Drug List Past Initial List Flashcards
Thiopental
Induction Agent/ Sedative
Barbiturates: depress Reticular Activating System, binding to GABA receptors and potentiate action of GABA
25 mg/ml
Induction: 3-5 mg/kg (3-6 mg/kg in M+M)
Onset: 30 secs
DOA: 20 mins
No longer available in USA as used for lethal injection
Neuroprotective
Decreased ICP, by decreasing CBF and CBV
Methohexital
Induction Agent/ Sedative
Brevital
Barbiturates: depress Reticular Activating System, binding to GABA receptors and potentiate action of GABA
10 mg/ml
Induction: 50-120 mg
Still used for Electro Convulsant Therapy (ECT), does not increase seizure threshold
M+M
IV
Induction: 1-2 mg/kg
Sedation: 0.2-0.4 mg/kg
Rectal
Induction (Children): 25 mg/kg (concentration 10%)
Flumazenil
Reversal Agent
Romazcion
Benzodiazepine antagonist: competitive with benzos
0.05-0.1 mg/ml
0.2 mg every 60 sec up to 1 mg
Onset: less than 1 min
DOA: 1-2 hrs
Scopolamine
Sedative w/ Variety of Uses: Amnesia Creation, Decrease Motion Sickness, Drowsiness Creation
Hyoscine
Cholinergic antagonist: binds to muscarinic cholinergic receptors preventing Ach binding, increase Ach concentrations to overcome
Transdermal Patch: 1.5 mg patch
IV: 0.4 mg push for trauma amnesia
Greater CNS effect than Atropine and Glycopyrrolate
Cefazolin
Antibiotic
Ancef
Antibiotic
1 gram reconstituted in 10 mls = 100 mg/ml
25 mg/kg
Celecoxib
Celebrex
COX-2 Inhibitor
PO
200-400 mg
Post-Op Pain
No Increased Bleeding Risk like non-specific COX meds (aspirin, etc.)
Decrease Post-OP Anesthetic Requirements
Gabapentin/Pregabalin
Gabapentin
Neurontin
300-1200 mg
Pregabalin
Lyrica
75-150 mg
Avoid in >65yo
Decrease Post-OP Anesthetic Requirements
Oxycontin
Extended-release oxycodone
5-20 mg for major surgery in absence of regional anesthesia
Decrease Post-OP Anesthetic Requirements
Dexamethasone
Decadron
4-10 mg
… after induction of anesthesia
PONV Prophylaxis
… w/ Zofran
Pentobarbital
Barbiturates: depress Reticular Activating System, binding to GABA receptors and potentiate action of GAB
Premedication
IM
2-4 mg/kg
Oral
2-4 mg/kg (concentration 5%)
Rectal
3 mg/kg
Alfentanil
Pain Medication
Opioid: Bind to Mu, Kappa, and delta receptors resulting in pain receptors not working
IV
Intraoperative anesthesia: 8-100 mcg/kg
Loading Dose Maintenance Infusion: 0.5-3 mcg/kg/min
Atracurium
Muscle Relaxant
Non-depolarizing MR: bind to the NMJR and prevent the depolarization of that receptor by endogenous ACH
10mg/ml
IV
Onset: 2.5-3 mins
DOA: 30-45 mins
Intubation: 0.5 mg/kg
If Succinylcholine used for Intubation: 0.25 mg/kg initially with 0.1 mg/kg every 10-20 mins
Infusion: 5-10 mcg/kg/min
Mivacurium
Muscle Relaxant
Non-depolarizing MR: bind to the NMJR and prevent the depolarization of that receptor by endogenous ACH
IV
Onset: 2-3 min
DOA: 20-30 min
Intubation: 0.15-0.2 mg/kg
Pyridostigmine
Reversal Agent
Cholinesterase inhibitor: prevent the breakdown of acetylcholine by blocking the enzyme called cholinesterase, allows for the action potential threshold to be reached so a new impulse can be triggered in the next neuron
5 mg/ml
IV
Onset: 10-15 min
DOA: 2+ hrs
0.25 mg/kg to a total of 20 mg in adults
Anti Cholinergic to prevent bradycardia
Glycopyrrolate: 0.05ml per 1 mg of pyridostigmine
Atropine: 0.1 mg per 1 mg of pyridostigmine (preferred?)
Physotigmine
Reversal Agent
Cholinesterase inhibitor: prevent the breakdown of acetylcholine by blocking the enzyme called cholinesterase, allows for the action potential threshold to be reached so a new impulse can be triggered in the next neuron
1mg/ml
IV
0.01 - 0.03 mg/kg
Anti Cholinergic
Not-neccessary
Clonidine
Adrenergic Agent
Anti-Hypertensive
A2 Agonist
IV: 1–3 mcg/kg
30 mcg/hr with an opioid
IM: 2 mcg/kg
Oral: 3–5 mcg/kg
Onset: 30-60 min
DOA: 12 hrs
0.1 mg twice a day… adjusted till BP is controlled (typically 0.1-0.3 mg twice a day)
Transdermal: 0.1–0.3 mg released per day
0.1, 0.2, 0.3 mg/d patches replaced every 7 days
Intrathecal: 15–30 mcg
Perineural or Epidural: 1–2 mcg/kg
Dopamine
Primarily Dopaminergic Receptors (DA1… and also D2)
Agonist A1, A2, B1, B2
200mg/5ml, 400 mg/10ml
Infusion: 1-20 mcg/kg/min
Effects vary with dose
Low doses 0.5-3mcg/kg/min mainly hits the dopaminergic receptors causing diuresis and slight RBF increase.
Moderate dose 3-10mcg/kg/min Beta-1 stimulation occurs causing Increased contractility, HR, SBP, and CO.
High doses 10-20mcg/kg/min really hit the Alpha-1 receptors, causing an increase in PVR (peripheral vascular resistance)
Isoproterenol
B1, B2 Agonist
Dobutamine
B1 (greater), B2 Agonists
250mg/20ml
Infusion: 2-20 mcg/kg/min
Fenoldopam
D1 Agonist
10mg/ml
Infusion: 0.1 mcg/kg/min… increased at 0.1 mcg/kg/min at 5-20 min intervals till target blood pressure is reached
Creates hypotensive effects
Phentolamine
Adrenergic Antagonist
Competitive blockade (reversible) at A1, A2
1-5 mg in adults bolus
Antagonism and direct smooth muscle relaxation responsible for peripheral vasodilation and decline in arterial blood pressure
Propranolol
Adrenergic Antagonist (Beta Blocker)
B1, B2 Nonselective
1mg/1ml ampullas
0.5 mg titration to effect very 3-5 mins… not to exceed 0.14 mg/kg
Nebivolol (Beta Blocker)
Adrenergic Antagonist
B1
Cause vasodilation via stimulation of endothelial nitric oxide production
Carvedilol
Adrenergic Antagonist (Beta Blocker)
Mixed B and A
Individualized… increased up to 25 mg twice daily
Sodium Nitroprusside
Hypotensive
Creates nitric oxide to vasodilate
Diluted to 100 mcg/ml
Onset: 1-2 mins
Infusion: 0.25-5 mcg/kg/min
Breakdown of these drug produces cyanide ions which at HIGH cumulative daily dose of 500mcg/kg or rate of 2mcg/kg/min
ACUTE CYANIDE TOXICITY: acidosis, cardiac arrhythmias, Increased Ven. O2
INTRACORONARY STEAL: stealing blood away from ischemic areas where coronary arterioles are already maximally dilatated
Nitroglycerin
Hypotensive Agent
Nitric Oxide production
diluted to 100 mcg/ml
Infusion: 0.5-5 mcg/kg/min
Sublingual: 0.3-0.4 mg tablet under tongue… peak effect 4 minutes
Transdermal: 24 hour release
Hydralazine
Hypotensive Agent
cGMP increased for vasodilation
Onset: 15 min
DOA: 2-4 hrs
5-20 mg
Fenoldopam
Hypotensive Agent
Activates D1 receptors
Onset: 15 mins
Infusion: 0.1 mcg/kg/min… increased by 0.1 mcg/kg/min every 15-20 mins till target BP achieved
Calcium Channel Blockers…
Medications that prevent calcium ions from entering certain cells in the body, particularly those in the heart and blood vessels
Dihydropyridine (Nicardipine, Clevidipine) are arterial selective vasodilators routine for cardiothoracic surgery. Minimal effect on cardiac conduction and ventricular contractility. Cardiac output increases due to preload maintained.
Nicardipine: infusion 5-15 mg/h (titrated to effect)
Inodilators…
Milrinone
Phosphodiesterase inhibitor
Used in treatment of heart failure. Increases cAMP concentration resulting in increased intracellular calcium concentration.
Improve myocardial contractility and systemic vasodilator
H1-Receptor Antagonists
H1-receptor antagonist properties have
considerable antimuscarinic, or atropine-like, activity (eg, dry mouth) or anti-serotonergic activity (antiemetic)
Suppression of allergic reactions and symptoms of upper respiratory tract infections (eg, urticaria, rhinitis, conjunctivitis); vertigo, nausea, and vomiting (eg, motion sickness, Ménière disease); sedation; suppression of cough; and dyskinesia (eg, parkinsonism, drug-induced extrapyramidal side effects)
H2-Receptor Antagonists
Competitively inhibit histamine binding to H2 receptors, thereby reducing gastric acid output and raising gastric pH
Antacids
Antacids neutralize the acidity of gastric fluid by providing a base (usually hydroxide, carbonate, bicarbonate, citrate, or trisilicate) that reacts with hydrogen ions to form water
Bicitra: 0.3 M solution (sodium citrate, citric acid)
OR
Polycitra (sodium citrate, potassium citrate, citric acid)
15-30 mL… 15-30 min prior to induction
Proton Pump Inhibitors
Bind to the proton pump of parietal cells in the gastric mucosa and inhibit secretion of hydrogen ions
Omeprazole/Prilosec: 20 mg
Lansoprazole/Prevacid: 15 mg
Rabeprazole/Aciphex: 20 mg
Pantoprazole/Protonix: 40 mg
Esomeprazole/Nexium
Naltrexone
Opioid antagonist with a high affinity for the μ receptor, but it has a significantly longer half-life than naloxone
Orally for maintenance treatment of addiction
Doxapram
Selective activation of carotid chemoreceptors by low doses of doxapram stimulates hypoxic drive, producing an increase in tidal volume and a slight increase in respiratory rate. At larger doses, respiratory centers in the medulla are stimulated.
Onset: 1 min
DOA: 5-12 mins
IV Bolus: 0.5-1 mg/kg
Infusion: 1-3 mg/min
Max 4 mg/kg
Capsaicin
TRPV1-receptor agonist
Depletes substance P and inhibits pain signal transmission
Neurokinin-1 Receptor Antagonist
Substance P is a neuropeptide that interacts with neurokinin-1 (NK1) receptors. NK1 antagonists inhibit substance P at central and peripheral receptors. Aprepitant, an NK1 antagonist, has been found to reduce PONV perioperatively and is additive with ondansetron for this indication
Induction Agent
Diprivan
Diisopropylphenol: binding to GABAa receptors to increase GABA affinity for GABAa receptors
10 mg/ml
IV
Onset: 15-30 secs
DOA: 3-10 mins
Induction:1.5-2.5 mg/kg
Maintenance: 50-200 mcg/kg/min
Sedation Infusion: 25-100 mcg/kg/min
