Download Case study for Unit 5 Key

RSPT 1213 Basic Respiratory Care Pharmacology: Unit 5: sedatives, Paralytics and
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Name:
Date:
2008
Case study #1
Your patient is a 45 YO LAF who is going to surgery in the morning for a total hysterectomy.
Because there is a concern about cancer, the operation will be via the abdomen rather than a vaginal
approach.
1.
Identify the types of drugs that this patient might get the day before the surgery.

Analgesics for pain relief without loss of consciousness
2. Identify the side effects of these drugs.

Analgesics: both acetaminophen & NSAID have liver damage as a side effect

Narcotic analgesic: decrease ventilatory drive and lower blood pressure most of these
drugs are addictive
3. Identify the type of drugs that this patient might get the night before surgery.

Narcotic analgesic, hypnotics & larger doses of anti-anti-anxiety for sleep the night
before surgery
4. Identify the side effects of these drugs.

hypnotics : loss of consciousness, decreased blood pressure and depressed
ventilatory drive. Loss of REM sleep can effect mental status

larger doses of anti-anxiety loss of consciousness, decreased blood pressure and
depressed ventilatory drive.
5. Once the patient goes into the OR, what types of drugs will she get for pain?

Anesthetics by IV such as those in the barbiturate family are used to induce
anesthesia.

These are frequently used with the inhaled anesthetics for general anesthesia.
6. What would be the advantage of giving more than one drugs for the same indication?

Because all CNS depressants have synergistic or potentiating interactions with one another,
mixing them will increase the level of sedation needed for general anesthesia
Case study # 2
Your patient is an 18 YO WM who was in an MVA [motor-vehicle accident]. Because he has compound
fractures of his pelvic and legs, we need to operate.
7. Differentiate between general anesthesia and local anesthesia.

We use a combination of different CNS depressants, both inhaled and IV to induce general
anesthesia in which the patient has complete loss of sensation, loss of consciousness and loss
of reflexes.

A local anesthetic is used to block pain receptors in a single part of the body so that the
patient never losses consciousness. Sometimes we need to give anti-anxiety to calm the
patient during these procedures, but the patient should never lose consciousness
8. Once he is intubated, what type of drugs will he get to minimize trauma to the muscles that
will be cut.

Paralytic drugs will relax the muscles so trauma is minimized
9. List the side effects of paralytic agents.

The patient has no loss of consciousness, no loss of sensation but he will have total loss of
motor neuron.

He cannot move. He cannot protect his airway, he cannot breathe. His blood pressure can
drop due to loss of muscle action on lower extremities’ blood vessels
10. Differentiate between reversible and non-reversible paralytic agents.

non-reversible paralytic agents are short acting and used to induce paralysis for less than 2030 minutes for short procedures such as intubation. These drugs work by causing
depolarization of the muscle so that teteny results

reversible paralytic agents are used for longer procedures such as while the patient is in
surgery or while the patient is on mechanical ventilation. These drugs work by competing
with acetylcholine at the skeletal muscle’s nerve endings.
11. Give an example of a paralytic agent that is reversible?

tubocurarine & pancuronium [Pavulon]
12. Discuss the specific side effects of general anesthesia.

During general anesthesia the patient’s airway and breathing must be maintained and the
patient’s Sp02, exhaled C02 and BP monitored constantly because the patient has loss
reflexes that protect the airway and his CNS the ability to notice hypercapnia & hypoxia as
well as acidosis. There can be low blood pressure from both these drugs and immobility
13. Which of these paralytic agents would be used for a surgical procedure that might last as
long as an hour?

We would use a reversible paralytic agent such as tubocurarine & pancuronium [Pavulon]
14. Once this patient is out of surgery and in the Recovery Room, what drug might he get to
reverse the narcotic?

Narcotics are reversed by narcan TM or naloxone
15. What drug might he get to reverse the paralytic agent

These drugs can be reversed by neostigmine.
Case study # 3
Your patient is a 35 YO BM with is history of seizures associated with a carbon monoxide
exposure 3 years ago that resulted in hypoxic encephopathy. He was trached with a # 6 shiley
at that time, because he could protect his airway. He frequently has serious pain from muscle
cramps around the hips and legs.
16. Identify the type of drugs he would get for the seizures.

Anti-epilepsy drugs or anti-seizure
17. Discuss the side effect of these drugs

at lower dose reduce excessive EEG activity without depressing the CNS, but at
high doses can start affecting consciousness
18. Identify the type of drugs he would get for the muscle cramps

Anti-spasmodics / muscle relaxers are used for analgesics when the pain is related to
muscle spasm
19. Discuss the side effects of these drugs

drowsiness, dizziness and physical dependence
20. How could getting these drugs adversely affect his ability to protect his airway?
Loss of reflexes, although in his case, because he is already trached, this would be minimal we would
worry more that the drugs might decrease his ventilatory drive
Case study # 4
Your patient is a 2 hour-old 28 week premature infant who presents in such respiratory
distress that he is intubed with a 2.5 endotracheal tube. He has crackles and diminished
breath sounds in the bases. The baby is 1800 grams.
21. What drug would you recommend at this point?

We need to instill exdogenous surfactant
22. How would this help the baby?

surfactant to decrease ST which increases the lung compliance and makes the WOB more
normal
23. What dose would you give this infant?

Could give one of three surfactants: Exosurf TM, Survanta TM , Infasurf TM
24. What are the side effects of this drug?

Immediately, instillation of the drug can become an airway obstruction so that the patient
can have hypoxemia, possibly go apnic, become bradycardic and require bagging BUT -

Within a few minutes the compliance can improve so much that the same PIP and PEEP
are now excessive and the Pa02 will rise rapidly so we might have to decrease the settings.
25. Differentiate between Prophylactic and rescue treatment

Prophylactic all infants below 1250-1350 grams get dose

rescue treatment only kids with s/s of respiratory distress should get these expensive
drugs
26. How often can you repeat this drug?
Exosurf TM, Q 12 hours
Infasurf TM
and
Survanta TM Q 6 hours
27. Discuss the route of this drug.

Instillation down the ET tube. Divide dose and give a little at a time so that the airway is not
obstructed completely