Additional Drug List Basics

Question 1

Thiopental

Answer 1

Induction Agent/ Sedative

Barbiturates: depress Reticular Activating System, binding to GABA receptors and potentiate action of GABA

25 mg/ml

Induction: 3-5 mg/kg (3-6 mg/kg in M+M)

Onset: 30 secs
DOA: 20 mins

No longer available in USA as used for lethal injection

Neuroprotective
Decreased ICP, by decreasing CBF and CBV

Question 2

Methohexital

Answer 2

Induction Agent/ Sedative
Brevital

Barbiturates: depress Reticular Activating System, binding to GABA receptors and potentiate action of GABA

10 mg/ml
Induction: 50-120 mg

Still used for Electro Convulsant Therapy (ECT), does not increase seizure threshold

M+M
IV
Induction: 1-2 mg/kg
Sedation: 0.2-0.4 mg/kg

Rectal
Induction (Children): 25 mg/kg (concentration 10%)

Question 3

Flumazenil

Answer 3

Reversal Agent
Romazcion

Benzodiazepine antagonist: competitive with benzos

0.05-0.1 mg/ml
0.2 mg over 15 seconds, can repeat Q 1 min up to 1 mg total, max dose 3 mg/hr

Peds Min/Max Dose: 0.01 mg/kg and 0.05 mg/kg

Onset: less than 1 min
DOA: 1-2 hrs

Question 4

Scopolamine

Answer 4

Sedative w/ Variety of Uses: Amnesia Creation, Decrease Motion Sickness, Drowsiness Creation

Hyoscine
Cholinergic antagonist: binds to muscarinic cholinergic receptors preventing Ach binding, increase Ach concentrations to overcome

Transdermal Patch: 1.5 mg patch
IV: 0.4 mg push for trauma amnesia

Greater CNS effect than Atropine and Glycopyrrolate

Question 5

Cefazolin

Answer 5

Antibiotic
Ancef

1 gram reconstituted in 10 mls = 100 mg/ml
25 mg/kg

Question 6

Celecoxib

Answer 6

Celebrex
COX-2 Inhibitor

PO
200-400 mg

Post-Op Pain
No Increased Bleeding Risk like non-specific COX meds (aspirin, etc.)

Decrease Post-OP Anesthetic Requirements

Question 7

Gabapentin/Pregabalin

Answer 7

Gabapentin
Neurontin
300-1200 mg

Pregabalin
Lyrica
75-150 mg

Avoid in >65yo

Decrease Post-OP Anesthetic Requirements

Question 8

Oxycontin

Answer 8

Extended-release oxycodone

5-20 mg for major surgery in absence of regional anesthesia

Decrease Post-OP Anesthetic Requirements

Question 9

Dexamethasone

Answer 9

Decadron

4-10 mg
… after induction of anesthesia

PONV Prophylaxis
… w/ Zofran

Question 10

Pentobarbital

Answer 10

Barbiturates: depress Reticular Activating System, binding to GABA receptors and potentiate action of GAB

Premedication
IM
2-4 mg/kg

Oral
2-4 mg/kg (concentration 5%)

Rectal
3 mg/kg

Question 11

Alfentanil

Answer 11

Pain Medication

Opioid: Bind to Mu, Kappa, and delta receptors resulting in pain receptors not working

IV
Intraoperative anesthesia: 8-100 mcg/kg
Loading Dose Maintenance Infusion: 0.5-3 mcg/kg/min

Question 12

Atracurium

Answer 12

Muscle Relaxant

Non-depolarizing MR: bind to the NMJR and prevent the depolarization of that receptor by endogenous ACH
10mg/ml

IV
Onset: 2.5-3 mins
DOA: 30-45 mins
Intubation: 0.5 mg/kg
If Succinylcholine used for Intubation: 0.25 mg/kg initially with 0.1 mg/kg every 10-20 mins
Infusion: 5-10 mcg/kg/min

Question 13

Mivacurium

Answer 13

Muscle Relaxant

Non-depolarizing MR: bind to the NMJR and prevent the depolarization of that receptor by endogenous ACH

IV
Onset: 2-3 min
DOA: 20-30 min
Intubation: 0.15-0.2 mg/kg

Question 14

Pyridostigmine

Answer 14

Reversal Agent

Cholinesterase inhibitor: prevent the breakdown of acetylcholine by blocking the enzyme called cholinesterase, allows for the action potential threshold to be reached so a new impulse can be triggered in the next neuron

5 mg/ml

IV
Onset: 10-15 min
DOA: 2+ hrs
0.25 mg/kg to a total of 20 mg in adults

Anti Cholinergic to prevent bradycardia
Glycopyrrolate: 0.05mg per 1 mg of pyridostigmine (preferred)
Atropine: 0.1 mg per 1 mg of pyridostigmine

Question 15

Physotigmine

Answer 15

Reversal Agent

Cholinesterase inhibitor: prevent the breakdown of acetylcholine by blocking the enzyme called cholinesterase, allows for the action potential threshold to be reached so a new impulse can be triggered in the next neuron

1mg/ml

IV
0.01 - 0.03 mg/kg

Anti Cholinergic
Not-neccessary

Question 16

Clonidine

Answer 16

Adrenergic Agent
Anti-Hypertensive
A2 Agonist

IV: 1–3 mcg/kg
30 mcg/hr with an opioid

IM: 2 mcg/kg

Oral: 3–5 mcg/kg
Onset: 30-60 min
DOA: 12 hrs
0.1 mg twice a day… adjusted till BP is controlled (typically 0.1-0.3 mg twice a day)

Transdermal: 0.1–0.3 mg released per day
0.1, 0.2, 0.3 mg/d patches replaced every 7 days

Intrathecal: 15–30 mcg

Perineural or Epidural: 1–2 mcg/kg

Question 17

Dopamine

Answer 17

Primarily Dopaminergic Receptors (DA1… and also D2)
Agonist A1, A2, B1, B2

200mg/5ml, 400 mg/10ml

Infusion: 1-20 mcg/kg/min

Effects vary with dose
Low doses 0.5-3mcg/kg/min mainly hits the dopaminergic receptors causing diuresis and slight RBF increase.

Moderate dose 3-10mcg/kg/min Beta-1 stimulation occurs causing Increased contractility, HR, SBP, and CO.

High doses 10-20mcg/kg/min really hit the Alpha-1 receptors, causing an increase in PVR (peripheral vascular resistance)

Question 18

Isoproterenol

Answer 18

B1, B2 Agonist

Question 19

Dobutamine

Answer 19

B1 (greater), B2 Agonists
250mg/20ml

Infusion: 2-20 mcg/kg/min

Question 20

Fenoldopam

Answer 20

D1 Agonist

10mg/ml

Infusion: 0.1 mcg/kg/min… increased at 0.1 mcg/kg/min at 5-20 min intervals till target blood pressure is reached

Creates hypotensive effects

Question 21

Phentolamine

Answer 21

Adrenergic Antagonist

Competitive blockade (reversible) at A1, A2

1-5 mg in adults bolus

Antagonism and direct smooth muscle relaxation responsible for peripheral vasodilation and decline in arterial blood pressure

Question 22

Propranolol

Answer 22

Adrenergic Antagonist (Beta Blocker)
B1, B2 Nonselective

1mg/1ml ampullas

0.5 mg titration to effect very 3-5 mins… not to exceed 0.14 mg/kg

Question 23

Nebivolol (Beta Blocker)

Answer 23

Adrenergic Antagonist
B1

Cause vasodilation via stimulation of endothelial nitric oxide production

Question 24

Carvedilol

Answer 24

Adrenergic Antagonist (Beta Blocker)
Mixed B and A

Individualized… increased up to 25 mg twice daily

Question 25

Sodium Nitroprusside

Answer 25

Hypotensive Creates nitric oxide to vasodilate Diluted to 100 mcg/ml Onset: 1-2 mins Infusion: 0.25-5 mcg/kg/min Breakdown of these drug produces cyanide ions which at HIGH cumulative daily dose of 500mcg/kg or rate of 2mcg/kg/min ACUTE CYANIDE TOXICITY: acidosis, cardiac arrhythmias, Increased Ven. O2 INTRACORONARY STEAL: stealing blood away from ischemic areas where coronary arterioles are already maximally dilatated

Question 26

Nitroglycerin

Answer 26

Hypotensive Agent Nitric Oxide production Diluted to 100 mcg/ml Infusion: 0.5-5 mcg/kg/min Sublingual: 0.3-0.4 mg tablet under tongue... peak effect 4 minutes Transdermal: 24 hour release

Question 27

Hydralazine

Answer 27

Hypotensive Agent cGMP increased for vasodilation Onset: 15 min DOA: 2-4 hrs 5-20 mg

Question 28

Fenoldopam

Answer 28

Hypotensive Agent Activates D1 receptors Onset: 15 mins Infusion: 0.1 mcg/kg/min... increased by 0.1 mcg/kg/min every 15-20 mins till target BP achieved

Question 29

Calcium Channel Blockers...

Answer 29

Medications that prevent calcium ions from entering certain cells in the body, particularly those in the heart and blood vessels Dihydropyridine (Nicardipine, Clevidipine) are arterial selective vasodilators routine for cardiothoracic surgery. Minimal effect on cardiac conduction and ventricular contractility. Cardiac output increases due to preload maintained. Nicardipine: infusion 5-15 mg/h (titrated to effect)

Question 30

Inodilators...

Answer 30

Milrinone Phosphodiesterase inhibitor Used in treatment of heart failure. Increases cAMP concentration resulting in increased intracellular calcium concentration. Improve myocardial contractility and systemic vasodilator

Question 31

H1-Receptor Antagonists

Answer 31

H1-receptor antagonist properties have considerable antimuscarinic, or atropine-like, activity (eg, dry mouth) or anti-serotonergic activity (antiemetic) Suppression of allergic reactions and symptoms of upper respiratory tract infections (eg, urticaria, rhinitis, conjunctivitis); vertigo, nausea, and vomiting (eg, motion sickness, Ménière disease); sedation; suppression of cough; and dyskinesia (eg, parkinsonism, drug-induced extrapyramidal side effects)

Question 32

H2-Receptor Antagonists

Answer 32

Competitively inhibit histamine binding to H2 receptors, thereby reducing gastric acid output and raising gastric pH

Question 33

Antacids

Answer 33

Antacids neutralize the acidity of gastric fluid by providing a base (usually hydroxide, carbonate, bicarbonate, citrate, or trisilicate) that reacts with hydrogen ions to form water Bicitra: 0.3 M solution (sodium citrate, citric acid) OR Polycitra (sodium citrate, potassium citrate, citric acid) 15-30 mL... 15-30 min prior to induction

Question 34

Proton Pump Inhibitors

Answer 34

Bind to the proton pump of parietal cells in the gastric mucosa and inhibit secretion of hydrogen ions Omeprazole/Prilosec: 20 mg Lansoprazole/Prevacid: 15 mg Rabeprazole/Aciphex: 20 mg Pantoprazole/Protonix: 40 mg Esomeprazole/Nexium

Question 35

Naltrexone

Answer 35

Opioid antagonist with a high affinity for the μ receptor, but it has a significantly longer half-life than naloxone Orally for maintenance treatment of addiction

Question 36

Doxapram

Answer 36

Selective activation of carotid chemoreceptors by low doses of doxapram stimulates hypoxic drive, producing an increase in tidal volume and a slight increase in respiratory rate. At larger doses, respiratory centers in the medulla are stimulated. Onset: 1 min DOA: 5-12 mins IV Bolus: 0.5-1 mg/kg Infusion: 1-3 mg/min Max 4 mg/kg

Question 37

Capsaicin

Answer 37

TRPV1-receptor agonist Depletes substance P and inhibits pain signal transmission

Question 38

Neurokinin-1 Receptor Antagonist

Answer 38

Substance P is a neuropeptide that interacts with neurokinin-1 (NK1) receptors. NK1 antagonists inhibit substance P at central and peripheral receptors. Aprepitant, an NK1 antagonist, has been found to reduce PONV perioperatively and is additive with ondansetron for this indication

Question 39

Format

Answer 39

Induction Agent Diprivan Diisopropylphenol: binding to GABAa receptors to increase GABA affinity for GABAa receptors 10 mg/ml IV Onset: 15-30 secs DOA: 3-10 mins Induction:1.5-2.5 mg/kg Maintenance: 50-200 mcg/kg/min Sedation Infusion: 25-100 mcg/kg/min