COCO Tips Flashcards
(25 cards)
How is Flumazenil Metabolized
By liver enzymes
Thiopental: Pharmacokinetics
Redistribution and absorption typically happens instantaneously through IV injection
Side effects of Flumazenil
None of the above (does not cause seizures/anxiety, hypertension, or Tachycardia)
Clinical effects of Midazolam
Being bipolar is a relative contraindication whereas pregnancy is not a relative contraindication
Onset times for drugs based on route of administration
IV Thiopental = 30-40 seconds (peaks at 1 minute)
Etomidate = 30 seconds (1 minute peak)
Propofol = 15 - 30 seconds
Midazolam = 2 minutes (peaks at 5 - 10 minutes)
Midazolam solubility
Water soluble outside and lipid soluble inside
Hydrophilic when pH is lower than 6
Lipophilic when pH is greater than 6
Why put someone on a daily aspirin therapy?
In people with high risks of heart attacks, a daily aspirin regimen can act as an antiplatelet drug to allow better perfusion to the heart.
Target sites for Local Anesthetics
Sodium Channels (Na+)
Barbiturate mechanism of action
Works directly on the CNS by stimulating the release of the inhibitory neurotransmitter GABA. GABA will bind to GABA receptors and cause the Cl- ion gated channels to stay open for a prolonged period of time. This in turn hyperpolarizes the cells and decreases the possibility of an effective action potential by raising the threshold. Thiopental also decreases the flow of calcium through cell membranes
Can control seizures and help maintain a state of sleep
Physical properties of induction drugs
Propofol = oil at room temperature, insoluble in aqueous solution and 98% protein binding
Etomidate = Water soluble at acidic pH and lipid soluble at physiologic pH, 35% glycerol, racemic mixture, and 76% protein binding in the bloodstream.
Ketamine = derived from PCP, with 27% protein binding
Effects of Propofol
Can decrease BP and increase HR
Induction drug that can cause hiccups
Etomidate
Alpha-1 (protein binding)
Basic drugs will bind to this acidic glycoprotein
Concentration of epinephrine in Local Anesthetics
0.5% = 1:200,000 epi
1% = 1:200,000 epi
1.5% = 1:200,000 epi
2% = 1:200,000 epi
1% = 1:100,000 epi
2% = 1:100,000 epi
Propofol additives
Glycerol = burns
bacteriostatic? I thought this was etomidate? = disodium edetate?
Clinical effects of Midazolam
Does Do:
Sedation and Hypnosis, Anxiolysis, Anticonvulsant, Anterograde Amnesia
Does Not Do:
Analgesia, Antidepressant, Antipsychotic, Protection from intubation
pH for ionization of basic drugs
pH must be below the pK for that drug
Contraindications of Benzodiazepines
Contraindicated in patients with narrow angle glaucoma and patients with hypersensitivity to the drug. Do not use at all in pregnant women.
Effect of aspirin on platelets
Low-dose, long-term aspirin use irreversibly inhibits platelet cyclooxygenase 1 preventing the formation of prostaglandin H2, and therefore thromboxane A2 in platelets, which are responsible for platelet aggregation. Aspirin is an antiplatelet drug.
Thiopental for burst suppression
Can be used to lower the CMRO2 and therefore CBF requirements to poorly perfused areas of the brain. Will result in an EEG flatline.
Hoffman elimination - temp and pH dependence
As pH and temperature decrease, Hoffmann Elimination also decreases. As pH and temperature increase, Hoffmann Elimination also increases. So febrile patients require higher doses of Atracurium.
Thiopental side effects - pain on injection
ongoing drowsiness;
weak or shallow breathing;
slow heartbeats;
chills or shivering;
sneezing, coughing, tight feeling in your throat; or.
bronchospasm (wheezing, chest tightness, trouble breathing).
Nipodimine Drug Class
A calcium channel blocker used to reduce brain damage caused by a bleeding blood vessel.
Peripheral Blood Lymphocyte - simvastatin
A “statin” used to treat high cholesterol and triglyceride levels. It can impair humoral and cell-mediated immunity by inhibiting lymphocyte homing, T-cell activation, and antigen cross-presentation.
