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
- Contraindicated in patients with head injury
- Good for children
- Very rapid distribution on/off; amnesia, sedative.
- 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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