Pharmacology Flashcards
Midazolam (Versed)
Use = sedation Benzodiazepine; anxiety/sedation A/E = -CNS depression -hypotension -respiratory depression -Paradoxical agitation
Diazepam (Valium)
Use = sedation Benzodiazepine; anxiety/sedation A/E = -Hypotension -Respiratory depression -Paradoxical agitation
Lorazepam (Ativan)
Use = sedation Benzodiazepine; anxiety/sedation A/E = -Hypotension (less than midazolam) -Respiratory depression -Paradoxical agitation -Hyperosmolar metabolic acidosis (IV prolonged infusion)
Propofol (Diprivan)
Use = sedation Nonbenzodiazepine; sedative/anesthetic A/E = -hypotension -fever -sepsis -hyperlipidemia -respiratory depression -CNS depression
Indications for intubation
Patency = inability to maintain airway patency,
Aspiration = inability to protect the airway against aspiration,
Ventilation = ventilatory compromise,
Oxygenation = failure to adequately oxygenate pulmonary capillary blood,
Clinical Course = anticipation of a deteriorating course that will eventually lead to the inability to maintain airway patency or protection.
GCS< 8 INTUBATE!
What is rapid sequence intubation?
RSI is the nearly simultaneous administration of a potent induction agent with a paralyzing dose of a neuromuscular blocking agent (NMBA)
Difficult to ventilate
OBESE to remember who is difficult to ventilate Obese (body mass index >26kg/m2) Bearded Elderly (older than 55y) Snorers Edentulous
Difficult to intubate
Difficult intubation has been defined by the need for more than three intubation attempts or attempts at intubation that last > 10 min (think LEMON)
1) Look externally. There may be some physical clue or foreign object that portends difficulty.
2) Evaluate using the 3:3:2 rule. Can the patient fit three fingers between the incisors? A mouth that can open that far has good temporomandibular joint mobility. Is the mandible length three fingers from the mentum to the hyoid bone? That’s a nice, normal length; either shorter or longer makes ventilation or intubation trickier, he said. Last, the distance from the hyoid to the thyroid tells you something about neck length–two fingers’ distance is ideal.
3) Mallampati classification. If the patient can cooperate, ask her to stand, open the mouth, stick out the tongue, and say, “Ahh.” The structures that are visible compose Mallampati class I (the easiest airway), II, III, or IV (most difficult). A Mallampati class IV = “This is going to be tough, and you need to be thinking about what your alternatives will be”
4) Obstruction. Look for anything that might get in your way. The enemies of airways include soft tissue swelling from smoke inhalation, burns, broken necks, trauma to the face or neck, foreign bodies in the airway, and excessive soft tissue from obesity.
5) Neck mobility is desirable. Unfortunately, many patients who need resuscitation in the emergency department arrive in neck braces or with compromised neck mobility, and you may not be able to move them into preferred positions for establishing a definitive airway.
Fentanyl
potent, synthetic opioid analgesic with a rapid onset and short duration of action; anesthesia and analgesia,
Lidocaine
common local anesthetic and class-1b antiarrhythmic drug
Etomidate
short acting intravenous anaesthetic agent used for the induction of general anaesthesia and for sedation[1] for short procedures such as reduction of dislocated joints, tracheal intubation and cardioversion.
Thiopentale
rapid-onset short-acting barbiturate general anesthetic
Ketamine
Other uses include sedation in intensive care, as a pain killer (particularly in emergency medicine and patients with potentially compromised respiration and/or allergies to opiate and barbiturate analgesics), as treatment of bronchospasm, and as a treatment for complex regional pain syndrome
Neuromuscular blocking agents (NMBAs)
succinylcholine
rocuronium
Osmotic Diuretics
Decadron - Corticosteroid,anti-inflammatory and immune-
suppressive.
Mannitol
Plasma Volume Expanders
Crystalloids Ex. NS, LR, Hypertonic Saline (3, 5, or 7%)
Colloids (plasma protein) Ex. Albumin, Dextran, Hetastarch
Antieplileptic
lorezapam
carbmaezpam
phenytoin
diazepam
Vasopressor
epinephrine and NE
Anxiolytics & Antidepressants
diazepam
Ambien
Zoloft (SSRI)
bupropion
Anti-manic agents, mood stabilizers, antipsychotics
Lithium Divalproex Carbamazepine Risperidone Haldol Seroquel Abilify
Antihypertensives
CCB BBlockers Diuretics ACE inhibitors angiotensin II inhibitors Vasodilators
Diurectics
Potassium-Sparing Diuretics = Spirnolactone (Aldactone)
Thiazides = Metolazone
Loop (High Ceiling) Diuretics = Furosemide (Lasix)
Angiotensin II inhibitors
- Losartan (Cozaar)
2. Irbesartan (Avapro)
ACE inhibitors
Enalapril (Vasotec)
CCB
Selective Smooth Muscle CCB
- Nifedipine (Adalat)
- Amlodipine
- selective for arterioles and myocardium (HR and CO)
Non-Selective Smooth Muscle CCB
- Verapamil (Isoptin)
- Diltiazem
- relaxes smooth muscle generally in heart and blood vessels (decreases HR and CO)
Vasodilators
- Hydralazine
2. Nitroprusside (Nipride)
Adrenergic agents
Alpha Blockers
- Doxazosin (Cardura)
- vasodilation
Beta Blockers (“-olol”)
- Metoprolol (Lopresor)(B1)
- HR, CO, O2 demand, conduction decrease
Alpha 2- Agonists
- Clonidine
- Methyldopa
Antiplatelet agents
Adenosine diphosphate (ADP) Receptor Blockers
- Clopidogrel (Plavix)
- reversibly alters ADP receptors on platelets (no ADP binding, no signal to aggregate or bind to injury).
Acetylsalicylic Acid (ASA)
- acts by binding IRRIVERSIBLY to the enzyme cyclooxygenase (COX-1 and COX-2) in platelets (inhibits thromboxane A2 – no platelet agg.)
- *FIRST TREATMENT FOR MI!!
Glycoprotein IIa/IIIb Inhibitors
- Reopro
- EXPENSIVE! MOST EFFICACIOUS!
- acts by inhibiting the GIIa/IIIb enzyme, preventing thrombus formation.
- IV only - Integrillin
Anticoagulants
- Warfarin (Coumadin)
- most common oral anticoagulant.
- long-term
- acts by inhibiting the synthesis of clotting factors II, VII, IX, and X.
* *Test for PT (12-15 sec.) or INR (2-3.5) therapeutic margin: 24-30 sec., 4-7. - Heparin (Hepalean)
- most common parenternal antic.
- acts by increasing the action of antithrombin III (inhibits thrombin, no fibrin can be made).
* *Test for PTT (25-45 sec., therapeutic margin: 50-90 sec.) - 1 Low Molecular Weight Heparins (LMWH)
- act by inhibit active factor X.
- less likely to cause thrombocytopenia, more stable, longer duration.
* *Drug of choice: clotting disorders
Thrombolytics
- Alteplase (Activase)
- Streptokinase (Streptase)
- Reteplase (Retavase)
* *used in artery BP line, thrombic CVA
Oral antidiabetics
Sulfonylureas
Biguanides
Thiazolidinediones
Meglitinides
Paralytics (NMBAs)
Neuromuscular blocking agents (NMBAs) act on the skeletal muscle postsynaptic nicotinic acetylcholine (ACh) receptor, paralyze skeletal muscles by blocking the transmission of nerve impulses at the myoneural junction
- Rapacuronium (Raplon)
- Succinylcholine
Succinylcholine
Succinylcholine (1.0–1.5 mg kg−1) produces the most rapid onset of neuromuscular block of all NMBDs (60 s). It is hydrolysed by plasma cholinesterase and its clinical duration of action is up to 12 min.
Adverse Effects: hyperkalaemia, malignant hyperpyrexia, bradyarrhythmias, increase in intraocular/intragastric/intracranial pressure, and a higher risk of anaphylaxis than with other NMBDs
Pain Management Medications
Fentanyl Hydromorphone Morphine Acetaminophen Aspirin Toradol
Inotropes
Digoxin Epinephrine Norepiephrine Atropine Dopamine Dobutamine Milrinone
S/E of cytotoxic medications
acute skin, eye, or mucous irritations, and chronic cancer or reproductive events.
