Pharmacology

Administration of methohexital produces modest decreases in systemic blood pressure that are transient due to compensatory increase in heart rate. This decrease in systemic blood pressure is principally due to peripheral vasodilatation. The resulting dilation of peripheral capacitance vessels leads to pooling of blood, decreased venous return and the potential for decreases in cardiac output […]

Etomidate is one of the few anesthetics that suppresses the adrenocortical axis. Etomidate causes adrenocortical suppression by producing a dose-dependent inhibition of the enzyme 11-beta-hydroxylase which is necessary for conversion of cholesterol to cortisol. This suppression lasts 4 to 8 hours after an induction dose of etomidate. Etomidate maintains hemodynamic stability and has little effect

Propofol has a direct smooth muscle effect on the bronchi, causing bronchodilation. Propofol decreases intracranial and intraocular pressure, and it does not potentiate neuromuscular blockade.

Metoclopramide stimulates gastric emptying, attenuates activity of the vomiting center and increases gastroesophageal sphincter tone. It must be administered at least 20 minutes prior to induction and its effect is decreased if administered in conjunction with an opioid. It acts on the dopamine receptor in the chemoreceptor trigger zone and thus can cause extrapyramidal effects.

Drug with ↓ solubility in blood = rapid induction and rapid recovery (NO ↓ solubility; Halothane ↑ solubility) Arteriovenous gradient = solubility in blood Drug with ↑ solubility in lipids = ↑ potency = 1/MAC MAC = Minimum Alveolar Concentration required to prevent 50% of subjects from moving in response to a noxious stimulus High

Hemostatic Agents Article: Comparison of Hemostatic Agents used in Vascular Surgery Surgiflo Sterile and absorbable hemostatic porcine gelatin matrix that is mixed with thrombin JMI (a protein substance produced through the interaction of thrombin of bovine origin and calcium chloride). FloSeal Bovine gelatin matrix, calcium chroride and plasma derived human thrombin Gelatin granules absorb blood and

Oxymetazoline (Afrin) Nasal spray α1 and α2 adrenergic agonist Rebound congestion after 3 days   Pseudoephedrine (Sudafed) α1 and α2 adrenergic agonist Used to make methamphetamine Rebound congestion if used more than 4-6 days

Albuterol (β2-Agonists) Relaxes bronchial smooth muscles (short acting) Used in acute exacerbation Salmeterol, formoterol (β2-Agonists) Long-acting agents for prophylaxis Adverse effects are tremors and arrhythmia Inhaled Corticosteroids (fluticasone, budesonide) Inhibits synthesis of all cytokines Inactivates NF-κB (transcription factor that induces production of TNF-α and other inflammatory agents) 1st line therapy for chronic asthma Muscarinic Antagonists

Neuromuscular Blocking Agents (NMBAs) Clinical Use of Neuromuscular Blockers in Anesthesia Depolarizing Succinylcholine (SCh) is the classic depolarizing agent, is an analogue of acetylcholine (ACh) that stimulates all cholinergic receptors throughout the parasympathetic and sympathetic nervous systems. SCh binds directly to the postsynaptic ACh receptors of the motor endplate, causing continuous stimulation of these receptors,

Opioids Percocet: Oxycodone-Acetaminophen Vicoden/Norco/Lortab: Hydrocodone-Acetaminophen Oxycontin/Roxicodone: Oxycodone Demerol: Meperidine Dilaudid: Hydromorphone   Mechanism of Action Act as agonists at opioid receptors (μ = β-endorphin, δ = enkephalin, κ = dynorphin) to modulate synaptic transmission—open K+ channels, close Ca2+ channels -> ↓ synaptic transmission. Inhibit release of ACh, norepinephrine, 5-HT, glutamate, substance P Clinical Use Pain,