Term
Narcan (Naloxone) 1 of 2
Class
Dose
MOA |
|
Definition
Opioid Antagonist
1-4 mcg/kg IV; 5mcg/kg/hr IV gtt
Competitively binds at all 3 opioid receptors. |
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|
Term
Narcan (Naloxone) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
2 min/30-45 min.
May need to redose d/t short DOA, N/V, SNS activation, may antagonize volatile anesthetic. |
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|
Term
Robinul (Glycopyrolate) 1 of 2
Class
Dose
MOA |
|
Definition
Anticholinergic (decreases salivation, increases HR, relaxes smooth muscle)
0.2 mg IV per 1 mg of Neostigmine (ex. 4 mg Neostig. 0.8mg of Robinul). 0.2 mg IV to reduce secretions.
Offsets the parasympathomimetic effects (dec. HR) of Neostigmine during reversal of muscle relaxation. (Anticholinergic = increased HR) |
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Term
Robinul (Glycopyrolate) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
2-3 min/30-60 min.
Effective for decreased oral secretions, intraop bradycardia. Does not cross BBB. Can lower LES pressure and cause reflux. |
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|
Term
Neostigmine (Prostigmine) 1 of 2
Class
Dose
MOA |
|
Definition
Anticholinesterase (facilitates the build up of Ach at the NMJ, reversing the effects of NDNMB.
0.043 mg/kg IV
70 kg = 3 mg
80 kg = 3.4 mg
90 kg = 3.9 mg
100 kg = 4.3 mg
Max of 5 mg
Inhibits acetylcholinesterase at the NMJ, facilitating the build up of Ach. The Ach and NDNMB balance shifts in favor of Ach. |
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|
Term
Neostigmine (Prostigmine) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
50% reversal in 3 min, 100% reversal in 7 min.
50/50 renal and hepatic clearance, overdose effects include bradycardia, salivation, bronchoconstriction, and abd cramps. Treated with atropine. Also used in the treatment of Myasthenia Gravis, glaucoma, and Alzheimer’s. |
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|
Term
Vecuronium (Norcuron) 1 of 2
Class
Dose
MOA |
|
Definition
Neuromuscular Blocking Agent (non-depolarizing)
0.1 mg/kg (Intub)
70 kg = 7 mg
80 kg = 8 mg
90 kg = 9 mg
100 kg = 10 mg.
1 mcg/kg/min maintenance gtt
Binds to cholinergic receptors antagonizing/blocking the effects of Ach. |
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Term
Vecuronium (Norcuron) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
| 3-5 min/20-35min. BOTH hepatic and renal metabolism. |
|
|
Term
Zemuron (Rocuronim) 1 of 2
(10 mg/ml)
Class
Dose
MOA |
|
Definition
Neuromuscular Blocking Agent (non-depolarizing)
1 mg/kg (Intub)
3-12 mcg/kg/min maintenance gtt.
Binds to cholinergic receptors antagonizing/blocking the effects of Ach. |
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Term
Zemuron (Rocuronim) 2 of 2
(10 mg/ml)
Onset/Duration
Anesthetic Implications |
|
Definition
90 seconds/ 20-35 min.
70% hepatic, 30% renal metabolism. No histamine release and no CV changes. Can be used in place of SUX in RSI. |
|
|
Term
Succinylcholine (Anectine, Quelicin) 1 of 2
(20 mg/ml)
Class
Dose
MOA |
|
Definition
Neuromuscular Blocking Agent
(depolarizing)
1-1.5 mg/kg (Intub)
JJN says give everyone 100 mg!
Mimics Ach at the NMJ causing continuous depolarization and prevents further transmission of nerve imp. |
|
|
Term
Succinylcholine (Anectine, Quelicin) 2 of 2
(20 mg/ml)
Onset/Duration
Anesthetic Implications |
|
Definition
30-60 seconds/
3-5 min.
DON’T GIVE IF:
• Hx of MH
• High K
• Trauma/Burn
• Kids
• Neuromuscular Disorders
• Increased ICP/IOP/IGP
Side Effects: Dysrhythmias, Hyperkalemia, Myalgia r/t fasiculations, Myoglobinuria, etc.. |
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|
Term
Ephedrine 1 of 2
Class
Dose
MOA |
|
Definition
Sympathomimetic
5-25 mg IV
Indirectly stimulates alpha- and beta-adrenergic receptors, by stimulating the release of NE. Also has some direct adrenergic stimulation. |
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Term
Ephedrine 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Immediate
First line drug for intraoperative hypotension in the absence of tachycardia. |
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Term
Kytril (Granisetron) 1 of 2
Class
Dose
MOA |
|
Definition
5-HT3-receptor antagonist. (more selective than Zofran)
0.02-0.04 mg/kg IV
70 kg = 2 mg
80 kg = 2.4 mg
90 kg = 3 mg
100 kg = 3-4 mg
Blocks serotonin from binding to 5-HT3 receptors, producing an antiemetic effect. |
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Term
Kytril (Granisetron) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
30 min / elimination ½ time is 9 hours.
Lasts 2.5 times longer than Zofran, concomitant dosing with Decadron improves antiemetic effects, expensive.
Side effects (mild): HA, sedation, and diarrhea. |
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|
Term
Reglan (Metoclopramide) 1 of 2
Class
Dose
MOA |
|
Definition
GI prokinetic
10-20 mg IV results in increased LES tone and decreased stomach contents.
Dopamine receptor antagonist, produces cholinergic stimulation of the GI tract. |
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Term
Reglan (Metoclopramide) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
15-30 min/ elimination ½ time is 2-4 hours.
Treatment of diabetic gastroparesis, GERD, and nausea. Give over 3-5 min to prevent cramping. Side effects include: Cramping, extrapyramidal effects resembling Parkinson’s, may increase effects of sedatives, may prolong the effects of Sux. |
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Term
Benadryl (Diphenhydramine) 1 of 2
Class
Dose
MOA |
|
Definition
Histamine-1 receptor antagonist
25-50 mg IV
Blocks Histamine at H1 receptors. |
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|
Term
Benadryl (Diphenhydramine) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
30mins/3-6 hours
Clinical uses include: relief of itching, allergic rxn’s, sedation, and PONV.
Side effects: anticholinergic effects (tachy, dry mouth), somnolence. |
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|
Term
Decadron (Dexamethasone) 1 of 2
Class
Dose
MOA |
|
Definition
Synthetic Corticosteroid
4 mg IV
Produces antiemetic effects by reducing surgical inflammation and increasing endorphins. |
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|
Term
Decadron (Dexamethasone) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Elimination ½ life is 3 hours, but antiemetic effects can last 24 hours
Administer at the beginning of surgery. Multimodal interventions (i.e. Zofran and Decadron) for antiemetic therapy should be reserved for pt’s at high risk for PONV. |
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Term
Toradol (Ketorolac) 1 of 2
Class
Dose
MOA |
|
Definition
NSAID
15-30 mg IV
Blocks the inflammatory effects of the enzymes COX and COX-2. |
|
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Term
Toradol (Ketorolac) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
45-60 min/ 4-5 hours
Potentiates opioids. Increases bleeding time. May cause Bronchospasm in asthmatics. Potential for renal toxicity in pt’s with renal dysfunction. |
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|
Term
Gentamycin 1 of 2
Class
Dose
MOA |
|
Definition
Antimicrobial (Macrolide)
1-2 g IVPB
Inhibits bacterial protein synthesis. |
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|
Term
Gentamycin 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
n/a
Large doses can cause neuromuscular block. Can cause colitis and significant diarrhea. |
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|
Term
Clindamycin 1 of 2
Class
Dose
MOA |
|
Definition
Antimicrobial (Macrolide)
1-2 g IVPB
Inhibits bacterial protein synthesis. |
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|
Term
Clindamycin 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
n/a
Large doses can cause neuromuscular block. Can cause colitis and significant diarrhea. |
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|
Term
Vancomycin 1 of 2
Class
Dose
MOA |
|
Definition
Antimicrobial
1 g IVPB
Inhibits bacterial cell wall synthesis. |
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|
Term
Vancomycin 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
n/a
Poorly absorbed from GI tract. Useful against staphylococcus. Alternative for patients who are allergic to PCN. Rapid infusion can cause hypotension and cardiac arrest secondary to histamine release. “Red-man syndrome” |
|
|
Term
|
Definition
| Antimicrobial 2 g IVPB Inhibits bacterial cell wall synthesis. |
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|
Term
Ampicillin 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
n/a
Don’t give to pt with PCN allergy. High incidence of skin rash. Renal excretion. |
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|
Term
Ancef (Kefzol, Cefazolin) 1 of 2
Class
Dose
MOA |
|
Definition
Antimicrobial
1-2 g IVPB
Inhibits bacterial cell wall synthesis. |
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|
Term
Ancef (Kefzol, Cefazolin) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
n/a
Extensive renal excretion. Alternative to patients who are allergic to PCN. |
|
|
Term
Neosynephrine (Phenylephrine) 1 of 2
Class
Dose
MOA |
|
Definition
Sympathomimetic
40 -100 mcg IV,
20 -50 mcg/min continuous gtt.
Direct acting alpha-adrenergic stimulation producing vasoconstriction of vascular smooth muscle. |
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|
Term
Neosynephrine (Phenylephrine) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Prompt onset (IV).
Treatment of intraoperative hypotension in the presence of tachycardia. |
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|
Term
Heparin 1 of 2
Class
Dose
MOA |
|
Definition
Anticoagulant
Prophylaxis against Venous Thromboembolism, 5000 units SQ.
Binds to antithrombin which then inactivates coagulation enzymes. Primarily heparin inhibits the activation of Factor V and VII. |
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Term
Heparin 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Effects and intensity increases disproportionately as dose increases.
PTT normally is 30-35 seconds, heparin increases 1.5 to 2.5 x. Effective in prevention of venous or pulmonary embolism. Side Effects: Hemmorhage, thrombocytopenia, allergy, decreases in MAP and PAP, altered protein binding, altered cell morphology, and decreased antithrombin. |
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|
Term
Vasotec (Enalapril) 1 of 2
Class
Dose
MOA |
|
Definition
ACE inhibitor
0.625-1.25 mg IV
Blocks the conversion of angiotensin I to angiotensin II, which is responsible for increased vascular smooth muscle constriction, aldosterone secretion, and SNS stimulation. |
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|
Term
Vasotec (Enalapril) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Prompt onset (IV).
1-2 hours PO / 18-30 hours PO
Renal excretion, lower dose in pt’s with renal dysfunction. |
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|
Term
Lopressor (Metoprolol) 1 of 2
Class
Dose
MOA |
|
Definition
Beta Blocker
1-15 mg IV
50-400 mg PO
Binds to beta adrenergic receptors, blocking the catecholamines or other sympathomimetics from provoking beta responses. |
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Term
Lopressor (Metoprolol) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Prompt onset (IV).
Elimination ½ time is 3-4 hours.
Hepatic clearance. No metabolites.
May cause bronchoconstriction in asthmatics. |
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|
Term
Esmolol (Brevibloc) 1 of 2
Class
Dose
MOA |
|
Definition
Beta Blocker
10-80 mg IV,
50-300 mcg/kg/min continuous gtt.
Binds to beta adrenergic receptors, blocking the catecholamines or other sympathomimetics from provoking beta responses. |
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|
Term
Esmolol (Brevibloc) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
60 sec/ 10-30 min
Rapid onset, short acting. Excellent for blunting sympathetic response to laryngoscopy (150mg, 2 min prior). |
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Term
Etomidate (Amidate) 1 of 2
Class
Dose
MOA |
|
Definition
GABA-mimetic/ IV Induction Anesthetic
0.2-0.4 mg/kg IV induction
70 kg = 21 mg
80 kg = 24 mg
90 kg = 27 mg
100 kg = 30 mg
Mimics the inhibitory transmitter GABA; Cl ion channels open, making the threshold potential more negative and inhibiting the transmission of further impulses. |
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Term
Etomidate (Amidate) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Peak levels < 60 sec, elimination ½ time 2-5 hours.
Cardiovascular stability, pain on injection, MYOCLONIA, and adrenocortical suppression. |
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Term
Lidocaine 1% 1 of 2
Class
Dose
MOA |
|
Definition
Local Anesthetic
30 mg IV prior to IV administration of Propofol.
Prevents transmission of nerve impulses by inhibiting passage of Na ions through Na channels in nerve membranes, slowing the rate of depolarization, until threshold is no longer reached and action potential cease to fire. |
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Term
Lidocaine 1% 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Rapid onset, 60-90 min (Spinal).
300 mg Max single dose
Toxic plasma conc. > 5 mcg/ml |
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|
Term
Propofol (Diprivan) 1 of 2
Class
Dose
MOA |
|
Definition
GABA-mimetic/ IV Induction Anesthetic
1.5 -2.5 mg/kg IV induction
70 kg = 140 mg
80 kg = 160 mg
90 kg = 180 mg
100 kg = 200 mg
Conscious sedation
25-100 mcg/kg/min
Anesthesia
100-300mcg/kg/mi
Mimics the inhibitory transmitter GABA; Cl ion channels open, making the threshold potential more negative and inhibiting the transmission of further impulses. |
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Term
Propofol (Diprivan) 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Rapid onset.
Rapid onset and rapid redistribution. Significant CV effects. Low incidence of PONV. Pain on injection. Decreases in tachycardia and HTN in post CABG pts. Side effects: allergic rxn, lactic acidosis, and seizures. Supports growth of bacteria. Discard unused syringes of Propofol after 6 hours. |
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Term
Atropine 1 of 2
Class
Dose
MOA |
|
Definition
Anticholingergic
15-70 mcg/kg IV Blocks cholinergic receptors leading to an increase in HR. |
|
|
Term
Atropine 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
|
|
Term
Epinephrine 1 of 2
Class
Dose
MOA |
|
Definition
Sympathomimetic
2-8 mcg IV (single dose), 1-20 mcg/min continuous gtt.
Binds to adrenergic receptors leading to an increase in HR, myocardial contractility, and vascular and bronchial smooth muscle tone. |
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|
Term
Epinephrine 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Rapid IV onset.
Stimulates alpha and beta receptors. Clinical uses: prolong local anesthesia, allergic rxn, ACLS, continous infusion for myocardial contractility. |
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|
Term
Lidocaine 1 of 2
Class
Dose
MOA |
|
Definition
Antidysrhythmic
2 mg/kg IV, followed by 1-4 mg/min continuous infusion.
Decreases the rate of spontaneous phase 4 depolarization, by preventing the permeability of Potassium during this phase. |
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Term
Lidocaine 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Rapid IV onset.
Use for ventricular dysrhythmias. Hepatic metabolism. Toxic effect include CNS depression, seizures, apnea, and cardiac arrest. |
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Term
Vasopressin 1 of 2
Class
Dose
MOA |
|
Definition
Hormone
40 Units IV (ACLS dose in place of Epinephrine), one time dose.
Direct vasoconstrictor. |
|
|
Term
Vasopressin 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Rapid IV onset.
Studies have shown that vasopressin is more effective than epinephrine in cases of asystole and refractory cardiac arrest. |
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Term
Labetalol 1 of 2
Class
Dose
MOA |
|
Definition
Beta Blocker (also has alpha effects)
0.1-0.5 mg/kg IV
(20-80 mg IV).
Binds to beta adrenergic receptors, blocking the catecholamines or other sympathomimetics from provoking beta responses. |
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|
Term
Labetalol 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Maximum effect 5-10 minutes.
Side Effects: orthostatic hypotension, bronchospasm, CHF, and bradycardia. Use diuretics with long term therapy. |
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Term
Albuterol 1 of 2
Class
Dose
MOA |
|
Definition
Sympathomimetic (Beta-2 agonist)
Inhaler - 100 mcg per puff x 2
Nebulizer – 2.5 – 5 mg.
Binds to Beta-2 Adrenergic receptors leading to bronchodilation. |
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|
Term
Albuterol 2 of 2
Onset/Duration
Anesthetic Implications |
|
Definition
Prompt onset.
Side Effects: Tachycardia and hypokalemia. |
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