Book cover for Pharmacology and the Nursing Process

Pharmacology and the Nursing Process

Linda Lane Lilley, Shelly Rainforth Collins, Julie S. Snyder

ISBN #9780323087896

7th Edition

394 Questions

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2,697 Students Helped

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Summary
Learning Objectives
Key Concepts
Example Problems
Explanations
Common Mistakes

Summary

This chapter delves into the distinctions between general and local anesthetics, exploring their anatomical, physiological, and pathophysiological underpinnings. It highlights the importance of understanding pharmacokinetics for drug selection, dosing, and managing interactions. Special attention is given to the clinical applications of MAO-B inhibitors in Parkinson's disease and the roles of other drug classes like alpha blockers, beta blockers, and alkylating agents in comprehensive patient care.

Learning Objectives

1

Differentiate between the anatomical, physiological, and pathophysiological aspects of general and local anesthesia.

2

Explain the mechanisms, clinical implications, and selection criteria for general versus local anesthetic techniques.

3

Analyze the pharmacokinetic profiles and therapeutic applications of various drugs including MAO-B inhibitors, alpha blockers, beta blockers, and alkylating agents.

4

Evaluate potential drug interactions, contraindications, and dosing strategies in clinical practice.

5

Apply knowledge of anesthetic drug profiles in the management of antiparkinson therapy and related clinical scenarios.

Key Concepts

CONCEPT

DEFINITION

General Anesthesia

A medically induced, reversible state of unconsciousness, loss of protective reflexes, and response to painful stimuli used during surgery to allow for pain-free procedures throughout the body.

Local Anesthesia

A technique that involves numbing a specific area of the body, blocking nerve conduction to prevent pain without affecting the patient's consciousness.

Pharmacokinetics

The study of how drugs are absorbed, distributed, metabolized, and excreted in the body, influencing dosing and clinical outcomes.

MAO-B Inhibitors

A class of drugs that inhibit monoamine oxidase B, used primarily in the treatment of Parkinson's disease to increase the availability of dopamine in the brain; examples include selegiline and rasagiline.

Alpha Blockers

Medications that inhibit alpha-adrenergic receptors, used to manage conditions such as hypertension and benign prostatic hyperplasia by relaxing smooth muscle tissues.

Beta Blockers

Drugs that block beta-adrenergic receptors, reducing heart rate and blood pressure, and used in various cardiovascular conditions.

Alkylating Agents

A group of compounds that add alkyl groups to DNA, used primarily in chemotherapy to prevent the replication of malignant cells.

Example Problems

Example 1

The physician has requested "lidocaine with epinephrine." The nurse recognizes that the most important reason for adding epinephrine is that it a helps to calm the patient before the procedure. b minimizes the risk of an allergic reaction. c enhances the effect of the local lidocaine. d reduces bleeding in the surgical area.

Example 2

The surgical nurse is reviewing operative cases scheduled for the day. Which of these patients is more prone to complications from general anesthesia? a A 79 -year-old woman who is about to have her gallbladder removed b A 49-year-old male athlete who quit heavy smoking 12 years ago c A 30 -year-old woman who is in perfect health but has never had anesthesia d A 50-year-old woman scheduled for outpatient laser surgery for vision correction

Example 3

Which nursing diagnosis is possible for a patient who is now recovering after having been under general anesthesia for 3 to 4 hours during surgery? a Impaired urinary elimination related to the use of vasopressors as anesthetics b Increased cardiac output related to the effects of general anesthesia c Risk for falls related to decreased sensorium for 2 to 4 days postoperatively d Impaired gas exchange due to the CNS depressant effect of general anesthesia

Example 4

A patient is recovering from general anesthesia. What is the nurse's main concern during the immediate postoperative period? a Airway b Pupillary reflexes c Return of sensations d Level of consciousness

Example 5

A patient is about to undergo cardioversion, and the nurse is reviewing the procedure and explaining moderate sedation. The patient asks, "I am afraid of feeling it when they shock me?" What is the nurse's best response? a "You won't receive enough of a shock to feel anything." b "You will feel the shock but you won't remember any of the pain." c "The medications you receive will reduce any pain and help you not to remember the procedure." d "They will give you enough pain medication to prevent you from feeling it."
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Step-by-Step Explanations

QUESTION

How do general and local anesthesia differ in their mechanisms and clinical applications?

STEP-BY-STEP ANSWER:

Step 1: Identify that general anesthesia induces a state of complete unconsciousness and an overall insensibility to pain, affecting the entire body.
Step 2: Recognize that local anesthesia involves targeting a specific area to block sensory nerve conduction, allowing the patient to remain conscious.
Step 3: Understand that general anesthesia involves complex interactions with the central nervous system, while local anesthesia primarily affects peripheral nerves.
Step 4: Consider the clinical implications: general anesthesia is used for extensive surgical procedures, whereas local anesthesia is ideal for minor or localized procedures.
Final Answer: General anesthesia results in a systemic loss of sensation and consciousness; conversely, local anesthesia numbs a specific area without affecting overall awareness.

General vs Local Anesthesia

QUESTION

How do pharmacokinetic profiles affect anesthetic drug selection and dosing?

STEP-BY-STEP ANSWER:

Step 1: Review absorption, distribution, metabolism, and excretion properties for each anesthetic drug.
Step 2: Analyze how these properties determine onset, duration, and intensity of anesthesia.
Step 3: Evaluate patient-specific factors such as age, weight, liver, and kidney function that may alter drug metabolism.
Step 4: Integrate this knowledge to select a drug that provides the desired duration and effectiveness with minimal risk of adverse interactions.
Final Answer: Pharmacokinetic profiles guide clinicians in tailoring anesthetic drug choices and dosing regimens to ensure efficacy and safety in diverse patient populations.

Pharmacokinetics of Anesthetic Drugs

QUESTION

What is the role of MAO-B inhibitors like selegiline and rasagiline in managing Parkinson's disease symptoms?

STEP-BY-STEP ANSWER:

Step 1: Understand that MAO-B inhibitors work by blocking the breakdown of dopamine in the brain.
Step 2: Recognize that increased dopamine levels help alleviate the motor symptoms associated with Parkinson’s disease.
Step 3: Consider dosing strategies and drug interactions, noting that these inhibitors require careful management to avoid adverse effects.
Step 4: Appreciate that these drugs are part of a comprehensive treatment plan combining medications and lifestyle interventions.
Final Answer: MAO-B inhibitors help improve the availability of dopamine, thereby mitigating the motor dysfunction in Parkinson’s disease when used appropriately in a treatment regimen.

MAO-B Inhibitors in Parkinson’s Treatment

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Common Mistakes

  • Confusing the systemic effects of general anesthesia with the localized effects of local anesthesia.
  • Overlooking the importance of pharmacokinetic variability when selecting and dosing anesthetic drugs.
  • Failing to consider potential drug interactions, particularly in patients already on medications such as beta blockers or MAO-B inhibitors.
  • Assuming that all anesthetic drugs work via the same mechanism, leading to improper selection for specific clinical scenarios.