Peak too high: Decrease the amount of each dose.

Trough too high: Decrease the frequency of doses (increase time interval between doses)


  • Increase cardiac work, O2 use, cerebral blood flow, secretions and BP.
  • No respiratory depression
  • Hallucinations
  • Contraindicated in patients with head injury
  • Amnesia/Analgesia
  • Good for children


  • Very rapid distribution on/off; amnesia, sedative.
  • Hypotension
  • Respiratory Depression
  • Safe in head injury patients
  • No analgesic
  • Propofol is lipid based: Do not use in patents with egg allergy
  • Metabolized in Liver and by plasma cholinesterase

Methoxyfluorane: has renal toxicity.

Halothane: is hepatotoxic

Succinylcholine: (Non-Competitive Ach receptor antagonist)

  • The only depolarizing agent used
  • (short half life) Metabolized by plasma cholinesterase
  • Many side effects: high ICP, Malignant hyperthermia, Hyperkalemia
  • Don’t use in: Burn patients, Neuro/spine injuries, massive trauma, acute renal failure, glaucoma, atypical cholinesterases.

Clindamycin: prolongs neuromuscular blockade

Demerol: should be avoided in patients on MAOIs

Octreotide: long-acting somatostatin analog

Reglan (metoclopramide): Prokinetic

  • Dopamine receptor blocker
  • Increase LES tone
  • Increase gastric motility

Zofran (Ondasetron): Serotonin receptor inhibitor, antiemetic

PPIs: blocks H+/K+ ATPase pump

  • Associated w/ enterochromaffin hyperplasia in rats but no evidence of carcinogenecity in humans.

Digoxin: Glycoside inhibits Na-K ATPase to increase Ca++ in heart.

  • Slows AV conduction
  • Inotrope but does not increase O2 consumption.
  • Associated with ischemic gut, decrease splanchnic flow.
  • Avoid hypokalemia

Amrinone: phosphodiesterase inhibitor

  • Inotrope, increase CO, decrease SVR

Metyrapone and Aminoglutethimide:

  • Medical adrenalectomy

Leuprolide: medical orchiectomy


  • Reduces splanchnic blood blow, portal flow ~40%
  • Useful in GIB, give with ß-blocker to avoid angina

Sodium nitroprusside: Relaxes arteries and veins; has cyanide toxicity

Nitroglycerin: Primarily relaxes veins


  • Irreversibly binds cyclooxygenase
  • Effective for life of platelets (~7 days)


  • Blocks PG production
  • Used to close PDA (effective in ~70%)
  • Decrease renal blood flow


  • Replaces PGE2 (cytoprotective)
  • For patients on NSAIDS, to reduce PUD

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