Drugs Flashcards
SEs of Succinylcholine
Malignant hyperthermia, hyperkalemia
SEs Ketamine
Tachycardia/increased secretions (sympathetic stimulatory effect), Hallucinations
SEs Propofol
Hypotension (peripheral vasodilation and myocardial depression), propofol-related infusion syndrome (Brady -> systole, acidosis, rhabdo; MC in kids with high doses)
SEs etomidate
Adrenal insufficiency
SEs meperidine
Seizures
SEs morphine
Histamine release, hypotension
MOA ketamine
Phencyclidine derivative
Dissociation of thalamus and limbic systems.
Amnesia, analgesia
Sympathetic stimulatory effect therefore CI in pts w/ ischemic heart disease
propofol infusion syndrome
RFs: longer use (>48 hr), doses > 4mg/kg/h, concomitant steroid and pressor use, presence of neurons injury or pathology
metabolic acidosis, rhabdo, renal insufficiency, refractory bradycardia, hyperlipidemia, transaminitis
tx: d/c, cardiopulmonary support, HD
Amphotericin B MOA
binds fungal cell wall sterols, causing cell death via lysis
Amphotericin B SEs
nephrotoxicity, electrolyte abnormality (hypokalemia, hypomagnesemia)
-Azole agents MOA
inhibit fungal sterol synthesis (needed for cell wall growth)
caspofungin
inhibits fungal cell wall synthesis
Sevoflurane
MC inhalation induction agent
Fast, minimal laryngospasm
Mask induction
Desflurane
Most rapid onset/offset
pungent odor
Not used for induction; used for maintenance anesthesia
Nitrous oxide
fast, minimal myocardial depression
Diffuses into closed spaces - not used in pts with SBO or PTX
Volatile anesthetic hepatitis
fever, eosinophilia, jaundice, increased LFTs
Propofol
MC IV induction agent
Not analgesic
SEs: hypotension (MC), resp depression
Propofol infusion syndrome
metabolic acidosis, renal failure, cardiac failure, death
MC in long-term use; MC in children
Etomidate
Used in RSI
Not analgesic
Fewest cardiac effects
SEs: adrenocortical suppression
Dexmedetomidine (Precedex)
\+Analgesia Doesn't blunt respiratory drive Used for early extubation protocols CNS alpha-2 rec agonist SEs: BP lability
Ketamine
Mech: NMDA rec antagonist; dissociation of thalamic and limbic systems
+analgesia
Good in kids
SEs: hallucinations, catecholamine release, increased airway secretions, increased cerebral blood flow
CI: head injury
Meperidine (Demerol)
acts on mu-opioid agonist
Toxic metabolite = normeperidine (analgesic activity, longer half-life)
Accumulates in pts w/ renal failure.
Toxic doses –> seizures and CNS irritability
Varenicline
selective nicotinic receptor partial agonist for a4b2 receptors
most effective adjunctive measure in aiding smoking cessation - superior to both nicotine replacement therapy and bupropion
MOA Norepi
Mixed alpha > beta adrenergic
1st-line for septic shock
May cause tachycardia
MOA Vaso
V1 receptors -> vasoconstrictor
V2 receptors on kidney -> water resorption (decreases UOP)
2nd-line for septic shock
May cause decreased stroke volume & CO in pts w/ myocardial dysfunction or cause ischemia in pts w/ CAD
MOA Epi
Mixed beta > alpha adrenergic
1st-line for anaphylactic shock
2nd/3rd-line for septic shock
May induce tachyarrythmias and ischemia. Decreases mesenteric perfusion
MOA Neo (Phenylephrine)
Pure alpha1 agonist -> vasoconstrictor
Added for hypotension in pts w/ preserved cardiac output
May decrease stroke volume & CO in pts w/ cardiac dysfunction
MOA Milrinone
PDE-3 inhibitor
Short-term cardiac output augmentation in cardiogenic shock refractory to other agents.
Renal cleared.
May cause peripheral vasodilation, hypotension, ventricular arrhythmia
MOA Dobutamine
Beta-1 & Beta-2 adrenergic
1st-line for cardiogenic shock
Added to norepinephrine in septic shock in pts w/ decreased cardiac output
Augments CO in pts w/ myocardial dysfunction or ongoing hypo perfusion despite adequate intravascular volume
Increases contractility and HR. May cause hypotension
MOA Dopamine
Dose-dependent
Low (0.5-3mcg/kg/min): dopamine recs. increases mesenteric and renal blood flow –> diuresis
Mod (3-5mcg/kg/min): beta-adrenergic. increases contractility
High (>5mcg/kg/min): alpha-adrenergic. vasoconstrictor
Warfarin reversal
Vit K
PCC
Dabigatran reversal
Praxbind - idarucizumab
direct thrombin inhibitor
Argatroban
Reversible direct thrombin inhibitor
Often used in pts with HIT
No reversal agent
Short half-life (45 min), stopping med and supportive care is enough for reversal
Rivaroxaban (Xarelto), Apixaban (Eliquis) & reversal agent
Inhibits factor Xa
Andexanet alfa (Andexxa)
Protamine
Cationic. Binds anionic heparin. Forms stable salt with no anticoagulant activity.
Also reverse anti factor Xa activity in LMWH. Partial reversal activity (~60%).
Administer slowly. Rapid infusion can cause hypotension and CV collapse.
Component of insulin aspart protamine and NPH insulin. DM pts can have hypersensitivity reactions.
Dosage depends on amount of heparin given. 1mg for 100u. Also adjusted depending on duration of time since heparin given b/c heparin half-life is 60-90min.
Cleared by reticuloendothelial system (not renal or hepatic). Dose doesn’t need to be adjusted for renal for hepatic insufficiency.
Neostigmine
Parasympathomimetic
Tx acute colonic pseudo-obstruction (2.5mg IV over 3 min)
Successful decompression in ~90% of pts w/in 10 min
Recurrence rate of 5%
SEs: brady, hypotension, dizziness.
Excreted by kidneys
Mafenide acetate
Eschar penetration for severe burns.
Gram neg coverage (Pseudomonas)
CI: TBSA >40%, allergy to sulfonamides
Aminoglycosides
Inhibit 30S ribosome. stop protein synthesis Aerobic GNR coverage (Pseudomonas) Bactericidal Resistance: decreased active transport SEs: ototoxicity, nephrotoxicity
Silver alginate
Used in wounds like burns, pressure ulcers, leg ulcers
Reduces bacterial load
Silver has antimicrobial properties: ribosomal toxicity, intercalates into DNA, denaturation of proteins, disruption of bacterial cell membrane
Acetaminophen toxicity
Acetylcysteine
Black widow spider antidote
Antivenum (latrodectus mactans)
Ca Channel Blocker toxicity antidote
Ca Gluconate
Malignant hypothermia, neuroleptic malignant syndrome antidotes
Dantrolene
Iron toxicity antidote
Deferoxamine mesylate
Benzo toxicity antidote
Flumazenil
Cyanide toxicity antidote
Amyl nitrate, hydroxycobalamin, sodium nitrite, sodium thiosulfate
Methotrexate toxicity antidote
Leucovorin calcium
Methemoglobinemia tx
Methylene blue
Anticholinergic toxicity antidote
Physostigmine
Heparin reversal
protamine
Lithium toxicity
Normal pharmakokinetics: absorbed in GI tract, excreted in kidneys. After gastric bypass surgery, increases gastric pH, increases deprotonated form of lithium -> increased absorption
2/2 decreased GFR, significant wt loss
Increased calc & mag reabsorption in LOH. Elevates PTH
Effects on Gastric bypass on drugs
Decreases absorption:
Phenytoin, erythromycin, warfarin, ampicillin, tamoxifen, cyclosporine, levonorgestrel, imatinib, tacrolimus
Increases absorption:
Digoxin, lithium, PCN, atorvastatin
SEs silver sulfadiazine
transient neutropenia and thrombocytopenia
Vancomycin infusion reaction
Hypersensitivity reaction to rapid infusion of Vanc
Degranulation of mast cells and basophils –> increased histamine
Tx: antihistamine
Meds that cause histamine release
Opioids (morphine, dilaudid, oxycodone)
Ketamine
Cipro
Rifampin
What meds can chelate fluoroquinolone?
Calcium
Iron
Mag
Aluminum
Anastrazole
Aromatase inhibitor (reversible binding of aromatase enzyme through competitive inhibition) Blocks conversion of androgens to estrogens in peripheral (extra-gonadal) tissue
Tamoxifen
Selective estrogen receptor modulator
Partial agonist of estrogen receptors
Trastuzumab
Monoclonal Ab binding of domain IV of extracellular segment of Her2/neu receptor
Makes cells undergo arrest during G1 phase
Reduced proliferation
Down-regulates activation of serine/threonine kinase Act
Suppresses angiogenesis by induction of antiangiogenic factors & repression of proangiogenic factors
SEs: cardiotoxicity (need echo)
Taxanes (paclitaxel, docetaxel)
impair cell division through inhibition of microtubule disassembly during mitosis
Doxorubicin (adriamycin)
impair DNA repair by inhibiting topoisomerase II
Bacitracin
bacteriostatic and bactericidal
inhibits bacterial cell wall synthesis & bacterial replication
nephrotoxic - tubular and glomerular necrosis -> oliguria and edema
cyclosporine
Calcineurin inhibitor, inhibit expression of IL-2, stops propagation of immune response
used for maintenance therapy in heart transplant patients
assoc with formation of gallstones, renal arterial constriction -> renal toxicity, hirsutism, gingival hyperplasia, thrombocytopenia
Tacrolimus
binds immunophilin FKBP12
inhibits calcineurin, dephosphorylates of nuclear factor of activated T cells, inhibits T cell activation
SEs: nephrotoxic, seizures, tremors, H/A, new onset T2DM, hyperlipidemia, HTN, alopecia
Dabigatran
non-vit-K oral anticoagulant (NOAC)
Direct thrombin inhibitor for VTE tx/prevention
Check creatinine clearance prior to deciding when to discontinue meds for surgery (cleared renally).
If CrCl <50mL/min -> d/c 3-5 days before surgery
If CrCl >50mL/min -> d/c 2 days before surgery
don’t need to bridge with heparin
tamoxifen med interactions
affected by SSRIs (fluoxetine, paroxetine) - decreases formation of active metabolites of tamoxifen -> decreases efficacy
Isoproterenol action
Pure beta-adrenergic agonist
Inotrope and chronotrope
Increases heart rate and cardiac contractility, peripheral vasodilation
Poor side effect profile to induce arrhythmias and increase cardiac demand (used solely for diagnostic procedures to provoke arrhythmias)
