Anesthesia Med Sheet MOA/INFO Flashcards
Etomidate S/E, metabolism and other
CV stable, less myocardial depression than propofol
S/E: myoclonus/pain on injection, cv stable, epileptic foci
METABOLISM: plasma esterases and hepatic enzymes; a single induction dose may inhibit 11 BH leading to adrenocortical suppression
ketamine S/E, metabolism and other
hallucinations
increased CO
increased HR
increased salivation
decreased BP
analgesia
metabolism: liver cyp450; redistribution
methohexital/brevital S/E, metabolism, other
porphyria
do not give with asthma
propofol S/E, metabolism and other
pain on injection
no use in egg/soy allergy
antiemetic
decreases CV
metabolism: liver and lungs
midazolam S/E, metabolism and other
decreased respiration
amnesia
1/2 life: 1-4 hrs
H2O soluble
benzo
eliminated renal
dexmedetomidine info to know
alpha 2 agonist
succinylcholine S/E, metabolism, other
short-acting depolarizing
can cause MH
locks NA channel
met: plasma pseudocholinesterase
mivacurium info to know
short-acting non depolarizing
met: plasma cholinesterase
can cause histamine release
atracurium info to know
intermediate acting nondepolarizing
metabolism: hoffman/ ester hydrolysis
can cause histamine release
vecuronium info to know
intermediate acting; nondepolarizing
metabolism: liver>kidney
high lipid solubility
rocuronium info to know
intermediate acting; nondepolarizing
metabolism: liver >kidney
painful on injection
shortest acting NDNMB
ciastracurium info to know
intermediate acting; nondepolarizing
met: hoffman/esterase hydrolysis
pancuronium info to know
long acting; nondepolarizing
metabolism: renal
increase HR- no NOREPI reuptake
fentanyl info to know
pulm 1st pass
can cause rigid chest
sufentanil info to know
can cause rigid chest
most potent
pulm 1st pass
remifentanil info to know
metabolized by hydrolysis esterase
ultra short acting
1/2 life: 6 min
meperidine info to know
metabolite = seizures
no with MAOIs
crosses placenta
increase HR
treats post op shivering
ketorolac info to know
bleeding/ inhibits COX
morphine info to know
can cause Nausea and vomitting
most allergies: +histamine
can cause biliary spasm
hydromorphone info to know
can cause N/V
+histamine
antitussive
1mg=7mg MSO4 (morphine sulfate)
etomidate MOA
GABA mimetic
binds to GABA receptor and enhances receptors affinity for GABA
Ketamine MOA
non competitively binds to NMDA (glutamate receptor)
inhibits glutamate receptor (excitatory)- decreases presynaptic release of glutamate and potentiates GABA release
methohexital MOA
barbituate
acts on GABA receptors
propofol MOA
modulates GABA receptors
increases transmembrane Cl- conduction- hyperpolarizes post-synaptic cell membrane
sedation and hypnosis
midazolam MOA
Works on the GABA receptor
To increases frequency of Cl-channel influx and
hyperpolarizes targeted cell
MOA of dexmedetomidine
Alpha 2 agonist
Binds with pre and postsynaptic alpha 2a agonist receptors
Decreases norepi levels; causes sedation and analgesia
Alpha 2 agonist
Decreases cAMP which inhibits the locus coeruleus in the pons = sedation
MOA of succinylcholine
Binds to one or both alpha subunits of nicotinic ACh receptors and mimics action of ACh
Depolarizes the membrane
MOA of mivacurium
binds competitively to cholinergic receptors to antagonize the action of ACh and cause neuromuscular blockade
MOA atracurium
reversibly competitive antagonism of ACh
MOA of vecuronium
reversibly competitive antagonism of ACh
MOA of rocuronium
reversibly competitive antagonism of ACh
MOA of cisatracurium
reversibly competitive antagonism of ACh
MOA of pancuronium
reversibly competitive antagonism of ACh
info about ephedrine
direct/indirect beta and alpha 1 agonist
can have tachyphylaxis
dont give with fast HR
dont give with MAOI
decreases uterine blood flow
info about phenylephrine
alpha 1 agonist
can cause reflex bradycardia (baroreceptor reflex)
info about epinephrine ( think hemodynamics)
direct beta1, beta2, alpha 1 agonist
causes increased CO
increased HR
increased contractility
increased SVR
info about dopamine
alpha1, beta1,beta2 and dopamine (renal perfusion) receptor agonist
avoid with MAOIs
400mg/250ml bag= 1600mcg/ml
info about dobutamine
selective beta1
inotrope
info about atropine
increases HR
causes mydriasis (pupil dilation)
tertiary ammonium (crosses BBB)
info about glycopyrrolate
decreases secretions
quaternary ammonium (DOES NOT CROSS BBB)
info about neostigmine
max dose 5mg
cholinergic syndrome
decreases HR
hepatic metabolism
info about physostigmine
crosses BBB (tertiary amine)
dont give with asthma
renal excreted
info about edrophonium
do not give with glycopyrrolate
renal excreted
can diagnose MG true reversible
info about flumazenil
benzo antagonist
repeat 0.2mg q 1min (3mg/hr max)
info about naloxone
reversal for opioids
info about hydralazine
Arteriole vasodilation causes increased cGMP
increased HR
increased CO
decreases SVR
increased RENIN
DOC with normal to low HR (beta blockers preferred for HTN with increased HR)
info about labetalol
alpha, beta1, beta2 antagonist
ratio 1:7 alpha to beta IV
decreases HR, give slow
info about esmolol
beta1 antagonist
metabolized by plasma hydrolysis
t1/2 9min
info on ondansetron
5HT3 antagonist
admin slowly to prevent headache
info about droperidol
paradoxical reaction( restless anxious)
decreases BP
change in dopamine in CNS (dont give with parkinsons)
info about dexamethasone
decreases inflammation
decreases immunity
muscarinic effects
decrease HR
bronchoconstriction
increased salivation
decreased BP
MIOSIS (pupil constriction)
intestinal spams
MOA of fentanyl
opioid mu receptor agonist
MOA of sufenta
opioid mu receptor agonist
MOA of ultiva/remifentanil
opioid mu receptor agonist
MOA of meperidine
synthetic opioid agonist at mu and kappa receptors
MOA of toradol
nonselective NSAID
inhibits COX1 and COX2
MOA of morphine
mostly mu agonist
inhibits ascending pain pathways
MOA of hydromorphone
mostly mu agonist and some kappa receptors
MOA of ephedrine
direct: alpha and beta agonist
indirect: causes release of endogenous catecholamines stored in nerve terminals
MOA of epinephrine
beta 2> beta1> alpha1
beta1: inotropy, chronotropy
beta2: vasodilation (skeletal muscles) and bronchodilation
alpha1: vasoconstriction
MOA of dopamine
adrenergic agonist
inotropic
precursor to norepi
alpha1, beta1, beta2, dopaminergic
MOA of atropine
inhibits postganglionic muscarinic receptors
competes with ACh at the muscarinic receptor sites as an antagonist
increases firing of SA node and conduction through the AV node by blocking the action of the vagus nerve
MOA of glycopyrrolate
competitively antagonizes ACh at muscarinic receptors
MOA of bridion/sugammadex
noncovalently binds to the steroidal muscle relaxant
prevents NDNMBs from binding to nicotinic ACh
immediate reversal of NDNMB
MOA of neostigmine
-anticholinesterase- accumulation of ACh at nicotinic receptors in NMJ
-does this by the formation of carbamyl esters
-reverses and restores neuromuscular transmission
MOA of physostigmine
-anticholinesterase- increases ACh at nicotinic receptors in NMJ
-does this by formation of carbamyl esters
-more neurotransmitters available for interaction with cholinergic receptors
MOA of edrophonium
anticholinesterase-
competitive inhibition through electrostatic attachment to the anionic site on the acetylcholinesterase enzyme (presynaptic)
MOA of flumazenil
competitive GABA antagonist
prevents or reverses effects of benzos
MOA of naloxone
competitively antagonizes mu, kappa, delta opioid receptors
greatest affinity for MU
MOA of hydralazine
activates guanylate cyclase
increases cGMP
decreases intracellular Ca
ateriolar relaxation
MOA of labetalol
selective alpha 1
nonselective beta1 and beta 2 blocker
MOA of esmolol
selective B1 blocker
MOA of ondansetron
5HT3 antagonist
blocks serotonin centrally at the CRTZ and peripherally
MOA of droperidol
butyrophenone
dopamine antagonist at GABA in CRTZ
MOA of dexamethasone
-glucocorticoid steroid
-derivative of prednisolone
-reduces surgery-induced inflammation due to inhibition of prostaglandin synthesis
what medication has less myocardial depression than propofol
etomidate
what medication can lead to adrenocortical suppression
etomidate
what are some CV considerations of etomidate
CV stable
less myocardial depression than propofol
what are side effects of etomidate
myoclonus
pain on injection
epileptic foci
how is etomidate metabolized
plasma esterases and hepatic enzymes
how does etomidate cause adrenocortical suppresssion
inhibits 11 beta hydroxylase
what does ketamine do to HR, CO and BP
HR increases
BP decreases
CO increases
what is a metabolism consideration with ketamine
redistribution
what are 3 side effects of ketamine
hallucinations
analgesia
increase salivation
what are the contraindications off methohexital
porphyria
asthma
what are signs and symptoms of porphyria
hyponatremia
peripheral neuropathy
severe abdominal pain
psych problems
where is propofol metabolized
lungs and liver
how is versed eliminated
renal
what is the half life of versed
1-4 hrs
is versed water soluble
yes
what are the short NMBs
succs
mivacurium
what are the intermediate NMBs
atracurium
vec
roc
cisatracurium
what is the long action NMB
pancuronium
what is the shortest onset non depolarizing muscle blocker
roc
what are considerations for succinylcholine?
metabolized by plasma pseudocholinesterase
locks sodium channel
can cause MH
what is the specific temperature and pH called that causes spontaneous degradation of atracurium
hofman elimination
what two NDNMB increase histamine release
mivacurium
atracurium
what two NMB are eliminated by Hofman elimination or ester hydrolysis
cisatracurium
atracurium
what are considerations for vecuronium
metabolized more in liver than kidney
increased lipid solubility
what are considerations for rocuronium
metabolized more in liver than kidney
painful injection
shortest onset NDNMB
what are considerations for pancuronium
increases HR
blocks norepi reuptake
eliminated in the kidneys
what are considerations for fentanyl
rigid chest
pulmonary 1st pass effect
what is pulmonary 1st pass effect
loss of drug on first circulation through the lungs
what are considerations for giving sufentanil
rigid chest
pulm 1st pass effect
MOST POTENT
what are considerations for remifentanil
ultra short acting
6.5 min half life
metabolized by hydrolysis esterase
what are considerations for merperidine
DO NOT GIVE WITH MAOIs
crosses placenta
metabolite can cause seizures
increase HR
used for post op shivering
what bp med is selective b1 and a positive inotrope
dobutamine
what are considerations for ephedrine admin
does not increase uterine blood flow
direct/indirect betal and alpha1
what should be done after admin of sugammadex
ptc
postetanic count aka twitches
what side effects should you look for with neostigmine
cholinergic syndrome
decreased HR
what class of drug is famotidine
H2 receptor antagonist
MOA of famotidine
H2 receptor antagonist that produces selective and reversible inhibition of H2-mediated secretion of hydrogen ions produced by the stomach
what is half life and peak of famotidine
half life: 2.5-4 hrs
peak: 1-3.5 hrs
What NDNMB are supplied in 10mg/ml
Atracurium
Rocuronium
What NDNMBs are supplied in 2 mg/ml
Mivacurium
Cisatracurium
And sometimes pancuronium
What NDNMBs are supplied in 1mg/ml
Pancuronium
Vecuronium
Edrophonium MOA
Anticholinesterase
Competitive inhibition through electrostatic attachment to the anionic site on the acetylcholinesterase enzyme (presynaptic)
MOA of phenylephrine
directly activates alpha1
constricts arteries and veins
Veins>arteries
alpha 1>alpha2
