CAALaw

Category: Drug Spotlight

  • Neostigmine

    Neostigmine

    by

    Bryan Rogers
    in

    Neostigmine The Synaptic Shield Drug Spotlight  ·  Reversal Agent  ·  Acetylcholinesterase Inhibitor TL;DR Neostigmine is an intravenous medication administered toward the conclusion of surgery to awaken muscles from chemical paralysis. It functions as a reversible acetylcholinesterase inhibitor, which means it halts the enzyme responsible for chewing up acetylcholine . By shielding acetylcholine from destruction, it…

  • Remifentanil

    Remifentanil

    by

    Bryan Rogers
    in

    Remifentanil The Disappearing Opioid Drug Spotlight  ·  Synthetic Opioid  ·  Esterase-Cleaved Mu-Agonist TL;DR Remifentanil is an ultra-potent synthetic intravenous opioid that acts like a real-time dimmer switch for surgical pain, delivering roughly 100 to 250 times the analgesic strength of intravenous morphine. It works by binding selectively to mu-opioid receptors in the central nervous system…

  • Methohexital

    Methohexital

    by

    Bryan Rogers
    in

    Methohexital Rapid Sedation Drug Spotlight  ·  IV Anesthetic  ·  Barbiturate TL;DR Methohexital is a potent, ultra-short-acting intravenous medication used to put patients to sleep for very brief procedures. It works by keeping the brain’s inhibitory channels open longer, effectively shutting down consciousness in under a minute. It is uniquely famous in the modern era for…

  • Fentanyl

    by

    Bryan Rogers
    in

    Fentanyl Drug Spotlight  ·  Synthetic Opioid  ·  Mu-Receptor Agonist TL;DR Fentanyl is the clear intravenous liquid you might see drawn up in an operating room. As I learn about pharmacology, it is fascinating to realize it is a lab-made synthetic opioid that is roughly 100 times stronger than morphine. It works by binding directly to…

  • Succinylcholine

    by

    Bryan Rogers
    in

    Succinylcholine The Depolarizing Paralytic Drug Spotlight  ·  IV Paralytic  ·  Neuromuscular Blocker TL;DR Succinylcholine is an ultra-rapid paralytic drug that freezes every skeletal muscle in the body within 60 seconds. It works by flooding the neuromuscular junction to force a massive initial muscle contraction before locking the receptors entirely shut. This makes it the absolute…

  • Sevoflurane

    Sevoflurane

    by

    Bryan Rogers
    in

    Sevoflurane Sweet Sleep Drug Spotlight  ·  Inhalational Anesthetic  ·  Volatile Gas TL;DR Sevoflurane is the sweet smelling gas you breathe through a mask to safely drift off to sleep in the operating room. It works by depressing the central nervous system through multiple receptor pathways, rapidly changing the brain’s state of consciousness. Because it enters…

  • Dexmedetomidine

    Dexmedetomidine

    by

    Bryan Rogers
    in

    Dexmedetomidine Rousable Sleep Drug Spotlight  ·  Alpha-2 Agonist  ·  Sympatholytic TL;DR Dexmedetomidine, sold as Precedex, is a sedative that calms patients by dialing down the body’s own “fight or flight” system rather than shutting the brain off the way most anesthetics do. It latches onto alpha-2 receptors, the tiny brakes that tell nerves to stop…

  • Etomidate

    Etomidate

    by

    Bryan Rogers
    in

    Etomidate is the induction agent of choice when blood pressure won’t tolerate a drop. Look at its GABA mechanism, adrenal suppression, and litigation patterns.

  • Midazolam

    Midazolam

    by

    Bryan Rogers
    in

    Midazolam is the short-acting benzodiazepine behind pre-op calm and procedural amnesia. Its pharmacology explains why it dominates malpractice case law.

  • Ketamine

    Ketamine

    by

    Bryan Rogers
    in

    Ketamine The Dissociative Drug Spotlight  ·  Dissociative Anesthetic  ·  NMDA Antagonist TL;DR Ketamine is a dissociative anesthetic, meaning it doesn’t just put you to sleep the way most anesthetics do. Instead, it disconnects your brain’s sensory processing from your conscious awareness. You’re technically “awake” in some sense, but you’re somewhere else entirely. It works by…