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Chapter 6

Chapter 6. Anesthetics, Analgesics, and Narcotics. Chapter 6 Topics. Divisions of the Nervous System Major Neurotransmitters Anesthesia General Anesthesia Local Anesthesia Pain Management Migraine Headaches. Learning Objectives.

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Chapter 6

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  1. Chapter 6 Anesthetics, Analgesics, and Narcotics

  2. Chapter 6 Topics • Divisions of the Nervous System • Major Neurotransmitters • Anesthesia • General Anesthesia • Local Anesthesia • Pain Management • Migraine Headaches

  3. Learning Objectives • Understand the central and peripheral nervous systems, their functions, and their relationship to drugs. • Become aware of the role of neurotransmitters. • Learn how drugs affect body systems and where they work in the body. • Understand the concepts of general and localanesthesia, and know the functions of these agents.

  4. Learning Objectives • Define the action of neuromuscular blocking agents in reducing muscle activity. • Distinguish between narcotic and nonnarcoticanalgesia. • Become familiar with the various types of agents for migraine headaches.

  5. Divisions of the Nervous System • Central Nervous System • Brain • Spinal cord • Peripheral Nervous System • Nerves • Sense organs

  6. Divisions of the Nervous System • Central Nervous System • Brain receives information • Evaluates information • Sends out a response • Peripheral Nervous System

  7. Divisions of the Nervous System • Central Nervous System • Peripheral Nervous System • Somatic Nervous System • Autonomic Nervous System

  8. Divisions of the Nervous System • Central Nervous System • Peripheral Nervous System • Somatic Nervous System Voluntary action: skeletal muscle contraction and movement • Autonomic Nervous System Involuntary activities: respiration, circulation, digestion, sweating

  9. Autonomic Nervous System

  10. Review The nervous system has two components. What are they?

  11. Review The nervous system has two components. What are they? Answer • Central nervous system (CNS) • Peripheral nervous system (PNS)

  12. Major Neurotransmitters • Acetylcholine • GABA • Dopamine • Epinephrine • Serotonin

  13. Major Neurotransmitters • Acetylcholine (ACh) • Smooth muscle, cardiac muscle, and exocrine glands • Anticholinergics block ACh receptors • GABA • Dopamine • Epinephrine • Serotonin

  14. Major Neurotransmitters • Acetylcholine • GABA (gamma-aminobutyric acid) Regulates message delivery system of the brain • Dopamine • Epinephrine • Serotonin

  15. Major Neurotransmitters • Acetylcholine • GABA • Dopamine Acts on the CNS and kidneys • Epinephrine • Serotonin

  16. Major Neurotransmitters • Acetylcholine • GABA • Dopamine • Epinephrine • Acts on cardiac and bronchodilator receptors • Known as Adrenaline • Serotonin

  17. Major Neurotransmitters • Acetylcholine • GABA • Dopamine • Epinephrine • Serotonin • Acts on smooth muscle and gastric mucosa (causes vasoconstriction) • Emotional responses: depression, anxiety

  18. Communication by Neurotransmitters Neurotransmitters are released from one axon and received by another neuron’s dendrites.

  19. Discussion What are three important types of receptors in the study of drugs?

  20. Discussion What are three important types of receptors in the study of drugs? Answer • Alpha • Beta-1 • Beta-2

  21. Types of Receptors • Alpha Vasoconstriction, raise BP • Beta-1 Heart stimulation • Beta-2 Vasodilation and bronchodilation

  22. Drug Effects on Receptors Drugs can have two types of effects on receptors. • Stimulating, causing a reaction • Blocking, preventing a reaction • Dopamine blocking • Anticholinergics

  23. Anticholinergic Side Effects • Decreased GI motility • Decreased sweating • Decreased urination • Dilated pupils • Dry eyes • Dry mouth

  24. Anesthesia In the “old days” the following were used for anesthesia.

  25. Anesthesia In the “old days” the following were used for anesthesia. • Alcohol • Drugs • Ice for numbing • Blow to the head • Strangulation

  26. Anesthesia Now, anesthesia is designed to focus on specific systems, such as

  27. Anesthesia Now, anesthesia is designed to focus on specific systems, such as • Nervous system • Skeletal system • Respiratory system • GI system • Endocrine system • Hepatic system • Cardiovascular system

  28. Anesthesia Goals of Balanced Anesthesia • Amnesia

  29. Anesthesia Goals of Balanced Anesthesia • Amnesia • Adequate Muscle Relaxation

  30. Anesthesia Goals of Balanced Anesthesia • Amnesia • Adequate Muscle Relaxation • Adequate Ventilation

  31. Anesthesia Goals of Balanced Anesthesia • Amnesia • Adequate Muscle Relaxation • Adequate Ventilation • Pain Control

  32. Types of Anesthesia • General • Local

  33. Types of Anesthesia • General • Local

  34. Discussion What are some of the indicators used to assess general anesthesia?

  35. Discussion What are some of the indicators used to access general anesthesia? Answer: Blood pressure, hypervolemia, oxygen level, pulse, respiratory rate, tissue perfusion, urinary output

  36. General Anesthesia Preanesthetic Medications • Control sedation • Reduce postoperative pain • Provide amnesia • Decrease anxiety

  37. General Anesthesia Malignant Hyperthermia • Side effect of anesthesia • Fever of 110°F or more • Life threatening • Treatment: dantrolene (Dantrium) Warning! Always check expiration date.

  38. Drug List Inhalant Anesthetics • desflurane (Suprane) • enflurane (Ethrane) • halothane • isoflurane (Forane) • nitrous oxide

  39. Inhalant Anesthesia Side Effects • Causes reduction in blood pressure • May cause nausea and vomiting

  40. nitrous oxide • Causes analgesia only; no amnesia or relaxation • May be given alone or may be given with more powerful anesthetics to hasten the uptake of the other agent(s) • Commonly used for dental procedures • Rapidly eliminated

  41. desflurane (Suprane) • Has rapid onset and recovery • Often used in ambulatory surgery

  42. General Anesthesia • Often dispensed by IV drip • Very lipid soluble

  43. Drug List Injectable Anesthetics • etomidate (Amidate) • fentanyl (Duragesic, Sublimaze) • fentanyl-droperidol • ketamine (Ketalar) • morphine • propofol (Diprivan) • sufentanil (Sufenta)

  44. Drug List Injectable Anesthetics Barbituates • methohexital (Brevital) • thiopental (Pentothal) Benzodiazepines • diazepam (Valium) • lorazepam (Ativan) • midazolam (Versed)

  45. propofol (Diprivan) • Used for maintenance of anesthesia, sedation, or treatment of agitation • Has antiemetic properties • Drowsiness • Respiratory depression • Motor restlessness • Increased blood pressure

  46. Injectable AnesthesiaDispensing Issues Diprivan (anesthetic) and Diflucan (antifungal) may be confused. This mix-up could be life-threatening. Warning!

  47. fentanyl • Dosage Forms • IV (Sublimaze) • patch (Duragesic) • lozenge (Actiq) for children • Used extensively for open-heart surgery due to lack of cardiac depression

  48. Benzodiazepines • Used for induction, short procedures, and dental procedures • Useful in controlling and preventing seizures induced by local anesthetics • midozolam (Versed) • fastest onset of action • greatest potency • most rapid elimination

  49. Antagonist Agents Antagonist agents reverse benzodiazepine and narcotic overdose.

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