Unit 1

Ch 13

ADHD: characterized by hyperactivity, hyperkinesis, impulsiveness (must persist for 6+ months)

CNS stimulants

MOA: block reuptake of dopamine & norepinephrine; stimulate release of dopamine & norepinephrine

AEs: high abuse potential, weight loss, cardiovascular effects, psychosis, insomnia, HTN, hallucinations (tx: chlorpromazine), seizures (tx: diazepam)

tips: give 1st thing in the AM with or without food

• amphetamine mixtures (Adderall) for ADHD or narcolepsy

• methylphenidate (Ritalin, Concerta) for ADHD or narcolepsy, available oral or topical patch

• dexmethylphenidate (Focalin): for ADHD, may take with/without food

• dextroamphetamine

• pemoline

• lisdexamfetamine (Vyvanse)

• methylxanthines: caffeine (~200 mg/day), taken on empty stomach → GI upset

• modafinil (Provigil, Alertec): for narcolepsy or shift-work sleep disorder, hepatic elimination (monitor ALT, AST)

non stimulants

• atomoxetine: no abuse potential, taken 1x/day, selective norepinephrine reuptake inhibitor

  • AEs: anorexia, mood swings, insomnia

  • interactions: MAOIs (w/n 14 days), (fluoxetine, quinidine, etc.)

• guanfacine

• clonidine

• bupropion

Ch 10

Ch 11

anesthesia

local (regional): no respiratory function paralysis

AEs: CNS excitement → depression, bradycardia, heart block, cardiac arrest, hypotension, allergic reactions, methemoglobinemia (esp. w/ topical benzocaine), headaches (eps. w/ spinal injections)

• esters (1 i): higher occurrence of allergic reactions!!!

  • procaine, chloroprocaine, tetracaine

• amides (2 i’s): lower occurrence of allergic reactions, hepatic metabolism, can → systemic toxicity (tinnitus, metallic taste, dizzy/lightheaded, numbness of mouth/tongue, unusual behavior)

  • lidocaine, bupivacaine, prilocaine, ropivacaine

• topical: applied to skin or mucous membranes (amides used)

• injection:

  • spinal/intraspinal

    • intrathecal: injection into subarachnoid space, made in lumbar region below cord termination

      • bupivacaine, lidocaine, tetracaine

    • epidural: injection into epidural space

      • bupivacaine, lidocaine

  • infiltration: used with vasoconstrictors (ex: epinephrine) to decrease bleeding, delay systemic absorption (→ prolonged duration of action), and reduce toxicity risk

    • systemic toxicity: palpitations, tachycardia, nervousness, HTN

      • not used in fingers, nose, toes, or penis!!!

  • nerve block: injection into/near nerves that supply the surgical field but at a distant site from the surgical field

  • peripheral nerve catheter attached to pump (Pain Buster, On-Q pump)

monitored anesthesia care (MAC): local anesthesia + sedation & analgesia (ex: colonoscopy)

combo of a benzodiazepine (ex: midazolam) or propofol + opiate analgesic (ex: fentanyl, morphine)

rapid onset, quickly metabolized

general: complete loss of consciousness, loss of body reflexes including paralysis of respiratory muscles

AEs: malignant hyperthermia!!!! (>104F, tachypnea, tachycardia, muscle rigidity → treated with dantrolene)

• inhalational (used commonly for dental care): nitrous oxide, enflurane, desflurane

• parenteral: propofol, etomidate, ketamine

  • ketamine: given IM or subq, low incidence of reduced cardiovascular/resp/bowel function, AEs: psychomimetic effects (hallucinations, etc.)

  • propofol: used to induce/maintain general anesthesia, may be used for sedation of vented pts in ICU, monitor triglycerides for long-term use

• dexmedetomidine (Precedex): alpha₂- adrenergic agonist, may be used for sedation of vented pts in ICU

neuromuscular blocking drugs

• succinylcholine (depol): slower metabolism, often used for endotracheal intubation

• rocuronium (nondepol): rapid/intermediate acting, used for endotracheal intubation or skeletal muscle relaxation

Ch 29

• isotonic solutions: maintenance fluids

  • LR, 0.9% NS, D5W

• hypotonic solutions: moves water into the cells; can → hyponatremia, worsen edema, cell lysis, depletes intravascular volume (→ hypotension); do NOT give to pt with increasing ICP or neonates

  • 0.45% or 0.33% NS

• hypertonic solutions: draws water out of the cells

  • 2% or 3% NS, D5NS, D5 0.45% NS, D5LR

signs of fluid overload: increased BP, JVD, edema, dyspnea, basilar crackles

crystalloids

• normal saline (0.9% NS)

• lactated ringers (LR): water + calcium, potassium, lactate, sodium, chloride

• dextrose:

  • D5W (dextrose 5%)

  • D5NS (dextrose 5% in 0.9% NS)

colloids

increase colloid oncotic pressure, moves fluid from interstitial to plasma

used for shock, burns, major trauma

• albumin: naturally produced in liver, volume expander

blood products

• cryoprecipitate: given to manage acute bleeding (50% slow loss, 20% rapid loss)

• fresh frozen plasma (FFP): increases clotting factors

• packed red blood cells (PRBCs): increases oxygen carrying capacity, up to 25% blood volume loss

• whole blood: over 25% blood volume loss, contains plasma & proteins to draw fluid back into blood vessels