Baldwin Exam 1: Immunology Overview

Immune System Overview

• Innate immunity is the body's first line of defense against pathogens, offering a non-specific response.
• Adaptive immunity involves T and B lymphocytes identifying and responding to specific pathogens by producing targeted antibodies.

Lymphocytes

• B cells transform into plasma cells upon encountering an invader, producing antibodies.
• T cells, particularly cytotoxic T cells, destroy infected or abnormal cells directly.

Immunomodulators

• Cyclosporine is an immunosuppressant used to prevent organ rejection, particularly affecting T cells.
• Echinacea and similar supplements may hinder the efficacy of immunosuppressants.
• Prednisone reduces inflammation but also suppresses immune function.

Immunoglobulins

• IgG: Most abundant, provides long-term immunity, crosses placenta.
• IgM: First immunoglobulin produced in response to an infection.
• IgE: Involved in allergic reactions.

Vaccines

• Live vaccines contain weakened pathogens (e.g., COVID, flu) but may not be safe for immunocompromised individuals.
• Inactivated vaccines use killed organisms (e.g., polio vaccine).
• Toxoid vaccines (e.g., tetanus) protect against toxins.
• Recombinant vaccines are lab-made and cannot cause the disease.

Pain Management and Analgesics

• Nociceptors detect pain; A fibers respond to sharp pain, while C fibers handle duller pain.
• Morphine targets mu and kappa receptors for severe pain but carries risks such as respiratory depression.
• Naloxone (Narcan) is used to reverse opioid overdose effects.

Non-Opioid Analgesics

• NSAIDs (e.g., aspirin, ibuprofen) inhibit COX enzymes to reduce pain and inflammation.
• Aspirin has significant anticoagulant effects and may cause Reye's syndrome in children.
• Ibuprofen is contraindicated in patients with peptic ulcer disease and should be used cautiously in those with kidney conditions.

Anesthesia

• Local anesthesia (e.g., lidocaine) focuses on a specific area without loss of consciousness.
• General anesthesia has stages, with Stage 3 being surgical anesthesia and Stage 4 being dangerous as it can lead to respiratory failure.
• Nitrous oxide is a short-acting anesthetic that does not cause complete unconsciousness.

Adverse Effects of Anesthetics

• Succinylcholine induces paralysis without pain relief and is unsafe for those with malignant hyperthermia.
• Isoflurane can cause muscle relaxation but is contraindicated in head injuries.

Immunity Classification

• Passive immunity involves pre-formed antibodies, such as maternal antibodies crossed through the placenta.
• Active immunity develops from exposure to pathogens or vaccinations.
• Cytokines produced by macrophages enhance immune responses against infections.

Nursing Considerations

• Administrate immunostimulants cautiously in patients with autoimmune disorders.
• Monitor for signs of toxicity when using immunosuppressants like cyclosporine, particularly regarding kidney function.
• Assess for blood pressure changes and respiratory rate in patients receiving opioids or opioid antagonists.

Additional Drug Considerations

• Interactions with grapefruit juice can elevate drug levels significantly, particularly with cyclosporine.
• Long-term steroid use may necessitate gradual tapering to avoid adrenal insufficiency and hyperglycemia.
• Combination of sedatives and opioids requires careful monitoring due to respiratory depression risks.

Pain Classification

• Acute pain occurs suddenly and typically has a clear cause, whereas chronic pain is long-lasting and often more challenging to treat.
• PCA (Patient-Controlled Analgesia) allows patients to manage their pain effectively while ensuring safety protocols are followed.

Specific Conditions and Treatments

• Migraines may be treated with triptans, which can cause vasoconstriction but are contraindicated in patients with heart conditions or pregnant individuals.
• Ergotamine is category X for pregnancy and should not be given to those who may be pregnant.### Corticosteroids
• Consult a drug guide prior to administration.
• Administer via intramuscular (IM) injection.
• Avoid if signs of systemic infection are present.
• Must taper off slowly to prevent withdrawal symptoms.

Acetaminophen

• Therapeutic Class: Antipyretic and analgesic.
• Pharmacologic Class: Centrally acting COX inhibitor.
• Function: Reduces fever by acting on the hypothalamus, lacks anti-inflammatory properties and does not affect platelet aggregation.
• Adverse Effects: Rare but includes risk for liver damage at high doses.
• Contraindications: Chronic alcoholism is a major risk factor.
• Interactions: Careful with other hepatotoxic drugs.
• Nursing Considerations: Monitor AST/ALT levels, do not exceed 4g/day, avoid in regular alcohol consumers, Pregnancy Category B.
• Overdose Treatment: Acetylcysteine is the antidote.

Pain Assessment and Classification

• Types: Acute vs. Chronic pain; Chronic pain includes neuropathic pain.
• Measurement: Scales and instruments are used for quantification.
• Classifications: Somatic pain (localized and sharp) vs. Visceral pain (dull, difficult to diagnose, harder to treat).

Pain Transmission Process

• Nociceptors are stimulated, sending impulses via A (myelinated, fast) and C (non-myelinated, slow) fibers to the spinal cord.
• Neurotransmitter Substance P is released, transmitting pain signals to the brain.
• Chronic pain may lead to psychological issues.

Opioid Analgesics

• Classifications: Opioid Agonist, Antagonist, and Mixed Agonist-Antagonist.
• Opioid Agonist: Treats severe pain (e.g., morphine, codeine, oxycodone).
• Opioid Antagonist: Reverses opioid intoxication severity (e.g., naloxone).
• Mixed Agonist-Antagonist: Stimulates opioid receptors with fewer adverse effects (e.g., butorphanol).

Morphine

• Therapeutic Class: Opioid analgesic.
• Pharmacologic Class: Opioid agonist.
• Action/Use: Binds to Mu and Kappa receptors, providing significant pain relief for severe pain.
• Adverse Effects: Dysphoria, hallucinations, nausea, constipation, and respiratory depression.
• Overdose: Can cause severe respiratory depression or cardiac arrest.
• Interactions: CNS depressants may enhance effects.

Codeine, Oxycodone, Hydromorphone

• Act primarily on Mu receptors; provide relief for moderate to severe pain.
• Adverse effects include respiratory depression, constipation, orthostatic hypotension, sedation, nausea, and vomiting.
• Interactions: Caution with CNS depressants, anticholinergics, antihistamines.
• Nursing Administration: Monitor pain levels and follow controlled substances procedures.

Naloxone (Narcan)

• Therapeutic Class: Drug for acute opioid overdose treatment.
• Pharmacologic Class: Opioid receptor antagonist.
• Action/Use: Reverses opioid effects in emergencies, induces withdrawal symptoms.
• Adverse Effects: Increased blood pressure, tremors, hyperventilation, nausea.

Aspirin

• Therapeutic Class: Non-opioid analgesic, NSAID.
• Pharmacologic Class: Salicylate.
• Action/Use: Inhibits prostaglandin synthesis for pain/inflammation relief; anticoagulation properties.
• Adverse Effects: GI discomfort, bleeding, salicylism.
• Contraindications: Caution with anticoagulants; Reye syndrome in children.
• Nursing Considerations: Discontinue one week prior to surgery, Pregnancy Category D.

Ibuprofen

• Therapeutic Class: Non-opioid analgesic, NSAID.
• Pharmacologic Class: COX-1 and COX-2 inhibitor.
• Action/Use: Reduces inflammation and relieves mild to moderate pain; fever reduction.
• Adverse Effects: Risk of impaired kidney function and GI bleeding.

Celecoxib

• Therapeutic Class: Non-opioid analgesic, NSAID (2nd generation).
• Pharmacologic Class: COX-2 inhibitor.
• Adverse Effects: Back pain, heightened blood pressure, increased cardiovascular risks.

Migraines and Treatments

• Tension Headache: Most common, treated with OTC analgesics.
• Migraine Treatment: Sumatriptan for vasoconstriction of cranial arteries; Ergotamine for unresponsive patients.

Sumatriptan

• Therapeutic Class: Antimigraine drug.
• Pharmacologic Class: Triptan.
• Adverse Effects: Dizziness, drowsiness, chest pressure.

Ergotamine

• Therapeutic Class: Antimigraine drug.
• Pharmacologic Class: Ergot alkaloid.
• Adverse Effects: GI discomfort, risk of ergotism leading to gangrene.

Local Anesthesia

• Patient remains conscious; administered via topical or nerve block.
• Mechanism: Blocks sodium ion entry into nerves, often combined with epinephrine for vasoconstriction.

Lidocaine

• Therapeutic Class: Anesthesia.
• Pharmacologic Class: Sodium channel blocker.
• Adverse Effects: CNS excitement, convulsions, respiratory depression.

General Anesthesia

• Induces complete sensation loss and unconsciousness.
• Stages:
  • Stage 1: Loss of pain
  • Stage 2: Distress symptoms
  • Stage 3: Surgical anesthesia
  • Stage 4: Medullary paralysis (critical concern).

Propofol

• Therapeutic Class: General anesthesia.
• Pharmacologic Class: NMDA receptor agonist.
• Adverse Effects: Apnea, respiratory depression.

Nitrous Oxide

• Therapeutic Class: General anesthesia.
• Aimed for short procedures; low potency.

Adjuncts to Anesthesia

• Anticholinergics pre-surgery for secretions; opioids might be administered intraoperatively.

Succinylcholine

• Therapeutic Class: Skeletal muscle paralytic drug.
• Pharmacologic Class: Depolarizing blocker.
• Adverse Effects: Bradycardia, respiratory depression, malignant hyperthermia risk.

Cyclobenzaprine

• Therapeutic Class: Centrally acting skeletal muscle relaxant.
• Adverse Effects: Drowsiness, blurred vision, dizziness.

Dantrolene Sodium

• Therapeutic Class: Direct-acting antispasmodic.
• Main Uses: Cerebral palsy, spinal injuries, malignant hyperthermia treatment.
• Adverse Effects: CNS depressant effects, muscle weakness.

Immune System Overview

• Innate immunity is the body's first line of defense against pathogens, offering a non-specific response.
• Adaptive immunity involves T and B lymphocytes identifying and responding to specific pathogens by producing targeted antibodies.

Lymphocytes

• B cells transform into plasma cells upon encountering an invader, producing antibodies.
• T cells, particularly cytotoxic T cells, destroy infected or abnormal cells directly.

Immunomodulators

• Cyclosporine is an immunosuppressant used to prevent organ rejection, particularly affecting T cells.
• Echinacea and similar supplements may hinder the efficacy of immunosuppressants.
• Prednisone reduces inflammation but also suppresses immune function.

Immunoglobulins

• IgG: Most abundant, provides long-term immunity, crosses placenta.
• IgM: First immunoglobulin produced in response to an infection.
• IgE: Involved in allergic reactions.

Vaccines

• Live vaccines contain weakened pathogens (e.g., COVID, flu) but may not be safe for immunocompromised individuals.
• Inactivated vaccines use killed organisms (e.g., polio vaccine).
• Toxoid vaccines (e.g., tetanus) protect against toxins.
• Recombinant vaccines are lab-made and cannot cause the disease.

Pain Management and Analgesics

• Nociceptors detect pain; A fibers respond to sharp pain, while C fibers handle duller pain.
• Morphine targets mu and kappa receptors for severe pain but carries risks such as respiratory depression.
• Naloxone (Narcan) is used to reverse opioid overdose effects.

Non-Opioid Analgesics

• NSAIDs (e.g., aspirin, ibuprofen) inhibit COX enzymes to reduce pain and inflammation.
• Aspirin has significant anticoagulant effects and may cause Reye's syndrome in children.
• Ibuprofen is contraindicated in patients with peptic ulcer disease and should be used cautiously in those with kidney conditions.

Anesthesia

• Local anesthesia (e.g., lidocaine) focuses on a specific area without loss of consciousness.
• General anesthesia has stages, with Stage 3 being surgical anesthesia and Stage 4 being dangerous as it can lead to respiratory failure.
• Nitrous oxide is a short-acting anesthetic that does not cause complete unconsciousness.

Adverse Effects of Anesthetics

• Succinylcholine induces paralysis without pain relief and is unsafe for those with malignant hyperthermia.
• Isoflurane can cause muscle relaxation but is contraindicated in head injuries.

Immunity Classification

• Passive immunity involves pre-formed antibodies, such as maternal antibodies crossed through the placenta.
• Active immunity develops from exposure to pathogens or vaccinations.
• Cytokines produced by macrophages enhance immune responses against infections.

Nursing Considerations

• Administrate immunostimulants cautiously in patients with autoimmune disorders.
• Monitor for signs of toxicity when using immunosuppressants like cyclosporine, particularly regarding kidney function.
• Assess for blood pressure changes and respiratory rate in patients receiving opioids or opioid antagonists.

Additional Drug Considerations

• Interactions with grapefruit juice can elevate drug levels significantly, particularly with cyclosporine.
• Long-term steroid use may necessitate gradual tapering to avoid adrenal insufficiency and hyperglycemia.
• Combination of sedatives and opioids requires careful monitoring due to respiratory depression risks.

Pain Classification

• Acute pain occurs suddenly and typically has a clear cause, whereas chronic pain is long-lasting and often more challenging to treat.
• PCA (Patient-Controlled Analgesia) allows patients to manage their pain effectively while ensuring safety protocols are followed.

Specific Conditions and Treatments

• Migraines may be treated with triptans, which can cause vasoconstriction but are contraindicated in patients with heart conditions or pregnant individuals.
• Ergotamine is category X for pregnancy and should not be given to those who may be pregnant.### Corticosteroids
• Consult a drug guide before administration.
• Administer intramuscularly; avoid if signs of a systemic infection are present.
• Taper dosage slowly to prevent withdrawal symptoms.

Acetaminophen

• Therapeutic Classification: Antipyretic and analgesic.
• Pharmacological Classification: Centrally acting COX inhibitor.
• Actions/Uses: Reduces fever by acting on the hypothalamus, lacks anti-inflammatory properties, and does not affect platelet aggregation.
• Adverse Effects: Rare at therapeutic doses but carry a risk for liver damage.
• Contraindications: Chronic alcoholism.
• Interactions: Use caution with other hepatotoxic drugs.
• Nursing Considerations: Monitor AST/ALT levels; do not exceed 4g/day; avoid in regular alcohol consumers; categorized as pregnancy category B.
• Overdose treatment: Acetylcysteine.

Pain Classification

• Differentiates between acute and chronic pain.
• Chronic pain often features neuropathic characteristics.
• Pain can be measured using scales and classified by source: somatic vs. visceral.

Somatic vs. Visceral Pain

• Somatic Pain: Localized, sharp, and well-defined.
• Visceral Pain: Dull, difficult to locate, challenging to diagnose and treat.
• Neuropathic Pain: Complex and very difficult to manage.

Pain Transmission Process

• Nociceptors are stimulated, sending impulses via myelinated A fibers (quick response) and unmyelinated C fibers (slower).
• Release of Substance P leads to continued pain impulse transmission to the brain.
• Chronic pain may result in psychological impacts.

Opioid Analgesics

• Used for severe pain; operate at various receptor sites (Mu, Kappa, Delta).
• Opioid Agonists: Treat severe to extreme pain; examples include morphine, codeine, oxycodone, hydromorphone.
• Opioid Antagonists: Reverse opioid intoxication effects; naloxone (Narcan) is crucial for emergencies.

Morphine

• Therapeutic Classification: Opioid analgesic.
• Pharmacological Classification: Opioid agonist.
• Actions/Uses: Binds to Mu and Kappa receptors for profound analgesia; used for both acute and chronic pain.
• Adverse Effects: Dysphoria, hallucinations, nausea, constipation, dizziness, itching; overdose risks include respiratory depression/cardiac arrest.
• Nursing Considerations: Monitor for orthostatic hypotension; classified as a Schedule II drug.

Other Opioid Agonists

• Codeine, Oxycodone, Hydromorphone: Act on Mu receptors for moderate to severe pain relief and cough suppression.
• Common adverse effects: Respiratory depression, constipation, sedation, and urinary retention.

Naloxone (Narcan)

• Therapeutic Classification: Drug for acute opioid overdose.
• Pharmacological Classification: Opioid receptor antagonist.
• Actions/Uses: Reverses opioid effects in emergencies but can induce withdrawal symptoms.
• Adverse Effects: Increased blood pressure, tremors, nausea, drowsiness.

Non-Opioid Analgesics and NSAIDs

• Aspirin: Salicylate, provides mild relief of fever and has anticoagulant activity, but can cause GI discomfort and Reye's syndrome.
• Ibuprofen: COX-1 and COX-2 inhibitor, effective for inflammation and mild to moderate pain; monitor for GI bleeding.
• Celecoxib: Second-generation NSAID, COX-2 inhibitor; monitor for cardiovascular risks and kidney function.

Migraines and Treatments

• Tension Headaches: Managed with OTC analgesics.
• Migraines: Treat with meds like Sumatriptan, which causes vasoconstriction of cranial arteries.
• Ergotamine: Used for migraine prevention but has a risk of complications like gangrene from vascular constriction.

Local Anesthesia

• Localized pain relief methods include topical applications and nerve blocks. Sodium channel blockers like Lidocaine are commonly used.
• Adverse effects for Lidocaine: CNS excitement, respiratory depression, hypotension.

General Anesthesia

• Propofol: NMDA receptor agonist for induction and maintenance; watch for respiratory depression and hypotension.
• Nitrous Oxide: Inhalation gas effective for short procedures, resulting in mild sedation without full consciousness loss.
• Isoflurane: Inhaled anesthetic with muscle relaxant properties; watch for malignant hyperthermia.

Muscle Relaxants

• Succinylcholine: Depolarizing blocker used with general anesthesia; contraindicated in patients with a history of malignant hyperthermia.
• Cyclobenzaprine: Centrally acting relaxant; monitor for common CNS side effects and potential cardiovascular risks.
• Dantrolene Sodium: Direct-acting muscle relaxant; used for spastic conditions and malignant hyperthermia treatment.

Overall Considerations

• Good postoperative pain control can enhance recovery and discharge times.
• Monitor vital signs and have emergency protocols in place for anesthesia and opioid-related interventions.

Immune System Overview

• Innate immunity is the body's first line of defense against pathogens, offering a non-specific response.
• Adaptive immunity involves T and B lymphocytes identifying and responding to specific pathogens by producing targeted antibodies.

Lymphocytes

• B cells transform into plasma cells upon encountering an invader, producing antibodies.
• T cells, particularly cytotoxic T cells, destroy infected or abnormal cells directly.

Immunomodulators

• Cyclosporine is an immunosuppressant used to prevent organ rejection, particularly affecting T cells.
• Echinacea and similar supplements may hinder the efficacy of immunosuppressants.
• Prednisone reduces inflammation but also suppresses immune function.

Immunoglobulins

• IgG: Most abundant, provides long-term immunity, crosses placenta.
• IgM: First immunoglobulin produced in response to an infection.
• IgE: Involved in allergic reactions.

Vaccines

• Live vaccines contain weakened pathogens (e.g., COVID, flu) but may not be safe for immunocompromised individuals.
• Inactivated vaccines use killed organisms (e.g., polio vaccine).
• Toxoid vaccines (e.g., tetanus) protect against toxins.
• Recombinant vaccines are lab-made and cannot cause the disease.

Pain Management and Analgesics

• Nociceptors detect pain; A fibers respond to sharp pain, while C fibers handle duller pain.
• Morphine targets mu and kappa receptors for severe pain but carries risks such as respiratory depression.
• Naloxone (Narcan) is used to reverse opioid overdose effects.

Non-Opioid Analgesics

• NSAIDs (e.g., aspirin, ibuprofen) inhibit COX enzymes to reduce pain and inflammation.
• Aspirin has significant anticoagulant effects and may cause Reye's syndrome in children.
• Ibuprofen is contraindicated in patients with peptic ulcer disease and should be used cautiously in those with kidney conditions.

Anesthesia

• Local anesthesia (e.g., lidocaine) focuses on a specific area without loss of consciousness.
• General anesthesia has stages, with Stage 3 being surgical anesthesia and Stage 4 being dangerous as it can lead to respiratory failure.
• Nitrous oxide is a short-acting anesthetic that does not cause complete unconsciousness.

Adverse Effects of Anesthetics

• Succinylcholine induces paralysis without pain relief and is unsafe for those with malignant hyperthermia.
• Isoflurane can cause muscle relaxation but is contraindicated in head injuries.

Immunity Classification

• Passive immunity involves pre-formed antibodies, such as maternal antibodies crossed through the placenta.
• Active immunity develops from exposure to pathogens or vaccinations.
• Cytokines produced by macrophages enhance immune responses against infections.

Nursing Considerations

• Administrate immunostimulants cautiously in patients with autoimmune disorders.
• Monitor for signs of toxicity when using immunosuppressants like cyclosporine, particularly regarding kidney function.
• Assess for blood pressure changes and respiratory rate in patients receiving opioids or opioid antagonists.

Additional Drug Considerations

• Interactions with grapefruit juice can elevate drug levels significantly, particularly with cyclosporine.
• Long-term steroid use may necessitate gradual tapering to avoid adrenal insufficiency and hyperglycemia.
• Combination of sedatives and opioids requires careful monitoring due to respiratory depression risks.

Pain Classification

• Acute pain occurs suddenly and typically has a clear cause, whereas chronic pain is long-lasting and often more challenging to treat.
• PCA (Patient-Controlled Analgesia) allows patients to manage their pain effectively while ensuring safety protocols are followed.

Specific Conditions and Treatments

• Migraines may be treated with triptans, which can cause vasoconstriction but are contraindicated in patients with heart conditions or pregnant individuals.
• Ergotamine is category X for pregnancy and should not be given to those who may be pregnant.### Corticosteroids
• Consult a drug guide before administration.
• Administer intramuscularly; avoid if signs of a systemic infection are present.
• Taper dosage slowly to prevent withdrawal symptoms.

Acetaminophen

• Therapeutic Classification: Antipyretic and analgesic.
• Pharmacological Classification: Centrally acting COX inhibitor.
• Actions/Uses: Reduces fever by acting on the hypothalamus, lacks anti-inflammatory properties, and does not affect platelet aggregation.
• Adverse Effects: Rare at therapeutic doses but carry a risk for liver damage.
• Contraindications: Chronic alcoholism.
• Interactions: Use caution with other hepatotoxic drugs.
• Nursing Considerations: Monitor AST/ALT levels; do not exceed 4g/day; avoid in regular alcohol consumers; categorized as pregnancy category B.
• Overdose treatment: Acetylcysteine.

Pain Classification

• Differentiates between acute and chronic pain.
• Chronic pain often features neuropathic characteristics.
• Pain can be measured using scales and classified by source: somatic vs. visceral.

Somatic vs. Visceral Pain

• Somatic Pain: Localized, sharp, and well-defined.
• Visceral Pain: Dull, difficult to locate, challenging to diagnose and treat.
• Neuropathic Pain: Complex and very difficult to manage.

Pain Transmission Process

• Nociceptors are stimulated, sending impulses via myelinated A fibers (quick response) and unmyelinated C fibers (slower).
• Release of Substance P leads to continued pain impulse transmission to the brain.
• Chronic pain may result in psychological impacts.

Opioid Analgesics

• Used for severe pain; operate at various receptor sites (Mu, Kappa, Delta).
• Opioid Agonists: Treat severe to extreme pain; examples include morphine, codeine, oxycodone, hydromorphone.
• Opioid Antagonists: Reverse opioid intoxication effects; naloxone (Narcan) is crucial for emergencies.

Morphine

• Therapeutic Classification: Opioid analgesic.
• Pharmacological Classification: Opioid agonist.
• Actions/Uses: Binds to Mu and Kappa receptors for profound analgesia; used for both acute and chronic pain.
• Adverse Effects: Dysphoria, hallucinations, nausea, constipation, dizziness, itching; overdose risks include respiratory depression/cardiac arrest.
• Nursing Considerations: Monitor for orthostatic hypotension; classified as a Schedule II drug.

Other Opioid Agonists

• Codeine, Oxycodone, Hydromorphone: Act on Mu receptors for moderate to severe pain relief and cough suppression.
• Common adverse effects: Respiratory depression, constipation, sedation, and urinary retention.

Naloxone (Narcan)

• Therapeutic Classification: Drug for acute opioid overdose.
• Pharmacological Classification: Opioid receptor antagonist.
• Actions/Uses: Reverses opioid effects in emergencies but can induce withdrawal symptoms.
• Adverse Effects: Increased blood pressure, tremors, nausea, drowsiness.

Non-Opioid Analgesics and NSAIDs

• Aspirin: Salicylate, provides mild relief of fever and has anticoagulant activity, but can cause GI discomfort and Reye's syndrome.
• Ibuprofen: COX-1 and COX-2 inhibitor, effective for inflammation and mild to moderate pain; monitor for GI bleeding.
• Celecoxib: Second-generation NSAID, COX-2 inhibitor; monitor for cardiovascular risks and kidney function.

Migraines and Treatments

• Tension Headaches: Managed with OTC analgesics.
• Migraines: Treat with meds like Sumatriptan, which causes vasoconstriction of cranial arteries.
• Ergotamine: Used for migraine prevention but has a risk of complications like gangrene from vascular constriction.

Local Anesthesia

• Localized pain relief methods include topical applications and nerve blocks. Sodium channel blockers like Lidocaine are commonly used.
• Adverse effects for Lidocaine: CNS excitement, respiratory depression, hypotension.

General Anesthesia

• Propofol: NMDA receptor agonist for induction and maintenance; watch for respiratory depression and hypotension.
• Nitrous Oxide: Inhalation gas effective for short procedures, resulting in mild sedation without full consciousness loss.
• Isoflurane: Inhaled anesthetic with muscle relaxant properties; watch for malignant hyperthermia.

Muscle Relaxants

• Succinylcholine: Depolarizing blocker used with general anesthesia; contraindicated in patients with a history of malignant hyperthermia.
• Cyclobenzaprine: Centrally acting relaxant; monitor for common CNS side effects and potential cardiovascular risks.
• Dantrolene Sodium: Direct-acting muscle relaxant; used for spastic conditions and malignant hyperthermia treatment.

Overall Considerations

• Good postoperative pain control can enhance recovery and discharge times.
• Monitor vital signs and have emergency protocols in place for anesthesia and opioid-related interventions.