Anesthesia pharmacology

Done by:
Ms. Meshael Awadh Alotaibi
 Drug Dose Drug type indications Contraindications
1- used for induction of general anesthesia.
1- Patients with hemodynamically unstable
2–3mg/kg. IV induction agent 2-Sedation or maintenance of anesthesia.
Propofol (Hypnotic) 2- Caution in severe allergy to eggs, peanuts,
3-Agent of choice for day care surgery. soya, soybean oil.

4- Rapid recovery and little nausea. 3- Caution in epilepsy.

5- It can be used for continuous infusion.

1- Emergence delirium reduced by
1-2 mg/kg IV induction agent Induction/ maintenance of anesthesia in benzodiazepines.
Ketamine (Hypnotic- analgesic) high-risk and hypovolemic patients 2- Caution in hypertension.
3- Control excess salivation with
antimuscarinic agent
Etomidate 0.15–0.3mg/kg IV induction agent. 1- used for induction of general anesthesia. 1- Pain on injection.
(Hypnotic) 2-Cardiovascular system stability in
therapeutic doses. 2- Adrenocortical suppression
3-Used for hypotensive patients
Thiopental 3–5mg/kg. Sedation- hypnotic 1-Induction of anesthesia. 1- Accumulation with repeated doses.
(Short-acting 2-Anticonvulsant
thiobarbiturate) 3- cerebral protection. 2- Caution in hypovolemia and elderly.
4- Recovery due to redistribution Porphyria.
Fentanyl 1-5 micrograms/kg Synthetic opioid 1- analgesic. 1-Reduce dose in elderly.
2- it is widely used in spinal anesthesia 2-Delayed respiratory
3- High lipid solubility and Cardiovascular 3-depression and pruritus
stability if epidural/spinal
 Drug Dose Drug type indications Contraindications
Morphine IV: 2.5–10mg. Natural opioid -It used to treat both acute and chronic pain. -Prolonged risk of respiratory depression,
pruritus, nausea when used via
spinal/epidural
Remifentanil 50 micrograms/ml short-acting synthetic -It used as an opioid analgesic that has a -patients with hypersensitivity to
opioid drug. rapid onset and rapid recovery time. remifentanil
-It used effectively during craniotomies,
spinal surgery, cardiac surgery, and gastric
bypass surgery.
Tramadol Slow IV/IM: opioid and non-opioid It used to relieve moderate to severe pain. -Caution in epilepsy.
50-100mg mechanisms of action -not recommended for intraoperative use.
-Monoamine oxidase inhibitors (MAOI).
Midazolam Sedation: 0.5– Short-acting Sedative, anxiolytic, amnesic, anticonvulsant. -acute angle-closure glaucoma
5mg/kg benzodiazepine - hypotension, and shock

Diazepam IV/IM/PO: Long-acting -Sedation or termination of status Thrombophlebitis

2–10mg/kg benzodiazepine. epilepticus.
-Alcohol withdrawal
- Plasma cholinesterase deficiency.
-rapid sequence induction -Recent burns or trauma within 24 to 72
hours.
1–1.5mg/kg Depolarizing muscle - it is the drug of choice in emergencies - Neuromuscular disorders
Succinylcholine relaxant where immediate airway management is -Hyperkalemia.
required. -Severe liver or renal failure.
6-Cerebrovascular accident longer than 72
hours.
- Malignant Hyperthermia.
 Drug Dose Drug type indications Contraindications
1- It used as an adjunct to general anesthesia 1- myasthenia gravis or myasthenic
0.2 mg/kg Intermediate-acting, facilitating tracheal intubation and syndrome.
Cisatracurium non-depolarizing mechanical ventilation during surgery. 2- Severe anaphylactic reactions to NMBDs
muscle relaxant 2- Useful in severe renal or hepatic disease.
Atracurium 0.5 mg/kg Intermediate-acting, - Provide skeletal muscle relaxation during - asthmatic patients
non-depolarizing endotracheal intubation and mechanical - neuromuscular disorders.
10 mg/ml muscle relaxant ventilation. - patients with hypersensitivity to drug.
- Provide airway muscle paralysis to
facilitate endotracheal intubation.
- Provide surgical paralysis to facilitate - allergic reaction to the drug
surgery.
- Provide chest wall relaxation to facilitate - It is advisable not to use rocuronium
Intubation: Intermediate-acting, mechanical ventilation in critically ill as an infusion to prevent critical
0.6–1mg/kg. non-depolarizing patients who are under adequate illness myopathy and polyneuropathy.
Rocuronium Maintenance: muscle relaxant sedation.
0.1–0.15mg/kg. - Provide defasciculating dose to prevent - patients with renal or hepatic
fasciculations during depolarizing muscle dysfunction
paralysis to prevent myalgias.
- Prevent shivering in patients post cardiac
resuscitation after the return of
spontaneous circulation during therapeutic
hypothermia.
Sugammadex T2 present 2mg/kg. cyclodextrin reversal - preventing rocuronium and vecuronium - Patients with a history of
To reverse full agent for rocuronium from acting at the acetylcholine receptor. hypersensitivity reaction.
Dose immediately and vecuronium. - Bradycardia
16mg/kg - Respiratory depression
 Drug Dose Drug type indications Contraindications
Ephedrine 3–6mg repeated Direct and indirect -treat the symptoms of Hypotension during -Caution in elderly, hypertension, and CVS
(dilute 30mg in sympathomimetic anesthesia. disease.
10mL saline) (α- and β-adrenergic -Vasopressor, safe in pregnancy -Tachyphylaxis.
action). -treat breathing problems (as a bronchodilator). -Avoid with MAOI
-nasal congestion (as a decongestant).
Mannitol 0.25–2g/kg Osmotic diuretic Used for renal protection and reduction of -Extracellular volume expansion.
ICP. -caution in severe renal and CVS disease
Acetazolamide IV/PO: 0.25–1g Carbonic anhydrase It used for acute reduction of intraocular -Extravasation causes necrosis.
inhibitor pressure -Hypokalemia/ hyponatremia.
-Hyperchloremic acidosis.
-Avoid in severe hepatic impairment
Dobutamine Infusion: 2.5–10 β1-adrenergic agonist, Indicated for the treatment of cardiogenic shock -Arrhythmias and hypertension.
micrograms/kg/min positive inotrope and and heart failure. -Phlebitis, but can be administered
chronotrope peripherally
Dopamine Infusion: 2–5 -Non-selective treat hypotension, bradycardia, low cardiac - patients with pheochromocytoma
micrograms/kg/min adrenergic agonist (α output and improves blood flow to the - tachyarrhythmias or ventricular fibrillation.
and β receptor action). kidneys.
-Inotropic agent
Oxytocin Post-partum slow IV: Nonapeptide hormone -Stimulates uterine contraction. -Fetal distress
5U, followed, if -Induction of labor and prevention of post- -Avoid rapid administration.
(Syntocinon) required, by infusion partum hemorrhage. - placenta previa
10U/hr. (40U in
40mL 0.9% saline)
Methergine 0.2 mg/ml ----------------------- -Stimulates uterine contraction. -pre-eclampsia
-used postpartum period to help deliver the -hypersensitivity
placenta and to help control bleeding.
 Drug Concentration Drug type indications Contraindications
Glycopyrrolate 0.2 mg/ml Anticholinergic agent. Bradycardia, blockade of muscarinic effects -Caution in glaucoma, CVS disease.
of anticholinesterases, antisialogogue. Unlike atropine, does not cross
blood–brain barrier
Metoclopramide 5mg/ml Dopaminergic antiemetic increases gastric emptying and lower -Hypertension in pheochromocytoma.
esophageal sphincter tone. -Inhibits plasma cholinesterase.
-Increases IOP
Atropine 600mg Muscarinic acetylcholine Vagal blockade at AV and sinus node -Obstructive uropathy and CVS
antagonist. increases heart rate. disease.
-Glaucoma, myasthenia gravis
Esmolol 100mg/10ml Short-acting selective Treatment of SVT or intraoperative Asthma, heart failure, AV block,
β-blocker. hypertension. verapamil treatment
Neostigmine 2.5mg/ml Anticholinesterase -Reversal of non-depolarizing muscle relaxant Administer with antimuscarinic agent.
expects rocuronium and vecuronium.
-Treatment of myasthenia gravis.
Ketorolac 15mg/ml NSAID analgesic for mild to moderate pain. Hypersensitivity to aspirin, asthma,
30mg/ml severe renal impairment, peptic
ulceration.
Granisetron 1mg/ml 5-HT3 receptor antagonist Long acting Antiemetic Pregnancy, breastfeeding, QT interval
prolongation
Ropivacaine 2mg/ml (0.2%) Local anesthetic (Amide) postoperative pain management patients with cardiovascular disease
10mg/ml spinal anesthesia
Dexamethasone 8mg/2ml corticosteroid Cerebral edema, edema prevention, Interacts with anticholinesterase
antiemetic. agents to increase weakness in
myasthenia gravis.
Bupivacaine 5mg/ml (heavy Local anesthetic (Amide) It used for infiltration, epidural, and spinal Greater cardiotoxicity than other local
0.5%) anesthesia. agents.
2.5mg/ml Do not use for IVRA.
Gentamicin 80mg/2ml Aminoglycoside antibiotic Active against Gram-negative bacteria. Impairs neuromuscular
transmission—avoid in myasthenia.
 Drug Concentration Drug type indications Contraindications
Lidocaine (1%, 10mg/ml Local anesthesia (Amide) treatment of ventricular arrhythmias. Hypersensitivity to local anesthesia
Reduction of pressor response to intubation.
2%) local anesthesia rapid onset
Diclofenac (supp) 100 mg NSAID Potent analgesic for mild to moderate pain Hypersensitivity to aspirin, asthma,
12.5 mg severe renal impairment, peptic
ulceration.
Phenylephrine 10mg/ml Selective direct- acting Peripheral vasoconstriction and treatment of Caution in elderly and CVS disease.
α-adrenergic agonist. hypotension. Hyperthyroidism
Salbutamol 100mcg/dose β2 receptor agonist. Treatment of bronchospasm. sensitivity to salbutamol
(bronchodilator) hypertension, hypokalemia
inhaler Monitor potassium concentration with
higher doses.
Hydrocortisone 100mg Anti-inflammatory Treatment of allergy Hydrocortisone 20mg,
(corticosteroid) prednisolone 5mg
Cefazoline 1g antibiotic Treatment of bacterial infection penicillin allergy
Labetalol 100mg/20ml Combined α- (mild) and β- BP control without reflex tachycardia. Asthma, heart failure, AV block,
adrenergic receptor verapamil treatment
antagonist.
Naloxone 0.4mg/ml opioid antagonist Reversal of opioid like Remifentanil Caution in opioid-dependent
patients—may precipitate acute
withdrawal.
Flumazenil 0.5mg/ml Benzodiazepine receptor Reversal of Benzodiazepine Benzodiazepine dependence
antagonist
 Drug Concentration Drug type Indication Contraindications
Lidocaine 1% +Epinephrine 1:100,000 Local anesthetic + non- It used for infiltration, epidural, and Hypersensitivity to local anesthesia
Lidocaine 2% +Epinephrine 1:200,000 selective adrenergic spinal anesthesia.
agonist (α and β
receptor)
Furosemide 10mg/ml Loop diuretic Treatment of hypertension, CCF, renal 1- electrolyte imbalance
failure, fluid overload 2- Acute myocardial infarction
3-hypovolemia, renal disease
4-orthostatic hypotension
5-urinary retention
Sodium bicarbonate 10 mEq Alkaline salt correction of acidosis and to enhance 1- Precipitation with calcium
50 mEq onset of action of LAs. 2- containing solutions, increased CO2
8.4% production, necrosis on extravasation.
Epinephrine (Prefilled 1mg/10ml Non-selective adrenergic 1. Treatment of anaphylaxis 1-hypersensitivity to 2-sympathomimetic
agonist (α and β receptor 2. Bronchodilator drugs
syringe) action). 3. Positive inotrope 3- closed angle glaucoma
4. Given by nebulizer for croup 4- anesthesia with halothane.
5. Prolongation of LA action. 5-Arrhythmias
Lidocaine 2% 20mg/ml Local anesthesia (Amide) 1-Treatment of ventricular arrhythmias. Hypersensitivity to local anesthesia
2-Reduction of pressor response to
(Prefilled syringe) intubation.
3-local anesthesia rapid onset
Atropine sulphate 1mg/10ml Muscarinic acetylcholine Vagal blockade at AV and sinus node 1-Obstructive uropathy and CVS disease.
antagonist. increases heart rate. 2-Glaucoma, myasthenia gravis
(Prefilled syringe)
Calcium chloride 10% 100mg/ml Electrolyte replacement 1- hypocalcemia 1-High calcium levels in the urine
2-hyperkalemia 2-renal calculi
(Prefilled syringe) 3-hypermagnesemia. 3- Low phosphate levels
4- Suspected digoxin toxicity
350mg NSAIDs Mild to moderate analgesic and acute liver failure, severe renal
Acetaminophen
1g antipyretic impairment, Neonates.
 Drug Concentration Drug type Indication Contraindications
Xylometazoline Pediatric a direct acting Reduce symptoms of nasal congestion, 1- Hypersensitive to Sympathomimetic
(0.05%) sympathomimetic allergic rhinitis, and sinusitis. Agents.
Adult (0.10%) adrenergic alpha-agonist 2- Hyperthyroidism
(vasoconstriction) 3-Hypertension
4-transsphenoidal hypophysectomy
Metoprolol tartrate 5mg/5ml selective β-blocker Treat angina, hypertension, and heart Asthma, heart failure, AV block,
failure. verapamil treatment
Hydralazine 20mg vasodilator Used to treat hypertension. 1- Allergy to the medication
2- Coronary artery disease
Triamcinolone 40mg/ml corticosteroid reduces the swelling, itching, and 1- Decreased function of the adrenal gland.
redness 2- small red skin lesions due to dilated
blood vessels.
Clindamycin 600mg/4ml antibiotic Treatment for bacterial infections. 1- patients with a history
of pseudomembranous
colitis or ulcerative colitis.
2- patients with hypersensitivity to
clindamycin, lincomycin, or any of their
components.
Diclofenac Sodium 75mg NSAID Potent NSAID analgesic for mild to Hypersensitivity to aspirin, asthma,
moderate pain severe renal impairment, peptic
ulceration, proctitis
Methylprednisolone 40mg/ml anti-inflammatory 1-Treat pain and swelling that occurs 1-hypersensitivity to the drug
glucocorticoid with arthritis, severe allergic reactions 2-Systemic fungal infections
acetate 2-Immune system disorders 3-intrathecal administration, live or
(DEPO-MEDROL®) attenuated virus vaccine, idiopathic
thrombocytopenia purpura, or in
premature infants.
 Drug Concentration Drug type Indication Contraindications
Protamine sulphate 10mg/ml Heparin antagonist used to reverse the effects of heparin 1- allergy reactions
2- ventricular dysfunction
3- cardiovascular collapse, pulmonary
edema
4- Pregnancy
Vancomycin 1g Antibiotic Treatment for aerobic and anaerobic hypersensitivity to this antibiotic.
Gram-positive bacteria.
Ranitidine 25mg/ml Histamine (H2) receptor Reduction in gastric acid secretion Porphyria
antagonist.
Nitroprusside 50mg Vasodilator, Treat hypertensive crisis and acute 1- inadequate cerebral perfusion
Antihypertensives drug congestive heart failure. 2- Acute heart failure with low systemic
vascular resistance
3- hypersensitivity to nitroprusside
Tranexamic acid 500mg/ml antifibrinolytic Inhibits plasminogen activation, Avoid in thromboembolic
reducing fibrin dissolution by plasmin. disease, renal impairment, and
Reduced hemorrhage in major trauma, pregnancy
prostatectomy, and dental extraction
Isoprotenol 0.2mg/ml non-selective β Treatment of bradycardia, heart block, Tachyarrhythmias
adrenergic agonist and rarely for asthma ventricular arrhythmias
Aminophylline 10 ml 250mg Bronchodilator used in prevention and treatment of Caution in patients already receiving oral
asthma. or IV theophylline.
Diphenhydramine 50mg/ml antihistamine Treat allergic reaction and itchiness, Hypersensitivity to diphenhydramine.
insomnia, motion sickness, and Asthma, glaucoma
extrapyramidal symptoms. Pregnancy, hypertension
Amiodarone 50mg/ml class III antiarrhythmic Treatment of supraventricular and Sinoatrial heart block, thyroid
ventricular arrhythmias dysfunction, pregnancy, porphyria, iodine
hydrochloride sensitivity.
 Drug Concentration Drug type Indication Contraindications
Phenytoin 250mg/5ml Anticonvulsant Treatment of digoxin toxicity. Avoid in AV heart block, pregnancy, and
porphyria
Methylprednisolone 40mg/ml anti-inflammatory Treatment for Allergic reaction, 1-hypersensitivity to the drug
glucocorticoid Dermatologic Diseases, Respiratory 2-Systemic fungal infections
Sodium succinate Diseases, Rheumatic Disorders and 3-intrathecal administration, live or
(SOLU-MEDROL®) Ophthalmic Diseases. attenuated virus vaccine, idiopathic
thrombocytopenia purpura, or in
premature infants.
Haloperidol 5mg/ml Antipsychotic treat certain mental disorders (e.g., 1-Neuroleptic malignant syndrome.
schizophrenia, schizoaffective 2-hypersensitive to this drug or have
disorders). Parkinson’s disease.
Dimenhydrinate 50mg/ml antihistamine 1- Reduces the effects of natural 1- glaucoma
chemical histamine in the body. 2- chronic lung disease
3- seizure disorder
2- Prevent nausea, vomiting, and
dizziness associated with motion
sickness.
Digoxin 0.25 mg/ml Weak inotrope Control of ventricular response in Reduce dose in elderly. Enhanced
supraventricular arrhythmia effect/toxicity in hypokalemia. Avoid
cardioversion in toxicity
Prochlorperazine 12.5mg/ml Phenothiazine antiemetic increases gastric emptying and lower 1- Hypotension on rapid IV
esophageal sphincter tone. administration.
2- Neuroleptic malignant syndrome
Bupivacaine Hcl -------------- Local anesthetic + non- It used for dental procedures Hypersensitivity to these drugs
selective adrenergic
0.5ml+ Epinephrine agonist (α and β
1:200,000 receptor)
 Drug Concentration Drug type Indication Contraindications
Metronidazole 500mg/100ml Antibiotic activity against anaerobic bacteria 1-hypersensitivity to metronidazole
infection 2-Psychotic Reaction with Disulfiram
3- Interaction with Alcohol
Nitroglycerin 250 ml 200mcg/ml vasodilator Controlled hypotension, angina, 1- hypersensitivity to nitroglycerin
congestive cardiac failure (CCF). 2- increased intracranial pressure, severe
anemia, right-sided myocardial infarction
Plasma protein 5% colloids -Adult Respiratory Distress Syndrome 1-Hypersensitivity to albumin
-Acute Liver Failure 2-volume overload
fraction 20 ml -Hypoalbuminemia, Hypovolemia
Glucose (dextrose) 25–50g (50– simple sugar Treatment of hypoglycemia in hyperglycemia
100mL 50% unconscious patient
solution). -Treatment of insulin overdose,
hyperkalemia.
Insulin -100 units of Human soluble -Facilitating intracellular transport of -Hypoglycemia
insulin per mL pancreatic hormone glucose and anabolism. -hypokalemia
(U-100) - 500 -Diabetes mellitus, ketoacidosis, and
units of insulin hyperkalemia
per mL (U-500).
Heparin 5.000 Units/ml anticoagulant prevent blood clots caused by certain -Hemorrhage,
25.000 Units/ml medical conditions. -thrombocytopenia, hyperkalemia
Dantrolene 1mg/kg, Direct-acting skeletal Treatment of malignant hyperthermia -Avoid combination with calcium channel
repeated every muscle relaxant and neuroleptic malignant syndrome. blockers (verapamil), as may cause
5min to a hyperkalemia and CVS collapse.
maximum -Crosses placenta
of 10mg/kg.