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Intro to Anesthesia Pharmacology > Pharmacology Lecture > Flashcards

Pharmacology Lecture Flashcards

0
Q

What is versed most frequently used for?

A

Anxiolytic and as an amnestic

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1
Q

In what kinds of cases can versed be used as an induction agent?

A

Longer cases, its duration of action limits its use to longer OR cases.

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2
Q

What is versed’s duration of action?

A

2 to 6 hours

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3
Q

What drug class is versed a member of?

A

Benzodiazepine

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4
Q

What are two important things to remember about versed before giving it?

A
  1. It can be painful

2. Dose may have to be adjusted due to tolerance issues of the patient

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5
Q

What drug can be used to reverse versed?

A

Fluemazenil/Romazicon

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6
Q

What is the induction dose of versed?

A

.1-.25 mg/kg for induction

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7
Q

Why is versed given in preop?

A

For anxious folks and for it amnestic qualities…it is given at smaller doses for these. Less than the induction doses

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8
Q

What is versed’s onset?

A

1 to 5 minutes

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9
Q

What is versed’s peak?

A

5 to 30 minutes

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10
Q

What is the duration of action of versed?

A

2 to 6 hours

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11
Q

What is the non-induction preop dose of versed?

A

1 to 5 mg

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12
Q

When given to patients with existing pulmonary disease and when given with other sedatives what can happen?

A

Respiratory depression

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13
Q

What is the other name for versed?

A

Midazolam

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14
Q

What is the dose of propofol?

A

1 to 2.5 mg/kg

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15
Q

What is another name for vecuronium?

A

Norcuron

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16
Q

What is the primary advantage of using propofol?

A

Its short duration of action. No “HANGOVER AFFECT”

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17
Q

What is the onset time of propofol?

A

15 to 30 seconds

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18
Q

What is the duration of action time for propofol?

A

5 to 10 minutes

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19
Q

In what type of allergy should propofol not be used in?

A

Egg allergy

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20
Q

What is a frequent complaint of propofol administration?

A

Pain

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21
Q

What are three ways the pain of propofol infusion can be averted?

A
  1. bigger vein
  2. bigger IV
  3. give lidocaine?
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22
Q

Besides being allergic to eggs, what other type of patient should propofol not be used in?

A

It is a cardiac suppressant, so it should not be used in a very sick patient as it tends to drop the BP…i.e. ASA 3 or 4 patients

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23
Q

Besides it induction properties, what is another characteristic of propofol?

A

antiemetic

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24
Q

Besides induction, what other case is propofol used for and why?

A

Its used as a sedative in MAC(minimal anesthesia care) cases, in these cases there is suppose to be no loss of lid reflex, so not general anesthesia

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25
Q

What drug should be used to induce sick patients that might not tolerate the cardiac suppressant affects of propofol?

A

Ketamine

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26
Q

What can be a reason not to use etomidate to induce a patient?

A

Nausea and Vomiting

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27
Q

What is two of the hallmark properties of using etomidate?

A
  1. Its cardiovascular stability

2. Its fast onset

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28
Q

What type of patient would be the ideal patient for etomidate?

A

The critical ill, ASA class 3 or 4 patient with no history of N and V with anesthesia

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29
Q

What is something to remember about the administration of etomidate?

A

Its painful due to being mixed in a propylene glycol solution

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30
Q

Why might you pretreat with fentanyl before giving etomidate?

A

To decrease the incidence of myoclonia/twitching movements…they go away when the patient is fully induced

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31
Q

What is the concentration of etomidate?

A

2 mg/ml

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32
Q

What is etomidate’s onset?

A

15 to 30 seconds

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33
Q

What is the duration of etomidate?

A

3 to 10 minutes

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34
Q

What is the dose of etomidate?

A

0.2-0.4 mg/kg

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35
Q

When would you decrease the dose of etomidate?

A

When it is given in conjuction with sedatives, opioids and hypnotics

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36
Q

What is a complication of Brevital?

A

Seizures…does not lower the sz thresh hold like propofol does

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37
Q

What is the drug class of Brevital?

A

Barbiturate

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38
Q

Brevital shares a similar effect as Etomidate….what is it?

A

Excitatory movements

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39
Q

In what type of patient should you avoid Brevital?

A

Epileptic

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40
Q

What is the concentration of Brevital?

A

10 mg/ml

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41
Q

What is the dose of Brevital?

A

1.5 to 2.5 mg/kg

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42
Q

What is the onset of Brevital?

A

20 - 40 seconds

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43
Q

What is the duration of action of Brevital?

A

5 to 10 minutes

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44
Q

What kind of depressant is Brevital?

A

Respiratory

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45
Q

Ketamine is a derivative of what?

A

PCP

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46
Q

What is a disturbing emergency reaction of Ketamine?

A

“Bad Trips”

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47
Q

What is the only induction agent that also has analgesia properties?

A

Ketamine

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48
Q

How does ketamine affect the HR and BP?

A

Ketamine is excellent for many critically ill patients as it increases both HR and BP. May be contraindicated in patients who cannot tolerate high heart rates or blood pressure. i.e. aortic stenois and patients with high ICP

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49
Q

Besides causing nightmares and “bad trips”, what other negative side affect does Ketamine have?

A

Increased secretions

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50
Q

What drug can help control the negative affects of Ketamine?

A

Robinol

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51
Q

What type of agent is Ketamine?

A

Opioid induction agent

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52
Q

What receptors are stimulated by Ketamine?

A

Kappa and Sigma

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53
Q

What is the 3 different types of concentration of Ketamine?

A

50 mg/ml
10 mg/ml
100 mg/ml

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54
Q

What is the typical IV induction dose of Ketamine?

A

1-2 mg/kg

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55
Q

What is the IM induction dose of Ketamine?

A

4 - 8 mg/kg

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56
Q

What is the onset of Ketamine?

A

30 - 60 seconds

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57
Q

How do you know when Ketamine has started to work?

A

The patient will have nystagmous

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58
Q

How long does Ketamine’s hypnotic affect last?

A

15 minutes, analgesia affect last much longer

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59
Q

What is the standard concentration of Fentanyl?

A

50 mcg/ml

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60
Q

At what dose does Fentanyl start having anagesia effects?

A

0.5 mcg/kg

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61
Q

At what dose is Fentanyl given when it is the primary anesthetic?

A

100 mcg/kg

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62
Q

What is the onset time for Fentanyl?

A

Typically about 30 seconds or 1 to 2 circulation.

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63
Q

What is the duration of action for an analgesic dose of Fentanyl?

A

30-60 minutes

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64
Q

When the dose of Fentanyl is greater than analgesic dosages, what happens to its duration of action?

A

It increases

65
Q

What is the primary adverse effect of Fentanyl?

A

Respiratory depression

66
Q

What medication will reverse the effects of Fentanyl?

67
Q

On which receptors does Fentanyl work?

A

Fentanyl works on the opioid receptors, primarily the mu opioid receptors

68
Q

What does the Mu receptors mediate?

A

They mediate the effects of analgesia, respiratory depression and addiction

69
Q

What is the analgesic dose of Sufentanil aka Sufenta?

A

0.1 mcg/kg

Much more potent than Fentanyl

70
Q

At what dose might someone receive Sufentanil aka Sufenta if they are having a complex or extremely painful surgery?

71
Q

What is the onset of Sufentanil?

A

15-30 seconds

72
Q

What is the duration of action for Sufentanil aka Sufenta?

A

20-45 minutes in analgesic doses. Duration of action increases as doses increased

73
Q

Sufenta aka Sufentanil use is limited to what and why?

A

Its use is limited to long and extremely stimulating surgical procedures due to being very expensive

74
Q

What is the #1 adverse reaction of Sufentanil?

A

Profound respiratory depression

75
Q

What receptors are stimulated by Sufentanil?

A

The Mu opioid receptors. They are primarily responsible for the clinical effects of sufenta

76
Q

What routes is Sufentanil available?

A

Although Fentanyl is available in many forms, Sufentanil aka Sufenta is only available in IV form.

77
Q

What is the other name for Demerol?

A

Meperidine

78
Q

What receptors do Demerol stimulate?

A

Opioid Mu receptors.

It is not a narcotic…is does not cause narcosis!

79
Q

In what way is Demerol similar to Atropine?

A

Due to a similar structure, it can cause an increased HR like atropine. It’s use should be avoided in patients who will not tolerate a higher HR.

80
Q

Demerol was the first what?

A

It was the first synthetic opioid

81
Q

What is the primary reason Meperidine is used in anesthesia?

A

Demerol is primarily used in the PACU for shivering

82
Q

What is the concentration of Demerol?

A

50 mg/ml is the most common, but may be supplied in either 25 mg/ml or 100 mg/ml

83
Q

What is the analgesic dose of Demerol?

A

0.5-2 mg/kg, smaller doses needed to stop shivering

84
Q

What is the onset of Demerol?

A

30-60 seconds

85
Q

What is the duration of action of Demerol?

86
Q

What receptors does Demerol act upon?

A

It works on the Mu receptors as well as other ones

87
Q

What are some adverse effects of Demerol?

A

tachycardia, respiratory depression, hallucinations

88
Q

If a patient is taking what kind of home meds should Demerol be avoided in?

89
Q

What is Morphine known for?

A

It was the original opioid, the prototype opioid agonist. It was derived from the opium poppy.

90
Q

What is the primary use of Morphine in anesthesia?

A

Post op pain relief.

91
Q

What is the concentration of Morphine?

A

1-15 mg/ml

92
Q

What is the typical analgesic dose of Morphine?

93
Q

What is the onset of Morphine?

A

30-60 seconds, peak analgesic effects much longer

The less potent an opioid is the longer its peak effect due to crossing the blood brain barrier

94
Q

What is the duration of action for Morphine?

95
Q

What are some side effects of Morphine?

A

Pruitis, nausea and vomiting, hallucinations, respiratory depression, hypotension, constipation

96
Q

What receptors does Morphine stimulate?

A

Morphine works primarily on the Mu opioid receptors but also the Kappa receptors

97
Q

Hydromorphone is what time of opioid?

A

Dilaudid is a semi-synthetic opioid, it is a derivative of morphine with approx 5 times greater potency of morphine

98
Q

What is the concentration of Dilaudid?

A

It is 1 mg/ml or 2mg/ml

99
Q

What is the typical dose of Hydromorphone?

A

0.25 - 2 mg for adults

100
Q

What is the onset of Dilaudid?

A

30-60 seconds

101
Q

What is the duration of action of Hydromorphone?

102
Q

What is the primary use of Dilaudid by anesthesia?

A

It is useful for post op pain relief in the PACU, also given towards the end of the case after spontaneous ventilation is restored to ensure comfortable wake up.

103
Q

What are the side effects of Dilaudid?

A

Respiratory depression and nausea and vomiting

104
Q

What receptors does Hydromorphone work?

105
Q

What is the concentration of Remifentanil?

A

It comes as a powder for reconstitution in 1 or 2 mg vials

106
Q

What is the dose for Remifentanil?

A

0.05-2 mcg/kg/min

107
Q

What is the onset of action of Remifentanil?

A

Onset is EXTREMELY rapid at 15 seconds

108
Q

What is the duration of action of Remifentanil?

A

Its duration of action is only 5-10 minutes as its rapidly metabolized

109
Q

In what type of surgical procedures is Remifentanil particularly useful?

A

It is very expensive, but it is particularly useful in surgical procedures requiring intensive but brief periods of analgesia. Often part of T.I.V.A.~total intravenous anesthetic(given with propofol and a skeletal muscle relaxant)

110
Q

What class of muscle relaxant is Succinylcholine aka sux?

A

Depolarizing agent

111
Q

What is Sux claim to fame?

A

It is the only muscle relaxant for true RSI! Its the drug of choice when securing the AW as rapidly as possible is the goal.

112
Q

What is the onset of Sux?

A

30-60 seconds

113
Q

What is the concentration of Anectine?

114
Q

What is the dose of Anectine?

A

1 - 1.5 mg/kg

115
Q

What is the duration of action of Sux?

A

3-5 minutes

116
Q

What are two very serious possible side effects of Succinylcholonine?

A

It may trigger malignant hyperthermia as well as it may transiently raise K+ levels so it is contraindicated with disease states that may exhibit hyperkalemia.

117
Q

What should be check before giving a non-depolarizer after the patient has received Anectine which is a depolarizer agent?

A

Twitches….this verifys that the effects of succinycholine has worn off

118
Q

What precedes muscle relaxation?

A

Fasciculations

119
Q

What type of muscle relaxant is Cisatracurium?

A

Non-depolarizer

120
Q

What is the concentration of Nimbex?

121
Q

What is the dose of Nimbex?

A

0.1-0.2 mg/kg

122
Q

What is the onset of Cisatracurium?

A

3-5 minutes

123
Q

What is the duration of action of Nimbex?

A

20-35 minutes

Requires no renal function for metabolism!!!!!

124
Q

When giving Nimbex What is the pre-treatment dose for succinylcholine administration?

125
Q

Cisatracurium aka Nimbex is the muscle relaxant of choice for what patient population?

A

Those in renal failure!

It is not metabolized by the kidneys.

126
Q

What is important about the storage of Cisatracurium?

A

It must be refrigerated for storage

127
Q

Why is Nimbex safe for infusion?

A

There are not cumulative effects

128
Q

What is the concentration of Vecuronium?

129
Q

What is the dose of Norcuron?

A

0.1 to 0.12 mg/kg

130
Q

What is the onset of action of Vecuronium?

A

1-3 minutes

131
Q

What is the duration of action of Norcuron?

A

20-35 minutes

132
Q

What are side effects of Vecuronium both good and bad not related to its muscle relaxation?

A

It has no cardiovascular or histamine releasing effects

It is less popular as an infusion as it has cumulative effects…requires hepatic function for metabolism.

133
Q

What is the concentration of Rocuronium?

134
Q

What is the classification of Zemuron?

A

Non-depolarizing skeletal muscle relaxant

135
Q

What is the intubating dose of Roc?

A

0.6 - 1.2 mg/kg

136
Q

What is Roc aka Zemuron’s claim to fame as a skeletal muscle relaxant?

A

It has a quicker onset than cis or vec, so this make it the second best drug after Sux for rapid intubationi

137
Q

What is the onset of action of Zemuron?

A

1-2 minutes dependent on the dose!

138
Q

What is the duration of action of Zemuron?

A

20-35 minutes with normal intubating dose, duration lengthens as doses increase

139
Q

How does Roc affect the cardiovascular/histamine systems?

A

It has minimal CV effects and no noticeable histamine release

140
Q

What is the most common reason Atropine is given by anesthesia?

A

it is given with acetylcholinesterase inhibiting drugs like neostigmine to prevent excessive drooling, bradycardia

141
Q

What is the concentration of Atropine?

A

0.4 mg/ml or 0.4 mg/0.5 ml

142
Q

What is the dose of Atropine when given with Neostigmine?

A

15-70 mcg/kg

143
Q

What is the onset of Atropine?

A

15- 30 seconds…works quicker than robinol

144
Q

What is the duration of action of Atropine?

145
Q

Why is Atropine used less than Robinol?

A

Atropine crosses the blood brain barrier and may lead to confusion as it has loco weed in it

146
Q

What is the drug classification of Atropine?

A

it is a Tertiary Amine Anticholinergic

147
Q

Why is Glycopyrrolate used by anesthesia?

A

Anti-muscarinic given with acetylcholinesterase inhibiting drugs to block the adverse effects of drooling and bradycardia

148
Q

What is the concentration of Robinal?

149
Q

What is the dose of Glycopyrrolate aka Robinal?

A

0.01-0.02 mg/kg or 10-20 mcg/kg

150
Q

How is Robinol administered in peds?

A

Glycopyrrolate administered in equal volume with neostigmine

151
Q

What is the onset of action of Glycopyrrolate?

A

1 minute or less

152
Q

What is the duration of action of Robinal?

153
Q

What is the drug classification of Robinal?

A

Quaternary Ammonium Anticholinergic

154
Q

How does Robinal compare to Atropine?

A

It does not cross the blood brain barrier so it does not contribute to post op delirium

155
Q

What is Neostigmine/Prostigmine known for?

A

It is the gold standard of anticholinesterase drugs, it blocks the active site of acetylcholinesterase so the enzyme can no longer break down the acetylcholine molecules before they reach the postsynaptic receptors. This allows for the threshold be reached so new impulses can be triggered in the next neuron.

156
Q

What concomitant drug is required for Neostigmine’s use?

A

Atropine or Robinal?

157
Q

What is the concentration of Neostigmine?

158
Q

What is the dose of Neostigmine?

A

0.45 to 0.07 mg/kg

159
Q

What is the onset of action of Neostigmine?

A

1-3 minutes

160
Q

What is the duration of action of Neostigmine?

A

40-60 minutes

161
Q

What’s important to know about Neostigmine on its limitations?

A

You can’t reverse a completely paralyzed patient, it must work in combination with spontaneous recovery from pharmaceutical muscle relaxers`

Intro to Anesthesia Pharmacology (9 decks)

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