ancillary anesthesia drugs Flashcards
which drugs used for sedation? when do you use them?
2 diff classes here.
1 class = 3 drugs
other class = 2 drugs
benzos: diazepam and lorazepam
1st gen-antihistamines: hydroxyzine, diphenylhradmine, promethazine
use for amnesci and calming effect (used night before for anxiolysis)
what do you use for analgesia?what ADEs do they have?
morphine and codeine (but they have ADEs for ortho HypoTN, constipation, N/V, respiratory depression/coma)
NSAIDs(ketorolac and ibuprofen but worry about post-sx bleeding and fracture healing
what do you use for aspiration pneumonitis?(2 drugs here)
neutralize acid w/H2 blockers: cimetidine and ranitdine = prevent new acid but you stilll have old contents in theree.
which two antacids are used in the context of aspiration penumonitis?
bicitra and polycitra
what do you use for prophylaxis to allergic rxn?
cimetidine and diphenhydramine
why do you use anticholinergics in anesthesia
to dry secretions, prevent reflex bradycardia, also sedate/amnesia
which three anticholinergics do you use?
atropine (bradycardia here)
glycopyrrolate(decreased secretions)
scopolamine( sedation/amnesia)
which drugs used in rapid sequence intubation?(4 FLAV)
lidocaine(for increased ICP and brochospasm)
fentanyl (for increased ICP,bleeding, CV dz)
vecuronium(decrease ICP increse caused by succinlycholine)
atropine (decrease bardy Cardia caused by succinlycholine)
which drugs used to hyopTN/what do you do for hypo tN?
GIVE fluids
give dopamine and phenylephrine or ephedrine
all the drugs used in aspiration pneumonitis
5
2H2s
2antacadis
D2 central antagonist aslo used for emesis prevention in migraines
cimetidine
ranitidine
bicitra
polycitra
metoclopramide
drugs used for N/V (3)
ondasestron
scopolamine
metoclopramide
drugs used for CV support (3)
dopamine
phenylephrine
4 drugs used in anaphylaxis prevention (HAME)
epinephrine
aminophylline
hydrocortisone
methylprednisolone
an anti-dopamine/cholinergic/histaminergic drug used to mitigate anxiety?
promethazine
2 1st gen anti histamines used to reduce anxiety with effects of bronchodilation, sedative, anxiolytic and analgesic?
hydroxyzine and diphenhydramine
what are 3 major differences btw H1 and H2 antagonists?
H1 antagonist: diphenyhydramine, promezathine, hydroxyzine
H2 antagonist: cimetidine and ranitidine
H1 antagonists have following action: sedative, cholinergic antagonism and anti-emetic effect
t/f. cimetidine has slight sedative action
true
3 major problems of opiate receptor agonists
ONE = OD triad
- orthostatic hyoptension, epigastric distress, antidiarrheal, and increased sphincter tone
- N/V via chemoreceptor trigger(dopamine antagonism) + delay of GI transit + increased GI secretion
- respiratory depressant + coma-inducing+miosis (OD triad)
why are H2 receptor antagonists (cimetidine and ranititdine) use in the prophophylaxis against respiration pneumonitis?
what are their ADEs(3)?
- fewer CNS effects and they lower the gastric pH
- ADE: headache, confusion, seizures, agitation in old pp?
why do pts receive bicitra and polycitra
b/c H2 antagonsists do not neutralize existsing stoamch contents or prevent gastric emptying
which agent used to stimulate gastric emptying?
metoclopramide
NOTE: antagonized by anticholinergics and narcotics.
central effects dopamine antagonism: sedation and lowers seizure threshold.
how much water needed to stimlate gastric stretch receptors to initate the process of natural stomach emptying?
150 mL
which inhaled ansethetic is especially pro-emetic
nitrous oxide
atropine - strongest effect
_anticholinergic _strongest: vagolytic - 3+; antisialoggoue effect; no sedation or amnesia
scopalamine - MOA
anticholinergic: strongest effect: 3+ sedation and amnesia; 2+ for antisialogogue; 1+ vagolytic
glycopyrrolate MOA
antichiolinergic = MOA - 3+ ANTI-sialogogue effect; 2+ vagolytic; 0 sedation and amnesia
why use anticholinergics in pre-op?
3 reasosn
- tx of reflex bradycardia
- blcok muscuraic efffects of anti-cholinesterases
- drying of secretions
rapid sequence intubation:
which drug described:
what: decreased intracranial and brochospasitc reponse in increased ICP or penetrating injury, reactive airway disease
lidocaine
RSI
what: decreased sympathetic responses to laryngoscopy/intubation
when: increased ICP, hemorrhage, cardiovascualr disease
fentanyl
RSI
what: mitigates bradycardia in response to succinlycholine in chidren under10 yrs
atropine
what: defaciculates and mitigates ICP response to succinlycholne in increased intracranial pressure of penetrating injury
vecuroniu
note sequence of rapid sequence intubation : IV push of sedative –> succinycholine(neuromuscular blockade)
which IV anesthetic agent has antiemetic qualities?
propofol
after how many drugs does the risk of polypharmacy increase dramatically?
10
bone cement and radio contrast dye are well known causative agents of what?
anaphylacxis in anesthesia
what are the 4 components of INITIAL anaphylaxis management?
- strop drug admin, discontinue anesthetisa
- give O2
- give Epinephrine
- intravascular volume expansion
drugs used in the prophylaxis of allergic reaction
cimetidine and diphenydramine (they prevent consequences fo the reaction, but do not prevent it from occuring)
