First Semester Drug Concepts Flashcards
adrenergic
drug that displays an effect of epinephrine
increases BP or HR or Both
analgesic
decreases pain
antiemetic
prevents/treats nausea/vomiting
anxiolytic
sedative
apnea
absence of breathing
bolus
inject an amount of drug all at once
catecholamine
any chemical produced in the adrenal medulla
usually refers to epinephrine/norepinephrine
cholinergic
drug that works on an acetylcholine (Ach) receptor
diuretic
drug that increases urine output
infusion
drug that infuses slowly over a period of time
at a constant rate
inotrope
drug that increases cardiac contractibility
intrathecal injection
injection into the subdural/subarachnoid space
“spinal” anesthesia
loading dose
larger dose given prior to an infusion
in effore to speed up the onset
local anesthetic
provides analgesia only to the area of the injection
(not the entire body)
median effective dose
(ED 50)
dose required to achieve a given effect in 50% of the population
median lethal dose
(LD 50)
dose that causes death in 50% of the population
narcotic
aka opiod
addictive drug that:
- decreases pain
- induces sedation
-decreases respiratory drive
opioid
synthetic narcotic that resembles naturally occurring opiates
opiate
- a narcotic that contains opium
- any substance that binds to opiate receptors
opium
a narcotic substance that is extracted from leaves
sympathomimetic
increases HR or BP or both
titrate
- starts with lower initial dose
- dose increased until desired effect achieved
- dose is reduced if drug goes beyond desired effect
therapeutic index
compares the amount of a drug that causes therapeutic effect to the amount that causes toxicity
small/narrow therapeutic index
- “narrow therapeutic range”
- drug is less safe
- small delta between ED and LD
high therapeutic index
- safer
- larger delta between ED and LD
vagolytic
combats a “vagal” (parasympathetic) response
- includes atropine and robinul
vasodilator
dilates blood vessels
decreases BP
vasopressor
constricts blood vessels
increases BP
autonomic nervous system
- sympathetic: “fight/flight”
- parasympathetic: “rest/digest”
sympathetic nervous system effects
(thoracolumbar)
increase HR
increase BP
bronchodilation
pupil dilation (mydriasis)
gastroparesis (inhibition of peristatlsis)
dry mouth
sympathetic nervous system neurotransmitters
epinephrine
norepinephrine
parasympathetic nervous system
(cranial sacral)
decrease HR
bronchoconstriction
pupil constriction (miosis)
peristalsis
airway secretions/saliva
parasympathetic nervous system neurotransmitters
acetylcholine (Ach)
lidocaine
- given prior to propofol to decrease IV burning
- decrease cough reflec during intubation
- antiarrhythmic: treat irregular heart beats/rhythms
LTA Kit
- lidocaine spray into trachea prior to intubation
- decrease coughing prior to extubation
Midazolam
(Versed)
- sedation
- amnesia
- often given in sedation anesthetics
- almost always given prior to GA
(sometimes in preop)
Precedex
(Dexmedetomidine)
- sedative
- analgesic
- produces minimal respiratory depression
- used with other narcotics to decrease amount of opiods needed for pain
- cannot completely cover surgical pain solo
Fentanyl
- analgesic (most common)
- fast onset (<1min)
- short duration (45 mins)
- respiratory depressant (decrease RR)
- too much can cause respiratory arrest
Sufentanil
- analgesic
- 10x more potent than fentanyl
Remifentanil
- analgesic
- ultra short durations (mins)
- limited use due to lack of postop pain relief
- typically infusion for sustained effects
Meperidine
(Demerol)
- analgesic
- postop shivering (25mg)
- local anesthetic properties
- contraindicated in patients w/seizure history
Morphine
- analgesic
- longer onset time (>10 mins)
- longer lasting (3-4 hrs)
Dilaudid
- 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
Ketorolac
(Toradol)
- NSAID analgesic
- no respiratory depression
- adjunct to narcotic dosing
- limited dosing due to renal toxicity
Ofirmev
(IV Acetaminophen)
- analgesic
- minimal respiratory depression
Propofol
- induction agent (most common)
- rapid onset
- short duration
- decreases BP
- respiratory depressant
–bag mask on hand to ventilate if needed
Etomidate
- induction agent (GA)
- no impact to BP
- minimal respiratory depression
- side effects:
– adrenal suppression
– PONV
Ketamine
- induction agent and analgesic
- increase HR
- increase BP
- minimal respiratory depression
- ONLY analgesic IA
- best bronchodilator IA
- side effects:
– hallucinations
– PONV
– increase airway secretions
Acetylcholine
(Ach)
2 types of Ach receptors
- Nicotinic Ach receptors (skeletal muscle)
- Muscarinic Ach receptors (all others)
Neuromuscular Junction
- motor (presynaptic) nerve is stimulated
- releases Ach into neuromuscular junction
- Ach binds nicotinic (postjunctional) Ach receptors
- muscle contracts
Nondepolarizing muscle relaxants
- bind nicotinic Ach receptors
- block Ach binding
rocuronium
Muscarinic Ach Receptors
parasympathetic
on all muscles except skeletal
heart - bradycardia
lungs - bronchoconstriction
GI - peristalsis
eyes - miosis
salivary glands - increase salivary production
Acetylcholinesterase
(AchE)
enzyme
breaks down Ach –> choline + acetic acid
Neostigmine
anticholinesterase (cholinesterase inhibitor)
– blocks acetylcholinesterase from doing its job
– floods neuromuscular junction w/Ach
“Reversing” nondepolarizing muscle paralysis
Neostigmine
- 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
Neostigmine negative effects
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
Robinul & Atropine
- anticholinegics/antimuscainics
- block muscarinic Ach receptors
- cause sympathetic effects
– increase HR
– bronchodilation
– mydriasis (pupil dilation)
– dry mouth - administered simultaneously w/neostigmine
–prevent parasympathetic response
“Reversing” nondepolarizing Muscle Paralysis
Sugammadex
- sugammadex binds/encapsulates the muscle relaxant
- frees up postjunctional receptor
- Ach binds pjrs –> normal muscle function
Sugammadex
- reversal agent (best)
- no parasympathetic response
Succinylcholine
- 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
Rocuronium
- nondepolarizing muscle relaxant
- longer onset
–not ideal for quick intubation (requires bag mask) - longer duration
–lasts duration of surgery
Vecuronium
- longer onset
- longer duration
– used for longer duration cases - does not work as well with sugammadex compared to zemuron (Roc)
Cistracurium
(Nimbex)
- muscle relaxant
– best for liver/kidney disease patients - reversed w/neostigmine
Robinul
- more commonly used w/neostigmine
- used to treat minor bradycardia
Atropine
- less commonly used w/neostigmine
- better HR increaser than Robinul
- used to treat profound/emergent bradycardia
Ondansetron
(Zofran)
- antiemetic (perioperative)
- treats nausea by blocking serotonin 5HT3 receptor
Metoclopramide
(Reglan)
- antiemetic (weaker than Zofran)
- upper GI stimulant (causes peristalsis)
–may be useful w/full stomach patients
Dexamethasone
(Decadron)
- antiemetic
- steroid
- treats swelling
–airway swelling after intubation trauma
Phenylephine
- alpha-1 agonist: increase BP (Vasoconstriction)
- can cause reflex bradycardia (low HR)
Given:
- low BP
- good HR
Avoided:
- bradycardic (low HR) patients
Ephedrine
- alpha-1 agonist: increase BP
- beta-1 agonist: increase HR
Given:
hypotension and bradycardia
(low BP / low HR patients)
Metaprolol
- beta blocker
- decrease HR
Esmolol
- beta blocker
- decrease HR
- fast onset
- short duration
quick fix
Labetalol
- beta blocker
- decrease HR
- decrease BP
Hydralazine
- vasodilator
- longer onset (10 mins)
- longer duration (2-4 hrs)
- treats hypertension (high BP) in low/normal HR patient
