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46 Cards in this Set

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What drug is the most rapid onset, ultra short acting muscle relaxant for intubation?
Succinylcholine

(Depolarizing NMB.)
Adverse Effects of Neosynephrine
Organ failure due to vasoconstriction.
Increased SVR and CHF due to vasoconstriction.
(Only use it long enough to restore volume.)
Which induction agent do you give to pts with cardiac disease?
Etomidate (does not decrease BP and CO)
What drug do you give for prevention of bradycardia?
Glycopyrrolate
What drug is an antisialagogue?
Glycopyyrolate
What are the drugs in a Basic Setup
Atropine,
Ephedrine,
Lidocaine,
Succinylcholine,
Phenylephrine (Neosynephrine),
Nitroglycerine,
Propofol,
Etomidate,
Thiopental
What are some side effects of Succinylcholine
Hyperkalemia
triggers malignant hyperthermia
Profound bradycardia with 2nd or 3rd dose.
Muscle fasciculations followed by brief flaccidity
What drugs do you give to trauma patients for intubation? For sedation?
Intubation: Ketamine
Sedation: Scopolamine
What is a side effect of scopolamine?
Can cause CNS excitability in awake pts (b/c it's an anticholinergic.)
Mydriasis
Cycloplegia
What is an adverse effect of Narcan?
CV stimulation or pulmonary edema if too much too fast.

If you use it in pts that are in alot of pain, they will be hurting for 1-4 hours.
What medication enhances the effects of 5-HT3 Antagonists?
Decadron
Name the prophylactic antiemetics?
Zofran (Ondansetron),
Anzemet (dolasetron),
Kytril (Granisetron)

(All are 5-HT3 receptor antagonists)
What drug reverses Versed?
Flumazenil
What are the side effects of Ketamine?
Hypotension with volatile Anesthetics,
Emergence Delirium, Increased Salivation (give glycopyrrolate), Increased ICP and cerebral O2 consumption, Vasoconstriction, increased BP and HR, spontaneous limb movements.
What is an adverse effect of Flumazenil
Can cause seizure in pt's who are on anti-epileptic drugs bc it reverses them.
What are the effects of Phenergan?
Antihistamine, Sedative, Antiemetic
Contraindications for Ketamine?
Severe CAD, Uncontrolled HTN, CHF, Arterial aneurisyms, pts with poor right ventricular function.

Pts who are already receiving volatile anesthetics (can cause dec. BP)

Patient's with a persoan/family hx of malignant hyperthermia
Contraindications for Doxapram/ Dopram
Do not give to pts on narcotics.
Do not give to pts with epilepsy, cerebral edema, or CVA.
What drug to you give tor symptomatic bradycardia?
Atropine. Blocks M2 receptors.
What are the adverse effects of Succinylcholine?
Elevates serum K+
Triggers Malig. Hyperthermia,
Profound Bradycardia w/ 2nd or 3rd dose
Causes muscle fasciculations followed by brief flaccidity
Will potentiate the effects of the other NMB's
Anaphylaxis
What are the Adverse Effects of Propofol?
Pain on injection
Allergic rxns with peanut allergy
Hypertriglyceridemia
Bradycardia that is less responsive to atropine
Decreased interocular pressure
Hypotension: (Use caution w/ cardiac pts: CHF, CAD (give etomidate instead))
Resp. Suppression with lactic acidosis
Bacterial Growth
Altered pharyngeal function - increased risk of imparied upper airway.
What are some Adverse Effects of Etomidate
Pain on injection
Myoclonus (premedicate w/ an opiod to prevent)
Transiently depressed adrenocortial function
N/V
Adverse Effects of Thiopental?
Decreases BP and CO
EKG changes (Use caution with cardiac pts..use etomidate instead)
Immunosuppression with long-term doses.
Uses of Epinephrine?
Increase HR, Contractility, Extreme Anaphylaxis, prolongs the duration of local anesthetics,cardiopulmonary resuscitation.
Metabolic effects of epinephrine?
Glyconeogenesis,
Lipolysis, increases lipids, cholesterol, inhibits insulin secretion (hyperglycemia)
Glycogenolysis in skeletal muscle
Radial muscle contraction -mydriasis.
Downsides of Propanolol
Duration: VERY LONG (reduces the ability to reverse with sympathomimetrics)
AE: Lack of selectivity: cause bronchoconstriction/ bronchospasm - blocks Beta 2 receptors
Downside of Labetalol?
Orthostatic hypotension due to the alpha 1 blockade ...be cautious in outpatient sx.
Adverse Effect of Hydralazine?
May cause reflex tachycardia. Follow with a beta blocker if necessary to control heart rate
Uses of Terbutaline?
Smooth Muscle Dilator
Uses: Vasodilation, Bronchodilation, Arrest of pre-term labor
Non-Depolarizing NMB's
Vecuronium
Rocuronium
Atracurium
Cistracurium
Doxacurium
Two NMB reversal agents
Neostigmine

Edrophonium
What are the three areas of interaction in the Drug Decisons?
1 - The clinical status of the pt
2- Effect of anesthesia on the pt
3- Effect of surgery on the pt
What drug causes amnesia effects without anesthesia and is used with trauma patients?
Scopolamine
Qualities of non-depolarizing NMB's
Block nicotinic receptors at the neuromuscular junction.
Prevent ACh from binding to nicotinic receptors.
Prevent depolarization of the muscle membrane - Paralysis.
Require reversal to ensure a return to baseline. Keys to reversibility are:
->Body temp: want normal.
->Drug Effect: how much is onboard the time of reversal
->Body pH - normal desired.
Are potentiated by volatile anesthetics.
Duration of action variability b/n drugs.
What non-depolarizing NMB can cause histamine release if large doses are given IV rapidly?
Atracurium

Can cause hypotension.
What non-depolarizing NMB has the most rapid onset and the longest duration?
Rocuronium

Duration = 20+ min.

Actually, L, Norcuron lasts 20-35 min; Nimbex lasts up to 45 min, and Doxacurium lasts 60-100 minutes.
NMB Dose After Succinylcholine:
Sux only lasts 2-3 min. You give a nondepolarizing NMB 5-10 min after Sux, When sux wears out.

The dose of NMB after succinylcholine will be less than the normal dose.
Intubating Dose
Requires a higher than normal dose of NMB's to provide a fast intubation
How do NMB reversal agents work?
Anticholinesterases: inhibit acetylcholinesterase, an enzyme that breaks down acetylcholine.

Increase ACh in synapse competes with the nicotinic blockers until it wins.

Neostigmine and Edrophonium
What drug must you give with neostigmine and why?
Glycopyrrolate. Neostigmine provokes profound Vagal Stimulation and bradycardia - - can stop the heart.
What drug must you give with Edrophonium and why?
Atropine

Edrophonium provokes profound Vagal Stimulation and bradycardia - - can stop the heart.
What drug is "The Magic Potion" and why?
Doxapram/ Dopram

A respiratory and CNS stimulant. Can cause awakening and resp stimulation in somnulent patients. Not for narcotized pts.
What are the adverse effects of Nimbex?
Hypotension, reflex tachycardia.

(Does not cause histamine release like atracurium.)
What is the only cholinergic that does not cross the blood brain barrier?
Glycopyrrolate

(No CNS side effects)
What is a side effect of glycopyrolate
relaxation of the lower esophageal sphincter...greater risk of aspiration
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