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17 Cards in this Set
- Front
- Back
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Cimetidine (Tagament)
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relative contraindication
H2 receptor blocker inhibits lidocaine biotransformaion CHF (ASA III) - &darr CO to live and &uarr CO to brain |
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Nonselective b-blockers: Vasoconstrictors
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&uarr BP
reflex bradycardia dose related inderal, corgard |
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TCAs
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Management of major depression - Elavil
Enhance C action of exogenous vasopressors Hypertensive Crisis (Levonordefrin potentiated 5-10x, Epi potentiated 2x Limit patients on TCAs to 0.05 or 5.4ml of 1:100,000epi |
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MAOIs and vasoconstrictors
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treatment of major depression
potentiate action of vasopressor Inhibition of biodegradation (MAO) Hypertensive crisis Only rxn with phenylephrine Epi, NE, Levornordefrin shown not to interact |
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Phenothiazines and vasoconstrictors
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Psychotropic drug
Phenothiazines block vasoconstriction Side-effect - postural hypotension (suppress the vc action of epi and the vd action of the LA is unopposed) Use w caution, aviod IV injections |
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Cocaine and vasoconstrictors
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significant stimulatory CNS and CVS
NE release, inhibitsw reuptake at adrenergic nerve end Tachycardia and hypertension &uarr risk MI, sudden death Avoid vasoconstrictors in cocaine abusers or individuals using cocaine within 24 hrs of appt. |
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Malignant Hyperthermia
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only TRUE anesthetic (general) emergency
AD inheritance, reduced penetrance Males > Females Children > adults |
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Malignant Hyperthermia
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Psychological events a bigger concern than physical agents in triggering MH (stress, excitement)
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Etiology of MH
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Most agents used for induction of GENERAL ANESTHESIA
Succinylcholine, halothane, isoflurane, enflurane, d-tubocuraraine, gallamine, ethylene, ether, ethyl chloride Amide LAs are considered SAFE! |
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Management of MH
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mim of outpatient management
always approch w caution consider dantrolene sodium prophylactically (discuss w MD) Safe Drugs: Amide LAs, benzodiazepines, propofol, barbituates, droperidol, pancuronium |
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Treatment of MH
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stop procedure
100% oxygen by mask cooling transport to hospital ASAP! Once in hospital, Dantrolene 2.5 mg/kg iV, repeat until 10 mg/kg rea ched, blocks the Ca+ realease |
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Atypical Plasma Cholinesterase
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Bigger concern is GA using succinylcholine - prolonged apnea
Avoid complications by using Amide LAs |
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Methemoglobinemia
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Congenital or acquired
Cyanosis-like state in the absence of cardiac or resp abnormalities Patient exposed to drugs which increase the formation of ferric rather than ferrous ions-bound to hemoglobin Ferric ion has increased affinity for oxygen and overabundane leads to tissue hypoxemia / cyanosis |
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Sg/Sx of Methemoglobinemia
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Usually develop 3-4 hrs after admin of drug
Lethargy resp disterss cyanosis pale (ashen) skin color Death is rare |
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Dx Methemoglobinemia
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Diagnosis made by:
oxygen does not improve skin color or blood color Blood appears as chocolate brown |
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Txt of Methemoglobinemia
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1% methylene blue 1.5 mg/kg by slow IV infusion repeated every 4 hrs if cyanosis persists
Vit C 100-200 mg/day IV or IM |
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Etiology of Methemoglobinemia
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Acquired:
OD of Articaine (Septocaine) or Prilocaine LAs 1% Methylene blue-ferric to ferrous atoms 100% O2 - no significant improvement |
