ANESTHETICS

The physiologic state induced by general anesthetics typically includes analgesia, amnesia, loss of consciousness, inhibition of sensory and autonomic reflexes, and skeletal muscle relaxation. The extent to which any individual anesthetic agent can exert these effects varies depending on the drug, the dosage, and the clinical situation. Anesthetics may be classified as general, local, or topical.

General anesthetics- act on the CNS or autonomic nervous system (ANS) to produce analgesia, amnesia, or hypnosis. they may be further classified as inhalation (i.e isoflurane, nitrous oxide, enflurane) or intravenous anesthetics (i.e. ketamine, propofol, fentanyl).

Local anesthetics- are administered to prevent or relieve pain in a specific area of the body. they act by blocking both sensory and motor nerve conduction to produce a temporary loss of consciousness. unlike general anesthetics, they do not cause CNS depression. They may be "amide" drugs (i.e. lidocaine, bupivacaine) or "ester" drugs (i.e. cocaine, tetracaine).

Topical anesthetics- are applied directly to intact skin or mucous membranes and are used to prevent or relieve minor pain (i.e. lidocaine, tetracaine)

INDICATIONS:
  • Surgery- a medical procedure that may involve the removal of diseased tissue, repair of damaged tissue, or examination of tissue to determine what type of disease is present. anesthetics are chosen depending on the site, duration, and gravity of the surgical procedure to be performed.
  • Relieve pain- patients who are in severe pain, such as burn injuries or cancer patients, may be given anesthetics when other pain medications are cannot alleviate the pain.
  • Catheter insertion- topical anesthetics may be given to numb the mucosal surfaces before a tube/catheter is inserted.

DRUGS:

1. BUPIVACAINE

BRAND NAMES:
  • Hospira Bupivacaine HCl amp
  • Marcaine vial
  • Sensorcaine Heavy inj

SPECIFIC CLASS: Local Anaesthetic

COMMON SIDE EFFECTS:
  • weak or shallow breathing;
  • fast heart rate, gasping, feeling unusually hot;
  • slow heart rate, weak pulse;
  • feeling restless or anxious, ringing in the ears, metallic taste, speech problems, numbness or tingling around your mouth, tremors, feeling light-headed, or fainting; or
  • problems with urination.

DOSAGE FORM:
  • Injection

CONTRAINDICATIONS:
  • Hypersensitivity
  • Paracervical block in obstetrics; spinal anaesthesia <18 yr.
  • Lactation

PREGNANCY CATEGORY:

  • Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

2. FENTANYL

BRAND NAMES:

  • Durogesic transdermal system
  • Hospira Fentanyl Citrate amp
  • Sublimax amp

SPECIFIC CLASS: Local Anaesthetic

COMMON SIDE EFFECTS:

  • sedation
  • Nausea & vomiting
  • transient hypotension
  • headache
  • Rash & itching(transdermal)

DOSAGE FORMS:
  • transdermal patch
  • ampule for injection

CONTRAINDICATIONS:
  • Hypersensitivity
  • severe liver or renal insufficiency
  • increased intracranial pressure

PREGNANCY CATEGORY:
  • Category C:Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

  • Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

3. ISOFLURANE

BRAND NAMES:
  • Aerrane
  • Florane
  • Pascual Isoflurane

SPECIFIC CLASS: General anesthetic

COMMON SIDE EFFECTS:
  • abdominal or stomach pain
  • back or leg pain
  • black or bloody vomit
  • fever
  • head ache

DOSAGE FORMS:
  • solution for inhalation

CONTRAINDICATIONS:
  • hypersensitivity to isoflurane
  • malignant hyperthermia
  • dorphyra

PREGNANCY CATEGORY:
  • Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

4. KETAMINE

BRAND NAMES:

  • Ketamax vial
  • Ketazol vial
  • Quetanex vial

SPECIFIC CLASS:
General Anaesthetic

SIDE EFFECTS:

  • hallucinations
  • Increased muscle tone sometimes resembling seizures
  • hypersalivation
  • nausea & vomiting
  • raised intraocular and CSF pressure

DOSAGE FORM:
Intravenous

CONTRAINDICATIONS:
  • Hypertension
  • Eye injury, raised ocular and intracranial pressure
  • Psychotic disorders

PREGNANCY CATEGORY:
  • Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters). 5.

5. LIDOCAINE

BRAND NAMES:
  • Xylocaine
  • Enducaine
  • Nobucaine

SPECIFIC CLASS: Local Anesthetic; amide anesthetic

SIDE EFFECTS:
  • Vascular disorders: hypotension, hypertension
  • Nausea and Vomiting
  • Paresthesia
  • Dizziness
  • Bradycardia

DOSAGE FORMS:

  • Vials
  • Ampules
  • Jellies
  • Oral wash

CONTRAINDICATIONS:
  • Patients with allergy to amide type anesthetics
  • hypovolemia
  • heart block

PREGNANCY CATEGORY:

  • Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

6. NALBUPHINE

BRAND NAMES:

  • Hospira Nalbuphine amp
  • Nubain
  • Nukaine

SPECIFIC CLASS:
Belongs to the class of morphinan derivative opioids

COMMON SIDE EFFECTS:

  • Cardiovascular: Hypertension, hypotension, bradycardia, tachycardia, pulmonary edema.
  • Gastrointestinal: Cramps, dyspepsia, bitter taste.
  • Respiration: Depression, dyspnea, asthma.
  • Dermatological: Itching, burning, urticaria.
  • Obstetric: Pseudo-sinusoidal fetal heart rhythm.

DOSAGE FORMS:

  • Solution Intravenous

CONTRAINDICATIONS:

  • It should not be administered to patients who are hypersensitive to nalbuphine hydrochloride, or to any of the other ingredients in NUBAIN.

PREGNANCY CATEGORY:
  • Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).
  • If prolonged use/high doses at term: Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective)

7.PETHIDINE

BRAND NAMES:
  • Demerol amp
  • Demerol vial
  • Deme

SPECIFIC CLASS: local anesthetic

COMMON SIDE EFFECTS:
  • nausea and vomiting
  • drowsiness
  • constipation
  • dry mouth
  • sweating

DOSAGE FORMS:
  • solution IV
  • tablet
  • solution IM

CONTRAINDICATIONS:
  • presence of hypersensitivity to narcotics
  • bronchial asthma
  • COPD

PREGNANCY CATEGORY:

  • Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

8.
PROPOFOL

BRAND NAMES:
  • Diprifol amp emulsion inj
  • Diprivan
  • Hospira propofol

SPECIFIC CLASS: hypnotic agent used to induce and maintain general anesthesia

COMMON SIDE EFFECTS:
  • Involuntary muscle movements
  • Nausea and vomiting
  • headache
  • bradycardia
  • burning/ stinging pain at inj site

DOSAGE FORMS:
  • pre-filled syringe
  • ampules
  • vial
  • IV infusion

CONTRAINDICATIONS:
  • patients with known allergy to propofol
  • hypovolemia
  • heart block

PREGNANCY CATEGORY
:
  • Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

*FYI only: Propofol is the drug that allegedly caused the death of Micheal Jackson

References:
  • Clinical Pharmacology made Incredibly Easy. Lippincott Williams & Wilkins
  • Pharmacology by Leonard S. Jacob
  • MIMS Philippines
  • www.rxlist.com

GROUP MEMBERS:
  • SY, JESSICA BELLE
  • ULATAN, KRISTINE LARA B.
  • VIDAL, IRISH TRISTAN
  • VINOYA, LEAMSI GAY L.

3:00- 4:00/ MWF/ A206

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