Other Common Drugs Used In Anesthesia

Question 1

What is the mechanism of action of aprepitant?

Answer 1

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

Question 2

How long does aprepitant last?

Answer 2

48 hours

Question 3

What is the mechanism of action of milrinone?

Answer 3

Phosphodiesterase iii inhibitor

Question 4

How do anticholinergics work?

Answer 4

By competitively blocking the binding of Ach

Question 5

What is the molecular makeup of anticholinergics?

Answer 5

Ester linkage of an aromatic acid with an organic base

Question 6

What are the CV effects of anticholinergics?

Answer 6

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

Question 7

What are the respiratory effects of anticholinergics

Answer 7

Decreased secretions

Relaxation of bronchial smooth muscle

Question 8

What is the effect of anticholinergics of thermoregulation

Answer 8

Inhibits sweat glands so may cause fever

Question 9

What is the duration of action of aTropine?

Answer 9

30-45 minutes

Question 10

What is the duration of action of glycopyrrolate

Answer 10

2-4 hours

Question 11

Which anticholinergic produces more CNS effects?

Answer 11

Scopolamine

Question 12

Which patients should not be given scopolamine

Answer 12

Closed angle glaucoma

Question 13

What mechanisms does promethazine act on?

Answer 13

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

Can cause akathisia and dyskinesia

Question 14

What is this MOA of alvimopan

Answer 14

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

Question 15

What is dronabinol?

Answer 15

Agonist of cannabinoid receptors CB1 and 2

Not effective for PONV!

Question 16

What is the mechanism of action of metoclopramide?

Answer 16

D2 antagonist
Anti muscarinic
Anti serotonergic

Question 17

What does metoclopramide due to the GI system?

Answer 17

Increases LES tone

Increases gastric motility

Question 18

What can hyperbaric oxygen therapy be used for?

Answer 18

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

Question 19

What does glycopyrrolate do to the GI system?

Answer 19

Decreases motility
Decreases LES tone
Decreases salivary and gastric secretions

Question 20

What does glycopyrrolate do to bronchial muscles?

Answer 20

Relaxes bronchial smooth muscle

Question 21

Why do patients taking SSRIs need more hydrocodone?

Answer 21

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

Question 22

How does mannitol cause pulmonary edema?

Answer 22

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

Question 23

How does mannitol decrease ICP.

Answer 23

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

Question 24

How long does the mannitol effect on ICP last?

Answer 24

6 hours

Question 25

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

Answer 25

30 minutes

Question 26

What are th side effects of mannitol?

Answer 26

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

Question 27

What is the MOA of gabapentin?

Answer 27

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

Question 28

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

Answer 28

2 mg/kg

Question 29

What is the MOA of sugammadex?

Answer 29

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

Question 30

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

Answer 30

Actual

Question 31

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

Answer 31

4 mg/kg

Question 32

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

Answer 32

Pediatrics Severe renal failure Hypersensitivity to cyclodextrin

Question 33

What medications is sugammadex incompatible with?

Answer 33

Ondansetron Ranitidine Verapamil

Question 34

How is nitric oxide metabolized?

Answer 34

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

Question 35

Why doesn't nitric oxide cause hypotension?

Answer 35

Because it is inactivated in the lungs

Question 36

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

Answer 36

Calcium channel a2-delta

Question 37

Which P450 does St. John wort increase?

Answer 37

3A4

Question 38

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

Answer 38

``` Alfentanil Midazolam Lidocaine Oral contraceptives Antiretrovirals NSAIDS (2C19) Clopidogrel (2C19) ```

Question 39

Which antibiotics prolong NMB?

Answer 39

Amino glycosides Tetracyclines Polymixin Lincomycins (clindamycin)

Question 40

Why do we give clindamycin slowly?

Answer 40

It has been known to cause cardiac arrest if given rapidly

Question 41

What other classes of drugs can potentiate NMB?

Answer 41

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

Question 42

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

Answer 42

NSAIDs

Question 43

What does cyclophosphamide do to our NMBs?

Answer 43

Prolongs the action of succinylcholine because it is a pseudocholinesterase inhibitor

Question 44

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

Answer 44

3-4 weeks

Question 45

Which chemotherapeutic drugs cause neuropathy and autonomic nervous system problems?

Answer 45

Vincristine and cisplatin

Question 46

What should be avoided in people taking vincristine and cisplatin?

Answer 46

Regional anesthesia since they cause neuropathies

Question 47

What drugs are contraindicated in the managing malignant hyperthermia?

Answer 47

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

Question 48

What is the initial dose of dantrolene?

Answer 48

2.5 mg/kg

Question 49

What is the infusion dosing of dantrolene?

Answer 49

0.25 mg/kg/hr

Question 50

What is the bolus dosing of dantrolene for maintenance?

Answer 50

1 mg/kg every 4-6 hours

Question 51

Which drug should not be used in ECT and why?

Answer 51

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

Question 52

What is the MOA of tirofiban, eptifibatide, abciximab?

Answer 52

G2b3a receptor inhibitor (prevent platelet aggregation)

Question 53

How is tirofiban metabolized?

Answer 53

Renally

Question 54

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

Answer 54

24 hours

Question 55

How long do you need to stop abciximab before surgery?

Answer 55

72 hours

Question 56

What happens to hemodynamics after a bolus of dexmedetomidine?

Answer 56

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

Question 57

What is the MOA of cyclopentolate

Answer 57

Anticholinergic Used to dilate the eyes Causes systemic anticholinergic symptoms