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Basic Pharmacology PDF
Basic Pharmacology PDF
anaesthesia-related drugs
Premedication Drugs
Aims:
Anxiolysis
Analgesia
Antisialagogue (drying of airway secretions)
Anti-emetic
Acid aspiration prophylaxis
Midazolam
It is a short acting benzodiazepine.
It is the most common drug used for sedation
and anxiolysis preoperatively
Side effect :
Respiratory depression, hypotension,
dysphoria
Should be used with caution because it can
cause seizure in high dosage - maximum
daily dose 1 g/day ( 20 mg/kg/day)
Contraindication in pt on MAOI
Atropine sulphate
Anticholinergic
Uses:
Preoperative: Antisialogogue, reduce incidence of
laryngospasm and reflex bradycardia arrythmia
during general anaesthesia
Postoperative: Counteract muscurinic effects of
anticholinergic agents used for reversal of
neuromuscular blocking agents.
Cardiac: Sinus bradycardia or asystole durig
cardiopulmonary resuscitation or drug toxicity.
Dosage:
Includes reversal of :
Muscle relaxation
Drug action ( antagonist )
Neostigmine
Anticholinesterase
reversal of non-depolarizing muscle relaxant
treatment of myasthenia gravis
Dose:
Reversal of muscle relaxant IV 0.04-0.05mg/kg
in combination with anticholinergic agent
Adverse/Side effects:
Muscarinic effects: nausea, vomiting, epigastric
discomfort, abdominal cramps, increase
salivation and bronchial secretions, bradycardia,
miosis, hypotension.
Nicotinic effects: Fasciculation’s, twitching,
generalised weakness, respiratory depression,
paralysis.
Overdosage: CNS stimulation, agitation , fear,
death
Naloxone
Uses:
1. Reversal respiratory depression due to opiods.
2.the diagnosis of opioid overdose.
Dosage:
Reversal of opioid: adult IV 1.5mcg/kg IV 0.1 mg
increments at 2-3 minutes intervals to the
desired effect. Child IV 0.005-0.1 mg/kg
repeated every 2-3 min up to 3 doses if
necessary
Adverse/ side effects:
Remarks:
Beware of renarcotization if reversing long-acting
opioid.
Caution in opiod addicts-may precipitate acute
withdrawal.
Flumazenil
Benzodiazepine antagonist
Side effects:
Arrythmias,seizures
Remarks:
Special precaution in benzodiazepine dependence
because can cause acute withdrawal.
Beware of resedation if long-acting
benzodiazepine
Miscellaneous:
Other drugs that are commonly used in
anaesthesia .
Dose:
IV 0.1-0.5 mg increments.
(10mg in 20 ml saline, 1 ml aliquots.)
IM: 2-5 mg
Infusion: 30-60 μ/min
Contraindication/precaution:
MAOI.
Caution in elderly or CVS disease
Side- effects:
Reflex Bradycardia, arrhythmias
Adrenaline
Uses:
1. Treatment of anaphylaxis
2. Bronchodilator
3. Positive inotrope
4. Given by nebulizer for croup
Dose:
IV/IM/ETT:
1 ml aliquots of 1:10 000 up to 5-10 ml (0.5-
1mg)
infusion: 2-20 mcg/min(0.04-0.4 mcg/kg/min)
nebulisation:5ml 1:1000
max dose for infiltration: 2 mcg/kg
Dilution: 3mg/50ml=1ml/hr=1μg /min
Diluent: Normal saline / D5%
Infusion range: 1.2-12+ ml/h
Initial rate: 5ml/h
Caution in elderly.
Can cause arrhythmias especially with halothane.
Side effects:
Hypertension, tachycardia, anxiety,
hyperglycaemia, arrhythmias.
Reduces uterine blood flow
Remarks:
Should be administered via central catheter.
Dobutamine
Side effects:
Tachycardia, decreased peripheral and pulmonary
vascular resistance.
Remarks:
Can cause phlebitis, but can be
administereed peripherally
Noradrenaline
Remark:
Administered via central catheter only.
Potentiated by MAOI and tricyclic antidepressants
Vasopressin
-ADH.
-vasoconstriction.
Uses:
Treatment of hypotension
Treatment of diabetes insipidus
Description:
Calcium gluconate 10% contains Ca2+ 220
μmol/ml.
Calcium chloride contains Ca2+ 680μmol/ml
Dose:
2-5 ml 10% solution (10mg/kg, 0.07 mmol/kg)
Side effects:
Arrythmias, hypertension, hypercalcaemia
Remarks:
Less phlebitis than calcium chloride
Potassium chloride
Dose:
Magnesium sulphate
50%=500mg/ml=2mmol Mg2+/ml.
Normal plasma level Mg2+ 1.5-2.2mEq/litre.
Uses:
1. Hypomagnesaemia: 10-15 mg/kg over 20 min,
then 1 g/h.
2. Arrythmias: 2g over 10 min.
3. Eclampsia: 4g over 10 min then 1 g/h for 24h.
Caution:
Potentiate muscle relaxants.
Monitoring of serum level essential during
treatment. Can cause heart block
Dose:
Wt(kg)x base deficit x 0.3) mmol
Normally administered undiluted (8.4%
solution)
Remarks:
8.4%=1000mmol/litre. Given via central line if
possible
Amiodarone
Dose:
Should be diluted with 5% dextrose only
Loading infusion : 5 mg/kg over 1-2 H then
15mg/kg over 24h
Maximum 1.2 g in 24H
Contraindication:
CI in Sinoatrial heart block, thyroid dysfunction
and pregnancy
Side effects:
Commonly causes thyroid dysfunction, reversible
corneal deposits, prolongation of QT interval.
Lung Fibrosis (rare)
Dose:
SVT: 0.5 mg/kg over 1 min, then 50-
200μg/kg/min.
Hypertension: 25-100 mg then 50-300
μg/kg/min
Dilution: 2.5g/50ml (50 mg/ml)
Contraindication:
Asthma, heart failure, AV block
Side effects:
Hypotension, bradycardia
Labetolol
Combined α (mild) and β adrenergic receptor
antagonist.
Blood pressure control without reflex tachycardia.
Duration 2-4 h
Dose:
5 mg increments up to 100 mg.
Infusion: 20-160mg/h