Medication and MOA	Onset/Peak	Duration	Metabolism
SevofluraneMAC: 2%MOA: fully fluorinated methyl isopropyl etherNon-pungent, minimal odor, produces bronchodilation, least degree of airway irritation out of all inhaled volatile anesthetics Breaks down in to compound A (nephrotoxin in rats)*Critical to have FGF > 1L/min during first 2 MAC hours, followed by increased FGF > 2L/min for remaining hours to prevent build up of compound A leading to combustion	MAC: 2%Blood:gas = 0.69Fat:blood = 48Vapor pressure: 160mm HG		M: potentially renal, 3-5% undergoes biodegradation, metabolite: inorganic fluoride (potentially nephrotoxin)
Midazolam1-2.5 mgMOA: enhance the affinity for GABA = frequent channel opening resulting in increased chloride conductance and hyperpolarization of the postsynaptic cell causing anxiolysis, sedation, anterograde amnesia, alcohol potentiation, and anticonvulsant and skeletal muscle relaxant effects.*Dose based on total body weight	O: 30-60secP: 3-5 min	30-60 min	M: hepatic (CYP 450)E: renal
Fentanyl1-2 mcg/kgMOA: mu selective opioid agonist causing CNS depression to pain; blunts the SNS response to DL. *Dose based on total body weight	O: < 1 minP: 5 min	45 min	M: hepaticE: renal
Lidocaine0.5-1.5 mg/kgMOA: blocks signal conduction by prolonging the inactivation of the fast voltage-gated Na+ channels in the neuronal membrane; slows rate of depolarization; blunts the SNS response to DL.	O: immediateP: 45-90 sec	5-10 min	M: CYP 3A4E: renal
Propofol1-2.5 mg/kgMOA: selective modulator of GABA by activating GABA increasing chloride conductance resulting in hyperpolarization of the postsynaptic cellBolus dosing based on lean body massLBM Man: 1.1 x TBW – 128 x (TBW / Ht)2LBM Woman: 1.07 x TBW – 148 x (TBW / Ht)2Infusion dosing based on total body weight	O: 30-60 secP: 5 minE½: 30-90 min	5-10 min	M: hepatic (CYP 450) & pulmonary E: renal – inactive metabolites
Rocuronium0.6-1.2 mg/kgMOA: non-depolarizing neuromuscular blocking agent that acts by competing for cholinergic receptors at the motor end plate	O: 2-3 minP: 45 min	60-90 min	M: hepaticE: bile
Glycopyrrolate0.2 mg per 1 mg of NeostigmineMOA: Competitively blocks Ach on muscarinic receptors to prevent PNS effects of anticholinesterases & enhance SNS activity. Works on presynaptic cholinoreceptors > inhibits release of NE.Blocks ALL muscarinic effects (non-specific) > enhances SNS activityRelaxes biliary and ureter smooth muscle contraction.	O: 1 minP: 5 min	2-4 h	M: hepaticE: renal
Sugammadex2mg/kg – 2 twitch on TOF4mg/kg – no TOF, but 1-2 PTC’s16mg/kg – reversal of RSI dose of RocuroniumMOA: modified gaba-cyclodextrin with a hydrophobic cavity and hydrophilic exterior that encapsulates steroidal neuromuscular blocking drugs through Van der Waals forces, thermodynamic H+ bonds, and hydrophobic interactions give it a tight complex with high association rate and low dissociation rate*SE: anaphylaxis, marked bradycardia, residual blockade, and risk of coagulopathy	O: 2-3 minP: unknownE½: 2 h	15 min	M: renal E: renal – mostly unchanged
DexamethasoneMOA: glucocorticoid steroid that inhibits prostaglandin synthesis to decrease PONV and inflammation *consider avoiding in patients with diabetes d/t increased risk of hyperglycemia or patients with anticipated large surgical wounds	O: 10 minP: 10-30 min	48-72 h	M: hepaticE: renal
ZofranMOA: 5HT3 receptor antagonist. Inhibit serotonin 5HT3 receptors in the chemoreceptor trigger zone. *prolong QTc interval	O: immediateP: 15-30 min	6-12 h	M: hepaticE: renal
Cefazolin1-3GMOA: first generation cephalosporin antibiotic – inhibit cell wall synthesis by binding to PCN binding protein stopping peptidoglycan synthesis	O: 5 minP: unknown	6-12 h	M: renalE: renal
AlbuterolMOA: beta 2 agonist, acts on beta 2 receptors on airway smooth muscle causing relaxation of airways from trachea to terminal bronchials Patient should receive this med the morning of DOS.	O: < 15 minP: 60-90 min	Up to 5 h	M: pulmonary & renalE: pulmonary & renal

Top Drawer Meds