Emergency Drugs Flashcards
Phenylephrine type and receptor
Synthetic non-catecholamine
Primarily alpha1-adrenergic receptor stimulant
Not for pts on beta blocker, heart can speed up or pump harder
Phenylephrine does what?
Treat hypotension in OR due to various reasons
increase MAP, SBP, DBP, SVR;
decreases HR, CO reflex bradycardia secondary to baroreceptor reflex
Venoconstriction>arterial constriction
Less potent than norepinephrine
Longer lasting
Phenylephrine dose and side effects
Dose: 50-200mcg IV (after dilution 0.5ml-2ml) can be used as continuous infusion (20-50 mcg/min)10mg/mL
Double dilution/or in 100mL. So draw up 1ml. (10mg/ml) the draw up 9ml saline now have 10mg/10ml or 1mg/ml the squirt out 9ml, and draw up another 9ml of saline now have 1mg/10ml or 0.1mg/ml or 100mcg/ml
Onset: immediate
Not used in OB anesthesia
Ephedrine type and receptor
Synthetic non-catecholamine
Indirect acting-stimulates beta and alpha adrenergic receptors
Ephedrine does what
Treat hypotension in OR due to various reasons
CV effects similar to epinephrine, longer lasting (10X)
SVR effected minimally
CV effects mostly due to increase contractility– increase MAP, SBP, DBP, HR, Coronary BF, decrease renal, splanchnic BF.
Ephedrine dose and side effects
50mg/mL Dilute once to concentration of 5mg/ml (10ml saline) or 10mg/ml (5ml saline) Dosage: 5-25mg IV/IM Onset: immediate Duration of action: 10-60min
Tachyphylaxis is common with this agent-due to indirect effect and occupying of receptors: depletion of storage of neurotransmitters the no longer effective.
Bronchodilators
Caution in pts taking MAOIs (have lots of nt)
Also cautions with trauma pt
Atropine type and receptors
Anticholinergic-antagonizes effect of Ach at cholinergic post ganglionic muscarinic receptors. (Ach is psns so that slows down hr, atropine blocks this from happening and hr goes up)
Muscarinics are present in: Heart, salivary glands, smooth muscles of GU and GI tract.
No/minimal effect at nicotinic receptors.
Combines reversibly with muscarinic receptors and prevents Ach from binding to these sites, competitive inhibitors.
M1-CNS & Stomach
M2-lungs and heart
M3-CNS, airway smooth muscles, glandular tissue
M4 & M5-CNS
Atropine does what
Drug of choice for treating intra op bradycardia.
Increases hr
Decreased salivary, bronchial, gastric secretions
Bronchial dilator
Decrease gi tone and mobility
Mydriasis and increased iop
Urinary retention
Tertiary amine-crosses bbb
Atropine dose and side effect
Dose: 15-75mcg/kg IV. Or .4-1mg IV adults
Other effects: antisialagogue, bronchodilation, mydriasis, decreased GI motility and acid production, bronchodilation, sedation.
Onset: immediate
Durations: 1-2hrs
If give minimal dose can get bradycardia
Sedation, nervousness, confusion, hallucinations
Not for older people
Glycopyrrolate (Robinul) type
Similar to atropine.
Quaternary amine-does not easily cross BBB so no sedative effects.
Glycopyrrolate (Robinul) does what
Uses similar to atropine, similar effects, more potent antisialagogue, less potent at increasing HR.
Glycopyrrolate (Robinul) dose
Dosage: .2-.4mg IV
Combine with anticholinestrases for reversal, .005-.007mg/kg (or 1cc of robinul for each cc of reversal drawn)
Succinylcholine type and receptor
Depolarizing muscle relaxant
SCh attaches to each of alpha subunits of the nicotinic cholinergic receptor
Mimics the action of ACh, depolarizing the post-junctional membrane.
Hydrolysis of SCh is slower than Ach
Sustained depolarization of the receptor ion channels.
Succinylcholine does what
Depolarizing muscle relaxant
Used for emergency a/w situations, rapid sequence induction.
Also used for laryngospasms
Succinylcholine dose and side effects
Dose: 0.5-1mg/kg OR 20-40mg for laryngospasms
Onset 30-60sec
Duration of action: 3-5minutes
Can cause: dysrhythmias (bradycardia, arrest-acts at cardiac muscarinic receptors mimics ACh),hyperkalemia, myalgias, increase GI pressure, ICP and IOP.
Malignant hyperthermia
Metabolized by pseudocholinesterase
