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Anesthesia MM/TL > Other Common Drugs Used In Anesthesia > Flashcards

Other Common Drugs Used In Anesthesia Flashcards

1
Q

What is the mechanism of action of aprepitant?

A

Neurokinin 1 antagonist (receptors in CTZ- area postrema and nucleus solitarius)

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2
Q

How long does aprepitant last?

A

48 hours

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3
Q

What is the mechanism of action of milrinone?

A

Phosphodiesterase iii inhibitor

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4
Q

How do anticholinergics work?

A

By competitively blocking the binding of Ach

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5
Q

What is the molecular makeup of anticholinergics?

A

Ester linkage of an aromatic acid with an organic base

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6
Q

What are the CV effects of anticholinergics?

A 
Decreased heart block
Atrial arrhythmias 
Nodal arrhythmias
Moderate norepinephrine release (due to blocking presynaptic muscarinic adrenergic receptors)
Dilation of cutaneous vessels
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7
Q

What are the respiratory effects of anticholinergics

A

Decreased secretions

Relaxation of bronchial smooth muscle

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8
Q

What is the effect of anticholinergics of thermoregulation

A

Inhibits sweat glands so may cause fever

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9
Q

What is the duration of action of aTropine?

A

30-45 minutes

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10
Q

What is the duration of action of glycopyrrolate

A

2-4 hours

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11
Q

Which anticholinergic produces more CNS effects?

A

Scopolamine

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12
Q

Which patients should not be given scopolamine

A

Closed angle glaucoma

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13
Q

What mechanisms does promethazine act on?

A

Blocking D2 in CTZ, histaminergic (vestibular afferents) , and cholinergic (muscarinic in nucleus solitarius)

Can cause akathisia and dyskinesia

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14
Q

What is this MOA of alvimopan

A

Peripherally acting mu opioid antagonist that can decrease opioid associated N/V

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15
Q

What is dronabinol?

A

Agonist of cannabinoid receptors CB1 and 2

Not effective for PONV!

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16
Q

What is the mechanism of action of metoclopramide?

A

D2 antagonist
Anti muscarinic
Anti serotonergic

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17
Q

What does metoclopramide due to the GI system?

A

Increases LES tone

Increases gastric motility

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18
Q

What can hyperbaric oxygen therapy be used for?

A 
Air embolism
Decompression sickness
Carbon monoxide poisoning 
Cyanide
Carbon tetrachloride
Hydrogen sulfide
Brown recluse bites
Necrotizing infection
Chronic osteomyelitis 
Intracranial abscess
Ischemia
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19
Q

What does glycopyrrolate do to the GI system?

A

Decreases motility
Decreases LES tone
Decreases salivary and gastric secretions

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20
Q

What does glycopyrrolate do to bronchial muscles?

A

Relaxes bronchial smooth muscle

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21
Q

Why do patients taking SSRIs need more hydrocodone?

A

Fluoxetine and paroxetine significantly inhibit CYP2D6 and slow conversion of hydrocodone to hydromorphone within the liver

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22
Q

How does mannitol cause pulmonary edema?

A

By increasing the circulating volume (from increased osmolality) in someone with ventricular dysfunction

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23
Q

How does mannitol decrease ICP.

A
  1. Increase extra cellular osmolality so increases volume expansion –» increased cardiac output and therefore CBF which causes a compensatory vasoconstriction of cerebral vessels
  2. Decreases viscosity of the blood thereby increasing flow in the vessels

Second phase: osmotic gradient and Diuresis across bbb

24
Q

How long does the mannitol effect on ICP last?

A

6 hours

25
Q

How long does it take for mannitol to work on ICP?

A

30 minutes

26
Q

What are th side effects of mannitol?

A 
Transient increase in ICP in normal patient
Hypotension (fast administration)
Pulmonary edema
Volume overload 
Hyperglycemia
Renal failure
27
Q

What is the MOA of gabapentin?

A

Binds voltage gated calcium channels in CNS which modulates glutamate synthesis, reduced release of monoamine NTs

28
Q

What is the dosage of sugammadex used for routine reversal neuromuscular blockade?

A

2 mg/kg

29
Q

What is the MOA of sugammadex?

A

It is a cyclodextrin with a lipophilic core and hydrophilic side chains that encapsulate and noncovalently bonds steroidal NMBs

30
Q

Is sugammadex dosing based of actual body weight or ideal body weight ?

A

Actual

31
Q

What is the dose of sugammadex used in people with no twitches?

A

4 mg/kg

32
Q

What are the patient populations in which sugammadex is not approved?

A

Pediatrics
Severe renal failure
Hypersensitivity to cyclodextrin

33
Q

What medications is sugammadex incompatible with?

A

Ondansetron
Ranitidine
Verapamil

34
Q

How is nitric oxide metabolized?

A

It is inactivated by hemoglobin in the pulmonary vasculature

It is oxidized by hemoglobin to nitrite which in turn binds oxyhemoglobin to make nitrate and methemoglobinemia

35
Q

Why doesn’t nitric oxide cause hypotension?

A

Because it is inactivated in the lungs

36
Q

Which site does gabapentin have most effect on in chronic neuropathic pain?

A

Calcium channel a2-delta

37
Q

Which P450 does St. John wort increase?

A

3A4

38
Q

What does St. John’s wort increase the metabolism of?

A 
Alfentanil 
Midazolam
Lidocaine
Oral contraceptives 
Antiretrovirals
NSAIDS (2C19)
Clopidogrel (2C19)
39
Q

Which antibiotics prolong NMB?

A

Amino glycosides
Tetracyclines
Polymixin
Lincomycins (clindamycin)

40
Q

Why do we give clindamycin slowly?

A

It has been known to cause cardiac arrest if given rapidly

41
Q

What other classes of drugs can potentiate NMB?

A

Anticonvulsants (carbamazepine)
Antiarrythmics (verapamil)
Diuretics (furosemide)

42
Q

What pain drugs that we give shouldn’t be used with methotrexate?

A

NSAIDs

43
Q

What does cyclophosphamide do to our NMBs?

A

Prolongs the action of succinylcholine because it is a pseudocholinesterase inhibitor

44
Q

How long do the pseudocholinesterase inhibitor effects of cyclophosphamide last after stopping it?

A

3-4 weeks

45
Q

Which chemotherapeutic drugs cause neuropathy and autonomic nervous system problems?

A

Vincristine and cisplatin

46
Q

What should be avoided in people taking vincristine and cisplatin?

A

Regional anesthesia since they cause neuropathies

47
Q

What drugs are contraindicated in the managing malignant hyperthermia?

A

CCBs due to dantrolene causing more release of Ca from SR with these agents.

48
Q

What is the initial dose of dantrolene?

A

2.5 mg/kg

49
Q

What is the infusion dosing of dantrolene?

A

0.25 mg/kg/hr

50
Q

What is the bolus dosing of dantrolene for maintenance?

A

1 mg/kg every 4-6 hours

51
Q

Which drug should not be used in ECT and why?

A

Lidocaine because it decreases seizure duration and you need the seizures to be 25-30 seconds

52
Q

What is the MOA of tirofiban, eptifibatide, abciximab?

A

G2b3a receptor inhibitor (prevent platelet aggregation)

53
Q

How is tirofiban metabolized?

A

Renally

54
Q

How long do you have to stop tirofiban and eptifibatide before surgery?

A

24 hours

55
Q

How long do you need to stop abciximab before surgery?

A

72 hours

56
Q

What happens to hemodynamics after a bolus of dexmedetomidine?

A

HTN because of peripheral alpha 2 receptors stimulation , then reflex Brady and decreased CO from central alpha 2 stimulation that increases parasympathetic outflow

57
Q

What is the MOA of cyclopentolate

A

Anticholinergic
Used to dilate the eyes
Causes systemic anticholinergic symptoms

Anesthesia MM/TL (36 decks)

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