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Anesthesia Pharm 1 > Anesthesia pharm 1 > Flashcards

Anesthesia pharm 1 Flashcards

1
Q

Epinephrine

A
  • 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
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2
Q

Norepinephrine

A
  • 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
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3
Q

Dopamine

A
  • low (1-3 mcg/kg/min) = D1 activation= coronary, renal, mesenteric vasodilation
  • moderate 3-10 mcg/kg/min= B1
  • high >10mcg/kg/min = a1
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4
Q

Fenoldopam

A
  • 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
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5
Q

Phenylephrine

A
  • pure alpha agonist

- venoC > arterial

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6
Q

Methoxamine

A
  • arterial constriction > veno

- longer acting

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7
Q

Midodrine

A
  • oral a1 agonist
  • used for dialysis induced hypotension
  • T1/2= 3 hrs
  • Duration 4-6
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8
Q

A2 agonist

A

-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

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9
Q

Anesthesia benefits of A2 stimulation

A

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

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10
Q

Dexmedetomidine

A
  • 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
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11
Q

Clonidine

A
  • 220:1 a2:a1 activity
  • PO dosing q8hrs
  • do not hold d/t rebound HTN
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12
Q

Isoproterenol

A
  • Non-selective B1 B2
  • High dose= tachycardia and hypotension
  • Chemical pacemaker
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13
Q

Dobutamine

A
  • 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
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14
Q

B2 Agonist

A
  • Asthma, COPD
  • Bronchodilation without systemic effects
  • overdosing causes B1 effects
  • Metaproterenol, albuterol, salmeterol
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15
Q

Terbutaline, Ritodrine

A
  • used for tocolysis in pregnancy

- B2 mediated relaxation of uterine smooth muscle

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16
Q

Ephedrine

A
  • 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
17
Q

Amphetamine and Methamphetamine

A
  • CNS stimulants
  • A and B
  • indirect
  • OD with dantolene to decrease temp
18
Q

Methylphenidate

A

Ritalin
similar effects to amphetamine
used for ADHD

19
Q

Vasopressin

A
  • 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
20
Q

Reserpine and A-methydopa

A

block synthesis and storage of NE

21
Q

Guanethidine

A

blocks release of NE

22
Q

Phenoxybenzamine

A

-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

23
Q

Phentolamine

A

used for infiltration of NE
causes vasoD
A blocker

24
Q

Parzosin

A

high affinity for A
to treat HTN
PO at bed

25
Q

Doxazosin and Tamsulosin

A

for BPH

A blockade

26
Q

Esmolol

A 
-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
27
Q

Labetalol

A
  • 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
28
Q

Metoprolol

A 
-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
29
Q

Atropine and Scopolamine

A
  • Anticholinergics
  • competitively inhibit ACh by reversibly binding to muscarinic receptors
  • Teritary amine= can cross BBB and have CNS effects
30
Q

Glycopyrrolate

A

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

31
Q

Neostigmine, Edrophonium, Echothiophate

A

anti cholinesterase

Anesthesia Pharm 1 (1 decks)

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