin, clindamycin, Furosemide.

3. Hypermagnesemia can potentiate NM blockade.

4. Hypothermia.
The vital capacity generated by the patient should be atleast....
10 ml/kg body weight.
The inspiratory force generated by the patient should be atleast...
20cm H2o
Important risk factors for complications in the PACU

Respiratory--
Cardiovascular --
Respiratory--Anesthetic Factors
Cardiovascular -- Patient and surgical factors.
SVR =
SVR= (MAP-CVP) / CO X 80
PCWP, Cardiac Index, SVR
for Hypovolemic shock

Treatment?
Low PCWP,
Low to normal Cardiac Index,
Normal to elevated SVR

IV administration of blood and crystalloid.
PCWP, Cardiac Index, SVR
for Cardiogenic Shock

Treatment?
Increased PCWP
Low Cardiac index
Elevated SVR

1. Optimize the ventricular preload.
When the left ventricle fails, it often functions best when the preload is elevated.

Add fluids+ inotropic support. May also add vasopressor to maintain the C.O.
Causes of hypertension in the PACU...
1. Pain
2. Hypercapnia
3. Hypoxemia
4. Excessive Intravascular fluid volume.
Dosing

Nitroprusside
Labetalol
Esmolol
Nitroprusside
Begin at 0.5 to 1.0 ug/kg per minute and titrated to an acceptable B.P. The dose should not exceed 10 ug/kg per minture or a total of 3mg/kg in 24 hours b/c of the metabolite cyanide.

Labetalol
IV 5mg increments.

Esmolol
continuous infusion of 25 go 300 ug/kg per minute.
Dysrythmias occuring in the PACU are often due to...
Metabolic or perfusion related problems.
Failure to regain consciousness in the PACU....work up...
1. Pharmacological reversal of most likely sedative drug.
2. Meatbolic reasons.
Hypothermia, Hypoglucemia/Hyperglycemia.
3. Structural Neurological abnormalities.
Physostigmine
1.25 mg IV can reverse the effects of some sedatives and inhalation Anesthetics.
What is a good way to control Post op pain for patients having major thoracic or abdominal surgery and at high risk for complications of parenteral analgesic therapy?
Continous epidural block, using mixture of short acting narcotics and dilute local anesthetic solutions.

When administerd in the thoracic space it can permit early post operative ambulation.
Reasonable alternative to narcotics during laparoscopic surgery?
Ibuprofen.
Common problem with fentaly and sufentanil but not so much with morphine...
Pruritis.
What type of surgeries espesially causes nause and vomiting? 3
Laparoscoping, middle ear, strabismus surgery .
Does propofol make you vomit?
No it has inherent Antiemitic activity.
Initial management of hypoxemia in the post op setting...4
1. Ensure patent airway
Chin lift, jaw thrust maneuvers.
2. Increase Fio2
Nasal Cannula, Face mask, non rebreathing mask, ETT
3. PPV
Mask, assisted, controlled ventilation.
4. Chest Xray
Asses lung volume, Heart size, Pulmonary infiltrate, Pneumothorax.
Main complications in the post op setting...6
1. Respiratory complications
Airway obstruction, Hypoxemia, Hypercapnia, Aspiration, hypoventilation
2. Ciruculatory complications.
Hypotension, Hypertension,Dysrythmias, M.I
3. Failure to regain consiousness.
4. Pain and agitation.
5. Post op Nausea and vomiting.
6. Hypothermia.
Causes of agitation in the post op setting besides pain...
Hypoxemia, Hypercapnia, Gastric distension, urinary retention with bladder distention.
What are the two selection criterias for good candidates for ambulatory surgery?
1. Patient criteria
Elderly patients focus is on physiologic age in terms of medical illness and ASA classification.

Patient age is only useful in the pediatric population.

Formerly premature infants- evaluation must asses the PCA and the infants risk of apnea.

If the PCA is younger than 50 weeks consider having the kid overnight.

Need a reliable escort, and some type of Preop needs to be done.
2. Procedure criteria.
What does the patient criteria consist of or ambulatory surgery?
Elderly patients focus is on physiologic age in terms of medical illness and ASA classification.

Patient age is only useful in the pediatric population.

Formerly premature infants- evaluation must asses the PCA and the infants risk of apnea.

If the PCA is younger than 50 weeks consider having the kid overnight.

Need a reliable escort, and some type of Preop needs to be done.
What are some side effects of spinal Anesthesia?

How can you counter this?
1. Prolonged motor blockade
2. Delayed voiding
3. Postdural puncture headaches
4. Prolonged procedure start time.

Can make it better by lowering the dose of local anasthetic while adding small amount of short acting narcotics .
Use a experienced staff
What is the average anesthetic turnover in an ambulatory setting?
8 to 12 minutes
How do you manage the general anasthetic during a face lift?

Why?
General anasthetic is managed with a natural airway.

Because oxygen may not be used because of concurrent electrocautery.
What is a LMA or COPA?
Supraglottic airway devices that serve as stents to keep the airway patent and conduits through which to deliver and scavenge volatile anesthetics.

They serve a similar function to a mask aiway, but allow the anesthesiologist a hands free alternative.
Most common post operative issues in ambulatory medicine?
pain and PONV.

Leading causes of delay and unanticipated admission to the hospital.
How should post op pain be treated in the ambulatory setting?
Preemptively.

1. decrease anxiety
2. use a preemptive block
if you are gonna give narcotics than give enough for the procedure and also the post op period. Because you dont want to have to regive it to them later and get them to stay longer.
How can you reduce PONV in the ambulatory setting? 7
1. decrese preop anxiety during the interview.
2. Use antiemetics pre or intra operatively.
3. Perform induction with propofol, and perhaps a small dose of propofol as antiemitic before emergence.
4. Ensure adequate rehydration.
5. minimize narcotic analgesia by using local anasthetics or nsaids
6. Avoid reversal of neuromuscular blockers, use shorter acting neuromuscular blockers or when possible none at all.
7. Avoid use of Nitrous oxide in high risk patients
---------Surgeries can be performed using general, regional or local anasthetics
Pelvic
Advantages and Disadvantages of N.O 5 each.
Advantages

1. The only Inhalational anasthetic that provides analgesia.
2. Fastest induction and emergence.
3. Less hypotension, Cardiac and resp depression.
4. Not pungent.
5. Only inhalational that is not a trigger for MH

Disadvantages
1. Low potency high MAC
2. Sympathetic stimulation
3. Bone Marrow toxicity.
4. Expands closed air spaces
5. Only inhalational that supports combustion.
Advantages and Disadvantages of Isoflurane each.
Advantages.
1.The most potent ( lowest MAC)

Disadvantages
1. Slower induction and emergence
2. Pungent odor.
Advantages and Disadvantages of Desflurane
Advantages
1. Lowest blood gas solubilty
2. Fastest induction and emergence

Disadvantages
1. Bronchoconstriction in smokers
2. CO formed in Co2 absorbent
3. Needs special heated vaporizer.
4. Sympathetic stimulation.
5. Pungent odor
Advantages and Disadvantages of Sevoflurane
Advantages
1. Pleasant odor
2. Suitable for mask induction in children
3. Bronchodilator

Disadvantages
1. High Hepatic metabolism.
2. High inorganic fluoride levels.
3. Compound A formed in Co2 absorber.
4. Potential renal toxicity.
5. Most souluble in fat and muscle
What do all of the Volatile Inhalational Anasthetics Isoflurane, Desflurane, Sevoflurane have in common?
1. Trigger for MH
2. Hypotension Because of vasodilator effect.
3. Should all be avoided in anyone with a previous history of anasthetic induced hepatitis
Of the inhalational Anesthetics, Discuss odor...
1. N.O- not pungent
2. Isoflurane and Desflurane Pungent odor
3. Sevoflurane- Pleasant odor.
Of the inhalational Anesthetics, Discuss hepatic metabolism...
D.I.E.S Hepatically

Desflurane 0.02%, Isoflurane 0.2%, Enflurane 2%, Sevoflurane 4% Halothane 20%
Of the inhalational Anesthetics, Who are good bronchodilators?
Isoflurane and Sevoflurane
Of the inhalational Anesthetics, Who are soluble in fat and muscle?

And thus...
Isoflurane and Sevoflurane

Thus they have slower induction and emergence
Of the volatile inhaltional anasthetics...who has the fastest induction and emergence?

Why?
Desflurane

Low blood gas solubility.
Rank the inhalational Anasthetics according to potency...
Isoflurane>Sevo>Des>N.O

Inverse for MAC
What is the only inhaled anasthetic that does not drop the blood pressure?
N.O

The rest cause a dose dependent drop in BP
Pulmonary and respiratory actions of Volatile anasthetics?
Rapid Respiration
Reduced Tidal Volume
leading to an overall slightly decreased minute ventilation.
Co2 curve is flattend and moves to the right.

They will have a higher CO2 and a lower respiratory response to hypercapnia.
Cardiovascular actions of all the volatile inhalational anasthetics?
Slight decrease in blood pressure and C.O
CNS actions of volatile inhalational anasthetics?
Increase cerebral blood flow, and intracranial pressure.
PPV to a person with a mediastinal mass?
Bad idea, can cause obstruction.
CNS actions of volatile inhalational anasthetics?

Cardiovascular actions of all the volatile inhalational anasthetics?

Pulmonary and respiratory actions of Volatile anasthetics?
Increase cerebral blood flow, and intracranial pressure.

Slight decrease in blood pressure and C.O

Rapid Respiration
Reduced Tidal Volume
leading to an overall slightly decreased minute ventilation.
Co2 curve is flattend and moves to the right.

They will have a higher CO2 and a lower respiratory response to hypercapnia.
60 % of all cardiac surgeries in america are...
CABG
What quantifies coronary artery stenosis?
70% or more narrowing.

50% or more in the LMCA.
Normal ejection fraction is
Greater than 55%
In an ECG what is the best lead to detect rhythm?

Why?

And therefore...
Lead 2

Because its vector orientation parallels that of atrial depolarization.

Lead 2 should always be one of the leads monitored.
What is the 5 lead ECG system and what are the 7 leads?
3 Bi polar leads: I, II, III
3 Augmented leads: aVR, aVL, aVF
1 of 6 unipolar leads: V1 to V6.
Is the use of automated real time ST segment analysis worth it during cardiac surgery?
Yes, increases the sensitivity of ischemia monitoring on ecg.
All patients about to have a CABG will get a preop...
Cathetirization.

To get both functional and anatomical data.
During a cardiac procedure what two temperatures should be monitored and how?
1. Central or core
Nasopharynx, Rectum, P.A, urinary bladder

2. Peripheral Temp
Skin, Forehead probe.
Four uses of a urinary catheter?
1. Indirect monitor for
Systemic perfusion
Intravascular volume status

3. protects the bladder from overdistension

4. Monitor temperature
What are some advantages of a PAC over a CVP line?
1. More accurate measurement of intravascular volume Preload.
2. provides a means measuring C.O
and thus you can derive SV, and both systemic and pulmonary vascular resistance.

3. Specialized PACs are available with cardiac pacing and continuous measurement of CO and pulmonary artery oxygen saturation.
Why can TEE be better than PAC ? 2
TEE allows for direct rela time analysis of cardiac function.

It can be used to guide the placement of various thing.
What are the three Broad stages to divide the CABG procedure?
Pre CPB
What is the major goal during Pre CPB ?
Induce general Anesthesia, and prevent further insult to the heart before the patient undergoes CPB while the bypass grafts are being constructed.
How do you define coronary perfusion pressure?
Difference between the mean aortic diastolic pressure and left venticular diastolic pressure.
what is the balanced technique that is used during cardiac surgery?

What is the advantage?
Low dose of narcotics 5 to 15 ug/kg fentanyl + modest dose of sodium thiopental 2 to 4mg/kg and supplemental isoflurane.

Advatage of less narcotics is faster emergence.
During CBP what is refered as the "ischemic time"
The time during which the cross clamp is placed (between the aortic canula and the patients heart) . During this time, no blood is allowed to enter the coronary artery.,
Antegrade cardioplegia...
Retrograde cardioplegia....
A canula placed between the aortic canula and the patients heart.

Venous system with the catheter placed in the coronary sinus.
Some ways to protect the myocardium from oxygen depletion during the CBP?
1. Mechanical Arrest
2. Heart is cooled.
3.Left ventricle is vented to prevent its distension which may lead to S.E.I
4. Various additives to maintain normal intramyocardial Ph, and provide substrate for anaerobic metabolism.
What are some adverse responses to protamine administration?
1. Histamine induced systemic hypotension.
2. IgE mediated allergic reactions
3. Complement mediated catastrophic pulmonary hypertension.
What is the problem with the pump needing to be primed?>
Significant dilutional effect on red blood cells, platelets and clotting factors.
What is aortocal comppression syndrome? 3 symptoms

What is the cause?
Whenever a pregnant woman lays supine she may get...

Maternal Hypotension
Tachcardia
Increase in femoral venous pressure

Caused due to IVC compression, due to the pressure from the gravid uterus.
Does maternal Hypotension always have to be pressent in aortocaval compression syndrome?
No, because pressure from the abdominal aorta can increase proximal arterial resistance and thus may increase the brachial artery bp

The femoral and thus the uterine artery hypotension may occur.
What is the clinical significance for the fetus with increase femoral venous pressure?
Increase in the femoral venous pressure further decreases uterine perfusion pressure, leading to fetal compromise.
What are the steps taken to prevent aotocaval compression>?2
1. Begening approximately 20 weeks gestation, the pregnant woman should not lie supine.

2. Placing a wedge under the right hip or tipping the operating table to create a 155 leftward tilt.
Changes in the respiratory system with pregnancy?
1. Capillary engorgement
2. Mucosal edema

can produce nasal obstruction, epistaxis,

Laryngeal edema can cause voice changes and upper airway obstruction.
What does progesterone do to the respiratory rate?
increases rate early in pregnancy.

later as Co2 increases there is another additional rise in minute ventilation.
How much is the uterine blood flow?
700ml/min or more.
up to 10% of maternal cardiac output.
Can the uterine vessesl auto regulate?
What is the significance?
No.
Thus, fetal nutrient delivery is dependent on the perfusion pressure.
fetal blood---placenta---back to fetus
Two umbilical arteries deliver fetal blood to placenta.

divide in to capillaries that transverse the placental villi.

Villi project in to the intevillious space and are bathed by maternal bood.

blood return to the fetus through a single umbilical vein.
maternal blood---placenta---back...
Uternie vessels---spiral arteries---pierce the basal plate of the placenta----circulate blood into the intervillous space---maternal blood then returns through the basal plate.
Do anesthetic agents readilly corss the placenta and enter fetal circulation?
Most do.
Except neuromuscular blockers beceuase they are large charged molecules that do not readily coess the lipid membrane.
Gastrointestinal changes in pregnancy..
Increased Intragastric pressure due to the expanding uterus.

Lower esophageal sphincter tone due to progesterone

Dramatically decreased gastric emptying that does not retunr to normal for 24 to 48 hours after delivery.
Endocine changes in pregnancy
diabetoigenic state-- increase basal hepatic glucose production and insulin resistance.

However, in most cases there is a fall in glucose concentration because of increased blood volume and a greater insuline responce to a meal
CNS changes in pregnancy?
Engorgement of the extradural venous plexus lead to a decrease in both the extradural and CSF volumes.
Engorgement of the extradural venous plexus lead to a decrease in both the extradural and CSF volumes.

Clinical significance?
Increased incidence of epidural venopuncture during epidural catheter placement.
What are the effects on inhalational and local anesthesia on pregnant women?
Increased sensitivity.
hematolgic changes in pregnancy?
Maternal blood volume increases 40 to 50%
increase in red cell mass 20%
So there is a physiologic anemia of pregnancy.

Increase in all clotting factors except 11 and 13.

Increased fibrinolytic activity. Increase in turnover of clotting factors.

decrease in serum anticoagulats (antithrombin 3, protein S) leading to a hypercoagulable state.

Throbocytopenia.
what are some causes of thrombocytopenia in pregnant women?
incidental thrombocytopenia.

idiopahic thrombocytopenic purpura
HEELP syndrome
What are some maternal problems related to Anesthesia? 7
1. Difficult intubation
2. Rapid Desaturation
Because of Decreased FRC, and increased oxygen consumption.
3. Hypotension
Anesthesia+ aorto caval compression+ decreased responsiveness to catecholamines.
4. Aspiration of gastric contents
5. High Spinal
Increased Sensitivity+ decreased lumbar csf volume. The LA dose should be reduced.
6. Gen Aesthesia overdose
Increased Sensitivity to Anesthesia+ Small FRC+ increased minute ventilation.
7. Coagulation
pregnancy related thrombocytopenia may preclude the use of R.A. Safe to use if platelet count is greather thank 100,000ml
Fetal problems related to surgery and Anesthesia during pregnancy. (3)
1. potentail teratogenic effects of anesthetics
Benzos- fetal cleft lip and palate.
N.O - Inhibits methinone synthetase

2. Fetal Asphyxia
depends on UBF, MAOC, approprate transfer of maternal oxygen to fetus.

Prevetion of hypotension by Left uterine displacement. Ephedrine 5to 10mg is the vasopressor of choice b.c it increases both maternal blood pressure and UBF.

3. Pre term labor
increased with surgery and ansthesia, but not so much during the second trimester.

Observe uterine activity in the post op period to detect early signs of labor.
Describe the two stages of labor pain.
1. First stage-

maybe from ischemia, activation of stretch receptors , nerve sensitization from prostoglandins.

visceral

Aching, cramping, burning.

Transmitted by the T10-L2 nerve roots. Small and easily blocked.

Generally over the abdomen, but may radiate to the back, perineum or legs.

2. Second Stage=

caused by pressure/ disruption of pain sensitive structure in the pelvis espesially the vagina.

Somatic

Carried by S2 to S4 Nerve roots.larger and more resistant to blockade.
Lamaze introduced breathing and relaxation techniques...and then Grantly Dick reid coined the term " Natural child birth"... what does he suggest is the cause of labor pain?
maternal anxiety and fear, which leads to pelvic muscle tension and subsequent pain.
What are some Non pharmacolgic options for labor analgesia? 10
child birth education
Psycoprophylacis
breathing and relaxation techniques
emotional support
hydrotherapy
massage
trancutaneous elctrical nerve stimulation

biofeedback
hypnosis
acupuncture/acupressure
What are the D.O.C systemic labor analgesia?

adjuncts?
opioid anlagesics are D.o.c

Adjuncts include tranquilizers that provide sedative and anxiolytic effects like phenothiazine, hydroxyzine, scopolamine, barbituates, benzos
neuroaxial techniques used for labor analgesia?
Lumbar epidural anlgesia and combined spinal epidural
What does the combined spinal epidural consist of?
A small dose of narcotic+local anesthetic is administerd in to the intrathecal space.

Provides satisfactory analgesia for 60 to 150 minutes.

epidural catheter is also places for prolonged analgesia.

It provides rapid analgesia and low failure rate.
What are the most common spinal medications used for cesarean section?
Lidocaine
60 to 80 % 2% or 5%

Bupivacaine
10 to 15 mg 0.5% to 0.75%

about 20ml will provide surgical anesthesia to T4 to T6 level.
What happens to dead space in the lungs during pregnancy?
goes up
what happens to TLC, FRC, ERV, RV,

What happens to Tidal volume, minute ventilation, Dead space, o2 consumption, co2 production

Respiration rate?
Down

Up

Same.
How does the international Association for the study of pain Define pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage , or described in terms of such damage"

It is both a physiologic sensation and an emotional reaction to that sensation.
What are the 3 components of pain?
1. Sensory discriminative
2. Motivational affective
3. Cognitive evaluative
What are the two classes of afferent never fibers responsible for nociceptive information?
The A delta fibers.

C fibers
A Delta fibers..
Rapidly conducting
Myelinated fibers
Rate of 5-30 m/sc
Sharp and pricking pain
C fibers
Small Diameter
unmyelinated Fibers
slower, 0.5 to 2m/sec
dull pain
Where do nociceptive afferent fibers from the skin terminate?
Laminae 1, 2, 5, of the dorsal horn.
Where do nociceptive afferent fibers from the viscera, muscle, and other deep tissues terminate?
laminae 1,5,10 of the dorsal horn.
The ascending spinal nociceptive pathways are comprised by?
1. Spinothalamic
2. Spinoreticular
3. Spinal mesencephalic
4. Post synaptic dorsal column tracts.
Spinothalamic to pain

whats the pathway
Spinothalamic tract decussates and then ascends the spinal cord

it goes to a number of thalamic targets including the Ventral posterolateral nucleus...then go to...

Primary sensory cortex
What is the spinoreticular pathway?

What is the path?
is an ascending pathway in the white matter of the spinal cord, positioned closely to the lateral spinothalamic tract.

Ascends on both sides of the spinal cord to the intralaminar nuceli of both right and left thalami

from here numerous projections involved in memory and emotions travel to the cingulate gyrus,
How are the nociceptive fibers carried?
mainly through the posterior root of the spinal cord.

In some cases, it can be the venral root.

In the case of the trigeminal nerve it goes to the brainstem.
What are some ways that pain is classified?
1. Neurophysiological mechanism: Is based on the inferred mechanism of pain.

Nociceptive
Somatic
Visceral

Non-nociceptive pain
Neuropathic
Idiopathic

2. Temporal- Defined by the duration of symptoms

Acute
Chronic
Malignant
Non Malignant

3. Etiologic: Primary process
cancer, arthritis, sore throat etc

4. Regions Affected
What is nociceptive pain?

how is it signaled?
Nociceptive pain: Pain that is presumed to be maintained by continual tissue injury. Could be either somatic or visceral.

Results from activation or sensitization of nociceptors in the periphery which transduces noxious stimuli...
What is neuropathic pain?

How is it treated?
A type of non nociceptive pain, which is caused by injury to neural structures within the PNS or CNS.

Antidepressants and Antiepileptics
What kind of drugs are espesially good for Non nociceptive neuropathic pain with a lancinating component?

What is the mechanism?
Antiepileptics.

Supress spontaneous neuronal firing through membrane stabilizing effects.
Pharmacologic management for Neuropathic pain...

Trigeminal neuralgia:

Diabetic neuropathy and Postherpetic neuralgia:

Severe Spasticity of the spinal cord:

Chronic Neuropathic pain:
Trigeminal neuralgia: Carbamazepine

Diabetic neuropathy and Postherpetic neuralgia: Gabapentin

Severe Spasticity of the spinal cord: Intrathecal Baclofen

Chronic Neuropathic pain: lamotrigine, topiramate and others.
What are 3 mixed aganoist- anatagonist opioids?
1. Pentazocine
2. Butorphanol
3. Buprenorphine
What are the relatively pure opioid agonists?
morphine, codeine, oxycodeon, leorphanol, meperidine, fentanyl, methadone.
Which opiod has a very long half life?
Methadone (15-30)
Levorphanol (12-16)
What opiod can be given subcutaneously?
Morphine
What is the most common pain in cancer patients?
Bone Pain

Followed by pain from tumor inflitration of nerve and hollow viscera
In terms of palliative care

____ are home care based.

____ are within or affiliated with hosptials etc.
Hospice

Palliative care units
What are some disease/ conditions that present with spasticity?

WAht is one mode of treatment
Multiple sclerosis, Spinal cord trauma, post stroke rigidity, Cerbral palsy.

intrathecal infusion.