Anesthesia pharm 1

Question 1

Epinephrine

Answer 1

• Release by adrenal medulla
• alpha1=alpha2
• beta1=beat2
• adrenal standard secretion rates= 0.2 mcg/kg/min
• beta1/2 predominate at low doses leads to decreased PVR
• alpha 1 and beta1/2 @ high does -> vast
• bolus will result in sharp increase in MAP with baroreceptor response and vagal reflex drop in MAP

Question 2

Norepinephrine

Answer 2

• Mainly alpha 1
• No beta 2
• 4-12mcg/min= alpha1 and beta 1
• low dose= b1 dominates
• high dose = a1 dominates
• may cause pulp HTN and right heart failure

Question 3

Dopamine

Answer 3

• low (1-3 mcg/kg/min) = D1 activation= coronary, renal, mesenteric vasodilation
• moderate 3-10 mcg/kg/min= B1
• high >10mcg/kg/min = a1

Question 4

Fenoldopam

Answer 4

• D1 agonist
• 10x potency of dopamine
• 0.1-0.8 mcg/kg/min
• 0.1-0.2 much/kg/min produces renal vasodilation, increased renal blood flow and increased GFR and Na excretion

Question 5

Phenylephrine

Answer 5

• pure alpha agonist

- venoC > arterial

Question 6

Methoxamine

Answer 6

• arterial constriction > veno

- longer acting

Question 7

Midodrine

Answer 7

• oral a1 agonist
• used for dialysis induced hypotension
• T1/2= 3 hrs
• Duration 4-6

Question 8

A2 agonist

Answer 8

-decrease CNS sympathetic output
-decrease NE release
-Sedation, hypnosis, sympatholysis, neruoprotection, diuresis,
inhibition of insulin and HGH secretion
-rapid delivery may increase BP due to postsynaptic a2b receptor mediated arterial and venom

Question 9

Anesthesia benefits of A2 stimulation

Answer 9

anxiolytics, sedation, decreased MAC, decreased opioid induced chest wall rigidity, decreased BP response to ETT, extubation, and incision, and decreased post anesthesia shivering

Question 10

Dexmedetomidine

Answer 10

• selective a2 agonist
• 1620:1 a2:a1
• decrease post-op analgesics, b-blockers, antiemetics, diuretics, and Epi for CABG pts.
• loading dose = 1 mcg/kg/hr over 10-20 min
• Infusion = 0.2-0.7 mcg/kg/hr
• can cause hypotension and bradycardia

Question 11

Clonidine

Answer 11

• 220:1 a2:a1 activity
• PO dosing q8hrs
• do not hold d/t rebound HTN

Question 12

Isoproterenol

Answer 12

• Non-selective B1 B2
• High dose= tachycardia and hypotension
• Chemical pacemaker

Question 13

Dobutamine

Answer 13

• B1 agonist
• A1 antagonist
• Minimal B2
• increase CO, decrease LV filling pressure, maintain HR and SVR until does > 10-20 mcg/kg/min
• can be used as stress test

Question 14

B2 Agonist

Answer 14

• Asthma, COPD
• Bronchodilation without systemic effects
• overdosing causes B1 effects
• Metaproterenol, albuterol, salmeterol

Question 15

Terbutaline, Ritodrine

Answer 15

• used for tocolysis in pregnancy

- B2 mediated relaxation of uterine smooth muscle

Question 16

Ephedrine

Answer 16

• Indirect sympathomimetic
• causes release of stored NE
• not for pt taking TCA or MAOI
• actions on A and B
• competes with NE for reuptake
• increase HR, BP and CO
• Tachyphylaxis= decreased response with repeated doses
• May increase MAC due to CNS stimulatory effects

Question 17

Amphetamine and Methamphetamine

Answer 17

• CNS stimulants
• A and B
• indirect
• OD with dantolene to decrease temp

Question 18

Methylphenidate

Answer 18

Ritalin
similar effects to amphetamine
used for ADHD

Question 19

Vasopressin

Answer 19

• endogenous hormone
• high concentration act on the V1a in vascular smooth muscle to vast
• treat refractory hypotension
• ACE or ARB induced refractory hypotension
• 1-8 unit doses

Question 20

Reserpine and A-methydopa

Answer 20

block synthesis and storage of NE

Question 21

Guanethidine

Answer 21

blocks release of NE

Question 22

Phenoxybenzamine

Answer 22

-A blockade in pheos
-irreversible, non-competitive blocker
T1/2= 18-24hrs
10-20 mg PO daily
Do not block B before you block A

Question 23

Phentolamine

Answer 23

used for infiltration of NE
causes vasoD
A blocker

Question 24

Parzosin

Answer 24

high affinity for A
to treat HTN
PO at bed

Question 25

Doxazosin and Tamsulosin

Answer 25

for BPH | A blockade

Question 26

Esmolol

Answer 26

``` -Selective B1 T1/2 9-10 min 90 sec onset -metabolized by non specific esters -10-20-40 mg boluses for HTN -Fast BP control, short duration ```

Question 27

Labetalol

Answer 27

- A1, B1 and B2 blocker - A:B= 1:7 - peripheral vasoD with reflex tachycardia - peak 5-15 min - duration 4-6 hrs - 5-10mg q5-10 min

Question 28

Metoprolol

Answer 28

``` -primarily B1 B1:B2 = 30:1 2-5 mg q 2-5 min up to 15mg max B1 black seen at .2mg/kg given to control HR when BP reduction is not needed ```

Question 29

Atropine and Scopolamine

Answer 29

- Anticholinergics - competitively inhibit ACh by reversibly binding to muscarinic receptors - Teritary amine= can cross BBB and have CNS effects

Question 30

Glycopyrrolate

Answer 30

anticholinergic competitively inhibit ACh by reversibly binding to muscarinic receptors quaternary amine= does not cross BBB

Question 31

Neostigmine, Edrophonium, Echothiophate

Answer 31

anti cholinesterase