ancillary anesthesia drugs

Question 1

which drugs used for sedation? when do you use them?

2 diff classes here.

1 class = 3 drugs

other class = 2 drugs

Answer 1

benzos: diazepam and lorazepam

1st gen-antihistamines: hydroxyzine, diphenylhradmine, promethazine

use for amnesci and calming effect (used night before for anxiolysis)

Question 2

what do you use for analgesia?what ADEs do they have?

Answer 2

morphine and codeine (but they have ADEs for ortho HypoTN, constipation, N/V, respiratory depression/coma)

NSAIDs(ketorolac and ibuprofen but worry about post-sx bleeding and fracture healing

Question 3

what do you use for aspiration pneumonitis?(2 drugs here)

Answer 3

neutralize acid w/H2 blockers: cimetidine and ranitdine = prevent new acid but you stilll have old contents in theree.

Question 4

which two antacids are used in the context of aspiration penumonitis?

Answer 4

bicitra and polycitra

Question 5

what do you use for prophylaxis to allergic rxn?

Answer 5

cimetidine and diphenhydramine

Question 6

why do you use anticholinergics in anesthesia

Answer 6

to dry secretions, prevent reflex bradycardia, also sedate/amnesia

Question 7

which three anticholinergics do you use?

Answer 7

atropine (bradycardia here)

glycopyrrolate(decreased secretions)

scopolamine( sedation/amnesia)

Question 8

which drugs used in rapid sequence intubation?(4 FLAV)

Answer 8

lidocaine(for increased ICP and brochospasm)

fentanyl (for increased ICP,bleeding, CV dz)

vecuronium(decrease ICP increse caused by succinlycholine)

atropine (decrease bardy Cardia caused by succinlycholine)

Question 9

which drugs used to hyopTN/what do you do for hypo tN?

Answer 9

GIVE fluids

give dopamine and phenylephrine or ephedrine

Question 10

all the drugs used in aspiration pneumonitis

5

2H2s

2antacadis

D2 central antagonist aslo used for emesis prevention in migraines

Answer 10

cimetidine

ranitidine

bicitra

polycitra

metoclopramide

Question 11

drugs used for N/V (3)

Answer 11

ondasestron

scopolamine

metoclopramide

Question 12

drugs used for CV support (3)

Answer 12

dopamine

phenylephrine

Question 13

4 drugs used in anaphylaxis prevention (HAME)

Answer 13

epinephrine

aminophylline

hydrocortisone

methylprednisolone

Question 14

an anti-dopamine/cholinergic/histaminergic drug used to mitigate anxiety?

Answer 14

promethazine

Question 15

2 1st gen anti histamines used to reduce anxiety with effects of bronchodilation, sedative, anxiolytic and analgesic?

Answer 15

hydroxyzine and diphenhydramine

Question 16

what are 3 major differences btw H1 and H2 antagonists?

H1 antagonist: diphenyhydramine, promezathine, hydroxyzine

H2 antagonist: cimetidine and ranitidine

Answer 16

H1 antagonists have following action: sedative, cholinergic antagonism and anti-emetic effect

Question 17

t/f. cimetidine has slight sedative action

Answer 17

true

Question 18

3 major problems of opiate receptor agonists

ONE = OD triad

Answer 18

1. orthostatic hyoptension, epigastric distress, antidiarrheal, and increased sphincter tone
2. N/V via chemoreceptor trigger(dopamine antagonism) + delay of GI transit + increased GI secretion
3. respiratory depressant + coma-inducing+miosis (OD triad)

Question 19

why are H2 receptor antagonists (cimetidine and ranititdine) use in the prophophylaxis against respiration pneumonitis?

what are their ADEs(3)?

Answer 19

1. fewer CNS effects and they lower the gastric pH
2. ADE: headache, confusion, seizures, agitation in old pp?

Question 20

why do pts receive bicitra and polycitra

Answer 20

b/c H2 antagonsists do not neutralize existsing stoamch contents or prevent gastric emptying

Question 21

which agent used to stimulate gastric emptying?

Answer 21

metoclopramide

NOTE: antagonized by anticholinergics and narcotics.

central effects dopamine antagonism: sedation and lowers seizure threshold.

Question 22

how much water needed to stimlate gastric stretch receptors to initate the process of natural stomach emptying?

Answer 22

150 mL

Question 23

which inhaled ansethetic is especially pro-emetic

Answer 23

nitrous oxide

Question 24

atropine - strongest effect

Answer 24

_anticholinergic _strongest: vagolytic - 3+; antisialoggoue effect; no sedation or amnesia

Question 25

scopalamine - MOA

Answer 25

**_anticholinergic:_** strongest effect: **_3+ sedation and amnesia_**; 2+ for antisialogogue; 1+ vagolytic

Question 26

glycopyrrolate MOA

Answer 26

**_antichiolinergic = MOA - 3+ ANTI-sialogogue effec_**t; 2+ vagolytic; 0 sedation and amnesia

Question 27

why use anticholinergics in pre-op? 3 reasosn

Answer 27

1. tx of reflex bradycardia 2. blcok muscuraic efffects of anti-cholinesterases 3. drying of secretions

Question 28

rapid sequence intubation: which drug described: what: **_decreased intracranial and brochospasitc reponse_** in increased ICP or penetrating injury, reactive airway disease

Answer 28

lidocaine

Question 29

RSI what: decreased sympathetic responses to laryngoscopy/intubation when: increased ICP, hemorrhage, cardiovascualr disease

Answer 29

fentanyl

Question 30

RSI what: mitigates bradycardia in response to succinlycholine in chidren under10 yrs

Answer 30

atropine

Question 31

what: defaciculates and mitigates ICP response to succinlycholne in increased intracranial pressure of penetrating injury

Answer 31

vecuroniu

Question 32

note sequence of rapid sequence intubation : IV push of sedative --\> succinycholine(neuromuscular blockade)

Question 33

which IV anesthetic agent has antiemetic qualities?

Answer 33

propofol

Question 34

after how many drugs does the risk of polypharmacy increase dramatically?

Answer 34

10

Question 35

bone cement and radio contrast dye are well known causative agents of what?

Answer 35

anaphylacxis in anesthesia

Question 36

what are the 4 components of INITIAL anaphylaxis management?

Answer 36

1. strop drug admin, discontinue anesthetisa 2. give O2 3. give Epinephrine 4. intravascular volume expansion

Question 37

drugs used in the prophylaxis of allergic reaction

Answer 37

cimetidine and diphenydramine (they prevent consequences fo the reaction, but do not prevent it from occuring)