Pharmacology Review
Alpha 2 Agonists
- Dexmedetomidine
- Clonidine
Rapid precedex administration can stimulate postsynaptic receptors causing inc BP. Over time presynaptic stimulation will overpower this peripheral response.
Anticoagulants
See the coagulation cascade in Anatomy and Physiology
Dual Antiplatelet Inhibitors
- 3-5-7 days
- Brillinta (Ticagrelor) - Plavix (clopidogrel)-Effient (Prasugrel)
If these medications are prescribed for drug eluding stents DES, review ACC guidelines on discontinuing or postpone the case as needed. See the graphics from the 2023 ECC
NOACS and DOACS and What to do!
Holding preop?
Reversal!
Other Considerations
TXA and Amicar
Beta Blocker Classifications
- A-M Selective B1
- N-Z Non Selective B1 and B2
- -olol: Pure beta
- -lol beta and alpha or potassium blocker activity (sotalol)
Chemotherapy
Indocyanine Green
- Summary
- For DaVinci by Intuitive Surgical
- Contains sodium iodide and should be used with caution in patients who have a history of allergy to iodides or iodinated contrast
- Preparation
- Mix ICG with 10ml sterile water to obtain 2.5mg/ml
- Administration
- 1.25mg or 0.5ml will normally yield good images with patients wieghing less than 90kg.
Total ICG dosages shoudl not exceed 2mg/kg per patient
Local Anesthetics
Max Dose
Use Safe Local App
- Chloroprocaine 12mg/kg
- Bupivacaine 3mg/kg
- Lidocaine 4.5 or 7mg/kg
- Ropiviciane 3mg/kg
- Fun math trick: 1mg lidocaine = 3.6mg ropivicaine
Do you need to Dilute Locals?
PDE Inhibitors
- Milrinone (PDEIII)
Protamine
See this pdf for some interesting persecptives on protamine administration such as the rate of reactions if the patient takes aspirin or does it make sense to give it through a PIV…
Sugammadex Safety
Ok in dialysis patients but need special filter
3.57mg of sugammadex binds to 1mg of Rocuronium
Crystallized with zofran
Binds to hormonal birth control
Use atropine and neostigmine with pregnant patients due to possibility of sugammadex binding to progesterone. 0.1mg atropine per 1mg neostigmine.