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Pharmacology > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

MOA propofol

A

Increases affinity for GABA-GABAa receptor> prolonged opening of Cl channel> hyper polarized nerve membrane> inhibitory effect on CNS>induction/maintenance of GA

May also be related to reduced glutaminergic activity through NMDA receptor blockade

Other effects:
CNS- decreased cerebral metabolic rate, oxygen consumption, ICP
CVS- decreased SVR, preload and contractility
RESP- decreased hypoxic/hypercapnic resp drive and decreased upper airway reflexes

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2
Q

Indications for propofol

A

Induction/maintenance of GA

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3
Q

Contraindications of propofol

A

Hypersensitivity (including eggs or soy)
<3YO
3rd trimester

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4
Q

Propofol dosage

A

RSI
Stable: 1-2.5mg/kg
Unstable: 0.5-1mg/kg

Continuous infusion 25-100mcg/kg/min (typically start at 50-60, 30-35for geris)

Bolus: Use program bolus dose&time (1mL= 10mg or 20mg depending on concentration), follow with increased dose rate so you’re not swinging wildly. Typically 10-20mg (Rico said 20-40)

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5
Q

Propofol formulary

A

2%= 2000mg/100mL= 20mg/mL
1%= 1000mg/100mL= 10mg/mL (CTS)

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6
Q

Propofol pharmacokinetics

A

Onset 30sec
Duration 3-10min

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7
Q

MOA Fentanyl

A

Analgesia- mu receptors in brain and spinal cord decrease release of pain neurotransmitters (glutamate, substance P, CGRP)

Respiratory and cardiac depression- mu receptors in brainstem

Other effects see Calgary Guide to Understanding Disease- Anesthesia

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8
Q

Fentanyl Indications and dosages

A

RSI: 1-4mcg/kg (or 50-200mcg)

Maintenance infusion: start at 25-50mcg/hr or 50-100mcg/hr (higher tolerance, painful state) up to 300mcg/hr.
BOLUS: 25-50mcg

Analgesia loading dose 0.5-1.0mcg/kg (IV/IM/IO) or 1.5-2.0mcg/kg (IN)

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9
Q

Fentanyl formulary

A

500mcg/50mL= 10mcg/mL
Compatible with d5w or NS

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10
Q

MOA Rocuronium

A

NDNMBA
Competitive antagonist of ACh at post synaptic nicotinic receptors on muscles— skeletal muscle paralysis

Other effects:
2. Vagolytic effect- blockage of vagal muscarinic receptors in SA—tachycardia
3. Anaphylaxis— IgE antibodies attach to ammonium and components of NMBAs or non-immunologic mast cell degranulation—> release of histamine—> bronchospasm and/or hypotension

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11
Q

Contraindications and side effects of Rocuronium

A

Allergy
Caution: liver failure (double half-life) and renal failure

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12
Q

Rocuronium dosage

A

RSI: 0.6-1.2mg/kg
Maintenance: 1mg/kg/hr (depends) Or 50mg aliquots q 30-45min

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13
Q

Rocuronium formulary

A

CTS: 50mg/5mL (10mg/mL) x4 vials =200mg
Standard infusion 2mg/mL
Compatible with NS, D5W, LR

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14
Q

Rocuronium effects on AAAA, Neuro, Resp

A

Causes areflexia and apnea other AAA no and neuro no.

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15
Q

Propofol effects on AAAA, Neuro, Resp

A

Amnesia yes*
Dose-dependent hypotension and RR depression
Neuro- sedative/hypnotic

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16
Q

Fentanyl effects on AAAA, Neuro, Resp

A

Causes Analgesia, areflexia (blocks pain and therefore reflex), autonomic stability (blunts sympathetic drive).

Hypoventilation/apnea
Neuro- DLOC

17
Q

MOA Succinylcholine

A

DNMBA
1. ACh mimic- agonist at nicotinic ACh receptors in muscles— continuous end-plate depolarization— inactivation of Na+ channels— prevents repolarization and additional action potentials—> skeletal muscle paralysis

  1. Continuous end-plate depolarization leads to fasciculations and myalgias
  2. Agonist at nicotinic receptors in parasympathetic ganglia, sympathetic ganglia, and muscarinic receptors in SA node— low dose—> parasympathetic, high dose —>sympathetic
18
Q

Contraindications and side effects of Succinylcholine

A

Avoid in burns(>24hrs), CVA, neuromuscular disorders S/E: Malignant Hyperthermia, muscle pain, hyperK, bradycardia

19
Q

Succinylcholine dosage and formulary

A

1.0-1.5mg/kg
CTS: 400mg/20mL (20mg/mL) x 2 vials= 800mg

20
Q

Succinylcholine effects on AAAA, neuro and resp

A

Causes areflexia and apnea, may cause bradycardia.

No effects on amnesia, analgesia, or LOC.

21
Q

MOA Ketamine

A

Opioid agonist, NMDA antagonist, muscarinic antagonist, enhances monoaminergic transmission

22
Q

Contraindications and side effects of Ketamine

A

allergy, conditions that would worsen with HTN* (depends)
S/E: hypersalivation, prolonged emergence (stage II), CARDIAC DEPRESSANT in catecholamine depleted states

23
Q

Ketamine dosing (GA only) and formulary

A

RSI: 0.5-2mg/kg

Maintenance: half induction dose/hr or 0.5mg/kg/hr or BOLUS: 25mg
1000mg/100mL=10mg/mL
Compatible with D5W, NS

CTS: 100mg/2mL x5 and 500mg/10mL x2= 1500mg

24
Q

Ketamine effects on AAAA, Neuro and Resp

A

AAAA yes, but balance between sympathetic enhancer vs. cardiac depressant
Neuro- DLOC
Resp- no effect (other than bronchodilation)

Pharmacology (6 decks)

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