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Drugs in
Anaesthesia
and Intensive
Care
FIFTH EDITION
Edward Scarth
Consultant in Anaesthesia and Intensive Care Medicine,
Torbay Hospital,
Torquay, Devon, UK
Susan Smith
Formerly Consultant in Anaesthesia and Intensive Care,
Cheltenham Hospital, UK, now practising in Pre- and
In-hospital Trauma Care and Event Medicine
1
1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2016
The moral rights of the authors have been asserted
First edition published in 1990
Second edition published in 1997
Third edition published in 2003
Fourth edition published in 2011
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2015949834
ISBN 978–0–19–876881–4
Printed in China by
C&C Offset Printing Co. Ltd
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-pregnant
adult who is not breast-feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
v
Preface to the fifth
edition
The aims of this book remain true to those of previous editions. In order to
make changes prior to the publication of this edition, a peer review process
was undertaken. We have tried to accommodate the changes that were
proposed by the reviewers and are grateful for their comments. The book
continues in its original structured format, the major changes being the
removal of agents no longer in use, the addition of new pharmacological
drugs, and the introduction of drug comparison tables and a number of
drug structure diagrams. We hope that this new edition will remain popular
with critical care professionals, operating department personnel, paramed-
ics, pre-hospital care specialists, and anaesthetists of all grades, in addition
to providing sound examination preparation for the FRCA and FFICM. Any
comments will be gratefully received via e-mail to [email protected] and
[email protected].
E.J.S.
S.P.S
Cheltenham, January 2015
vi
Preface to the first
edition
The aim of this book is twofold: firstly to summarize concisely the main
pharmacodynamic and pharmacokinetic properties of the drugs with which
the practising anaesthetist might be expected to be familiar. Secondly, it
seeks to introduce the candidate for the FRCAnaes (and, in particular, for
the second part of this examination) to an ordered scheme for the pres-
entation of information, which we have found to be of value in both the
written and oral sections of the examinations. Examiners are more likely to
turn a blind eye to minor errors or omissions of knowledge if they are in
the context of a clear and well-ordered presentation. A further advantage
of this scheme of presentation is that it allows rapid access to specific infor-
mation. It is our hope that this compendium will prove to be a useful rapid
source of reference for clinical anaesthetists in their day-to-day endeavours,
both in the theatre and intensive care unit.
This book is intended to complement, rather than to replace, the stand-
ard texts on pharmacology for anaesthetists, since it includes no discussion
of the principles of pharmacology, an understanding of which is essential for
the clinical use of drugs. We feel that these aspects are very satisfactorily
covered elsewhere.
Although our research has been as comprehensive as possible, there will
obviously remain some information that will have eluded us, or perhaps
remains to be discovered. Many practitioners will disagree with our choice
of 172 drugs. Any comments or suggestions will be most gratefully and
humbly received in order that further editions of this book may hopefully
prove to be more useful.
Finally, we should like to thank the members of the Oxford Regional
Drug Information Unit, the many drug company information departments,
and all our colleagues for their help and support in this venture. In particular,
we should like to thank Professor Roy Spector and Drs John Sear and Tim
Peto for their invaluable advice on the manuscript.
M.P.S
S.P.S.
Oxford, 1990
vii
How to use this book
The layout of this book requires some explanation in order for the reader
to gain the maximum benefit. The 184 drugs we have included are arranged
in alphabetical order to obviate both reference to an index and the artificial
categorization of some drugs. Each drug is presented in an identical format
and confined to one, two, or three pages under the following headings:
Uses The main clinical uses are listed.
Chemical A brief chemical classification is given.
Presentation The formulations of the commercially available prepara-
tions are described.
Main action The fundamental pharmacological properties are briefly
indicated.
Mode of action The mode of action at a cellular or molecular level
(where known) is described.
Routes of administration/doses The manufacturer’s recommended
dose ranges are listed in this section; alternative clinical uses are also
mentioned.
Effects The pharmacodynamic properties are systematically reviewed.
Where a drug has no specific or known action on a particular physiological
system, the relevant section has been omitted.
The systems described are:
CVS Cardiovascular system.
RS Respiratory system.
CNS Central nervous system.
AS Alimentary system.
GS Genitourinary system.
Metabolic/other Metabolic, endocrine, and miscellaneous.
Toxicity/side effects The major side effects are listed, with particular
reference to the practice of anaesthesia and intensive care.
Kinetics The available pharmacokinetic data are provided. Quantitative
data are not available for all drugs, particularly the long established ones.
Where information on the absorption, distribution, metabolism, or excre-
tion is unavailable for a particular drug, the relevant section has been
omitted.
Absorption Details of the absorption and bioavailability are given.
viii How to use this book
Distribution This section provides information on the volume of distribution
and degree of protein binding of the drug, together with, where appropriate,
details of central nervous penetration, transplacental passage, etc.
Metabolism The site and route of metabolic transformation and the nature
and activity of metabolites are described.
Excretion The excretory pathways, clearance, and elimination half-life are
listed. Although clearances are usually expressed in ml/min/kg, this has not
always been possible due to inadequacies in the original source material.
Special points This section describes points of relevance to the practice
of anaesthesia and intensive care; in particular, significant drug interactions
are reviewed.
This standard format offers great advantages; it enables specific questions
to be answered very rapidly. For example, the question ‘How is fentanyl
metabolized?’ may be answered simply by locating the drug alphabetically
and then consulting the Metabolism section of the text. This principle holds
true for all possible permutations of queries.
ix
Contents
Glossary of terms used in this book xi
Drugs in anaesthesia and intensive care, A–Z 1
Appendix 417
Index of drug derivation 421
Index of medical uses 425
xi
Glossary of terms used
in this book
% percent
< less than
≤ less than or equal to
> greater than
≥ greater than or equal to
± plus or minus
°C degree Celsius
®
registered
A2RA angiotensin II receptor antagonist
ACEI angiotensin-converting enzyme inhibitor
ACT activated coagulation time
ACTH adrenocorticotrophic hormone
ADH antidiuretic hormone
ADHD attention-deficit/hyperactivity disorder
ADP adenosine diphosphate
ALT alanine transaminase
AMP adenosine monophosphate
ANC absolute neutrophil count
APTT activated partial thromboplastin time
ARDS acute respiratory distress syndrome
AS abdominal system
AST aspartate transaminase
ATIII antithrombin III
ATP adenosine triphosphate
AUC area under curve
AV atrioventricular
BRCP breast cancer resistance protein
Ca2+ calcium ion
cal calorie
cAMP cyclic adenosine monophosphate
cf. confer (compare with)
cGMP cyclic guanosine monophosphate
cmH2O centimetre of water
CNS central nervous system
CO2 carbon dioxide
COX cyclo-oxygenase
xii Glossary of terms used in this book
CRP C-reactive protein
CSF cerebrospinal fluid
CVS cardiovascular system
CYP cytochrome
DIC disseminated intravascular coagulation
DNA deoxyribonucleic acid
DVT deep vein thrombosis
ECG electrocardiogram
EEG electroencephalogram
e.g. exempli gratia (for example)
EMLA® Eutectic Mixture of Local Anaesthetics
ESBL extended-spectrum beta-lactamase
ESR erythrocyte sedimentation rate
FEV1 forced expiratory volume in first second
FiO2 partial pressure of oxygen in inspired air
FVC forced vital capacity
g gram
GABA gamma-amino-butyric acid
GU genitourinary
HAFOE high airflow oxygen enrichment
HAS human albumin solution
HDL high-density lipoprotein
HepBsAg hepatitis B surface antigen
HFIP hexafluoroisopropanol
HIT heparin-induced thrombocytopenia
HITT heparin-induced thrombocytopenia and thrombosis
HIV human immunodeficiency virus
HMGCoA 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase
5HT 5-hydroxytryptamine
Hz hertz
i.e. id est (that is)
IgG immunoglobulin G
IL-1 interleukin-1
IL-6 interleukin-6
IL-8 interleukin-8
INR international normalized ratio
ITU intensive treatment unit
IU international unit
K+ potassium ion
kcal kilocalorie
Glossary of terms used in this book xiii
kg kilogram
KIU kallikrein inhibitory unit
kPa kilopascal
l litre
LMA laryngeal mask airway
LMWH low-molecular-weight heparin
MAC minimal alveolar concentration
MAOI monoamine oxidase inhibitor
mb millibar
MDMA 3,4-methylenedioxymethamphetamine
mEq milliequivalent
mg milligram
MIC minimal alveolar concentration
min minute
ml millilitre
mmHg millimetre of mercury
mmol millimole
MOP mu-opioid
mOsm milliosmole
MRI magnetic resonance imaging
mRNA messenger ribonucleic acid
MRSA meticillin-resistant Staphylococcus aureus
Na+ sodium ion
NAC N-acetylcysteine
NAPQI N-acetyl-p-benzo-quinoneimine
ng nanogram
nm nanometre
NMB neuromuscular-blocking
NMDA N-methyl-D-aspartate
NO nitric oxide
N2O nitrous oxide
NSAID non-steroidal anti-inflammatory drug
PaCO2 partial pressure of carbon dioxide in arterial blood
PaO2 partial pressure of oxygen in arterial blood
PBP penicillin-binding protein
PCO2 partial pressure of carbon dioxide in arterial blood
PEFR peak expiratory flow rate
PIFE pentafluoroisopropenyl fluoromethyl ether
PMFE pentafluoromethoxy isopropyl fluoromethyl ether
PONV post-operative nausea and vomiting
xiv Glossary of terms used in this book
ppm part per million
PVR pulmonary vascular resistance
RDS respiratory distress syndrome
REM rapid eye movement
RNA ribonucleic acid
RS respiratory system
rtPA recombinant tissue plasminogen activator
spp. species
SSRI selective serotonin reuptake inhibitor
STP standard temperature and pressure
TCI target-controlled infusion
TNF tumour necrosis factor
TPN total parenteral nutrition
tRNA transfer ribonucleic acid
UK United Kingdom
USA United States of America
VD volume of distribution
VDSS volume of distribution at steady state
VIE vacuum-insulated evaporator
VMA vanillylmandelic acid
vpm volume per million
VRE vancomycin-resistant Enterococcus
vWF von Willebrand factor
w/v weight per volume
w/w weight per weight
1
Drugs in anaesthesia and
intensive care, A–Z
