ISPP 2015

Career Opportunities in Pharmacy
Pharm 1 Pain meds study session

this lecture is on chapter 10 and 11 and the from ecology book which is analgesics and anesthetics both are used for pain relief one puts you to sleep and one does not please asleep usually so analgesics are used as pain relief mostly and anesthetics are mostly considered hypnotics I'm just going to go ahead and use the PowerPoint provided by the text because it's pretty it covers everything that I need you to know and I'll tell you I will stress the importance of what you should know on the final as we go okay so stay with me we need to learn this stuff very important try to make it as short and sweet as it can so the drugs that we're going to worry about are a set of meta fene or just has an all tramadol fentanyl morphine in the lock zone which was not which was not discussed in class naloxone Demerol meperidine lidocaine sumatriptan nitrous oxide ISO fluorine and succinylcholine yep that's 11 drugs here we go okay so like I said analgesics are used for painkillers without losing consciousness unlike anesthetics which are used as hypnotics first sedation we have two kinds really we have opioid analgesics which is derived from the opioid plant mostly or it's a synthetic version of that and then we have non-opioid analgesics which are not derived from the opioid plan and then we have adjuvant drugs these are given along with that opioids are non opioids and if you've never seen it opioid I'm sure you guys have it's a plant mostly grows in tropical climates and they extract the SAP and there's several types of medications in there one of which is opium and we take that and we sort of modify it and turn it into various different levels of painkillers and of course heroin is the street drug that's derived from the same thing alright so analgesics will painkillers and aesthetics or pain relievers are sedatives sorry a little bit about pain pain is a perception it is different for everybody because it's not a real physical thing it's something that's created in our mind we have complete control over our perception of pain and because of that some pain will be worse for others and some pain will be less for others depending on that person's mental state of mind emotions have a lot to do with it sensory our sensory system has a lot to do with our pain perception as a nurse you guys are going to constantly be asking your patients their level of pain it's gonna be different for everyone and you have to treat it as such before we get into the drugs though there are many ways to relieve okay it's pain or your own pain drug free of course it you really do have control of your pain perception it is a completely cerebral manifestation it is not a physical thing it is a response to tissue damage that your brain perceives so pain as a perception and because of that it can be difficult to treat there's not a cut and drive like a what like a right way to treat pain ok nos deception is important to understand mostly from med-surg and I know you guys already took about certifying off by the time you get this video so too little too late but I'm going to recover it anyways nos deception is our sensory system for pain so when you read the word mass deception you can think pain perception because this is our nerve network that will send these pain signals up to our brain these pain signals came from down it's tissue when any kind of tissue in your body when it's damaged when a cell breaks or a certain amount of cells break nociceptors our nerves that will send that signal up to your brain and say that there's tissue damage your brain perceives that is pain and that elicits a huge response to do many different things in the body to alleviate and fix that tissue damage okay so nociception is pain perception and nociceptors are the nerves that are sitting everywhere in your body just waiting to detect tissue damage and it's very important that you understand just generally how that works because the drugs we're going to talk about of course are always going to work at different parts of the body so it's just how it works in general you sense pain somewhere out in your periphery so there's some Mouse acceptors out here in your finger and that sends a signal up to your spinal cord so all pain perception or all NASA scepters go to your spinal cord cord first and we take advantage of this in pharmacology we've blocked the pain perception in our spinal cord or we'd like that pain signal in our spinal cord so it's really important that we understand the pathway and it's a really simple pathway it goes from the outside periphery to wherever you're herded to the spinal cord and there's a communication in the spinal cord that happens that we usually intercept and then if we didn't intercept if it goes to the brain the brain perceives pain and it sends the signal back down and tells your finger that you now hurt so your finger doesn't hurt until the pain perception comes back down okay so this is important because we have sodium channels here running through our mouths acceptors and that's how the electrons flow I'm sorry the protons flow in and out of your neurons creating an action potential right so the electricity that flows through your neurons up to your spinal cord and all your neurons is sodium so sodium floods it and that sends the signal this is important because we will have talked about sodium channel blockers which end in cane all the Canes like lidocaine and benzocaine they're called sodium channel blockers and they stop playing perception by blocking this this gates right here for sodium to flood in okay then in the spinal cord we have a communication here between the detecting neuron or the sensory neuron and the inner neuron or the spinal neuron that's gonna go up to the brain this is where the opioids act the opioids will okay on these neurons and your spinal cord you'll have these opioid receptors on the side and the opioids will be released from your body because your body also makes a version of opiates called endorphins those will be released from your brain which is what's happening in these green part here and they will send down your spinal cord or they've traveled on your spinal cord and they'll land on these opioid receptors and they will stop this transmission here so the opioid receptors stopped the pain transmission up to the brain and when your endorphins kick in it's asthma saying that means your brain told your hypothalamus to make the endorphins and send them down your spinal cord and land on the opioid receptors and stop the pain transmission up to your spine heroin lands here all the synthetic versions of opioids land here morphine lands here and also some drugs that block the opioid response there some drugs that land here that block opioids from coming down and we use those drugs when we have an opioid overdose so it's really understanding it's really important that we understand opioid receptors the pain they sit on the neurons and your spinal cord and when it okay we land on them they will stop that spinal cord that that neuron from releasing its neurotransmitters that tell the brain that you have pain so it's so opioids stop pain perception in the spine that's where this they stop the signal okay all right that's good so sodium channel blockers and opioid receptors okay you need to understand their role because we're going to talk about drugs that basically do one or the other okay everybody has will start certain pain threshold of course and it's not just a painter avoid pain threshold that our brain has our nerve receptors have a certain threshold they can handle before they will send that signal to your spine so they can handle a certain amount of stimulation before they're gonna be like okay this is too much and I'm hurting so I'm gonna I'm gonna tell the brain what's going on that's why you can kind of prick yourself you know a little bit and you don't really register it as being painful because there's a certain threshold your nerves pain tolerance how much pain a person can endure without it bothering them too much everybody has different levels of pain tolerance because of course like we said pain is a perception pain is a perception okay so we have a cute pain which happens right away of course chronic pain longer than three months this chronic pain so there's different types of pain and the reason that there's different types of pain is because it just means it some different tissue was damaged in the body of a so somatic pain is just anybody so that's a very general way visceral pain is some kind of organ the lining of an organ or the covering on the outer side of an Oregon yeah that's really it it's really the smooth muscle that is lying in your organs that visceral pain comes from or some Organists disease indicating that can also cause pain superficial pain on top of the skin deep pain deep under the skin vascular pain from a vessel blood vessel referred pain this is like when something hurts some at a certain spot you can feel it at another spot or a delayed kind of reaction at a different spot on the body neuropathic pain is nerve pain it's the worst pain it's the most painful usually for most of us and it's very difficult to treat this is actual nerve damage when your nerves are damaged they will send pain signals to your brain because nerve damage is the sign of tissue damage phantom pains when we feel the pain of a body part is no longer there it's a very real thing and that's because pain is a perception cancer pain this is dying tissue it's very similar to visceral pain central pain I don't know what that is your body hurts all over they're just making up it's not okay Kate they're your pain this is um this is the way we think it works which is what I just showed you so these pain receptors are bringing their pain signals in from your periphery and they're sending the neurotransmitters to an interneuron or up the chain to the brain so that so what I just explained to you on the other slide how it all works that's called the gate theory and the game theory supports the existence of opioid receptors on the side of these nerve endings where we can intercept our pain signal by stimulating these opiate receptors okay so the gate theory is just describing like the steps that I showed you on the other the other slide so many current pain management systems are ended stopping the gate they are using the gate theory to battle pain signal transmission to the brain so we don't try to change how the brain perceives pain we try to stop the brain getting the signal that they that were experiencing pain for analgesics and anesthetics okay so analgesics and anesthetics try to stop the signal the brain is getting that you're hurting other things can stop your perception of pain in the brain like antidepressants or just benzodiazepines and barbiturates alcohol those things will change your perception of pain in the brain and sometimes we'll get both of these kind of drugs at the same time so we can really tackle the pain for a patient okay when when tissue in jus injury occurs nos acceptors are stimulated and at that site where tissue and Joey was our cells just released like I'm having trouble talking anything I can't say injury okay our cells release many different little chemicals to tell your body that there's tissue damage here and so we have the brain Akins the histamines prostaglandins and even some serotonins braddock and histamine and prostaglandins are the local messengers that tell the body okay we need more blood this way we need more cells this way we need white blood cells this way everybody needs to come over here so we can fight anything that's going to get into this broken tissue and it can heal this tissue and it's like a little repair team and so those things hurt because you have swelling at the site of injury because all these guys are there now and they brought all the blood with them that's that's called inflammation so these guys start the inflammation process potassium has a role to play as well and so anti-inflammatories will stop these chemicals from working and decrease the swelling it will delay your healing time though because these guys aren't bringing all the fighters to the site of injury so it does delay your anytime that it decreases your pain okay so the body has opioids that it makes naturally they they're called endogenous neurotransmitters and they come from the brain and they go down the spinal cord and they land on those opioid receptors they're called endorphins or ankle things in Kelvin site and calculon's these are so when somebody says your body makes natural endorphins that's what they mean is the chemical structure of the endorphins and encapsulants are very similar to make chemical structure at births of opium of some of the analgesics and opium so this is how our body handles our paint perception so we have these naturally occurring ones and we give medications that do the same thing rubbing something when it hurts actually works because you have large and small sensory fibers that are sending pain to the brain even the area of the large fiber and the small fiber the large fiber carried like pressure pain to the brain the small fiber carries sharp pain to the brain and so if you want to get rid of sharp pain you can stimulate the heck out of your pressure dull King nerves and so it's like when you stub your toe and you just squeeze the crap out of it or you shake it you're stimulating these dull pain receptors more it's letting your brain with these dull pain receptor transmission and you're blacking out with sharp pain so it's real it's a real thing that really works you are stimulating the large sensory fibers okay okay adjuvant drugs these are very important these are drugs that we give alongside our big guys or because they're going to be the opioid analgesics are the non-opioid analgesics and we give needs to help them along we have the insides to help with inflammation we have the antidepressants to help with our pain perception in the brain and anticonvulsants to stop seizures and we had for neuropathic pain and then corticosteroids are going to help with inflammation as well so we kind of fight the battle on all fronts gabapentin is a popular and convulsive okay so adjuvant drugs are given alongside the main primary drug for pain relief and there's a couple of different drugs that we need to be aware of and we'll talk about I'm gonna get to them alright so opioid drugs are first they bind to the opioid receptors in the spinal cord where the understanding we got a quick little lesson in the spinal cord that opiate receptors on the outside so that stops this communication here and the brain never got the message that's something that tissue damage occurred okay very strong pain relievers they work really well we have built in up your receptors so we take advantage of that um you can overstimulate the opioid receptors and they will stop responding to the influx of opium so that in my case your pills won't work for you anymore and most drugs work that way so sometimes we have to use non you know non opioids in these cases alright so the drugs that are opioids that we care about are the paradeen which is Demerol there are all widely given for like pancreatic cancer attacks we give them all for toddlers we give done one for any kind of situation where we need heavy painkillers morphine sulfate of course this is working and this cotton was there named rabbit we need to know and for ya the parody Nats Demerol and then we have Sentinel Sentinel has many different name Browns we usually used the generic drug let me talk about fentanyl so we have Demerol morphine and fentanyl but you can see any code on code on coding sulfate oxycodone these are all opioid analgesics okay they can work a few ways and and it is important that we know this remember an agonist is something that's going to do the same thing that the natural thing does so okay wait Agnes are going to land on those opioid receptors and block nerve transmission just like opioid would or an endorphin would the partial agonist argued on land on an opioid receptor but block other opioids natural opioids from getting in so they do the same thing but they don't do it as well because they're not as a a mimic of opioid like the agonist days it prevents other opioids from landing in there and it lands in there itself so they're not as strong and then we have the opposite an opioid antagonist is going to block the opiate receptor and that is using low toxicity and there is one that we need to know and it is on the final so I'm going to get to it I'll highlight okay so agonist bind to an opioid receptor and do what the opiates do it will just block nerve transmission to the brain meet agonist antagonist that's the partial agonist they also bite until the pain receptor that they don't allow naturally-occurring opiates to land and so we don't get the full opioid response our body's trying to do and so because of weaker neurologic response and also call them partial or in this mixed opioid agonist and they have the antagonist these by to the opioid receptor but they just blocked the opioid receptor from naturally occurring opioids or a drug or purely to them okay so we use this for opioid poisoning okay there's different type of opioid receptors and know you don't have to know and I'm not going to cover them you just gonna say it there's new Kappa and Delta and these are different type of opioid receptors or endorphin receptors because their body has several types of endorphins and endorphins and they will land on the different receptors okay so me Oh Kevin Delta different kinds of opioid receptors okay reasons we could we would give opioids besides pain it's that's an easy one we know that opioid analgesic use for pain there's some other ones that we need to understand that they're not gonna be on the final but I'm sure you're going to get this on the pharmacy opioids worked for coughs under suppression you can take morphine to help you with a chronic persistent dry cough that is just tearing up your esophagus and your muscles of your chest and abdomen so opioids work to suppress your coffee your coffee flex and that's a we need to know that and you can also use them to treat diarrhea because morphine causes constipation and that is on the final I believe I've been working causing constipation if I know so of course it's a really good diarrhea treatment okay so cough suppression for morphine and morphine causes constipation so we'll help you with diarrhea and the biggest thing we need to worry about when giving an opioid is our respiratory rate so respiratory insufficiency is a problem because it will lower our respirations usually and so for our deann respiratory distress or we already have a low respiratory rate that's an issue address and adverse effects of opioid use central nervous system depression so respiratory distress depression so that's a really good big one that you need to remember respiratory depression so before we give an opioid our most important nursing assessment is monitoring respiratory depressions or respiratory rate and that is the assignment question don't need trips and fold and think that the heart rate is going to be the most important thing it's not it's a respiratory rate also constipation for opioids which I just went over that urinary retention because these opioids shut down their GI tract and so that's why they will cause constipation and that's why they would cause urinary retention and sometimes you can have flushing and itching and one of the final test questions is do you know the adverse effects of vicodin a vicodin is a combination drug it has it has hydrocodone in it vicodin has hydrocodone in it so oxycodone hydrocodone those are all the same thing so they're opioids and so we need to know the adverse effects of vicodin and so we have them here we have urinary retention constipation itching and lightheadedness lightheadedness is not here what you need to know it it doesn't cause nervousness it makes you feel sedated so you don't feel nervous and it doesn't cause diarrhea cause constipation okay so yes you're gonna have a select all that apply question four the adverse effects of opioids and the drug here given us vicodin which is a brand name for hydrocodone combination drugs all right moving along talked about tolerance for analgesics already physical dependence is when your body has a physiological dependence on the drug not a psychological dependence and this does happen your brain is used to getting those opioids Athens opiate receptors and when it doesn't get them it starts to get overstimulated and you start to perceive pain at a level that you wouldn't have before and then you know psychological dependence of course is your brain on drugs okay another a final question that's important there are five questions on the final regarding chapter ten and eleven by the way toxicity what do we do when we overdose our patient or a patient has overdosed themselves on opioids we give an opioid antagonist an opioid blocker and the one that you need to know is naloxone or narcan you need to know when you give narcan and it's mostly tied to a patient to respiratory rate so if he has very shallow respirations patient is lethargic and the respiratory rate is at seven per minute or below then you your priority action is to administer naloxone or narcan regardless of withdrawal symptoms when a patient experiences severe respiratory depress and opioid antagonist should be given and severe respiratory depression is very shallow respirations with a rate of seven per minute okay so this is a concept that is on the final naloxone is an opioid antagonist respiratory depression is our issue with opioids and toxicity and we do not call the hearth a health care provider we did not probably nurse we administer naloxone immediately okay so relaxing is an antidote to opioid poison we don't need to know opioid overdose symptoms okay things that opioids can react with our other Downers so an opioid isn't is a downer it makes you which make you sleepy and sort of lethargic and so other Downers are going to be are going to interact and they can highlight and exasperate the effects of each other so alcohol is a downer and histamines will make you their kind of sedative like barbiturates and Wenzel days affines either sedatives or central nervous system depressants is our central nervous system depressants and then monoamine oxidase inhibitors as well it's kind of complicated but monoamine oxidase remember I taught you that there's different maoi receptors in the body not just for norepinephrine causing the fight-or-flight response so these can also cause a set of a sedative effect that it in a way that I didn't teach you our video ki so we'll just leave it at that but you don't need to remember that one just know that opioid analgesics our central nervous system depressants and so they will interact adversely with other central nervous system depressants ok tylenol is considered ok so we're done with opioids tylenol is considered an on opioid it's called a centrally acting drug instead of medicine of course is the trade name I'm sorry the generic name um tylenol is cool because it has it doesn't cause sedation but it causes pain relief and we don't understand how it works at all you know it works in the brain it doesn't work at this at the level of the spinal cord but we do not understand how it works when so you just really need to know that tylenol is an an opioid analgesic and it doesn't really help with inflammation like the inside still oh look it says never mind I thought we hadn't really sunk our teeth into how tylenol works mmm and have its prostaglandin synthesis know whatever I don't think they know that for sure okay we know Tylenol all we need to know this maximum dose for a healthy adult is 300 milligrams a day just I'm sorry mm mm milligrams a day for those who are elderly over the liver disease because tylenol our liver disease is a contraindication for tylenol the tylenol foods metabolized readily in the liver and so it can cause it can exasperate liver diseases so liver dysfunction and liver failure is a contraindication of Tylenol yes I'm not gonna ask you that on my final that that will be on the front I see tylenol messes up the liver tylenol liver all right that's gonna do it for your chapter 10 I'm just coming through here to see if there's any more points I should make constipation is a common and adverse effect of opioids respiratory depressions or the nursing a priority assessment respiratory wait of rate of less than 10 rest for a minute is of concern but seven breaths per minute is administering narcan all right moving on quickly to chapter eleven so that was our analgesics now we're gonna get into our anesthetic so we have covered on our drug list tylenol tramadol fentanyl morphine naloxone the paradeen which is governor all and now we're going to talk about lidocaine sumatriptan nitrous oxide isoflurane and six I'm holding okay so these are sedatives or hypnotics trying to put the patient to sleep or paralyze them so this is not lowering their pain this is stopping their pain well this is stop being nerve transmission or making them less conscious consciousness okay that's what we're trying to do here with anesthetics we're either blocking nerve transmission all nerve transmission in the spine or we are putting them to sleep living consciousness alright so quickly chapter 11 okay so a little bit about of course I gotta teach you I know I wish I know I know if this let me tell you what's on the final I can't do it I gotta teach you okay anesthetics drugs that reduce or eliminate pain by either stopping all nerve function in the central nervous system or spine and we have general anesthesia which is when we put somebody to sleep or local anesthesia which is when we stop sensation at some certain area of the body and usually there's still awake we're in a balance where we do both we stop pain perception at a certain part of the body and we put them to sleep for all the credit basis out there I'm kidding some people and you don't need all that okay so these aren't aesthetics do different things they stop the pair of transmission and they will also relax your skeletal muscles this is very important for pain control and they can reduce your reflexes and that's because they're stopping and transmission we have ones that we inhale and we have ones that we use an IV so we have inhalation and for us our inhalations are nitrous oxide which us that's laughing gas and isoflurane that Harpreet group presented to us with just really extremely funny video hilarious and that's ISIL firing or foreign and then our parentally administered drugs are succinylcholine and lidocaine lidocaine can be a topical anesthetic or in a parental anesthetic okay so inhaled first we have nitrous oxide laughing gas and we have ISIL flirt slurring or foreign any of them that have Ain or have some kind of halogen name so halo fluorine those are ISIL fluorines and they actually have fluorine in them when that is what's causing the sedation okay so this is inhaled sedation and they they can produce amnesia which is interesting so you can completely forget what happened I've been personally privy to this parental anesthetics we don't have any none of the ones we're covering there here so I'm just going to move on our guys are here sedative hypnotics these will also put you to put you to sleep and but they're not considered general or local anesthetics so they're adjunct drugs that we give alongside and we give these to help the patient feel less pain but not have to give them so much anesthesia and help them forget what happened and we usually put it in a little cocktail that we give them before surgery and that's what Simone little cocktail that they give you before surgery all these guys so we have birth vigilance and benzodiazepines these are to make you happy and give you anesthesia and then promethazine and hydrox things these are gonna help what's pain relief I'm sorry these are anti-anxiety and then these pain relief the pyridine is Demerol morphine and fentanyl these are all opioids so we have pain sedation and anxiety these are all things that we give before the anaesthesia okay other very important drugs we can give when we're trying to do anaesthesia or this very important class neuromuscular blocking drugs and they usually see it shortened to nm BD and everybody that's like that on the finals yes it is so you need to know n NB D is neuromuscular blocking drugs and these guys stop pain transmission than the spine okay they working really well they don't work like an opioid where they come down and land on the receptor and then stop the communication between your spinal and your cranial nerves these just stopped nerve transmission in the spine and they work really well the one that we need to know is succinylcholine succinylcholine is our neuromuscular blocking drug and we use it for general anesthesia and it causes paralysis another and we'll get more into him in a minute another adjunct drug is anticholinergics atropine is one below for meanness one that we cover in class atropine is one we cover in class these are to block the cholinergic system to just sort of shut it down and so okay so that doesn't make sense right why would we need to shut it down because when a patient is doing surgery we want your GI tract to stop working we don't want them producing fecal matter urine or peeing or anything we want to stop all that and so we give an anticholinergic to stop their GI tract usually okay alright so we're talking about general anesthesia right now we can use it to elicit unconsciousness we can use it to start just a paralysis for our skeletal muscles it's a skeleton let's all relax ation with you paralysis or we can stop our smooth muscles from working so they're sore smooth muscle relaxation okay now these ones will cause myocardial depression so the analgesic Scouts respiratory depression opioid analgesics cause respiratory the anesthetics are the ones that will lower your heart rate and big huge test point and not through my toes for the pharmacy nice cause malignant hyperthermia it will cause your body to elevate in temperature sudden elevation and body temperature malignant hypothermia common adverse side effect of general anesthesia and we have tachycardia of course elevated heart rate muscle rigidity because your muscles have been paralyzed um if your muscles become rigid you can use dantrolene it's a skeletal muscle relaxer relaxant so if this patient is experiencing this severe adverse effect where they have high heart rate and muscle rigidity they can be given dantrolene which will relax their skeletal muscles and help with the rigidity naturally and is a common drug you guys need to know okay all right so we have general anesthesia which is complete unconsciousness usually we can also do moderate sedation so there's levels of sedation and we initially they only want to get to level three there's four levels usually they only want to get to level three to be safe for operations level two and level one or four when we want to be awake for an operation we just want to have some local anesthetics at the site so moderate sedation would be a little 2 or level 1 and it's conscious sedation so we give very heavy painkillers and some drugs that make you very tired but you're not gonna lose consciousness so you stay awake okay moving on so the last group we have to talk about our local anaesthetics and that's going to be lidocaine in our case we can give so local anesthetics are when we just want to numb a certain area of your body so we don't lose consciousness general anesthetic is lose consciousness local anesthetic is not topical is our lidocaine we can give Linna can be a topical or you can give it parental via IV and we can also do a spinal tap intricate intrathecal intrathecal these are in the spine and epidural this is different depths of the spine infiltration nerve block or topical so different ways we can give local anesthetic so the Canes are sodium channel blockers and the way they work is they stop sodium from flooding into your nerve cells your neurons and they stop the electrical impulse or the action potential so the block nerves transmission and therefore they block pain perception and they can cause paralysis there's love so you don't feel anything where the Canes are hanging around the drive that Heather presented was lidocaine and they used an example of the topical lidocaine on Justine's back when she had back pain Heather put a lidocaine patch on her so that's a topical version but they also have the IV version of Lady Jane as well and this is the steps that you're feeling will be lost so autonomic activity is lost this is your involuntary system then pain and other sensory functions are lost and then motor activity is lost so that's usually a step-down system and then when they wear off they come back the opposite order so usually could make you move your leg first and then you'll start to feel some sobbing pain and then eventually you'll be able to go pee again so automatic activity is going to pee okay so we know why we give these names local anesthetics or local procedures noting that it's going to be to traumatize him for the patient okay there's a important final question so a week when we want to give a anaesthesia via IV which is infiltration okay that's IV we will give epinephrine as well mixed in because I've been offering those two things it causes vasodilation because it's phase evaluation and it will cause and because it causes phase of violations the medication that it was given with is going to hang out in that dilated artery more because isolated and so it's a big balloon and so that causes the medication to stay at the site so epinephrine causes vasodilation and they will the opposite vasoconstriction I'm sorry it's phase a constriction I meant to say that basal constriction keeps blood at the site and so that will increase the duration of action of the anesthesia so epinephrine is an adjuvant drug that we give along with IV anesthesia because it causes vasoconstriction at the site it keeps the drug there and because it causes vasoconstriction it will decrease bleeding at the site of wherever the procedure is okay so epinephrine is twofold nasal constriction works to keep the anesthetic at the site of action and decrease incision will bleeding and so it prevents the anesthesia from traveling around all over the place in your blood so we'll keep it there and reduce blood loss sorry about that confusion doesn't cause vasodilation causes vasoconstriction of course epinephrine is fight-or-flight which is phase a constrictor so it works locally at the site of injection that is a test question and they just stumbled all the way through it all right I think we are then their flock anesthesia yes and soon adverse effects mm-hmm oh one more narrow muscular blocking drugs I kind of mentioned it already succinylcholine is our drug succinylcholine and we need to understand it is N and n B D so these prevent nerves transmission and certain muscles resulting in paralysis so these guys will paralyze you we when we use these guys we have to do mechanical ventilation because it's paralyzed or respiratory and skeletal muscles so it's really important that we artificially ventilator our patients when we use our end and these succinylcholine is our NM BP they don't cause sedation or pain relief they cause paralysis so if you give this to a patient they can still be conscious so there's our guy succinylcholine where it's to stimulate neurotransmitter acetylcholine causes depolarization and stops a nerve transmission this is the description of how you're going to fill in your on it he's primarily is to control ventilation during surgical procedures so if we want to put somebody under and we don't want their autonomic smooth muscle fighting against us we fighting against the tube the ventilation tube we will give them an NM BD in order to stop those smooth muscles of their esophagus and trachea from contracting or just in the throat from contracting so that the ventilation ticking we put in and not necessarily your own body but also when you're on this you need ventilation because it's also paralyzing so you need it when you're on it and and you also need it for ventilation adverse effects low blood pressure increased heart rate because of the low blood pressure you have to use some emergency ventilation equipment of you on or arguing you you if you're on it you might need that by you're not already ventilated cardiovascular collapses all isn't is an issue I'm looking for the antidote slide because that's the last thing that you need to know no it's out here well that's retarded okay so if you have if you want to reverse the effects of succinylcholine or neuromuscular blocking drugs so you want to wake the muscles back up and stop the paralysis neostigmine is used so Neos ketamine reverses the effects of neuromuscular blocking drugs that just succinylcholine okay and we need to know this for the final yes that you mean was introduced in chapter 15 of them who have in chapter 21 of those two we knew it before to treat myosin famous to things but it's also used as an antagonist of neuromuscular blocking drugs okay that's gonna do it if you guys need anything send me email I will be available Wednesday morning from 11:00 to 12:00 or even 10 to 12 if you need me let me know bye

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