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Anesthesia Pharmacology > Induction Drugs > Flashcards

Induction Drugs Flashcards

1
Q

VERSED (trade name)

Generic name & Classification

A

VERSED

Generic name - Midazolam

Classification - Benzodiazepine

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2
Q

Contraindications of Versed

A

Contraindications - Pregnancy, lactation, CNS depression

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3
Q

Versed Doses (Adult & Pediatric)

A

Dose - (Adults) IV: 0.5-2 mg (usual total dose 2-5 mg)

Induction - 0.1-0.2 mg/kg IV

IM: 0.07-0.08 mg/kg

Pediatric:

Oral: 0.5 mg/kg (20 mg max)

IM: 0.07-0.1 mg/kg

IV: 0.025-0.05 mg/kg

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4
Q

What routes can Versed be given as?

A

IM, IV, PO

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5
Q

Versed Mechanism of Action?

A

Mechanism of Action - (CNS depressant) MOA - binds to GABA receptor exerts its actions by modulating chloride channels

(GABA receptor increases the frequency of chloride channel opening, resulting in postsynaptic membrane hyperpolarization and neuronal transmissions is inhibited)

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6
Q

Versed Elimination?

Onset?

Peak?

Duration?

A

Elimination: Renal & Hepatic

Onset: IV 30-60 seconds

Peak: IV 2.8-5.6 minutes

Duration: IV 15-80 minutes

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7
Q

Misc. Info on Versed

A
  • Most common side effect is depression of ventilation caused by a decrease in hypoxic drive.
  • Known for powerful amnestic effect and passes BBB.
  • Cardiopulmonary bypass increases half-time dramatically.
  • Cleared primarily by the liver but kidneys as well.
  • Flumazenil is reversal.
  • May be given in small doses (0.5-1 mg IV) for paradoxical vocal cord motion and stridor post surgery.
  • Should push midazolam slowly over 2 minutes.
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8
Q

Fentanyl

Trade Name & Classification

A

Trade name - (SUBLIMAZE)

Classification - Opioid Agonist

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9
Q

Fentanyl Contraindications

A

Contraindications

- Reduce fentanyl doses in elderly or hypovolemic.

  • Crosses the placental barrier, may produce depression of respiration in the neonate.
  • Prolonged respiratory depression after cessation of transdermal patch use.
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10
Q

Fentanyl Doses

Adults & Pediatrics

A

Dose –

Analgesia: IV: 1 to 2 mcg/kg

Induction: 50-100mcg (the norm per hammon) (attempt to blunt circulatory response to direct laryngoscopy or sudden changes in level of surgical stimulation)

Epidural bolus:1 to 2 mcg/kg; infusion: 2 to 60 mcg/hr

Spinal bolus: 0.1 to 0.4 mcg/kg

Dosage form: injection: 0.05 mg/mL;

transdermal patch: 100 mcg/hr.

In conjunction with epidural administration: 1 to 2 mcg/kg.

For infusion with epidural: 2 to 60 mcg/hr.

In conjunction with spinal anesthesia: bolus dose of 0.1 to 0.4 mcg/kg.

Children 2-8 years old: 15-20mcg/kg (45 minutes before induction however, use of fentanyl in pediatrics shows an increase in PONV not influenced by prophylactic doses of droperidol)

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11
Q

Fentanyl Routes

A

Transdermal, IV, IM, Epidural/Spinal, Transmucosal

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12
Q

Fentanyl Mechanism of Action

A

Mechanism of Action - Opioids mimic the actions of enkephalins, endorphins, and dynorphins (endogenous ligands) by binding to opioid receptors, resulting in activation of pain-modulating (antinociceptive) systems.

Causes analgesia and anesthesia.

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13
Q

Fentanyl Elimination

A

Renal

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14
Q

Fentanyl Onset, Peak, Duration.

A

Onset –

IV: within 30 seconds

IM: less than 8 minutes

Epidural/spinal: 4 to 10 minutes.

Peak – 3.6 minutes

Duration –

IV: 30 to 60 minutes;

IM: 1 to 2 hours

Epidural/spinal: 4 to 8 hours.

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15
Q

Fentanyl Misc Info.

A

Miscellaneous

– Reversal Agent: (Narcan 0.2 to 0.4 mg IV).

  • Large doses can be used as the sole anesthetic for surgery.
  • Used as an induction agent to reduce the amount of other sedation medications.
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16
Q

Propofol (generic Name)

Trade name, Classification

A

Propofol (generic) Diprivan (trade)

Classification: Sedative/Hypnotic

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17
Q

Propofol Contraindications

A

Contraindications:
· Avoid in patients with known hypersensitivity to Propofol, its components or have a lipid metabolism disorder
· Do not use with patients who are sensitive to sodium metabisulfite –may cause anaphylactic symptoms
· Caution is advised in elderly, debilitated, and cardiac-compromised patients
· Controversy exists regarding whether Propofol should be avoided in patients who are allergic to eggs, soy, or peanuts.

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18
Q

Propofol Doses

A

Dose:
Induction: 1.5-2.5 mg/kg
Anesthesia maintenance: 100-300 mcg/kg/min
Subhypnotic: 10-15 mg (used as antiemetic or to treat neuropathic pain)

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19
Q

Propofol Route

A

IV

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20
Q

Propofol MOA

A

Mechanism of Action (MOA): Increases GABA affinity for GABAa receptor. This decreases the rate of disassociation of the inhibitory neurotransmitter, GABA from the receptor and increases the duration of the GABA-activated opening of the chloride channel which leads to hyperpolarization of cell membranes (inhibition of the cell)

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21
Q

Propofol Elimination?

A

Elimination: Half time: 0.5-1.5 hours
Rapid metabolic clearance that exceeds hepatic blood flow. P450 –water soluble metabolites excreted by the kidneys. Less than 0.3% is unchanged in urine (

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22
Q

Propofol Onset, Peak, Duration?

A

Onset: Dose Dependent, rapid onset, less than a minute
Peak: 1 minute
Duration: 15-45 minutes depending on dose

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23
Q

Propofol Misc. Info

A

Miscellaneous:
· Can cause pain at injection site
· Does NOT trigger malignant hyperthermia
· Strongly supports growth of E-cloi & Psudomonas aeruginosa. It is recommended that the contents of an unused ampule be discarded after 6 hours, and in the ICU the tubing and any unused portion be discarded after 12 hours
· No evidence of impaired elimination in patients with liver cirrhosis.
· Renal dysfunction does not influence the clearance of Propofol.
· Prolonged infusions may result in excretion of green urine reflecting the presence of phenols. This does not alter renal function.
· Propofol is associated with significant decreases in intraocular pressure that occur immediately after induction of anesthesia
· Can cause lactic acidosis in pediatric and adult patients with prolonged, high-dose infusions (Propofol infusion syndrome)

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24
Q

Rocuronium

Trade Name, Classicfication

A

Trade name - Zemuron

Classification - Nondepolarizing Neuromuscular Blocker

25
Q

Rocuronium Contraindication

A

Contraindications- Bromide hypersensitivity and Precaution in liver pts

26
Q

Rocuronium Doses

A

Dose- 0.6-1.2mg/kg

RSI dose: 1.2mg/kg

Fasciculation dose: 10% of full dose given before propofol dose when using succs.

27
Q

Rocuronium Route

A

IV

28
Q

Rocuronium MOA

A

Mechanism of Action - Binds to nicotinic acetylcholine receptors at the postsynaptic muscle membrane. Competitive antagonist of Ach

29
Q

Rocuronium Elimination

A

Liver, Billiary

30
Q

Rocuronium Onset, Peak, & Duration

A

Onset- 1-3 minutes

Peak- 1.7 minutes

Duration- 30-120 minutes (Nagelhout, p. 693) *could be prolonged in pts with hepatic and renal disease*

31
Q

Rocuronium Misc. Info

A

Miscellaneous

Rocuronium can be used in patients who are hemodynamically compromised due to the less or no histamines present in the drug

  • reversal agent is Sugammadex
  • Drug of choice in RSI when succinylcholine is contraindicated
32
Q

Succinylcholine

Trade Name, Classification

A

Trade: (Anectine, Quelicin)

Classification: Depolarizing skeletal muscle relaxant

33
Q

Succinylcholine Contraindications

A

Contraindications:

  • Succinylcholine should not be used for routine intubation in children younger the age of 12 because of reports of sudden cardiac arrest in children with undiagnosed Duchenne muscular dystrophy and with muscle disorders.
  • Succinylcholine is contraindicated in patients with malignant hyperthermia,

genetic variants of plasma cholinesterase or cholinesterase deficiencies,

myopathies associated with elevated creatinine phosphokinase values,

muscle disorders or muscular dystrophies,

acute narrow-angle glaucoma,

severe muscle trauma or muscle wasting,

neurologic injury (i.e., paraplegia, quadriplegia, spinal cord injury, or cerebrovascular accident),

hyperkalemia,

severe sepsis,

electrolyte imbalances,

or third-degree burns over more than 25% total body surface due to potentially life threatening hyperkalemia.

Repeated doses at short intervals (less than 5 minutes) are associated with bradycardia.

34
Q

Succunylcholine Doses

A

Dose:

Adults: intravenous: 1 to 1.5 mg/kg

Children: intravenous: 1 to 2 mg/kg; intramuscular: 2 to 4 mg.kg

Dosage forms: injection: 20 mg/mL; powder for infusion: 500 mg (mix in 500 mL for 1 mg/mL solution.

35
Q

Succinylcholine Routes

A

IV, IM

36
Q

Succinycholine MOA

A

Mechanism of Action (MOA)

Partial agonist against the nicotinic acetylcholine receptor (nAChR) and depolarizes (opens) the ion channels. This opening requires the binding of only one molecule of SCh to the α subunit. The other α subunit can be occupied by either acetylcholine or SCh. Because SCh is not hydrolyzed by acetylcholinesterase, the channel remains open for a longer period of time than would be produced by acetylcholine, resulting in a depolarizing block (sustained depolarization prevents propagation of an action potential)

37
Q

Succinylcholine Elimination

A

Elimination :Elimination half-life of 47 seconds

Cleared from the area of the NMJ and is exposed to hydrolysis by plasma cholinesterase.

90% metabolized by cholinesterase in plasma. 10% excreted unchanged by the kidneys

38
Q

Succynylcholine Misc. Info

A

Miscellaneous

Pretreat with atropine because of the incidence of bradycardia.

Cardiovascular effects: Sinus bradycardia, junctional rhythm, and even sinus arrest. Cardiac dysrhythmias are most likely to occur when a second dose of succinylcholine is administered approximately 5 minutes after the first dose. These cardiac effects reflect the actions of succinylcholine at cardiac muscarinic cholinergic receptors where the drug mimics the physiologic effects of acetylcholine. (Flood, p. 327)

Hyperkalemia: Associated with approximately 0.5 mEq/dL increase in the plasma potassium concentration from the skeletal muscles in healthy individuals, which is well tolerated and generally does not cause dysrhythmias. (Flood, p. 327; p. 444)

Increased intraocular pressure: The intraocular pressure peaks at 2 to 4 minutes after administration and returns to normal by 6 minutes.

Increased intracranial pressure, Myoglobinuria, Myalgias, Masseter spasm

39
Q

Lidocaine

Trade Name, Classification

A

Name: Lidocaine (Xylocaine)

Classification: Class 1b antiarrhythmic agent (membrane stabilizing and mild NA channels effects) and a local anesthetic

40
Q

Lidocaine Contraindications

A

Contraindications: Do Not give this drug when PVCs occur with bradycardia or escape rhythm. May cause Seizures, Restlessness, vertigo, tinnitus, and difficulty focusing

41
Q

Lidocaine Dose

A

Dose: 1.5-2 mg/kg bolus

1.5mg/kg/hr should not exceed 300mg/hr.

Epidural 50-300mg max dose.

Local 300mg max dose.

Transdermal: 3 patches within a 24hr timeframe.

42
Q

Lidocaine Route

A

IV, IM, SQ, TOpical, Epidural, Spinal

43
Q

Lidocaine MOA

A

Mechanism of action: It is amide, binds to specific sites in voltage gated sodium channels blocking sodium current reducing excitability of neuronal, cardiac, CNS.

44
Q

Lidocaine Eliminiation?

A

Hepatic

45
Q

Lidocaine Onset, Peak, Duration

A

Onset: 45-90 seconds

Peak: 10-20 minutes

Duration: 30 minutes-4 hours

46
Q

Lidocaine Misc. Info

A

Miscellaneous: May be given in conjunction with epinephrine to help increase potency and decrease systemic effects. Helps with laryngeal spasms. Also blunts the gag reflex.

47
Q

Etomidate

Trade Name & Classification

A

Trade name- Amidate.

Classification- Central nervous system agent; nonbarbiturate hypnotic without analgesic activity

48
Q

Etomidate Contraindications

A

Contraindications- Causes Adrenal Suppression→inhibition of cortisol, avoid in sepsis & hemorrhage (need cortisol)

49
Q

Etomidate Dose & Route

A

Dose-0.2-0.4mg/kg

Route IV

50
Q

Etomidate MOA

A

Mechanisms of action- (Gaba- mimetic) Binds to GABAA receptors→increase inhibitory neurotransmitter effect.

51
Q

Etomidate

Elimination, Onset, Peak, Duration, & Misc.

A

Elimination - ester hydrolysis is the primary mode of metabolism in the liver and plasma

Onset- 30seconds-60 seconds

Peak- within 1 minute

Duration- 5-15

Miscellaneous- pain on injection

52
Q

Vecuronium

Trade Name & Classification

A

Trade - Norcuron

Classification - (Nondepolarizing/ Steroidal Compound) Monoquarternary neuromuscular blocker

53
Q

Vecuronium Contraindications

A

Contraindications - caution use in patients with decreased liver and kidney function, anaphylaxis

54
Q

Vecuronium Dose & Route

A

Dose - Intubating Dose: 0.1 mg/ kg

Route - IV

55
Q

Vecuronium MOA

A

Mechanism of Action (MOA) - Binds to nicotinic acetylcholine receptors at the postsynaptic muscle membrane

56
Q

Vecuronium Elimination

A

Primarily eliminated by the liver and excreted in bile (renal - 30% of administered dose)

57
Q

Vecuronium Onset, Peak, Duration

A

Onset - within 3 minutes

Peak - 2.4 min

Duration- intermediate: 20-50 min

58
Q

Vecuronium Misc. Info.

A

Miscellaneous -

  • Molecular instability in solution (prepared as a lyophilized powder),
  • less potent than pancuronium,
  • duration of block is dependent on liver function,
  • 80% of blocking potency is from the metabolite 3-OH and long term administration can have lingering effects because of this metabolite,
  • No histamine release so it is more appropriate for those that are hemodynamically unstable,
  • reversed by Sugammadex
59
Q
A

Anesthesia Pharmacology (1 decks)

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