Term
|
Definition
gold standard
m and k agonistsLo
first-pass hepatic metabolism
SE - vent depression, inc ICP, constipation, bile duct spasm, hypotension |
|
|
Term
|
Definition
strong opoid agonist - much more potent than morphine
general anesthesia, conscious sedation
transdermal and transmucosal |
|
|
Term
|
Definition
long-term pain control and detox
great oral bioavailability
longer half-life and accumulation with repeat administration |
|
|
Term
|
Definition
only <48 hour use
no biliary tract spasm
short half-life, reqs freq dosing
can lead to tremor, seizures, status epilepticus
DDI with MAOIs, inc 5HT (delirium, fever, coma, death) |
|
|
Term
|
Definition
5-10x as potent as morphine
must be careful when substituting, bc lethal outcomes possible |
|
|
Term
|
Definition
very lipophilic, causing a rush
metabolized to morphine in CNS |
|
|
Term
Codeine
Hydrocodone
Oxycodone |
|
Definition
used for moderate pain, often with ASA or acetaminophen
antitussive activity
breaking controlled-released tables causes opioid-like euphoria and abuse |
|
|
Term
|
Definition
adjunct for severe pain
stimulates alpha-2 receptors - analgesia in spinal cord, dec SNS outflow in brain |
|
|
Term
Anticonvulsants:
Carbamazepine
Gabapentin
Lamotrigine |
|
Definition
adjunct for severe pain
block sodium channels - dec AP to sensory nerves |
|
|
Term
|
Definition
strong k agonist, weak m agonist (inhibitory effect)
toxic at high doses
SE - opposite of morphine - dysphoria, hallucination, HTN, tachycardia
don't give to pt taking pure opioid agonist |
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|
Term
|
Definition
k agonist, m antagonist
dose response curve for analgesia, vent depression, flattens out quickly
less CV effects than pentazocine
don't give to pt taking pure opioid agonist |
|
|
Term
|
Definition
dx or tx opioid OD
blocks all opioid receptors
fast-acting, short duration |
|
|
Term
| Local anesthetics (general) |
|
Definition
must be non-ionized (neutral charge) to diffuse in - pKa is typically 8-9
binds to and inactivates Na channels on rapidly firing neurons (small, nonmyelinated), causes loss of pain > temp > touch > deep pressure
lidocaine can by used IV for anti-arrhythmic tx but only by anesthesiologist
SE - CV depression (esp bupivacaine), vent depression, CNS stimu (seizures - apnea during seizures main cause of death) |
|
|
Term
Esters:
Procaine
Chlorprocaine
Tetracaine |
|
Definition
rarely used
low potency, slow onset, short duration
high allergenicity |
|
|
Term
|
Definition
most widely used LA
hepatic metabolism
low allergenicity |
|
|
Term
| LA + vasoconstrictors (EPI) |
|
Definition
slows systemic absorption - faster onset, longer duration, inc intensity, dec risk of systemic toxicity
can use in pts with HTN
do not use in areas like the finger - can cause ischemia |
|
|
Term
|
Definition
short-term use on small areas of skin and mucous membranes
hydrolyzed to PABA
excessive use causes dermatitis and further overuse |
|
|
Term
|
Definition
cerebral cortical stimulant, blocks NE reuptake
only topical use medically
sympathomimetic effects (vasoconstriction) |
|
|
Term
| Inhalation agents for general anesthesia (general) |
|
Definition
? GABA-A receptor chloride channel and activation of K channels
MAC - min conc to abolish pain in 50% of pts
Malignant hyperthermia - (esp with succinylcholine), dec Ca uptake by sarcoplasmic reticulum causes skeletal muscle contracture, metabolic heat production, and fever - treat with dantrolene |
|
|
Term
| Volatile liquid halogenated hydrocarbon agents (general) |
|
Definition
liquids at STP
very low MAC - very potent, low TI
lots of DDI - +catecholamines cause inc arrhthmogenicity |
|
|
Term
|
Definition
#1 inhaled anestetic in US
may cause baroreflex HTN and tachycardia |
|
|
Term
|
Definition
very insoluble in blood, so very potent
expensive, pungent, poor induction
tachycardia via SNS activation can lead to inc ICP |
|
|
Term
|
Definition
used for adjunct analgesia
MAC very high
CV depression |
|
|
Term
| IV agents for general anesthesia (general) |
|
Definition
rapid effects - often used for induction
important adjunctive actions with inhaled agents, but can be used alone |
|
|
Term
|
Definition
IV benzodiazepine for rapid induction and sedation with fast recovery
great for amnesia
can be used for conscious sedation with an analgesia like fentanyl |
|
|
Term
|
Definition
most common parenteral anesthetic for induction or maintenance
fast onset, short duration
no laryngospasm |
|
|
Term
|
Definition
induction agent
good for pts with CV risk (hypotension)
can cause myoclonic seizures |
|
|
Term
|
Definition
dissociative anesthetic - excellent amnesia and profound analgesia
activates SNS, causes bronchodilation
inc CBF and ICP |
|
|
Term
Ulta short-acting IV barbiturates:
Thiobarbiturates
Methoxexinal |
|
Definition
induce unconsciousness in seconds
risk of CV depression and laryngospasm |
|
|
Term
IV opoids:
Fentanyl
Sufentanyl
Femifentanil |
|
Definition
greater potency than morphine
pharmacokinetics more useful for an operation |
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