Anesthesia Drug Cards Flashcards

Terms Definitions
Category: General anesthetic
Use: induction of anesthesia greater than 3yo; maintenance of anesthesia in 2m or older, sedation for mechanically intubated patients in an ICU setting
Unlabeled use: postop antiemetic, refractory delirium treatment
Contraindications: hypersensitivity to propofol, eggs, soybeans/soy products (contains egg lecithin and soybean oil)
Dose: 3-5 minutes between dosage changes, increase dose for chronic alcoholism, Onset 9-51 sec, Duration 3-10min
Children 3-16 yo 2.5-3.5 mg/kg over 20-30 sec
Adults: 2-2.5 mg/kg 40mg every 10 sec until onset of induction
Elderly: 1-1.5 mg/kg 20mg every 10 sec. until onset of induction
Children 2m-16yo 125-300 mcg/kg/min or 7.5-18 mg/kg/hr, children less than 5 may need larger doses
Adults: 100-200 mcg/kg/min or 6-12 mg/kg/hr
Elderly: 50-100 mcg/kg/min or 3-6 mg/kg/hr
Boluses: 25-50 mg
Precautions: hypersensitivity, anaphylaxis, angioedema, bronchospasm, hypotension, propofol related infusion syndrome (dysrhythmias, heart failure, rhabdo)
Adverse Reactions: Hypotension, movement, burning at site of infusion, rash, hypertriglyceridemia, respiratory acidosis
Mechanism of Action: global CNS depression possibly agonist actions of GABA receptors and reduced glutamatergic activity through NMDA receptor blockade
Protein binding 97-99%, hepatic water soluble, renal excretion
Half-life: initial 40 min; terminal 4-7 hrs.; 10+day infusion1-3 days
Class: NDNMB
Onset: 1-1.5 min
Duration: 30-60 min
Use: rapid sequence and routine intubation and skeletal muscle relaxant for surgery
MOA: blocks acetylcholine from binding to receptors on motor endplate inhibiting depolarization
Metabolism: hepatic (biliary excretion)
Supplied: 10mg/ml
Adverse Reactions: transient hypo/hypertension, arrhythmias, bronchospasms, hiccups, N/V, prolonged use acute quadriplegic myopathy syndrome, myositis ossificans
Drug Interactions: cardiac glycosides, steroids, quinine
Contraindications: prolonged 10-25 % renal and 70% hepatic disease
Class: Non Depolarizing NeuroMuscluar Blocker/cholinergic antagonist
Dose: Infants/Children Intubation 0.1-.15 mg/kg
Infusion .5-10 mcg/kg/min
Adults Intubating 0.15-2 mg/kg
Onset: 2-3m
Duration: 20-35 min
Use: adjunct to general anesthesia to facilitate intubation and relax skeletal muscle
MOA: blocks neural transmission of the myoneural junction by binding w cholinergic receptors
Metabolism: rapid nonenzymatic degradation in the bloodstream (Hofmann elimination) to laudanosine and inactive metabolites
Half life: 22-29 min Supply: 2mg/ml
Adverse Reactions: electrolyte imbalances, , myasthenia gravis, denervation, immobilization, bradycardia
Drug Interactions: quinine, corticosteroids, cardiac glycoside
Contraindications: sensitivity to cisatricurium
Name: Succinylcholine/Anectine/Quelicin
Category: depolarizing Muscle Relaxant
Use: muscle paralysis
Mechanism of Action: acts similar to acetocholine, producing depolarization at the motor endplate at the myoneural junction causing sustained flaccidity
Onset: 30-60 sec.
Duration: 5-15 min
Metabolism: hydrolosis by plasma cholinesterase to succinic acid and choline
Contraindication: muscle injuries, burn injury, prolonged immobilization and denervation
Dose: Children Initial 2-mg/kg maintenance 0.3-0.6 mg/kg, not to exceed 150mg
Adults Intubation 0.6 mg/kg (0.3-1.1)
RSI (rapid sequence intubation): 1-1.5 mg/kg
Laryngospasm 20mg
Supply: 200mg/10ml or 20mg/ml
Adverse reactions: Caution with children! HYPERKALEMIA, INC ICP/IOP, RHABDOMYLOSIS, dysrhythmias, tachycardia, bradycardia with repeated dosing, MYALGIA, myogolbinemia, Inc. intragastric pressure, masseter spasm, histamine release
Class: NDNMB
Dose: Children 0.1-.15mg/kg initial, 1-2.5 mcg/kg/min, intermittent bolus .1 mg/kg
Adults 0.08-.1 mg/kg intubation, maint. 0.8-1.2 mcg/kg/min
Onset: 2.5-3 min
Duration: 25-65 min
Use: intubation and relaxiaton of skeletal muscle during surgery
MOA: blocks acetylcholine from binding to receptors on motor endplate inhibiting
Metabolism: active metabolite: 3 desacetyl vecuronium, renal 40-50%, hepatic 50-60%
Half life: 65-75 minutes, late pregnancy 35-40 min
Adverse Reactions: electrolyte imbalances, resistance in burn patients, bradycardia, prolonged use acute quadriplegic myopathy syndrome, myositis ossificans
Drug Interactions: cardiac glycosides, steroids, quinine
Contraindications: prolonged with hepatic/renal disease, avoid in femal patients with renal failure
Supplied: 10mg/ml
Category: general anesthetic
Use: induction and maintenance of anesthesia, unlabeled use for seizures
Contraindications: hypersensitivity to etomidate
Induction: 10yo to adults 0.2-0.6 mg/kg over 30-60 sec. and
Maintenance: 5-20 mcg/kg/min
Procedural: 0.1-0.2 induction and 0.05 mg/kg every 3-5min as needed
Precautions: inhibits 11-B-hydroxylase and enzyme that helps in adrenal steroid production, inhibiting adrenal cortisol (adrenal insufficiency)
Adverse reactions: N/V, localized pain at injection site, myoclonus, uncontrolled eye movements, transient skeletal movements, hiccups, decreased cerebral metabolism and cerebral blood flow while maintaining perfusion pressure-premedicate with benzo to decrease myoclonus
Mechanism of Action: ultra short acting nonbarbiturate hypnotic, carboxylated imidazole which produces rapid induction of anesthesia
Onset: 30-60 sec
Duration: 3-5 min
Protein binding: 76%
Metabolism: hepatic and plasma esterases
Half-life: terminal 2.6hrs
Category: barbiturate, general
Use: general anesthetic, induction and general sedation unlabeled use-Wada test (half brain, memory/language)
Contraindications: hypersensitivity to barbiturates, porphyria
Dosing: Children
IM: 6.6-10mg/kg of a 5% (50mg/ml) solution
Rectal: (usual) 25 mg/kg of 1% (10mg/ml) solution
IV: (unlabeled use) 1-2 mg/kg of 1% solution
Procedural sedation (unlabeled)
IV: Initial 0.5 mg/kg to a max total of 2 mg/kg
Rectal 25mg/kg of a 10% solution given 5-15 prior to procedure, max dose of 500mg
Induction 1-1.5 mg/kg
Procedural (unlabeled): .75-1 mg/kg can redoes 0.5mg/kg every 2-5 min
Elderly: use low dose of adult dosing
Precautions: use caution with liver, renal impairment, cardiovascular disease, heart failure, severe anemia, extreme obesity, seizure disorders, may cause hypotension, respiratory depression, pulmonary patients, COPD, asthma, laryngospasm and muscle twitching US BOX WARNING: CONTINUOUS MONITORING IN A HOSPITAL SETTING WITH ACCESS TO RESUSITATVE DRUGS AND INTUBATION EQUIPMENT
Adverse reactions: cardiorespiratory arrest, circulatory depression, hypotension, anxiety, delirium, headache, and seizure, muscle twitching, asthmaticus, and laryngospasms
Mechanism of Action: ultra short acting IV barbiturate anesthetic
Onset: IV immediate, IM 2-5 minutes, Rectal 5-15 minutes
Duration: single dose IV 10-20 minutes, rectal 45 minutes
Metabolism: hepatic via dmethylation and oxidation
Category: general anesthetic
Use: induction and maintenance of general anesthesia
Contraindications: hypersensitivity to ketamine, increase in blood pressure
Dosing: Children
IM: 2-5 mg/kg
IV: .5-1 mg/kg
Continuous 5-20 mcg/kg/min
IM: 2-4 mg/kg
IV: 0.2-0.75 mg/kg
Continuous: 2-7 mcg/kg/min
Precautions: coronary artery disease, hypertension, tachycardia, confusion, respiratory depression, apnea, chronic alcohol use, delirium
Adverse reactions: arrhythmias, csf pressure increase, erythema, anorexia, nausea, salivation increased, vomiting, airway obstruction, apnea, laryngospasms, diplopia, anaphylaxis, confusion, hallucination (pre treat with benzos)
Mechanism of Action: cataleptic like state in which patient disassociated from surroundings, direct action on cortex and limbic system, noncompetitive NMDA receptor antagonist blocks glutamate
Onset: IV 30 sec, IM 3-4 min
Duration: IV 5-10 min, IM 12-25 min
Metabolism: hepatic via hydroxylation and N demethylation, excretion kidneys
Half-life: alpha 10-15 min, beta 2.5 hrs
Category: general anesthetic, inhalation
Use: induction and maintenance of general anethesia
Contraindications: hypersensitivity, malignant hyperthermia
Dosing: MAC
0-1m 3%, 6m-3y 2.8%, 3-12y 2.5%, 25y 2.6%, 40y 2.1 %, 60y 1.7%, 80y 1.4%
Precautions: reaction with CO2 absorbents (forms formaldehyde) respiratory irritation and carbon monoxide, respiratory depression
Adverse reactions: hypotension, agitation, nausea, vomiting, cough, somnolence, dizziness, salivation increase, laryngospasm, airway obstruction, apnea, shivering,
Mechanism of Action: alter activity of neuronal ion channels particularly the fast synaptic neuor transmitter receptors nicotinic acetylcholine, GABA, and glutamate
Onset: induction within 2 minutes
Duration: 90% decrement time, short .63 blood gas solubility
Metabolism: exhaled gases
Category: general anesthetic, inhaled, halogenated ether
Use: maintenance of general anesthesia
Contraindications: hypersensitivity genetic malignant hyperthermia
Dosing: 1.15% 44y, maintenance with nitrous oxide 1%-2.5%, without nitrous 1.5-3.5%
Precautions: hypotension to peripheral vasodilatation, reflex tachycardia, reparatory depression
Adverse reactions: arrhythmias, hypotension, mood changes, hyperglycemia, decreased cholesterol, hyperkalemia, ileus, nausea, vomiting, rare hepatic dysfunction, decreased BUN increased Cr., malignant hyperthermia, shivering, respirator depression
Mechanism of Action: gaba, glutamate, glycine binding (glycine receptors decrease movement)
Onset: 7-10 minutes
Duration: depends on blood concentration
Metabolism: exhalation
Category: general anesthetic, inhalation
Use: induction and/or maintenance of general anesthesia in adults, maintenance in children (not recommended for induction due to odor and coughing) lowest fat to blood solubility of inhaled anesthetics, may be useful in obese patients
Contraindication: hypersensitivity and malignant hyperthermia
Dose: adults 2.4% range 2.5-8.5% maintenance
Precautions: laryngospasms, coughing, malignant hyperthermia, elevated carbon monoxide levels (need absorbent), transient increase in blood pressure and heart rate, hypotension due to peripheral vasodilatation, , decrease in renal and hepatic blood flow, periop hyperkalemia,
Adverse reactions: N/V, cough, breath holding, delirium, headache, salivation increase, conjunctivitis, laryngospasms, pharyngitis,
Mechanism of Action: enhances inhibitory postsynaptic channel activity and inhibits excitatory synaptic activity
Onset: 1-2 minutes
Duration: depends on blood concentration , low gas solubility 0.42
Category: local anesthetic
Use: local anesthetic, post op pain management, OB procedures local and regional
Contraindication: hypersensitivity
Dose: Surgical Anesthesia
Lumbar epidural 15-30ml of .5-1% solution
Lumbar epidural block for cesarean 20-30ml of 0.5% or 15-20ml of 0.75%
Thoracic epidural block 5-15ml of 0.5%
Lumbar and thoracic continuous 6-14ml/hr of 0.2% solution 1-100ml of 0.2% or 1-40ml of 0.5%
Major Nerve Block:
35-50ml of 0.5% solution 175-250mg
10-40ml of 0.75% solution 75-300mg
Field Block: 1-40 ml dose of 0.5%
Labor pain management: initial10-20ml of 0.2% solution, continuous 6-14ml/hr of 0.2%
Peripheral nerve block continuous 5-10ml/hr of 0.2% solution
Precautions: restlessness, anxiety, drowsiness, liver, cardiovascular, neuro, and psychiatric precautions due to toxicity, hypotension, hypovolemic, heart block
Adverse reactions: hypotension, bradycardia, N/V, fever, headache,
Mechanism of Action: blocks both initiation and conduction of nerve impulses by decreasing neuronal membranes permeability to sodium ions, inhibiting depolarization
Pharmacokinetics: Onset: 3-15 minutes
Duration: dose and route dependent 3-15hrs
Metabolism: hepatic to metabolites, urine excretion 86%
Half-life: epidural 5-7 hrs
Category: local anesthetic
Use: local or regional anesthesia, spinal anesthesia OB
Contraindication: hypersensitivity
Dose: 12y-adult 0.25, 0.5, and 0.75% solutions 0.75% not for OB use
Local anesthesia infiltration .25% max 175 mg
Caudal block (preservative free): 15-30ml of 0.25-0.5%
Epidural block (preservative free): 3-5ml increments 10-20ml of .25-.5%
Peripheral nerve block: 5ml of 0.25-.5% solution max 400mg/day
Sympathetic nerve block: 20-50ml of 0.25%
Retrobulbar anesthesia 2-4ml of 0.75% solution
Precautions: 0.75% solution in OB cases cardiac arrest/death, respiratory arrest
Adverse reactions: seizures (toxicity), hypotension, heart block, and ventricular arrhythmias, N/V
Mechanism of Action: blocks initiation and conduction of nerve impulses, decreasing permeability of sodium ions, inhibiting depolarization
Onset: 1-17 minutes
Duration: 2-9hrs
Metabolism: hepatic, excreted renal
Half-life: neonates 8.1 and adult’s 2.7hrs
Name: Lidocaine/xylocaine
Category: antiarrhythmic, local anesthetic
Use: local, regional anesthesia, acute treatment of ventricular arrhythmias
Contraindication: hypersensitivity, Adam stokes syndrome, heart blocks, allergies to Corn
Dose: antiarrhythmic-.5-1mg/kg, gtt 20-50mcg/kg/min not to exceed 20 if shock, hepatic disease, intratracheal 2-3mg/kg
Anesthetic: MAX 4.5mg/kg not to exceed 300mg within 2hrs
Concentration 2g in 250ml D5W 1mg/min= 7.5ml/hr etc
Precautions: hepatic failure, reduce dosing 0.75mg/min or 10mcg/kg/min max dose 1.5mg/min or 20mcg/kg/min
Adverse reactions: arrhythmia, bradycardia, arterial spasms, edema heart block, hypotension etc
Spinal= headache, shivering, nausea, peripheral nerve symptoms, double vision, respiratory inadequacy
Mechanism of Action: decreases permeability of sodium ions, inhibits depolarization
Onset: single bolus 45-90 seconds
Duration: 10-20 minutes
Metabolism: 90 % hepatic, can accumulate cause CNS toxicity
Protein binding: 60-80%
Half-life: biphasic, initial 7-30 min terminal infants 3.2 hrs adults 1.5-2hrs
Class: NDNMB
Dose: Children 0.06-.1 mg/kg or 0.05 mg/kg after succs, maint. 0.01 mg/kg 60-100 min after initial dose
ADULTS Intubation 0.08-.12 mg/kg, Maint. 0.06-0.1mg/kg then 1-2 mcg/kg/min
Onset: 2-3 min
Duration: 60-100 min
Use: intubation and skeletal muscle relaxant
MOA: blocks neural transmission at the myoneural junction by binding with cholinergic receptor sites
Metabolism: renal, some hepatic 30-45%
Half life: 110 min
Supplied: 1-2mg/ml
Adverse Reactions: Vagolytic, slight indirect catecholamine release, tachycardia, increased BP and HR increased, salivation, prolonged use acute quadriplegic myopathy syndrome, myositis ossifications
Drug Interactions: cardiac glycosides, steroids, quinines, loop diuretics (decreased efficacy)
Contraindications: renal disease
Class: NDNMB
Dose: Children 0.3-0.5 mg/kg then 0.08-.1 mg/kg 20-45 after for maintenance
Adults 0.2-0.4 mg/kg
ICU: 5-13 mcg/kg/min
Onset: 2-3m
Duration: 20-35 min to 95% control 60-70 min
Use: relax skeletal muscle for surgery
MOA: blocks neural transmission at the myoneural junction by binding with cholinergic receptor sites
Metabolism: ester hydrolysis and hofmann elimination
Adverse Reactions: histamine release, flusing, erythema, hives
Drug Interactions: quinine, cardiac glycosides, corticosteroids
Contraindications: reduce and inject slowly for patients with cardiovascular disease, histamine release (secure airway), electrolyte imbalances, myasthenia gravis, eaton-lambert syndrome, resistant in burn patients
Supplied: 10mg/ml
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