Key principles of pharmacology :

Pharmacokinetics : What the body does to the drug.

A. Absorption
D. Distribution
M. Metabolism
E. Excretion

Pharmacodynamics: A drug’s biochemical and physiologic effects on the body.

  • Receptor binding
  • Receptor sensitivity
  • Post-receptor effects

4 induction agents to familiarize yourself with for the first day in the OR:

  1. Propofol

  2. Inhibitory neurotransmission via the GABA receptor

  3. Provides reliable amnesia and anesthesia, but does not have any analgesic properties
  4. Potent cardiac and respiratory depressant
  5. Easily titratable due to high volume of distribution and short initial distribution half-life

  6. Induction dose is 1-2.5 mg/kg

  7. Ketamine

  8. NMDA receptor antagonist

  9. Has analgesic, amnesia and anesthetic properties.
  10. Can cause emergence delirium
  11. Causes central sympathetic stimulation

  12. Induction dose 0.5-2 mg/kg

  13. Midazolam

  14. Enhances the affinity of GABA for its receptor

  15. Minimal cardiorespiratory depression and produces anxiolysis and anterograde amnesia
  16. Longer-acting; elimination half-life of 1-4 hours
  17. Induction doses: 0.02- 0.04 mg/kg (1-2 mg in adults)

  18. Antagonist available: Flumazenil

  19. Etomidate

  20. Increases the receptor’s affinity for GABA

  21. Cardio-respiratory stable
  22. Very fast onset/offset due to high lipophilicity; an induction dose of 0.1 mg/kg will provide 1.5 minutes of unconsciousness
  23. Produces a light plane of anesthesia for laryngoscopy
  24. Can cause adrenocortical insufficiency

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