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Anesthesia Pharmacology © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 5 © Jones & Bartlett Learning, LLC Anesthesia© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION PharmacologyNOT FOR SALE OR DISTRIBUTION CONTENTS © Jones & Bartlett■■ Pharmacology Learning, Pearls LLC © Jones & Bartlett Learning, LLC NOT FOR SALE■■ Volatile OR AnestheticsDISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ Sedation, Anxiolytic, Amnestic ■■ Alpha 2 Agonists ■■ Induction Agents ■■ Total Intravenous Anesthetic (TIVA) © Jones & Bartlett Learning,■■ Narcotic LLC Opioids © Jones & Bartlett Learning, LLC ■■ NOT FOR SALE OR DISTRIBUTIONNonopioid Analgesics NOT FOR SALE OR DISTRIBUTION ■■ Agonist–Antagonists (Partial Agonists) ■■ Antagonist Agents ■■ Muscle Relaxants ■■ Anticholinesterase ■■ Anticholinergic © Jones & Bartlett Learning, LLC ■■ Antiemetics—Receptor© Jones Specific & andBartlett Adjunct Learning, LLC NOT FOR SALE OR DISTRIBUTION ■■ Local AnestheticsNOT (LA) FOR SALE OR DISTRIBUTION ■■ Antibiotics ■■ Corticosteroids ■■ Drugs to Affect Heart Rate ■■ Beta-Blockers Pharm © Jones & Bartlett Learning, LLC 151 © Jones & Bartlett Learning, LLC NOT FOR SALE© Jones OR & Bartlett DISTRIBUTION Learning, LLC. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284115147_CH05_151_242.indd 151 27/10/16 2:40 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 152 Chapter 5 Anesthesia Pharmacology NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■■ Angiotensin Inhibitors (Ace inhibitors; ACEi; ARB) ■■ Calcium Channel Blockers (CCB) ■■ Vasopressors–Inotropes ■■ Vasodilators © Jones & Bartlett Learning, LLC ■■ Antiarrhythmic IV Agents© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION ■■ Herbals NOT FOR SALE OR DISTRIBUTION ■■ 5.1 Pharmacology Pearls The metabolic, cardiovascular, and pulmonary function differences between a patient with ideal body weight (IBW) and morbid obesity is clear. Because these © Jones & Bartlett differences affect Learning, the apparent LLC volume of distribution of © Jones & Bartlett Learning, LLC some drugs, there is increased risk of anesthesia in the NOT FOR SALEmorbidly OR obese. DISTRIBUTION As drug dosages based on total body NOT FOR SALE OR DISTRIBUTION weight (TBW) can result in overdose, conversely, adminis- tration of drugs based on IBW can result in subtherapeutic doses. Drugs That Need to Be Given in Ideal Body Weight © Jones & Bartlett Learning,IBW is the LLC difference between TBW and fat mass.© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONPropofol—induction dose NOT FOR SALE OR DISTRIBUTION Rocuronium Vecuronium Remifentanil Morphine © Jones & Bartlett Learning, LLC Alfentanil © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Sufentanil—maintenanceNOT dose FOR SALE OR DISTRIBUTION Sugammadex (IBW + 40% excess weight) Formula for IBW: Males: 50 kg + 2.3 kg for each inch above 5 feet Pharm Females: 45 kg + 2.3 kg for each inch above 5 feet © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE© Jones OR & Bartlett DISTRIBUTION Learning, LLC. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284115147_CH05_151_242.indd 152 24/10/16 11:04 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chapter 5 Anesthesia Pharmacology 153 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Drugs That Need to Be Given in Total Body Weight TBW Propofol—maintenance dose © Jones & Bartlett Learning, LLC Succinylcholine © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Neostigmine NOT FOR SALE OR DISTRIBUTION TIVA anesthetic Midazolam Atracurium Cisatracurium © Jones & FentanylBartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALESufentanil—induction OR DISTRIBUTION dose NOT FOR SALE OR DISTRIBUTION Thiopental ■■ 5.2 Volatile Anesthetics Inhalational agent pharmacokinetics is divided into four © Jones & Bartlett Learning,phases: absorption, LLC distribution to the brain, metabolism,© Jones & Bartlett Learning, LLC and excretion. The ultimate goal is to establish a particular NOT FOR SALE OR DISTRIBUTIONpartial pressure of an agent in the alveoli (PA), whichNOT will FOR SALE OR DISTRIBUTION equilibrate to attain a therapeutic tissue concentration with the brain to produce an anesthetized state. Uptake and Distribution Partial pressure of agent in alveoli (PA) is determined by © Jones & Bartlett Learning, LLC delivery minus loss. It is a ©reflection Jones of partial& Bartlett pressure of Learning, LLC agent in brain. NOT FOR SALE OR DISTRIBUTION • Delivery affected by: inspiredNOT partialFOR pressure, SALE alveolar OR DISTRIBUTION ventilation • Uptake affected by: solubility, cardiac output, alveolar-to-venous partial pressure difference • The relative solubilities of anesthetic in air, blood, and tissues are expressed as partition coefficients. The greater Pharm © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE© Jones OR & Bartlett DISTRIBUTION Learning, LLC. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284115147_CH05_151_242.indd 153 24/10/16 11:04 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ©9781284115147_CH05_151_242.indd 154 Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 154 TABLE 5-1 Alpha Beta Dopa Chart © Jones & Bartlett Learning,Receptors LLC Tissue Actions © Jones & BartlettAgonist Learning, Antagonist LLC Alpha 1 Smooth muscle constriction: α1: STIMULATORY RESPONSE Norepinephrine Treat HTN and NOT FOR SALE OR DISTRIBUTIONvascular, iris, uterus, bladder *Vasoconstriction,NOT inrecreased FOR peripheral SALE ++++ OR DISTRIBUTIONBPH: Selective sphincters, heart resistance Epinephrine +++ antagonists: Pupil *Increased BP Phenylephrine +++ Minipress Smooth *Inotrope (activation increases intracellular Dopamine ++ Hytrin muscle- gastrointestinal calcium ion → concentration muscle Ephedrine ++ Cardura contraction) Flomax © Jones & Bartlett Learning, LLC © Jones*Increase & Bartlett bladder sphincter Learning, LLC Prazosin NOT FOR SALE OR DISTRIBUTION NOT FOR*Decrease SALE splanchnic OR flow DISTRIBUTION Nonselective *Mydrias is (dilates pupil) antagonists: *Pancreas-insulin inhibited Phentolamine = *Liver-hepatic glycogenesis Phen oxybenzamine * GI relaxation Pharm Alpha 2 Platelets, Adrenergic & α2: INHIBITORY RESPONSE *alpha 2 Dexmedetomidine Yohimbe © Jones & Bartlett Learning, Cholinergic pathways, LLCNEGATIVE FEEDBACK LOOP — decr NE © Jones++++ & Bartlett Learning, LLC NOT FOR SALE© Jones OR & BartlettVascular DISTRIBUTION Learning, smooth LLC. muscle, NOT FOR SALErelease OR DISTRIBUTION & SNS outflow NOT FOR SALE OR DISTRIBUTION 24/10/16 11:04 PM Coronary arteries, Kidney, Brain, Fat cells © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ©9781284115147_CH05_151_242.indd 155 Jones & Bartlett Learning,
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