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Anesthesiology > Drugs - Medication Cart > Flashcards

Drugs - Medication Cart Flashcards

1
Q

Name the different Adrenergic receptors and their functions.

A 
Adrenergic Receptors - bind NE and E, Sympathetic nervous system
a1 - SMOOTH MUSCLE CONTRACTION
a2 - SMOOTH MUSCLE CONTRACTION
b1 - HEART
b2 - SMOOTH MUSCLE RELAXATION

alpha-1: Smooth muscle contraction, Vasoconstriction of blood vessels, Increase BP, Urinary retention, Pupillary dilation (mydriasis)

alpha-2: exclusively in the CNS and when bound it blocks the Sympathetic signal, Vasoconstriction of blood vessels, Pre-synaptic receptor, inhibits NE release, inhibits insulin release, inhibits ACh release

beta-1: Increase HR (tachycardia) acts on SA and AV nodes of the heart, increase cardiac output, increase strength of contraction (inotropy), Renin release from kidneys (renin leads to vasoconstriction via Angiotensinogen –> Renin –> Angiotensin I –> ACE –> Angiotensin II, a potent vasoconstrictor)

beta-2: Vasodilation of blood vessels (to skeletal muscle), Bronchodilation (smooth muscle relaxation)

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2
Q

Amiodarone
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Anti-arrhythmic
2 - Class 3 anti-arrhythmic (K+ channel blocker)
3 - Treat heart arrhythmia, ACLS

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3
Q

Esmolol
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Anti-hypertensive
2 - Beta blocker, selective for B1 (blocks NE from binding)
3 - Reduce high blood pressure/hypertension

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4
Q 
Hydralazine
1 - Class?
2 - Mechanism?
3 - Use?
4 - Initial Bolus Dose?
A

1 - Anti-hypertensive
2 - LONG-ACTING Vasodilation - acts directly on arteries/arterioles - LESS PREDICTABLE pharmacokinetics and pharmacodynamics
* Lasts 2-6 hours
* Opens K+ channels to cause vasodilation
3 - Reduce high blood pressure/hypertension
4 - 5mg

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5
Q

Metoprolol
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Anti-hypertensive
2 - Beta blocker, selective for B1
3 - Reduce high blood pressure/hypertension

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6
Q

Labetalol
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Anti-hypertensive
2 - Beta blocker, NON-SELECTIVE
3 - Reduce high blood pressure/hypertension - SYRINGE

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7
Q

Lidocaine
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Local anesthetic; Class 1B anti-arrhythmic
2 - Stabilization of Neuronal Membranes
3 - Can be used intravenously prior to injecting Propofol, ALSO anesthetize the skin before placing an IV

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8
Q

Ocular Lubrication - use?

A

Prevent corneal abrasions (which occur in 0.64% of non-ocular surgeries)

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9
Q

Generic Name: Ondansetron

Brand name?

A

Zofran

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10
Q 
Ondansetron / Zofran
1 - Class?
2 - Mechanism?
3 - Use?
4 - When is it given?
A

1 - Anti-emetic
2 - 5-HT3-receptor (serotonin) Antagonist - it blocks serotonin which causes nausea and vomiting
3 - Reduces nausea and vomiting
4 - Given at the END of the case

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11
Q 
Dexamethasone
1 - Class?
2 - Mechanism?
3 - Use?
4 - When is it given?
A 
1 - Corticosteroid and Anti-emetic
     *ANTI-INFLAMMATORY
     *ANTI-EMETIC
2 - Mimics endogenous corticosteroids
3 - Reduce inflammation AND nausea/vomiting
4 - Given at BEGINNING of the case
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12
Q

Hydrocortisone
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Corticosteroid - ANTI-INFLAMMATORY
2 - Mimics endogenous corticosteroids
3 - Reduces inflammation
** For transplants, used for immunosuppression
*** If pt is on chronic steroids and needs stress dose steroids

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13
Q 
Epinephrine
1 - Class?
2 - Mechanism?
3 - Uses?
4 - Dosage?
A 
1 - Vasopressor - constricts blood vessels
2 - alpha and beta adrenergic agonist
3 - EMERGENCY DRUG* ACLS
   - Cardiac Arrest - may use whole vile
   - Anaphylaxis - may dilute
   - Bronchospasm - may dilute
4 - 1 mg/ml at 1 : 1,000 concentration
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14
Q 
Norepinephrine
1 - Class?
2 - Mechanism?
3 - Uses?
4 - Dosage
A 
1 - Vasopressor - constricts blood vessels
2 - alpha and beta adrenergic agonist
3 - EMERGENCY DRUG* ACLS
   - May be used as an IV infusion
4 - 1 mg/ml
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15
Q

Atropine
1 - Class?
2 - Mechanism?
3 - Uses?

A

1 - Anti-cholinergic / Anti-muscarinic (binds M receptors so ACh cannot)
2 - Acetylcholine (ACh) antagonist
3 - Bradycardia - used to INCREASE HR in emergency situations, also decreases salivation
- Atropine used to treat vasovagal syncope

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16
Q

Ephedrine
1 - Class?
2 - Mechanism?
3 - Uses?

A

1 - Vasopressor - constricts blood vessels
2 - Sympathomimetic Amine
3 - Increase BP and HR

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17
Q

Phenylephrine (Neosynephrine)
1 - Class?
2 - Mechanism?
3 - Uses?

A

1 - Vasopressor - constricts blood vessels
2 - Selective alpha-1 agonist
3 - Increase BP and Decrease HR

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18
Q

Albuterol
1 - Class?
2 - Mechanism?
3 - Uses?

A

1 - Bronchodilator (inhaler)
2 - Beta-2 receptor agonist
3 - Treat Anaphylaxis or Bronchospasm

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19
Q

Generic Name: Ketorolac

Brand name?

A

Toradol

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20
Q 
Ketorolac / Toradol
1 - Class?
2 - Mechanism?
3 - Uses?
4 - Contraindications?
A

1 - NSAID
2 - Non-selective COX inhibitor
3 - Anti-inflammatory, Analgesic
4 - Pts taking ibuprofen (causes kidney problems)

21
Q

Generic Name: Sugammadex

Brand name?

A

Bridion

22
Q

Generic Name: Furosemide

Brand name?

A

Lasix

23
Q

Furosemide / Lasix
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Diuretic, Anti-hypertensive (decreases renal reabsorption of sodium those resulting in net fluid loss to lower BP)
2 - Na-K-Cl cotransporter inhibition
3 - Diuresis if pt is fluid-overloaded or during kidney transplant

24
Q

Generic Name: Diphenhydramine

Brand name?

A

Benadryl

25
Q

Diphenhydramine / Benadryl
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Anti-histamine
2 - Competitive H1-receptor inhibition
3 - Allergic reaction, prior to resorting to epinephrine

26
Q

Types of receptors in the Parasympathetic and Sympathetic Nervous Systems?
What neurotransmitters do they bind?

A

Parasympathetic –> Cholinergic (Nicotinic and Muscarinic)
- Binds Acetylcholine (ACh)
Sympathetic –> Adrenergic
- Binds catecholamines, Epinephrine and Norepinephrine

27
Q

Vasoconstrictors to treat Hypotension

A

1 - Phenlyephrine
2 - Norepinephrine
3 - Vasopressin

28
Q

What is a Positive Inotrope?
What does it treat?
What receptors do they bind?

A
  • Positive Inotrope = agent that strengthens the heart’s contractions to pump more blood with fewer heartbeats
  • Treats hypotension
  • They bind beta-1 adrenergic receptors
29
Q

Which Positive Inotropes treat hypotension?

A

1 - Ephedrine
2 - Epinephrine

  • Both are also vasopressors*
30
Q 
Rocuronium
1 - Class?
2 - Mechanism?
3 - Use?
4 - Reversal?
A

1 - Paralytic / Neuromuscular Blockade
2 - Non-depolarizing neuromuscular junction (NMJ) blockade
3 - Paralysis under anesthesia
4 - Neostigmine and Glycopyrrolate or Sugammadex alone

31
Q 
Succinylcholine
1 - Class?
2 - Mechanism?
3 - Use?
4 - What does it prevent during intubation?
5 - What type of receptor does it block?
A

1 - Paralytic / Neuromuscular Blockade
2 - Depolarizing neuromuscular junction (NMJ) blockade
3 - Paralysis under anesthesia
** KICKS IN QUICKLY
** EMERGENCY situation such as Rapid Sequence Intubation (RSI) for a quick intubation
** Always have this drawn up for emergency intubation
4 - Prevents laryngospasm during intubation, breaks laryngospasm
5 - Nicotinic (cholinergic) receptors on the skeletal muscle, blocking ACh from binding

32
Q

Which drugs treat hypotension?

A

1 - Vasopressor (vasoconstrictor) - lasts 30-60 mins
2 - Phenylephrine (Sudafed) (vasoconstrictor) - lasts 10-15 mins
3 - Norepinephrine (vasoconstrictor) - lasts 1-2 mins
4 - Epinephrine (positive inotrope and vasoconstrictor) - lasts under 5 mins
5 - Ephedrine (positive inotrope and vasoconstrictor) - lasts 60 mins

1,2,3,4,5 - Vasoconstrictors –> increase BP by constricting blood vessels
4,5 - Positive Inotropes –> increase BP by strengthening heart contractions to pump more blood

33
Q

What is/are the commonly used Depolarizing paralytics?

A
  1. Succinylcholine
34
Q

Which 2 drugs are used in conjunction to reverse paralysis from Non-Depolarizing Agents (namely Rocuronium)? Why do we need 2?

A

1 - Neostigmine (cholinesterase inhibitor, thereby increasing ACh, reigniting the muscle activity)
2 - Glycopyrrolate –> an anticholinergic, reduces the muscarinic/parasympathetic/cholinergic effects of Neostigmine including (1) Bradycardia and (2) SLUDGE (salivation, lacrimation, urination, defecation, GI issues, emesis)

OR

1 - Sugammadex alone - no need for an anticholinergic with it
- Sugammadex tightly binds Rocuronium

35
Q

What is SLUDGE?

A 
Muscarinic/Cholinergic/Parasympathetic effects of high ACh (the main neurotransmitter of the Parasympathetic nervous system)
SLUDGE:
   S - salivation
   L - lacrimation
   U - urination
   D - defecation
   G - GI issues
   E - emesis
36
Q

Neostigmine
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Cholinergic (increases ACh)
2 - Acetylcholinesterase inhibitor - it prevents the enzyme acetylcholinesterase from breaking down ACh
3 - Increases acetylcholine (ACh) to regain movement - used in conjunction with Glycopyrrolate
*** Causes muscarinic side effects: BRADYCARDIA and SLUDGE (salivation, lacrimation (tears), urination, defecation (diarrhea), GI upset, emesis) - so must use with Glycopyrrolate to reduce these effects

37
Q

Glycopyrrolate
1 - Class?
2 - Mechanism?
3 - Use?

A

1 - Anti-cholinergic
2 - Acetylcholine inhibition
3 - Reduces unpleasant muscarinic side effects (Bradycardia and SLUDGE) of ACh (caused by Neostigmine)

38
Q

Disadvantages of Succinylcholine (Sux):

A

Succinylcholine may lead to:
1 - Malignant Hyperthermia (MH)
2 - Lethal Hyperkalemia in stroke and burn patients - why?
- Succinylcholine binds to ACh receptors causing one maintained depolarization –> release of K+ extracellularly during depolarization, increase in K+ is not significant in healthy patients, but significant in burn patients, stroke patients and patients with kidney/renal problems (cannot properly excrete K+)

39
Q

What is/are the commonly used Non-Depolarizing paralytics?

A

1 - Rocuronium
2 - Vecuronium
3 - Cisatracurium

40
Q

Succinylcholine:

  • Onset (mins)
  • Intubating dose (mg/kg)
  • Duration to 25% recovery (mins)
  • Elimination
  • Intra-op Maintenance
A

Succinylcholine:

  • Onset - 1 min –> QUICK for RSI
  • Intubating dose - 1 mg/kg
  • Duration to 25% recovery - 6-8 mins
  • Eliminated by cholinesterase in the plasma
  • Intra-op Maintenance - rarely done
41
Q

Rocuronium:

  • Onset (mins)
  • Intubating dose (mg/kg)
  • Duration to 25% recovery (mins)
  • Elimination
  • Intra-op Maintenance
A

Rocuronium:

  • Onset - 1.5-2 mins —- if RSI, then 1 min
  • Intubating dose - 0.6 mg/kg —- if RSI, 1.2 mg/kg
  • Duration to 25% recovery - 30-40 mins —- if RSI, over 60 mins
  • Elimination - metabolized by the liver, excreted via bile and urine
  • Intra-op Maintenance - 0.1-0.2 mg/kg PRN
42
Q

What does Sugammadex reverse?

A

Rocuronium and Vecuronium (???) RAPIDLY and EFFECTIVELY
- After receiving a 1.2mg/kg dose of Rocuronium, a 16mg/kg dose of Sugammadex decreases time to full recovery
from 122 minutes to <2 minutes

43
Q

For pregnant patients, should you use Neostigmine or Sugammadex as the NMBA reversal agent, and why?

A

Sugammadex, because it does not cross the placenta

44
Q

ACE inhibitors

  • Use?
  • Suffix?
  • Mechanism?
A

ACE inhibitors

  • Anti-hypertensive
  • “-pril” (like Lisinopril)
  • Blocks ACE (Angiotensin Converting Enzyme) to prevent the conversion of Angiotensin I to Angiotensin II (which is a potent vasoconstrictor)
45
Q

ARBs (Angiotensin Receptor Blockers)

  • Use?
  • Suffix?
  • Mechanism?
A

ARBs (Angiotensin Receptor Blockers)

  • Anti-hypertensives
  • “-sartan” (like Losartan)
  • Competitive antagonist at the AII receptor
46
Q

Anti-anginals

  • Use?
  • Drugs?
  • Emergency response to angina or a heart attack
A

Anti-anginals
- Treat angina (chest pain due to insufficient oxygen to cardiac muscle)
- 1. Nitroglycerin - vasodilates coronary artery smooth muscle to increase O2
2. Propranolol - relaxes the heart thereby reducing O2 demand
3. CCBs (calcium-channel blockers) - causes vasodilation which reduces peripheral resistance thereby reducing O2 demand
- Emergency response to angina or heart attack/MI:
MONA - Morphine, Oxygen, Nitroglycerine, Aspirin

*Nitroglycerine - sublingual tablet

47
Q

Anti-arrhythmic

  • Use?
  • Types?
A
  • Treats irregular heartbeats
  • Type 1 = Na+ channel blockers on cardiac muscle ONLY
    1A = lengthens refractory period to slow heart rate (ex: Procainamide)
    1B = shortens refractory period to speed up heart rate (ex: Lidocaine)
  • Type 2 = Beta blockers
  • Type 3 = K+ channel blockers (ex: Amiodarone)
  • Type 4 = CCBs (Ca2+ channel blockers) (ex: Verapamil)
48
Q

Which anti-arrhythmic drugs can treat Atrial Fibrillation (A-Fib) and what types are they

A

Quinidine - Type 1A (Na+ channel blocker, lengthens refractory period)
Procainamide - Type 1A (Na+ channel blocker, lengthens refractory period)
Verapamil - Type 4 (CCB)
Digitalis - Cardiac Glycoside

49
Q

What is “code dose” epinephrine?

A

1 mg

Anesthesiology (5 decks)

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