DRUG STUDY ON ANESTHETICS

Pharmacology
Lahoz, Maria Catherine Shayne V.
BSN 207

MECHANISM OF SIDE EFFECT

DRUG INDICATION CONTRAINDICATION NURSING RESPONSIBILITIES
ACTION /ADVERSE EFFECT
INHALATION ANESTHETICS
Inhalation Anesthetics The following conditions Classification: -After completion of the procedure,
are contraindicated with the patient must be monitored by
 VOLATILE
- Administered as a primary this drug:  Nausea/vomiting the recovery room nurses until the
LIQUIDS
therapy for preoperative  Risk of malignant patient is fully awake and
sedation and adjunctive Anesthetics
Conditions: hyperthermia hemodynamically stable.
Generic name: Forane
anesthesia maintenance to  Postoperative
intravenous (IV) anesthetic shivering
Brand name: isoflurane  high levels of Inhalational anesthetics
agents (i.e., midazolam,
potassium in the hyperpolarizes neurons and  Increase blood - Monitor the vital signs
propofol) in the pressure and heart
Generic name: Desflurane blood hence reduce both continuously during induction and
perioperative setting. rate
Brand name: Suprane pacemaker neuron and maintenance to ensure that the
 myasthenia gravis  Hypersensitivity
post-synaptic neuron action patient is not only sedated but has
Route & Dosages: reaction to no pain.
 a skeletal muscle potentials.
Inhalation  - Preoperative anesthetic may
sedation – primary disorder
Inhalational and occur.
or adjunctive; rapid  disease affecting intravenous anesthetics - Ensure that resuscitation
 GAS induction of muscles and nerves affect synaptic function by equipment is always available when
sedation, providing
 duchenne muscular inhibiting excitatory using anesthetic gases.
Nitrous oxide amnesia and
anesthesia during dystrophy synapses and enhancing
(laughing gas, dinitrogen surgical procedures inhibitory synapses.
monoxide and dinitrogen  torsades de pointes
 Perioperative - Ensure that the gas canisters are
oxide)  a type of abnormal General anesthetics act by
sedation increasing the sensitivity of full and that all the monitoring
maintenance – adju heart rhythm equipment is in working order.
Route & Dosages: the gamma-aminobutyric
Inhalation nctive; maintains  prolonged QT acid (GABA) A receptor to
anesthesia after interval on EKG GABA thus enhancing
sedation by IV inhibitory
benzodiazepines or  abnormal EKG with neurotransmission and
propofol QT changes from depressing nervous system
birth activity. Glycine receptor-
 ICU sedation –
primary or  low blood pressure mediated activation of
adjunctive; chloride channels is
facilitates tolerance  liver problems responsible for inhibition of
of intubation, neurotransmission in the
 kidney disease with spinal cord and brain stem.
mechanical reduction in kidney
ventilation, bedside Ketamine, nitrous oxide
function
procedures and xenon act via N-
 seizures methyl-d-aspartate
(NMDA) receptors and
 elevation of proteins cause long-term modulation
in the urine of synaptic responses.
 a condition where
there is excess sugar
in the urine
 a condition with high
fevers and muscle
contractions called
malignant
 hyperthermia
 high pressure within
the skull

Allergies:

 Inhaled Anesthetics
(Halogen Based)

INTRAVENOUS ANESTHETICS
Generic name: Ketamine CNS: General depression
Brand name: Ketalar of the CNS can produce
respiratory and
cardiovascular depression.
Generic name: Etomidate Slow release of thiopental
Brand name: Amidate distributed into tissues may
Classification: result in some sedation for
up to 24 hours after use.
Anesthetics
Ketamine has minimal
effects on ventilator drive.
Hallucinations and vivid
dreams are common during
recovery from ketamine in
adults (emergence
reactions, that can be
minimized by co-
administration of a
benzodiazepine), but are
less frequent in children.
 Muscular System:
Extraneous muscle
movement is
common with
etomidate, and to a
lesser degree with
propofol. They can
be reduced by
a benzodiazepine or
opioid analgesic
given before
induction. Ketamine
increases muscle
tone and can
cause laryngospasm

 Cardiovascular
System: Thiopental
and propofol
depress the heart,
producing bradycar
dia and reducing
blood pressure.
Etomidate has no
effect on the heart or
systemic vascular
resistance. By
contrast, ketamine
 more often
produces tachycardi
a and an increase in
blood pressure
through sympathetic
nervous
system stimulation.

 Nausea and
vomiting during
recovery. Propofol
has
an antiemetic action

 Convulsions have
been reported after
propofol. These can
be delayed,
indicating the need
for particular
caution after day
surgery.

 Pain on injection
with etomidate and
propofol. This can
be reduced by
injecting into a large
vein, by giving an
 opioid analgesic just
before induction, or
giving
intravenous lignocai
ne with propofol.
Thiopental is an
alkaline solution
that is irritant; if it
extravagates outside
the vein, it can
cause tissue necrosis

 Propofol is not used

for prolonged
sedation at high
doses because of the
risk of ‘propofol
infusion syndrome’,
which includes
metabolic acidosis,
heart failure and
rhabdomyolysis.

LOCAL ANESTHETICS
 AMIDES Local anesthetics are Allergy to anesthetics and
Classification:  CNS: headache Prepare emergency equipment to
indicated for the following: parabens. To avoid (especially with maintain airway and provide
Generic name: Lidocaine hypersensitivity reactions. Local injectable anesthesia epidural and spinal mechanical ventilation if needed.
Infiltration anesthesia,
Brand name: anesthesia),
1.Lidamantle peripheral and sympathetic
2. Xylocaine nerve blocks, central nerve
blocks, spinal and caudal
Generic name: Prilocaine anesthesia, topical
Brand name: Citanest HCl anesthetic for skin or
Plain mucous membrane
disorders.
In Children:
 ESTERS
Assessment of child for any levels of ester-type local
Generic name: procaine skin breakdown related to
Brand name: immobility; and safety
1. Novocain precautions.
2. Mericaine
Local anesthetics are used fetus and baby.
Generic name: in children in much the
chloroprocaine same way as they are used
Brand name: in adults.
1. Nesacaine, Infants are at particular risk
2. Clorotekal for systemic absorption and
3. Nesacaine-MPF toxicity from topically-
applied local anesthetics.
Tight diapers and occlusive
Route & Dosages: IM dressings can increase
systemic absorption.
In Adults:
They should receive
education about what will
happen during
Heart block. Could be restlessness, -Ensure that patients receiving
exacerbated with systemic anxiety, dizziness, spinal anesthesia or epidural
absorption tremors, blurred anesthesia are well hydrated and
vision, backache remain lying down for up to 12
Shock. Can alter the local
 CV: peripheral hours after the anesthesia to
delivery and absorption of minimize headache.
vasodilation,
these drugs
myocardial
-Provide skin care to site of
Decreased plasma depression,
administration to reduce risk of skin
esterase. Can result in toxic arrhythmias, blood
breakdown.
pressure changes
anesthetics  Respiratory: - Provide comfort measures to help
respiratory arrest patient tolerate drug effects.
Pregnancy, lactation.
 GI: nausea,
Potential adverse effects to -Monitor patient response to therapy
vomiting
(loss of feeling in designated area).
 Loss of skin
integrity, especially -Monitor for adverse effects (e.g.
in patients who are respiratory depression, blood
unable to move. pressure changes, arrhythmias, GI
upset, skin breakdown, injury, CNS
alterations, etc).
 administration of
anesthesia. Expected body
reactions should also be
explained.
Regional or local
anesthetics are preferred if
surgery is needed during
pregnancy.
In Older adults:
They are more susceptible
to adverse effects (e.g.
CNS, CV, and
dermatological effects).
At risk for developing
toxicity because of possible
hepatic and renal
impairment.
Safety measures should be
instituted (e.g. side rails,
call light, ambulation
assistance, and skin care).
Longer monitoring and
regular orienting and
reassuring is essential.

REFERENCES:
Inhalational anesthetics. (2019, June 16). Retrieved from https://www.amboss.com/us/knowledge/Inhalational_anesthetics.
Inhalational Anesthetic. (n.d.). Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/inhalational-anaesthetic.
Intravenous anesthetics. (2019, October 30). Retrieved from https://www.amboss.com/us/knowledge/Intravenous_anesthetics.
Tabangcora, I. D., Tabangcora, I. D., & Dawn, I. (2019, June 7). General and Local Anesthetic Agents: Nursing Pharmacology Study Guide. Retrieved from
https://nurseslabs.com/general-local-anesthetic-agents/#Indications-5.