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Sp: Pmc > First Semester Drug Concepts > Flashcards

First Semester Drug Concepts Flashcards

1
Q

adrenergic

A

drug that displays an effect of epinephrine
increases BP or HR or Both

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2
Q

analgesic

A

decreases pain

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3
Q

antiemetic

A

prevents/treats nausea/vomiting

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4
Q

anxiolytic

A

sedative

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5
Q

apnea

A

absence of breathing

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6
Q

bolus

A

inject an amount of drug all at once

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7
Q

catecholamine

A

any chemical produced in the adrenal medulla
usually refers to epinephrine/norepinephrine

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8
Q

cholinergic

A

drug that works on an acetylcholine (Ach) receptor

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9
Q

diuretic

A

drug that increases urine output

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10
Q

infusion

A

drug that infuses slowly over a period of time
at a constant rate

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11
Q

inotrope

A

drug that increases cardiac contractibility

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12
Q

intrathecal injection

A

injection into the subdural/subarachnoid space
“spinal” anesthesia

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13
Q

loading dose

A

larger dose given prior to an infusion
in effore to speed up the onset

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14
Q

local anesthetic

A

provides analgesia only to the area of the injection
(not the entire body)

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15
Q

median effective dose
(ED 50)

A

dose required to achieve a given effect in 50% of the population

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16
Q

median lethal dose
(LD 50)

A

dose that causes death in 50% of the population

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17
Q

narcotic
aka opiod

A

addictive drug that:
- decreases pain
- induces sedation
-decreases respiratory drive

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18
Q

opioid

A

synthetic narcotic that resembles naturally occurring opiates

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19
Q

opiate

A
  • a narcotic that contains opium
  • any substance that binds to opiate receptors
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20
Q

opium

A

a narcotic substance that is extracted from leaves

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21
Q

sympathomimetic

A

increases HR or BP or both

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22
Q

titrate

A
  • starts with lower initial dose
  • dose increased until desired effect achieved
  • dose is reduced if drug goes beyond desired effect
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23
Q

therapeutic index

A

compares the amount of a drug that causes therapeutic effect to the amount that causes toxicity

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24
Q

small/narrow therapeutic index

A
  • “narrow therapeutic range”
  • drug is less safe
  • small delta between ED and LD
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25
Q

high therapeutic index

A
  • safer
  • larger delta between ED and LD
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26
Q

vagolytic

A

combats a “vagal” (parasympathetic) response
- includes atropine and robinul

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27
Q

vasodilator

A

dilates blood vessels
decreases BP

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28
Q

vasopressor

A

constricts blood vessels
increases BP

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29
Q

autonomic nervous system

A
  • sympathetic: “fight/flight”
  • parasympathetic: “rest/digest”
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30
Q

sympathetic nervous system effects
(thoracolumbar)

A

increase HR
increase BP
bronchodilation
pupil dilation (mydriasis)
gastroparesis (inhibition of peristatlsis)
dry mouth

31
Q

sympathetic nervous system neurotransmitters

A

epinephrine
norepinephrine

32
Q

parasympathetic nervous system
(cranial sacral)

A

decrease HR
bronchoconstriction
pupil constriction (miosis)
peristalsis
airway secretions/saliva

33
Q

parasympathetic nervous system neurotransmitters

A

acetylcholine (Ach)

34
Q

lidocaine

A
  • given prior to propofol to decrease IV burning
  • decrease cough reflec during intubation
  • antiarrhythmic: treat irregular heart beats/rhythms
35
Q

LTA Kit

A
  • lidocaine spray into trachea prior to intubation
  • decrease coughing prior to extubation
36
Q

Midazolam
(Versed)

A
  • sedation
  • amnesia
  • often given in sedation anesthetics
  • almost always given prior to GA
    (sometimes in preop)
37
Q

Precedex
(Dexmedetomidine)

A
  • sedative
  • analgesic
  • produces minimal respiratory depression
  • used with other narcotics to decrease amount of opiods needed for pain
  • cannot completely cover surgical pain solo
38
Q

Fentanyl

A
  • analgesic (most common)
  • fast onset (<1min)
  • short duration (45 mins)
  • respiratory depressant (decrease RR)
  • too much can cause respiratory arrest
39
Q

Sufentanil

A
  • analgesic
  • 10x more potent than fentanyl
40
Q

Remifentanil

A
  • analgesic
  • ultra short durations (mins)
  • limited use due to lack of postop pain relief
  • typically infusion for sustained effects
41
Q

Meperidine
(Demerol)

A
  • analgesic
  • postop shivering (25mg)
  • local anesthetic properties
  • contraindicated in patients w/seizure history
42
Q

Morphine

A
  • analgesic
  • longer onset time (>10 mins)
  • longer lasting (3-4 hrs)
43
Q

Dilaudid

A
  • analgesic
  • longer onset time (>10 mins)
  • longer lasting (3-4 hrs)
  • favored over morphine due to less side effects
    – kidneys/sleepiness/confusion
  • 1mg dilaudid = 7mg morphine
44
Q

Ketorolac
(Toradol)

A
  • NSAID analgesic
  • no respiratory depression
  • adjunct to narcotic dosing
  • limited dosing due to renal toxicity
45
Q

Ofirmev
(IV Acetaminophen)

A
  • analgesic
  • minimal respiratory depression
46
Q

Propofol

A
  • induction agent (most common)
  • rapid onset
  • short duration
  • decreases BP
  • respiratory depressant
    –bag mask on hand to ventilate if needed
47
Q

Etomidate

A
  • induction agent (GA)
  • no impact to BP
  • minimal respiratory depression
  • side effects:
    – adrenal suppression
    – PONV
48
Q

Ketamine

A
  • induction agent and analgesic
  • increase HR
  • increase BP
  • minimal respiratory depression
  • ONLY analgesic IA
  • best bronchodilator IA
  • side effects:
    – hallucinations
    – PONV
    – increase airway secretions
49
Q

Acetylcholine
(Ach)

A

2 types of Ach receptors
- Nicotinic Ach receptors (skeletal muscle)
- Muscarinic Ach receptors (all others)

50
Q

Neuromuscular Junction

A
  • motor (presynaptic) nerve is stimulated
  • releases Ach into neuromuscular junction
  • Ach binds nicotinic (postjunctional) Ach receptors
  • muscle contracts
51
Q

Nondepolarizing muscle relaxants

A
  • bind nicotinic Ach receptors
  • block Ach binding

rocuronium

52
Q

Muscarinic Ach Receptors

A

parasympathetic
on all muscles except skeletal

heart - bradycardia
lungs - bronchoconstriction
GI - peristalsis
eyes - miosis
salivary glands - increase salivary production

53
Q

Acetylcholinesterase
(AchE)

A

enzyme
breaks down Ach –> choline + acetic acid

54
Q

Neostigmine

A

anticholinesterase (cholinesterase inhibitor)
– blocks acetylcholinesterase from doing its job
– floods neuromuscular junction w/Ach

55
Q

“Reversing” nondepolarizing muscle paralysis
Neostigmine

A
  • neostigmine floods neuromuscular junction w/Ach
  • extra Ach can overcome muscle relaxant

BLUF: neostigmine blocks acetylcholinesterase and floods neuromuscular junction w/Ach resulting in muscle contraction

56
Q

Neostigmine negative effects

A

floods entire body w/ACh causing overall body to experience a
paraympathetic response:
–heart - bradycardia
–lungs - increase airway secretion/bronchoconstriction
–eyes - pupil constriction
–gut - peristalsis

57
Q

Robinul & Atropine

A
  • anticholinegics/antimuscainics
  • block muscarinic Ach receptors
  • cause sympathetic effects
    – increase HR
    – bronchodilation
    – mydriasis (pupil dilation)
    – dry mouth
  • administered simultaneously w/neostigmine
    –prevent parasympathetic response
58
Q

“Reversing” nondepolarizing Muscle Paralysis
Sugammadex

A
  • sugammadex binds/encapsulates the muscle relaxant
  • frees up postjunctional receptor
  • Ach binds pjrs –> normal muscle function
59
Q

Sugammadex

A
  • reversal agent (best)
  • no parasympathetic response
60
Q

Succinylcholine

A
  • depolarizing muscle relaxant
  • primary use: paralyze vocal cords before intubation
  • binds to pj Ach receptors
  • causes “maximum contraction” of muscles
  • paralysis occurs due to muscle fatigue
  • fastest onset
    –ideal for quick intubation situations (full stomachs)
  • shortest duration (wears off w/out reversal)
    –wont last surgery duration
61
Q

Rocuronium

A
  • nondepolarizing muscle relaxant
  • longer onset
    –not ideal for quick intubation (requires bag mask)
  • longer duration
    –lasts duration of surgery
62
Q

Vecuronium

A
  • longer onset
  • longer duration
    – used for longer duration cases
  • does not work as well with sugammadex compared to zemuron (Roc)
63
Q

Cistracurium
(Nimbex)

A
  • muscle relaxant
    – best for liver/kidney disease patients
  • reversed w/neostigmine
64
Q

Robinul

A
  • more commonly used w/neostigmine
  • used to treat minor bradycardia
65
Q

Atropine

A
  • less commonly used w/neostigmine
  • better HR increaser than Robinul
  • used to treat profound/emergent bradycardia
66
Q

Ondansetron
(Zofran)

A
  • antiemetic (perioperative)
  • treats nausea by blocking serotonin 5HT3 receptor
67
Q

Metoclopramide
(Reglan)

A
  • antiemetic (weaker than Zofran)
  • upper GI stimulant (causes peristalsis)
    –may be useful w/full stomach patients
68
Q

Dexamethasone
(Decadron)

A
  • antiemetic
  • steroid
  • treats swelling
    –airway swelling after intubation trauma
69
Q

Phenylephine

A
  • alpha-1 agonist: increase BP (Vasoconstriction)
  • can cause reflex bradycardia (low HR)

Given:
- low BP
- good HR

Avoided:
- bradycardic (low HR) patients

70
Q

Ephedrine

A
  • alpha-1 agonist: increase BP
  • beta-1 agonist: increase HR

Given:
hypotension and bradycardia
(low BP / low HR patients)

71
Q

Metaprolol

A
  • beta blocker
  • decrease HR
72
Q

Esmolol

A
  • beta blocker
  • decrease HR
  • fast onset
  • short duration
    quick fix
73
Q

Labetalol

A
  • beta blocker
  • decrease HR
  • decrease BP
74
Q

Hydralazine

A
  • vasodilator
  • longer onset (10 mins)
  • longer duration (2-4 hrs)
  • treats hypertension (high BP) in low/normal HR patient

Sp: Pmc (7 decks)

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