ANESTHETIC AGENTS

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ANESTHESIA
 State in w/c the perception of
and response to painful
stimulation is blocked.
 General anesthetic agents
suppress CNS function to reduce
consciousness and block the
sensation of pain (inhalation
and IV)
 Local and regional anesthetic
agents block sensitivity to pain
in one part of the body.
LOCAL ANESTHESIA

 Sensory stimulation
transmitted through
peripheral nerves is blocked
only in restricted region of
the body.
a. Surface Anesthesia
– benzocaine, dibucaine,
pramoxine
LOCAL ANESTHESIA

b. Local Anesthetic administered by injection

– bupivacaine, lidocaine, procaine
1. Infiltration anesthesia
2. Nerve block anesthesia
– Injection along a nerve before it
reaches the surgical site
1. Epidural anesthesia
– Adm. outside the dura mater
– Caudal anesthesia
4. Spinal anesthesia
– Injection into the subarachnoid space
– Blocks nerve roots for the entire
lower body
– Saddle block – OB for NSD
– Spinal headache – dec. in CSF
pressure caused by a leak of fluid at
the site insertion (remain flat on bed
for 12 hours)
– Hypotension (monitor BP)
 Review table 20-6
 Local anesthetics
 P’col by Kee, Hayes,
McCuistion
 Page 319
GENERAL ANESTHESIA

 A condition in w/c the

subject is usually
unconscious undergoing most
major surgical procedures.
a. Inhaled
b. IV anesthetic
Inhaled anesthesia
 desflurane, enflurane, halothane,
isoflurane, sevoflurane, nitrous oxide
 MOA: lipid structure of cell membrane is
altered; GABA is activated to GABA
receptor that pushes Cl ions into the
neurons; the ascending reticular
activating system is altered
 Produces the classic anesthetic state
a. Analgesia
b. Hypnosis
c. Amnesia
d. Depression of reflexes
Anesthetics
Balanced anesthesia – a combination of drugs
1. Hypnotic given the night before surgery
2. A premed is given - a narcotic analgesic
with an anticholinergic to decrease
secretions
3. A short – acting barbiturate like Pentothal
is administered
4. An inhaled gas like nitrous oxide is given
with oxygen
5. A muscle relaxant is given if needed

Balanced anesthesia minimizes cardiovascular

problems, decreases the amount of
anesthesia needed, reduces N and V and
decreases recovery time
Stages of Anesthesia

1. Analgesia – begins with consciousness

and ends with loss of consciousness
 Induction stage
1. Excitement or delirium – loss of
consciousness caused by depression of
the cerebral cortex
2. Surgical – respiration become more
shallow and RR is increased
3. Medullary paralysis – toxic stage
 Respirations are lost and circulatory
collapse occurs
Intravenous Anesthetics
 Primarily used in the induction of
anesthetic state usually in short surgical
procedures or where inhaled anesthetics
will be employed for maintenance
 Barbiturates: thiopental
 Benzodiazepines: diazepam, midazolam
 Opioids: fentanil, sufentanil
 Others: etomidate, ketamine, propofol
 AR: resp and CV depression
FOR MORE INFORMATION
REGARDING ANESTHETICS.
PLEASE SUPPLEMENT THE
DISCUSSION BY READING
PHARMACOLOGY BOOKS
ANTICONVULSANTS
Definition

 Seizures are a pattern of abN

neuronal discharges within the
brain resulting in changes in
the LOC, motor activity,
sensory phenomena and
behavior
 Epilepsy – neurologic d/o
char. by recurrent seizures
Epilepsy – seizure disorder caused by
abnormal electric discharges from
cerebral neurons characterized by loss
or disturbance of consciousness and
usually by a convulsion
 Causes: primary or idiopathic (50%);

trauma, anoxia, infection,

Cerebrovascular accidents (CVA)
 Diagnosed by electroencephalogram

(EEG), computerized tomography (CT)

scan, or magnetic resonance imaging
(MRI)
Classification of Epilepsy
 Partial Seizures
– Arise from a focal area in the cerberal
cortex
– Can be simple or complex and can become
generalized
 Generalized Seizures
– Involve both hemispheres of the brain
– Tonic-clonic / Grand mal
– Absence seizures / Petit mal
 Status Epilepticus
– Rapid succession or continuous seizures
lasting 30 mins or more
YOUR TASK!!

 Study the different

classification of Seizures
 Refer to table 22-1 of Kee,
Hayes, McCuistion P’col book
 Page 340
Drugs Used to Treat Seizures

 Anticonvulsants / Antiepileptics
 Suppress the abnormal electric
impulses from the seizure focus
to other cortical areas thus
preventing the seizure, not
eliminating the cause
 Action of Anticonvulsants
 Suppresses sodium influx through the drug binding to
the sodium channel when it is inactivated thus
prolonging the channel inactivation, preventing
neuronal firing (carbamazepine, phenytoin,valproic
acid)
 Suppressing calcium influx, preventing the electric
current generated by calcium ions to the T calcium
channel (ethosuximide,trimethadione,valproic acid)
 Increasing the action of gamma amino butyric acid
(GABA), inhibiting neurotransmitters throughout the
brain (benzodiazepines and barbiturates)
ANTICONVULSANTS: Hydantoins
 Phenytoin, mephenytoin,
fosphenytoin
 MOA: reduce the rate of recovery
of Na channels from inactivated
state
 Use to treat gen.tonic-clonic
seizures, status epilepticus,
refractory cases of simple and
complex partial seizures
Anticonvulsant: Phenytoin
 Phenytoin (Dilantin)
– First anticonvulsant to treat
seizures
– Highly protein bound, competes
with ASA, anti-coagulants
– Therapeutic range: 10-20
mcg/ml
– Dilute in NS; dextrose can cause
precipitation
Anticonvulsant: Phenytoin
– IV rate of >50 mg/min causes
hypotension and cardiac
dysrhythmias; Not given IM
– AR: Teratogenic (fetal hydantoin
syndrome);
– gingival hyperplasia (overgrowth of
gum tissue)
– slurred speech, confusion,
depression,
– thrombocytopenia, leukopenia
– Inhibits release of insulin – causes
hyperglycemia
Anticonvulsant: Phenytoin
Drug-drug interactions:
 Anticoagulants and ASA- displaced by

hydantoins from binding site

 Sulfonamides and Cimetidine- inhibit

metabolism of hydantoins
 Antacids and calcium prep and

antineoplastic drugs- decrease

absorbtion of hydantoins
 ANTICONVULSANTS
Iminostilbenes Carbamazepine tonic-clonic,partial sz

Barbiturates Phenobarbital tonic-clonic sz, status

epilepticus, simple
partial
Succinimides Ethosuximide DOC – absence sz

Valproates Valproic acid TC sz, absence,

myoclonic, partial
Benzodiazepines Clonazepam, Absence sz, Status
diazepam, lorazepam epilepticus
Oxazolidinediones Paramethadione, Absence sz
trimethadione
Miscellaneous Acetazolamide, TC sz
gabapentin
 Common Side Effects of
Anticonvulsants
 Teratogenic effects
 Gum irritation, gingivitis
 Sore throat
 Bruising
 Nosebleeds
 Nystagmus ( involuntary movement of
the eyeball )
 Slurred speech
 Nursing interventions
 During pregnancy, sz frequently increased bec. of increase
metabolism, serum levels of anticonvulsant should be monitored
 Inform patients to avoid CNS depressants and alcohol
 Advise the client to abtain medical alert ID card that indicates the
health problem
 Instruct client not to d/c drug abruptly
 Intruct the client the need for preventive dental check up
 Teach the client not to self medicate with OTC w/o consulating
the dr
 Cts with diabetes- monitor serum glucose level
 Advise ct that urine may be a harmless pinkish-red or reddish
brown
 Maintain good oral hygine
 Report symptoms of adverse reactions