Pharmacology Flashcards
Heparin
[half-life elimination time]
1 -2 hours
2-Chloroprocaine
[rapid onset]
able to use high concentrations due to its low systemic toxicitiy
- unlike normally, does not depend on PKa, which is about 9 and thus more pronated (less likely to cross cell membrane) at physiologic pH
5-HT3
[receptor]
serotonin on platelets and GI tract
Adrenergic Agonists
[which 2 have the greatest increase on CO]
isoproterenol and dobutamien
Adrengergic Agonists
[which 2 cause a large decrease in renal blood flow]
phenylephrine and norepinephrine
Agents
[effect on SA node]
depresses SA node automaticity
- only modest effects on AV node; explains the occurrence of junctional tachycardia when administering an anticholinergic during inhalation anesthesia
Agents
[effects on blood pressure]
decrease
- Des, Sevo, and Iso decrease blood pressure due to a decrease in systemic vascular resistance
- halothane depression is due to decreases in myocardial contractility and cardiac output
Agents
[effects on cardiac output]
minimal decrease
Agents
[effects on CVP]
slight increase except for Sevoflurane
- However, around 1.5 MAC, sevo will show an increase in CVP, then drop again
Agents
[effects on heart rate]
increase heart rate
- Sevoflurane only increases HR when MAC > 1.5
- halothane has no effect on heart rate
Agents
[effects on minute ventilation]
decrease
- increase respiratory rate while decreasing tidal volume
- except for Isoflurane
Agents
[effects on pulmonary vascular resistance]
little to no effect
Agents
[effects on systemic vascular resistance]
decrease SVR
Agents
[ventilatory response]
decrease response to incrasing PaCO2
- Desflurane above 1 MAC has the greatest effect
Agents
[best for ablative procedures]
Sevoflurane
- no effect on AV conduction
- Isoflurane increases the refractoriness of accessory pathways
Alpha Blockers
[examples]
prazosin
phentolamine
phenoxybenzamine
Alpha-1 Agonists
[cardiovascular effects]
vasoconstriction
leading to an increase in peripheral vascular resistance, left ventricular afterload, and atrial blood pressure
Alpha-1 Agonist
[mechanism of action]
increase intracellular [Ca2+] leading to contraction of smooth muscles
Alpha-2 Agonists
[cardiovascular effects]
reduction of sympathetic outflow
peripheral vasodilation and lower blood pressure
Alpha-2 Agonists
[mechanism of action]
inhibits adenylate cyclase activity
- decreases the entry of calcium ions into neuronal terminal, which limits exit of norepinephrine
anesthetic agent with low potency and poor blood solubility
Desflurane
(and N2O)
Anti-Arrhythmic Agents
[Class I - type]
Na+ channel blocker
- blocks voltage-gated Na+ channels and decreases the slope of phase 0 (Vmax)
Anti-Arrhytmic Agents
[Class III - examples]
amiodarone and sotalol
Anti-Arrhytmic Agents
[largest increase in QT interval]
amiodarone
Anti-Arrhytmic Agents
[best for supraventricular arrhythmias]
adenosine
Anti-Arrhytmic Agents
[class I - examples]
quinidine
lidocaine
phenytoin
flecainide
Anti-Arrhytmic Agents
[Class II - examples]
esmolol and metoprolol
Anti-Arrhytmic Agents
[class II - type]
beta blocker
Anti-Arrhytmic Agents
[class III - type]
K+ channel blocker
- prolongs repolarization
Anti-Arrhytmic Agents
[Class IV - examples]
verapamil and diltiazem
Anti-Arrhytmic Agents
[class IV - type]
Ca2+ channel blocker
- blocks slow calcium channels
Anticholinergics
[effects on cardiovascular system]
tachycardia
- blockade of muscarinic receptors in the SA node
Anticholinergics
[respiratory effects]
decrease secretions
bronchodilation
Anticholinesterase
[muscarinic effects on gastrointestinal system]
increased spasm and salvation
Anticholinesterase
[muscarinic side effects on cardiovascular system]
decreased heart rate and bradyarrhythmias
Anticholinesterase
[muscarinic side effets on pulmonary system]
bronchospasm
Antimuscarinics
[3 examples]
atropine
scopolamine
glycopyrrolate
Atracurium
[metabolism]
ester hydrolysis and hofmann elimination
Atracurium
[side effects]
histamine release
- avoid in severe asthmatics
Atropine
[anti-sialagogue IM dose]
0.01 - 0.02 mg/kg
Barbiturates
[effect on ICP]
greatest decrease in ICP
Barbiturates
[effect on seizure threshold]
lowers seizure threshold
Barbiturates
[effects on cerebral physiology]
decrease CMR, CBF, and ICP
Benzodiazepines
[effects on cerebral physiology]
slightly decreases CMR, CBF, and ICP
Benzodiazepines
[mechanism of action]
enhance GABA receptor affinity, but do not directly activate
Benzodiazepines
[pregnancy and labor]
crosses placenta and may lead to CNS depression
- may increase risk of cleft lip/palate when given during first trimester
Bleomycin
[adverse effects]
pulmonary fibrosis
Bronchodilators
[order of effectiveness]
Beta agonists
glucocorticoids
leukotriene blockers
mast-cell stabilizers
theophyllines
anticholinergics
Bupivacaine
(marcaine)
[duration of action]
5 - 15 hours (anesthesia)
- epinephrine is less effective in prolonging anesthesia because duration of action is independent of local blood flow
Calcium Channel Blockers
[greatest risk of SVT]
verapamil and diltiazem
Cerebral Vasospasm
[treatment]
Nimodipine
Cisatracurium
[metabolism]
Hofmann elimination
Cisplatin
[adverse effects]
renal impairment
Clomipramine
[drug class]
tricyclic anti-depressant
Clomipramine
[treatment]
obsessive-compulsive disorder
Clonidine
(catapres)
[mechanism of action]
alpha-2 agonist
- less selective and longer acting than dexmedetomidine (precedex)
Context Sensitive Half-Time
[definition]
time necessary for the plasma drug concentration to decrease 50% after discontinuing a continuous infusion
Coronary Steal Syndrome
theory that coronary vasodilators that target smaller coronary vessels would redistribute blood from ischemic to nonischemic areas
- Examples: Isoflurane, adenosine, dipyridamole, and nitroprusside
- not clinically proven
Creatinine Clearance
[equation estimate]
[140 - age] x kg
divided by
72 x [creatinine%]
- multiply by 85% for women
- “Cockroft and Gault” equation
Cryoprecipitate
[components]
von willebrands
fibrinogen
factor VIII and XIII
Cyclosporine
[mechanism of action]
calcineurin inhibitor
Cyclosporine
[treatment]
immunosuppression for organ transplant
Anesthetic implications of decreased SVR
- excess perfusion relative to oxygen needs
- loss of body heat due to increase cutaneous blood flow
- enhanced delivery of drugs to NMJ
Desflurane
[vaporizer]
desflurane is heated to 39oC to raise its partial pressure to 1,500 mmHg
- ensures a constant concentration despite changes in barometric pressure or temperature
Desflurane
[Blood:Gas]
0.42
Desflurane
[Brand name]
Suprane
Desflurane
[MAC]
6.0
Desflurane
[vapor pressure]
660
Dexmedetomidine
(precedex)
[adverse effects]
antimuscarinic effects
- dry mouth and blurred vision
Dexmedetomidine
(precedex)
[mechanism of action]
alpha-2 agonist
Dexmedetomidine
[receptor selectivity]
alpha-2 > alpha-1
Dextrose 5%
[osmolarity]
252
Diffusion Hypoxia
occurs with abrubtly ending inhalation of N2O
Diuretics
[3 K+-Sparing Examples]
Spironolactone (aldactone)
Triamterene (dyrenium)
amiloride (midamor)
Diuretics
[4 Loop Examples]
Furosemide (lasix)
Bumetanide (bumex)
Torasemide (demadex)
Ethacrynic acid (edecrin)
Dobutamine
[effects]
enhances cardiac output without changing blood pressure
Dobutamine
[receptor selectivity]
Beta-1 >> beta-2
Droperidol
[mechanism of action]
D2 Antagonist
Droperidol
[side effets]
dystonia
QT prolongation
decreased seizure threshold
Drugs causing decreased renal perfusion
NSAIDS
ACE inhibitors
IV contrast
cyclosporines
drugs causing direct tubular injury
aminoglycosides
IV contrast
heavy metals
myoglobin and hemoglobin
HIV protease
Edrophonium
[reversal dose of Atropine]
0.014 mg per mg of anti-cholinesterase
Effect on MAC
[hypernatremia]
increase