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115 Cards in this Set
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prop of Halothane as anesthetic
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high lipid and blood solubility (high potency, slow induction, slow recovery time)
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prop of N2O as anesthetic
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low blood and lipid solubility--fast induction, low potency
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SE inhaled anesthetics
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cardiac, respir depression, N/V, increase cerbral BF
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toxicity of inhaled anesthetics
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halothane=hepatic
methoxyflurane=kidney enflurane=sz malignant hyperthermia (rare) |
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name inhaled anesthetics (6)
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halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, N2O
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how determine potency (formula) for anesthetics
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1/MAC
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general prop and use thiopental
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IV anesthetic=hi lipid solubility, used induction and short procedures. terminated by redistribution from brain. decr cerbral BF
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benzodiazepine used in anesthesia
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midazolam (IV anesthetic)
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midazolam use, prop
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(IV anesthetic, benzodiazepine) commonly for endo, adjunctively with gaseous anesthesias and narcotics. severe postop respir depression and amnesia
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midazolam toxicities
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severe postop respir depression and amnesia
(a benzo used in endoscopy) |
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ketamine, type Rx, use
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a PCP analog, IV dissociative anesthetic.
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SE ketamine
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cardio stim, increase cerebral BF,
-disorientation, hallucination, bad dreams |
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propofol use
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IV anesthetic, for rapid induction and short procedures, less post op N than thiopental
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Name depolarizing NM blockers
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Succinyl choline
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stages reversal of depolarizing NM blockers
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(succinyl choline)
1. prolonged depolar-no antidote, block is + by - CE 2. repolarized, blocked-use - CE (ie neostigmine) |
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name nondepolarizing NM block (5)
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tubocurarine, atracurium, mivacurium, pancuronium, vecuronium
(-curonium, -curium) |
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reversal atracurium
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(a non depol NM block)
an - CE (ie neostigmine, edrophonium) |
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dantrolene, mech, use (2)
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tx malignant hyperthermia (caused by inhaled anesthet exc N2O and succinylcholine).
tx neuroleptic malign syndrome mech: prevent Ca rel from SR skel mscl |
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name local anesthetics
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esters=procaine, cocaine, tetracaine
amides=lidocaine, bupivicaine |
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mech local anesthetics
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block Na channel to binding to specif R on inner portion channel. tertiary amines penetrate mem uncharged, then bind as charged
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order of nerve blocked w local anesthetics
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small>large diameter, myelyinated>nonmyelinated
small unmyelinated>sm myelinated>large myelinate |
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loss of sensations w nerve blockade
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pain (lose first)>temperature>touch>pressure
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SE local anesth, general, 2 specific Rx
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bupivicaine=severe cardiac tox
cocaine=arrhyth HTN |
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opoiod analges R
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act at opoiod receptors
mu=morphine delta=enkephalin kappa=dynorphin |
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dextramethorphan
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an opoiod used for cough suppression
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loperamide
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opoiod used for diarrhea
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diphenoxylate
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opoiod used for diarrhea
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generally opoiods used for 2 things
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1) pain
2) acute pul edema |
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methadone
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an opoiod used in maintenance for addicts
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toxicity of opoiods
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addiction, respir depression, constipation, miosis (pinpoint), additive CNS depression
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tx of opoiod OD
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naloxone, naltrexone (opoiod R antagonist)
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name NSAIDs
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ibuprofen, naproxen, indomethacin
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2 effects of NSAIDs
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1) reversibly inhibi COX1,2
2) block PG synthesis |
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toxicity of NSAIDs
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renal damage, aplastic anemia, GI distress, ulcers
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tx of opoiod OD
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naloxone, naltrexone (opoiod R antagonist)
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name NSAIDs
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ibuprofen, naproxen, indomethacin
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2 mech effects of NSAIDs
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1) reversibly inhibi COX1,2
2) block PG synthesis |
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toxicity of NSAIDs
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renal damage, aplastic anemia, GI distress, ulcers
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NSAIDs used for
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anti-pyretic, analgesic, anti-inflamm (indomethacin to close PDA)
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acetaminophen, how difft NSAID
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-rev inhibits COX mostly in CNS (inactiv peripher)
-anti-pyretic, analgesic, no anti-inflamm |
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toxicity acetaminophen, mech , how tx
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hepatic necrosis (depletes glutathione and forms toxic NADQI
(N acetylcysteine antidote) |
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mechanism of class I anti arrhyth
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local anesthetics, decr conduction, esp depolarized. decr slope 4 depolar, increase threshold in abnormal pace
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T/F class I antiarrhythm good for fast tachycardias
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yes, bc they are state dependent (they selectively depress tissue freq depolarized)
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class IA arrhytmics
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quinidine, amiodarone, procainamide, disopyramide
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class IB arrhytmics
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lidocaine, mexiletene, tocainide
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mexiletene
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class IB arrhytmic
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prop of IA arrhyth
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increase AP, incr ERP, incr QT
effect both atrial and ventricle |
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toxicity quinidine
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cinchonism
HA, tinnitus, thrombocytopenia, torsades de pointes |
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toxicity procainamide
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(IA) reseversible SLE-like
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prop IB arrhyth
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decr AP, affect ischaemia or depol Purknje and ventricular
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IB used for
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acute ventricular (esp s/p MI) and digitalis-induced
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pneu for IB Rx
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"IB Sancho (Na), I like mex taco"
IB Na, Lidocaine, mexiletene, toacainide |
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toxicity IB
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CNS stim/depress, cardiovas depression
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IC arrhyth
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flecainide, ecainide, propafenone
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propafenone
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IC arrhyth
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flecainide
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IC arrhyth
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prop/use IC
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no affect AP, useful in VT that ->VF or intractable SVT.
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toxicity IC arrhyth
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proarrhyth (esp s/p MI)
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summary AP duration class I
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IA- increase
IB- decrease IC- no change |
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what type Rx are II arrhyth?
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beta blockers
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mech II arrhyth
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decr cAMP, decr Ca, suppress abnl by decr slope ph 4. AV node esp sensitive
increase PR interval |
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how II arrhyth affect intervals
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incr PR (as do class IV)
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drugs that decr slope ph 4
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class I, II arrhyth
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name class II arrhyth Rx
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propanolol, esmolol (short t1/2), metoprolol, atenolol, timolol
(P MEAT) |
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toxicity II arrhyth
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same as SE beta blockers-impotence, exacerb asthma, CV (bradycardia, AV block, CHF), CNS (sedate, sleep). May mask hypoglycemia
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what type Rx III arrhyth
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K channel blockers
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name III arrhyth
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sotalol, ibutilide, bretylium, amiodarone, dofetilide "K IS BAD"
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dofetilide
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III arrhyth
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sotalol
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III arrhyth (NOT b blocker!)
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amiodarone
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both IA and III
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prop of III arrhyth
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incr AP duration, incr ERP, incr QT. used when others FAIL
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which incr QT
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IA, III
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toxicity sotalol
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torsades de pointes, excessive block
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toxicity ibtuilide
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t de pointes
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toxicity bretylium
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new arrhythmia, hypotension
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toxicity amiodarone
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pul fibrosis, hepatotoxic, change thyroid
also corneal deposit, photodermatitis, neuro, constipation, CVS |
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type Rx is IV arrhyth
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Ca blockers
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name IV arrhyth
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verapamil, diltiazem
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prop IV arrhyth
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mostly affect AV node, decr conduction, incr ERP, incr PR.
used in prevention nodal arrhythmias |
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toxicity IV arrhyth
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constipation, flushing, edema, CV (CHF, AV block, sinus node depression)
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adenosine use arrhyth
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diagnose/abolishing AV nodal arrhyth
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K+ in arrhyth, mech
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depress ectopic pacemakers, esp for digoxin toxicity
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Mg use in arrhyth
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t de pointes, digoxin toxicity
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effect statins
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much decr LDL, small decr tg, small incr HDL
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problems with statins
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expensive, reversible incr LFTs, myositis
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effect niacin on lipid
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decr LDL, incr HDL, sl decr TG
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problems with niacin
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red, flushed face which decr w longtime use
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names bile acid resins
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cholestyramine, colestipol
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effect of cholestyramine
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decr LDL, slight incr tg
(a bile resin) |
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problems w bile resins
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pts hate-tastes bad, GI discomfort
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ezetimibe
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cholesterol absorption blocker
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effect ezetimibe
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decr LDL
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toxicity ezetimibe
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rare incr LFTs
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colestipol
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a bile resin
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gemfibrozil
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a fibrate
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effect of fibrates
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decr LDL, incr HDL, big decr tg
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problem w fibrates
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myositis, incr LFTs
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mech fibrates
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stimulate LPL
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what step niacin inhibit
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cholesterol being secreted as VLDL
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name sulfonylurea
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tolbutamide, chlorpropamide, 2nd gen: glyburide, glipizide
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mech sulfonylureas
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stimulate ins release, closes K channel on beta-cell membrane incr Ca influx
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toxicities sulfonylurea
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hypoglycemia (more common with gly and glip)
disulfiram-like effects (not with gly and glip) |
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tolbutamide
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sulfonylurea
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chlorpropamide
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sulfonylurea
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mech metformin
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inhib gluconeo and incr glycolysis
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use of metformin
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both DMII, and DMI (doesn't require islet fxn)
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SE metformin
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lactic acidosis
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glitazones, name II
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pioglitazone, rosiglitazone
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mech glitazone
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incr target cell response to insulin (for DMII)
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SE glitazone
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weight gain, hepatotoxic (troglitazone)
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miglitol
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a glucosidase inhibitor
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mech a-glucosidase inhib
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inhibits brush border alpha glucosidases causing delay of hydrolysis, decr postprandial glu
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toxicity a-glucosidase inhib
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GI disturbance
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mech insulin R, effect?
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R has tyrosine kinase activity.
mscl-stim glycogen and protein syn adipose-incr tg storage |
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toxicity insulin, 2nd use
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hypoglycemia (rare hypersensit),
also used for hyperkalemia |