Analgesic+Drugs+&+General+and+Local+Anesthetics

= ﻿ ANALGESIC DRUGS & GENERAL AND LOCAL ANESTHETICS=

FOR THE MANAGEMENT OF PAIN
=To understand pain relief medication, first you should understand pain...= =PAIN=

=What is pain??=
 * ====An unpleasant sensory and emotional experience associated with actual or potential tissue damage.====
 * ====Pain results from the stimulation of sensory nerve fibers known as nociceptors that transmit pain signals from various body regions to the spinal cord or brain.====
 * ====Involves physical, psychological, and cultural factors====
 * ====Personal and Individual Experience====

=PERCEPTION OF PAIN= media type="youtube" key="0Ck9ji9aS8M" height="390" width="480"

=PAIN THRESHOLD vs. PAIN TOLERANCE= ==
 * ===**Pain Threshold:** The level of stimulus needed to produce a painful sensation===
 * ===Three main receptors involved with pain: mu, kappa, and delta located in both the CNS and various body tissues===
 * ===Mu receptors influence pain perception===
 * ====High number of mu receptors indicated diminished pain sensitivity====
 * ====With reduced or missing receptors minor noxious stimuli may be perceived as painful====
 * ===__Pain Tolerance:__ amount of pain a person can endure without it interfering with normal function.===
 * ====Pain tolerance can vary from person to person or even within the same person depending on the circumstances involved.====

Emotional response to pain is influenced by the patient's age, sex, culture, previous pain experience, and anxiety level.

 * ===Pain Threshold=== || ===Condition=== ||
 * ====**Lowered**==== || ====Anger, anxiety, depression, discomfort, fear, isolation, chronic pain, sleeplessness, tiredness==== ||
 * ====**Raised**==== || ====Diversion, empathy, rest, sympathy, medication==== ||

MYTBUSTERS: Who has more pain __tolerance__ (not threshold)- males or females??
media type="youtube" key="u4kvpjQe8nw" height="390" width="640" ====**While the pain threshold is generally the same for every individual, the pain tolerance varied. Results could be affected by factors such as anger/anxiety that lowered the threshold or medication or rest that raised it.====

=ACUTE PAIN vs. CHRONIC PAIN= =CLASSIFICATIONS OF PAIN..= =..ACCORDING TO SOURCE=
 * ==Acute Pain: sudden and usually subsides when treated (i.e. postoperative pain)==
 * ==Chronic Pain: persistent or recurring, lasting 3 to 6 months==
 * ====Often more difficult to treat because of increased tolerance or physical dependence.====
 * ===Type of Pain=== || ===Onset=== || ===Duration=== || ===Examples=== ||
 * ===Acute=== || ====Sudden (minutes to hours); usually sharp, localized; physiologic response (SNS: tachycardia, sweating, pallor, increased blood pressure)==== || ====Limited (has an end)==== || ====Myocardial infarction, appendicitis, dental procedures, kidney stones, surgical procedures==== ||
 * ===Chronic=== || ====Slow (days to months); long duration; dull, persistent aching==== || ====Persistent or recurring (endless)==== || ====Arthritis, cancer, lower back pain, peripheral neuropathy==== ||

**Deep Pain:**occurs in tissues below the skin level
=..ACCORDING TO CAUSE=

**Phantom Pain:** occurs in the area of a body part that has been removed-surgically or traumatically-and is often described as burning, itching, tingling, or stabbing
====**Cancer Pain**: results from mechanical pressure of tumor mass against nerves, organs, or tissues, Other causes include hypoxia from blockage of blood supply to an organ, metastases, pathologic features, muscle spasms, and adverse effects of radiation, surgery, and chemotherapy====

**Central Pain:** occurs with tumors, trauma, inflammation, or disease affecting CNS tissues
=PAIN RELIEF THEORY: GATE THEORY=
 * ====Most common====
 * ====Uses the analogy of the gate to describe how impulses from damaged tissues are sensed in the brain====
 * ====**STEP 1**====
 * ====Tissue injury causes the release of substances bradykinin, histamine, postassium, prostaglandins, serotonin====
 * ====**STEP 2**====
 * ====Action potential is initiated====
 * ====Travels along a sensory nerve fiber====
 * ====Activates a pain receptor====
 * ====**STEP 3**====
 * ====Pain fibers enter the spinal cord in the doral horn====
 * ===="Gates" are located in the dorsal horn====
 * ====Pain impulses travel to the brain====
 * ====The gates regulate the flow of sensory impulses to the brain====
 * ====** If the impulse is blocked at the gate, it never reaches the brain and no pain is perceived **====

=ANALGESIC DRUGS =

What is an analgesic?

 * ====a medication that relieve pain without causing loss of consciousness (sometimes referred to as painkillers)====



﻿Opioid Analgesics
Drugs 
 * originate from opium poppy plan
 * only 3 alkaloids clinically usefull : morphine, codeine, and papaverine
 * morphine and codeine are pain relievers
 * papverine is a smooth muscle relaxant
 * 3 different chemical classes of opiod
 * morphine - like drugs
 * meperidine - like drugs
 * methadone - like drugs
 * Morphine **
 * for severe pain
 * Fentanyl **
 * <span style="font-family: 'Comic Sans MS',cursive;">for severe and chronic pain
 * <span style="font-family: 'Comic Sans MS',cursive;">second most commonly used opiod
 * <span style="font-family: 'Comic Sans MS',cursive;">rapid onset of action and a short duration
 * <span style="font-family: 'Comic Sans MS',cursive;">comes in a transdermal patch (chronic pain)
 * <span style="font-family: 'Comic Sans MS',cursive;">lollipop form (newest) for cancer pain management
 * <span style="font-family: 'Comic Sans MS',cursive;">caution with IV for, if given to fast can cause chest wall rigidity
 * <span style="font-family: 'Comic Sans MS',cursive;">Meperidine (demerol) **
 * <span style="font-family: 'Comic Sans MS',cursive;">high abuse and high addiction rates
 * <span style="font-family: 'Comic Sans MS',cursive;">short term use, usually less than 72 hours
 * <span style="font-family: 'Comic Sans MS',cursive;">normeperidine - active metabolite that can accumulate to toxic levles leading to seizures
 * <span style="font-family: 'Comic Sans MS',cursive;">Indications of us for opiod analgesics **
 * <span style="font-family: 'Comic Sans MS',cursive;">mainly to alleviate moderate to severe pain
 * <span style="font-family: 'Comic Sans MS',cursive;">often given additionally with
 * <span style="font-family: 'Comic Sans MS',cursive;">NSAIDS
 * <span style="font-family: 'Comic Sans MS',cursive;">Antidepressents
 * <span style="font-family: 'Comic Sans MS',cursive;">Anticonvulsants
 * <span style="font-family: 'Comic Sans MS',cursive;">Corticosteroids
 * <span style="font-family: 'Comic Sans MS',cursive;">when given with adjucant analgesic agents side effects are decreased and a synergist effect occurs (1+1=3)
 * <span style="font-family: 'Comic Sans MS',cursive;">also used for cough suppression
 * <span style="font-family: 'Comic Sans MS',cursive;">diarrhea
 * <span style="font-family: 'Comic Sans MS',cursive;">balanced anesthesia
 * <span style="font-family: 'Comic Sans MS',cursive;">Side Effects **
 * <span style="font-family: 'Comic Sans MS',cursive;">Respiratory depression *MOST SERIOUS*
 * <span style="font-family: 'Comic Sans MS',cursive;">Euphoria
 * <span style="font-family: 'Comic Sans MS',cursive;">CNS depression
 * <span style="font-family: 'Comic Sans MS',cursive;">N & V
 * <span style="font-family: 'Comic Sans MS',cursive;">Urinary retention
 * <span style="font-family: 'Comic Sans MS',cursive;">Diaphoresis and flushing
 * <span style="font-family: 'Comic Sans MS',cursive;">pupil constrictionconstipation
 * <span style="font-family: 'Comic Sans MS',cursive;">itching
 * <span style="font-family: 'Comic Sans MS',cursive;">Contraindications **
 * <span style="font-family: 'Comic Sans MS',cursive;">known drug allergy
 * <span style="font-family: 'Comic Sans MS',cursive;">severe asthma or other respiratory insufficiency
 * <span style="font-family: 'Comic Sans MS',cursive;">elevated ICP
 * <span style="font-family: 'Comic Sans MS',cursive;">Caution with pregnancy
 * <span style="font-family: 'Comic Sans MS',cursive;">Nursing Implications **
 * <span style="font-family: 'Comic Sans MS',cursive;">Take health history, allergies, meds, alcohol use
 * <span style="font-family: 'Comic Sans MS',cursive;">baseline I&O and VS
 * <span style="font-family: 'Comic Sans MS',cursive;">asses possible contraindications
 * <span style="font-family: 'Comic Sans MS',cursive;">before begining therapy
 * <span style="font-family: 'Comic Sans MS',cursive;">perform pain assesment
 * <span style="font-family: 'Comic Sans MS',cursive;">medicate pt before pain becomes severe
 * <span style="font-family: 'Comic Sans MS',cursive;">use pharmacological and nonpharmacological approaches
 * <span style="font-family: 'Comic Sans MS',cursive;">notify MD with signs of allergic reaction or adverse effects

=<span style="color: #ff00e9; font-family: 'Comic Sans MS',cursive;">Opiate Antagonists = <span style="font-family: 'Comic Sans MS',cursive;">Naloxone (Narcan) <span style="font-family: 'Comic Sans MS',cursive;">Naltrexone (Revia)
 * <span style="font-family: 'Comic Sans MS',cursive;">DRUGS **
 * <span style="font-family: 'Comic Sans MS',cursive;">reversal of respiratory depression
 * <span style="font-family: 'Comic Sans MS',cursive;">last about 1 hour and may reappear for long acting opiods.
 * <span style="font-family: 'Comic Sans MS',cursive;">Used for complete or partial reversal of opiod-induced respiratory depression
 * <span style="font-family: 'Comic Sans MS',cursive;">reverses pain control

<span style="font-family: 'Comic Sans MS',cursive;">Opioid Tolerance <span style="font-family: 'Comic Sans MS',cursive;">physical dependence
 * <span style="font-family: 'Comic Sans MS',cursive;">Risks **
 * <span style="font-family: 'Comic Sans MS',cursive;">physiologic result from chronic opiod use
 * <span style="font-family: 'Comic Sans MS',cursive;">meaning larger does are needed to have therapeutic effect
 * <span style="font-family: 'Comic Sans MS',cursive;">physiologic adaptation of the body to presence of opioid
 * <span style="font-family: 'Comic Sans MS',cursive;">if drug stopped abruptly withdraw symptoms occur
 * <span style="font-family: 'Comic Sans MS',cursive;">narcotic withdrawl
 * <span style="font-family: 'Comic Sans MS',cursive;">opioid abstinence syndrome
 * <span style="font-family: 'Comic Sans MS',cursive;">manifested as: anxiety, irritability, chills, hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, NVD, abdominal crampsshould not be confused with addiction
 * <span style="font-family: 'Comic Sans MS',cursive;">misunderstanding leads to ineffective pain management and contribute to under treatment of pain"break - through" pain
 * <span style="font-family: 'Comic Sans MS',cursive;">get shorter or fast acting forms on a regular schedule
 * <span style="font-family: 'Comic Sans MS',cursive;">baseline dose of the narcotic may need to be titrated up, or increased in increments
 * <span style="font-family: 'Comic Sans MS',cursive;">Nursing Implications **
 * <span style="font-family: 'Comic Sans MS',cursive;">Notify MD and withhold med if
 * <span style="font-family: 'Comic Sans MS',cursive;">decline in pt overall condition
 * <span style="font-family: 'Comic Sans MS',cursive;">vs are abnormal
 * <span style="font-family: 'Comic Sans MS',cursive;">bad if respiratory rate is less than 12 breaths/min
 * <span style="font-family: 'Comic Sans MS',cursive;">check dosage carefully!
 * <span style="font-family: 'Comic Sans MS',cursive;">ensure safety measures
 * <span style="font-family: 'Comic Sans MS',cursive;">constipation prevented with adequate fluid and fiver intake
 * <span style="font-family: 'Comic Sans MS',cursive;">encourage pt to keep record of pain experience and response to treatment
 * <span style="font-family: 'Comic Sans MS',cursive;">possible orthostatic hypotension
 * <span style="font-family: 'Comic Sans MS',cursive;">PO forms take with food

=<span style="color: #4ad6ed; font-family: 'Comic Sans MS',cursive;">NONopioid Analgesics =


 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Acetaminophen **
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">analgesic and antipyretic effects
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">little to no antiinflammatory effects
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">available OTC and can be found in combination products with opioids
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Indications **
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">mild to moderate pain
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">fever
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">alternative for pts who can't take asprin
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Risks **
 * **<span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Toxicity and Overdose **
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">lethal when overdosed
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">causes hepatic necrosis
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">nephropathy
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">recommended antidote: acetylcysteine
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">managmenet
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">max adult dose 4000mg/ day
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">inadvertent excessive doses may occur when different combo drug products are taken together
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">no acetaminophen content in all current meds pt is taking
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">antidote **<span style="color: #000000; font-family: 'Comic Sans MS',cursive;"> __Acetylcysteine (Mucomyst)__ **
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">foul smelling and can only be given for single ingestions
 * **<span style="color: #000000; font-family: 'Comic Sans MS',cursive;">Interactions **
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">dangerous interactions can occur when taken with alcohol
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">should not take if have:
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">liver dysfunction
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">possible liver failure
 * <span style="color: #000000; font-family: 'Comic Sans MS',cursive;">when taking other hepatotoxic drugs

<span style="color: #10f411; font-family: 'Comic Sans MS',cursive;">* decreased fever with acetaminophen
Adverse Effects || Patient Education || · Cause an analgesic response (reduction of pain sensation) || **// -Respiratory Depression //** -Euphoria -CNS depression -Nausea and vomiting -Urinary retention -Diaphoresis and flushing -Pupil constriction -Constipation -Itching ** Withhold dose if respirations < 12/min ** || Contraindications: • Severe asthma or other respiratory insufficiency • Elevated intracranial pressure Use with caution in pregnancy || · Cough Suppressant || Same as above || Same as above || Same as above || · Severe Pain in the ER   · Short-term pain management <72 hours || Same as above || Same as above • Normeperidine – an active metabolite • Can accumulate to toxic levels and lead to seizures || Same as above · High Abuse · High Addiction || · Addictions (Heroin) || Same as above -Does not produce the euphoric effect of other opiate Agonists || Same as above with the exception of euphoric effect || Use with caution in pregnancy/breastfeeding || Chronic Pain || · Binds to an opioid pain receptor in the brain · Causes reduction of pain sensation || Same as above || Contraindications: • Severe asthma or other respiratory insufficiency • Elevated intracranial pressure Use with caution in pregnancy || Cough Suppressant || Same as above || Same as above || Same as above || Chronic Pain || Same as above Rapid Onset – Short Duration || Same as above and: IV SLOW PUSH – pushing quickly can cause chest wall rigidity || Same as above · Available in Patch for chronic pain management · Available in lollipop form – Cancer Patients || • Used for complete or partial reversal of  opioid-induced respiratory depression || • Reverses the respiratory depression but also reverses the pain control! • Respiratory depression may reappear for long-acting opioids! || xxxxxxxxxxxxxxxxxxx ||
 * Classification || Name of Drug || Indication || Mechanism of Action || Side Effects
 * Opiate Agonist || morph//ine// sulfate || Severe Pain || · Bind to an opioid pain receptor in the brain
 * Opiate Agonist || code//ine// sulfate || · Moderate Pain
 * Opiate Agonist || meperid//ine// HCl (Demerol) || · Postoperative pain
 * Opiate Agonist || methad//one// HCl (Dolophine) || · Opiod Abstinence Syndrome
 * Opiate Agonist || Oxycodone CR (OxyContin) || Severe Pain
 * Opiate Agonist || Hydrocodone || Moderate – Severe Pain
 * Opiate Agonist || Fentanyl citrate || Severe Pain
 * Opiate Antagonist || ** nal//oxone// ( ** Narcan) || Reversal for narcotic drugs || • Bind to opiate receptors and prevents a response

=GENERAL AND LOCAL ANESTHETICS=

<span style="font-family: Arial,Helvetica,sans-serif;">** 1) General anesthesia- create a state in which the CNS is altered, indications include surgical procdures and electroconclusive therapy **

 * Purpose: pain relief/sensory loss, depression of conciousness, skeletal muscle relaxation, reflex reduction, smooth muscle relaxation, and paralysis of respiratory muscles (may be require one or more drug to produce all)
 * Types: Inhaled- volitale liquids or gases that are vaporized in oxygen (eg. halothane, isoflurane, enflurane, methoxyflurane, nitrous oxide)

Injectable-IV administered, used to create/maintain anethesia, produce amnesia, use in addition to inhaled (eg. propofol/diprivan, ketamine/ketalar) *Diprivan= rapid onset (30-60 seconds), rapid recovery (10-25 minutes), less hangover effects *Ketalar=rapid onset (30 seconds), longer recovery (45 minutes), used when cardiac depression is not safe


 * Side Effects/Adverse Effects: diprivan may cause local burning at injection site, bradycardia, hypotesion, pulmonary edema
 * Side Effects/Adverse Effects: ketalar is able to cross the blood-brain barrier and cause hallucinations, dreams, psychotic episodes
 * More Side/Adverse Effects: dependent on dose and drug used- heart complications, peripheral circulation, liver and kidney complications, respiratory tract, and myocardial depression
 * Contrainications: allergy, pregnancy, narrow angle glaucoma, known history of malignant hyperthermia

<span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">﻿Malignant hyperthermia- not common, potentially fatal, typically genetic, produces an adverse metabolic reaction to GA. Ususally occurs with inhaled anesthetics or depolarizing NMBD (succinylcholine) <span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">S/S: tachycardia, tachypnea, muscle rigidity, rise in body temp greater than 104= LIFE THREATENING <span style="color: #000080; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Treatment: support heart and lungs, give Dantrolene to reduce muscle rigidity

2) Balanced Anethesia: also called combination, and allows less of each drug to be used, less side effects, and is a more controlled state

 * Involves a sedative (barbituates such as thiopental/pentothal), benzodiazepines (midazolam/versed), opiod (narcotics like morphine or fentanyl)
 * Also use anticholinergics (atropine), NMBA's (succinylcholine), nondepolarizing agents (vecuronium)

-Breakdown of the Drugs
Barbituates ~Thiopental (Pentothal): IV med used for rapid anethesia, it can be maintained by inhaled drug. It has a rapid onset of 10-30 seconds and recovery time of 5-8 minutes it is lipophilic and absorbed fast through the blood-brain barrier

Benzodiazepines ~Midazolam (Versed): potent and used to induce amnesia and be continuous sedation for intubaded patients. Used for diagnostic, endoscopic, and therapeutic procedures Function not known, but also has a rapid onset and peak of 30 to 60 minutes. Side effects include drowsiness, sedations, constipation, disorientation

Neuromuscular Blocking Agents ~Succinylcholine, Vercuronium: these prevent nerve transmission in certain muscles which produces paralysis, is used in conjunction with anethetics. Requires a vent, and do not relieve pain or provide sedation. Used to maintain controlled vent, reduce muscle contractions in area of surgery, and diagnostic for myasthenia gravis. Side effects include hypotension, tachycardia. Overdose could cause cardiac collapseand/or need ventilation.

3) Local Anesthetics

 * ==Used for surgical, dental, and diagnostic procedures as well as certain types of pain.==
 * Can be topical (skin, mucus membranes) or parenteral (spinal injections)
 * Respiratory muscles not paralyzed, and does get rid of pain
 * Types: intrathecal, epidural, infiltration, nerve block, topical

**﻿-Breakdown of the Drugs**
~Lidocaine (Xylocaine) is a local that is short acting, and dangerous if systemically absorbed ~Ropivacaine (Naropin) epidural/spinal, good pain management for obstetrics/post op, avoid rapid infusion ~Mepivacaine (Carbocaine) ~Procaine (Novocain) ~Tetracaine (Pontocaine) ~Bupivaine (Marcaine)


 * When used on you: autonomic, then pain/sensory functions, and then motor activity is lost. When recovering it wears off in reverse order.
 * Side effects are small but can result in accidentally IV injection, too much of a dose, slow metabolic breakdown, could be injected into highely vascular tissue

4) Moderate/Concious Sedation
<iframe title="YouTube video player" width="640" height="390" src="[]" frameborder="0" allowfullscreen>
 * No ventilation required, patient can respond to verbal commands, used for diagnostic and minor procedures, can be combined with local ansthetics
 * fast recovery and better safety profile than general anesthesia

-Breaking Down the Drugs
~Midazalam (Versed): IV benzo ~Morphine/Fentanyl: opiate analgesic -these meds reduce anxiety and sensitivity to pain and patinet won't remember it afterwards

Nursing Implications

 * 1) Assess alcohol and drug use
 * 2) Obtain baseline VS, lab work, EKG, ABC's
 * 3) Continually monitor all body systems
 * 4) Be wary of cardiac or respiratory depression post op
 * 5) Make patient aware of awake feeling with NMBA's
 * 6) Teach deep breathe and cough for post op

** - Isoflurane ** ** -Nitrous oxide ** || -To induce or maintain general anesthesia || Sites primarily affected: -Heart -Peripheral circulation - Liver -Kidneys -Respiratory tract -Myocardial depression || Contraindications -Drug allergy -Pregnancy – depending on drug type -Narrow angle glaucoma -Known susceptibility: Malignant Hyperthermia || ** -Ketamine (Ketalar) ** || -To induce or maintain general anesthesia -As an adjunct to inhalation-type anesthetics || __ Propofol (Diprivan) __ -Local burning at injection site -Bradycardia, hypotension, pulmonary edema __ Ketamine (Ketalar) __ Crosses blood brain barrier: -hallucinations, dreams, psychotic episodes || __ Propofol (Diprivan) __ -Rapid onset: 30-60 sec -Recovery: 10-25 min -Less “hangover” effect __ Ketamine (Ketalar) __ -Rapid Onset: 30 Seconds -Recovery: 45 minutes -Useful in situations where cardiac depression is dangerous || ** -Thiopental (Pentothal) ** || -IV Drug used to induce rapid anesthesia || Associated with depression of the CNS: ◦ Decreased pulse ◦ Hypotension ◦ Suppressed respirations ◦ Decreased GI activity ◦ Nausea and vomiting after recovery || __ Thiopental (Pentothal) __ Very rapid onset of action: ◦ 10 – 30 seconds Very short recovery time: ◦ 5-8 minutes || ** -Midazolam (Versed ** ) || Produces sedation and amnesia for: -Diagnostic, Endoscopic, Therapeutic Procedures || -Drowsiness, sedation, constipation, phlebitis at IV site, disorientation || __ Midazolam (Versed) __ -Rapid Onset – Peak effectiveness 30-60 min -Patients can follow commands -Patients have no memory of procedure || ** -Atropine ** ** - **** S **** copolamine ** || Same as above || See Anticholinergics || See Anticholinergics || ** -Succinylcholine ** ** -Vecuronium ** || · Maintaining controlled ventilation during surgery · Endotracheal intubation · To reduce muscle contractions during surgery · Diagnostic agents for myasthenia gravis || ◦ Hypotension ◦ Tachycardia ◦ Hypotension ** Overdose ** ◦ paralysis requiring prolonged mechanical ventilation ◦ Cardiovascular collapse || Conditions that increase sensitivity include: • Acidosis • Electrolyte imbalances • Myasthenia gravis • Paraplegia || ** -Morphine ** ** - Fentanyl ** || Adjunct to inhaled or injectable anesthetics || See Chapter 10 Study Guide || See Chapter 10 study guide || · Intravascular injection occurs · Excessive dose or rate of injection n   · Slow metabolic breakdown · Injection into a highly vascular tissue || Avoid rapid infusion Good pain relief for Obstetrics and Postoperatively || Danger of absorbed systemically || Conscious Sedation || ** Midazalam (Versed) ** ** And ** ** Morphine or Fentanyl ** || ◦ GI procedures, endoscopy ◦ Rapid recovery time and greater safety profile than general anesthesia || See above for Midazalam (versed) See chapter 10 for Morphine/Fentanyl || Anxiety and sensitivity to pain are reduced, and patient cannot recall the procedure ||
 * Inhaled Anesthetics || ** -Halothane **
 * Injectable Anesthetics || ** -Propofol(Diprivan) **
 * Balanced Anesthesia || Barbiturates:
 * Balanced Anesthesia || Benzodiazepines:
 * Balanced anesthesia || Anticholinergics:
 * Balanced Anesthesia || NMBA
 * Balanced Anesthesia || Opioids
 * Local Anesthesia || ** -Ropivacaine (Naropin) ** || Local/epidural || Adverse effects result if:
 * Local Anesthesia || ** Bupiva//caine// (Marcaine) ** || Local/epidural || Same as above || none ||
 * Local Anesthesia || ** Lido//caine// (Xylocaine) ** || Local || Same as above || Short acting – preferred for short procedures
 * Moderate Sedation

All References

Lane, L, Collins, S, Harington, S, Rainforth, S, & S., J. (2010). //Pharmacology and the nursing process.//Mosby Inc.

Petges, Nancy RN MSN. Pharmacology : Analgesic Agents Powerpoint, 2011.