1. Local & General Anesthetics Ch 11

2. General Anesthesia Alters responses of the Central Nervous system Causes one or more of the following Pain relief Muscle relaxation Relaxation of reflexes Deep sleep Commonly used during surgery

3. Main Categories Inhaled – may be liquid or gas Nitrous oxide – gas Halothane – liquid Several others that end with –ane Inhaled drugs are used together with IV drugs to provide the best level of sedation for the patient & procedure = Balanced Anesthesia

4. Intravenous Fentanyl Opioid analgesic – pain relief Versed Benzodiazepine - amnesia Atropine Anticholinergic – decreases secretions Demerol, morphine Opioid analgesics – lighter pain relief Vistaril, phenergan, seconal Sedative/hypnotic – lighter amnesia/sedation

5. Local Anesthetics AKA Regional anesthetics Block nerve conduction in specific area of body Prevents pain sensation 2 Forms Topical Parenteral (injected)

6. Topical May be patch, cream or lotion, liquid, spray Dermoplast Lidocaine Pontocaine EMLA cream

7. Parenteral Spinal Into the space surrounding the spinal cord Epidural Through catheter into the epidural space just outside the spinal cord May remain in place for continuous infusion Infiltration – to numb area to be sutured Nerve block – stop impulses from specific nerve (example: chronic back pain)

8. Neuromuscular Blockers Used during surgery Paralyze respiratory and skeletal muscles Requires artificial ventilation Also used in ICU with ventilator patients

9. CNS Depressants & Muscle Relaxants Ch 12

10. Sedatives Reduce nervousness Reduce excitability Reduce irritability Do Not cause sleepiness

11. Hypnotics Reduce nervousness Reduce excitability Reduce irritability Do cause sleep

12. Sedative-Hypnotics Drugs that can have either sedative or hypnotic effect 3 classifications Barbiturates Benzodiazepines Miscellaneous agents

13. Barbiturates Are Habit-forming (addictive) Rapidly lead to toxicity Depress respirations Used for Anesthesia Control convulsive conditions Prevent epileptic seizures

14. Barbiturates, cont’d Phenobarbital Most commonly prescribed Forms Tablets Capsules Elixirs Injections Suppositories

15. Benzodiapines Relatively safe Most commonly prescribed Used for Sedation Sleep induction Skeletal muscle relaxation Reduce anxiety

16. Benzodiazapines, cont’d Examples Temazepam = restoril Zolpidem = ambien Antidote is flumazenil = romazicon

17. Muscle Relaxants Act on the CNS Benefit is more from sedation than from relaxation of muscles Primarily used for relief of muscle spasms Best when used with physical therapy No specific antidote

18. Miscellaneous agents Chloral hydrate = Noctec Oldest in this category Relatively short duration of action Does not suppress REM sleep Tizanidine = zanaflex Treats muscle spasms

19. Antiepileptic Agents Ch 13

20. Epilepsy Common name for seizure disorder Not a disease CNS dysfunction Momentary lapses to total body convulsions Action not completely known Alter electrolytes

21. Treatment Diazepam = valium to stop seizure once it has started Phenytoin = dilantin to prevent future seizure activity