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Sub-groups:
- Sedatives
- Analgesics
- Paralytics
- Rescue medications

Key information to collect:
- Drug name
- Mode of action
- Half-life
- Preparation
- Dosages
- Administration
- Side effects
- Safety information

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Propofol 1%

Mode of action:

The action of propofol involves a positive modulation of the inhibitory function of the neurotransmitter gama-aminobutyric acid (GABA) through GABA-A receptors.

Half-life:
Initial distribution phase 1.8-9.5 minutes.
Second redistribution phase 21-70 minutes.
Terminal elimination phase 1.5-31 hours.

Preparation:
Give neat - undiluted.

Dosages:
1.5mg/kg for emergency induction.
Then 5-20ml/hr continuous infusion.

Administration:
Given via PVC or CVC. Bolus or continuous infusion.

Side effects:
Decreases BP + SV. Decreases cardiac output (CO) by 25%. Decreases HR.

Safety information:
The tubing and any unused propofol injectable emulsion drug product should be discarded after 12 hours. This is because propofol injectable emulsion contains no preservatives and is capable of supporting growth of microorganisms. Do not given propofol to patients with egg or soy allergy. Check compatibility with other drugs. Compatible with alfentanil.

Other:
Decreases laryngeal reflex which aids intubation. Has anti-emetic properties.

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Alfentanil

Mode of action:
Alfentanil binds opioid receptors, and is most active at the mu receptors. Effects are analgesia, sedation, anxiolysis and induction of anaesthesia.

Half-life:
90-111 minutes

Preparation:
Give neat - undiluted.

Dosages:
Initially 50–100 micrograms/kg, dose to be administered over 10 minutes or as a bolus, followed by maintenance 30–60 micrograms/kg/hour. In ICU usually an adult over 50kg is given a maintenance rate of 1-5ml/hr.

Administration:
Given via PVC or CVC. Bolus or continual infusion.

Side effects:
Decreased respiratory rare, blurred vision, chest pain or discomfort, confusion, difficult or troubled breathing, dizziness, faintness, or light-headedness when getting up suddenly from a lying or sitting position, fainting, irregular heartbeat.

Safety information: Monitor respiratory rate closely when administering alfentanil as it can cause respiratory depression. Check compatibility, compatible with propofol.

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Rocuronium

Mode of action:
Rocuronium bromide is a competitive antagonist for the nicotinic acetyl-choline receptors at the neuromuscular junction. Of the neuromuscular-blocking drugs it is considered to be a non-depolarizing neuromuscular junction blocker, because it acts by dampening the receptor action causing muscle relaxation, instead of continual depolarisation which is the mechanism of action of the depolarizing neuromuscular junction blockers, like succinylcholine.

Half-life:
The rapid distribution half-life is 1-2 minutes and the slower distribution half-life is 14-18 minutes. Renal impairment has no net effect on half-life, however, half-life is almost doubled in patients with impaired liver function.

Preparation:
Give neat - undiluted.

Dosages:
The recommended initial dose of rocuronium bromide is 0.6 mg/kg. Then maintenance dose running at 1-5ml/hr.

Administration:
Given via PVC or CVC. Bolus or continuous infusion.

Side effects:
Common: flushing, hypotension.
Uncommon: bronchospasm, hypersensitivity, skin reactions, tachycardia.
Rare: circulatory collapse, shock, muscle weakness (after prolonger use in ICU), myopathy (after prolonged use in ICU).

Safety information:
Check compatibility with other drugs. Ideally given through a separate lumen from other drugs if available. Use with caution in patients with hepatic or renal impairment as may prolong duration of action.

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Adrenaline (1 in 10,000) (1mg/10ml)

Mode of action:
Adrenaline is a non-selective adrenergic agonist with potent β₁ and moderate α₁ and β₂-receptor activity. Increased myocardial force of contraction (positive inotrope) and heart rate (positive chronotrope) occur as a result of β₁ receptor stimulation. Systemic vascular resistance is increased overall because the stimulation of α₁ receptors results in peripheral vasoconstriction, which counters the vasodilation due to β₂ receptor activation. These β₂ effects also relax bronchial smooth muscle and stabilise mast cells.

Half life:
Onset of action: 1–2 minutes.

Duration of action: 2–10 minutes.

Half-life: 5 minutes.

Preparation: Dilute 1ml of Adrenaline 1 in 10,000 to 10ml with 0.9% saline.

Dosages: Bolus dose 0.1 ml/kg (1mcg/kg) of Adrenaline 1 in 10,000 (max single bolus = 2ml). Bolus frequency: as required usually every 30 seconds to 10 minutes.

Administration: Bolus via PVC or CVC. Continuous infusion via CVC only.

Side effects: Angina, tachycardia, arrythmias and palpitations, tissue ischaemia or necrosis due to vasoconstriction, hyperglycaemia, Lactic acidaemia.

Safety information: Carefully check the concentrations as available in 1:1000 and 1:10000.
Monitor fluid balance, electrolytes and blood glucose.

Interactions with other drugs - Cocaine enhances sympathomimetic effects of adrenaline and increases the risk of hypertension, tachycardia and fatal arrhythmias. Avoid this combination in cocaine misusers if it is less than 24 hours since they last used it.

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Atropine

Mode of action:
Atropine binds to and inhibits muscarinic acetylcholine receptors, competitively blocking the effects of acetylcholine and other choline esters. It acts as a reversible non-specific antagonist of muscarinic receptors, showing affinity for the M1, M2, M3, M4 and M5 receptor subtypes. Atropine antagonises the effects of acetylcholine on tissues innervated by postganglionic cholinergic nerves, such as smooth muscle, cardiac tissue, exocrine glands and the central nervous system. Also, it acts in less innervated smooth muscle that responds to endogenous acetylcholine. The actions of atropine can be overcome by increasing the concentration of acetylcholine at receptor sites (for instance, the use of anti-cholinesterase agents that inhibit the hydrolysis of acetylcholine).

Half-life:
Following intravenous and intramuscular doses of atropine, half-life values range from approximately 2 to 4 hours. In geriatric patients (65-75 years old), intravenous atropine has a longer half-life (10 hours). Also, the half-life of atropine is slightly shorter (approximately 20 minutes) in females than in males.

Preparation:
For ET administration, dilute 1 mg to 2 mg in 10 mL of sterile water or normal saline before administration.

Dosages:
300–600 micrograms to be given as IV bolus.

Administration:
Atropine can be administered by intravenous (IV), subcutaneous, intramuscular, or endotracheal (ET) methods; IV is preferred.

Side effects:
The anticholinergic effects of atropine can produce tachycardia, pupil dilation, dry mouth, urinary retention, inhibition of sweating (anhidrosis), blurred vision and constipation. However, most of these side effects are only manifested with excessive dosing or with repeated dosing.

Safety information:
It may potentiate barbiturates, alcohol, or tranquillisers, and therefore, its use requires caution.