Pantoprazole
Protonix
Proton pump inhibitor
Irreversibly inhibits the gastric H⁺/K⁺-ATPase (proton pump) → ↓ gastric acid secretion + volume.
Indications
- •Aspiration prophylaxis (raise gastric pH, reduce volume — high-risk/OB, given the night before + morning of)
- •GI bleeding (high-dose infusion)
- •GERD / stress-ulcer prophylaxis
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Aspiration prophylaxis | 40 mg IV/PO (most effective if a dose is given the evening before + morning of surgery) | — |
| GI bleed | 80 mg IV bolus, then 8 mg/hr infusion | — |
Pharmacokinetics
Onset slower than H2 blockers/citrate (needs to act on active pumps) — timing matters. Hepatic CYP2C19.
Side effects
- !Generally well tolerated (acute)
- !Hypomagnesemia + C. diff + fractures (chronic)
Contraindications
- ×None significant for perioperative single use
Clinical pearls
- ★For aspiration prophylaxis, PPIs work best dosed the NIGHT BEFORE + morning of — a single on-call dose is less reliable than non-particulate citrate (which works immediately).
- ★Multimodal aspiration prophylaxis = PPI/H2 blocker + metoclopramide + non-particulate antacid (citrate).
Other drugs in Others
- Dantrolene
Blocks RYR1 (ryanodine receptor) → ↓ Ca²⁺ release from sarcoplasmic reticulum → muscle relaxation. The only drug for malignant hyperthermia.
- Lipid Emulsion 20%
Theory: 'Lipid sink' sequesters lipophilic drugs (especially LAs), shifts to better Ca²⁺ handling, fatty acid metabolic support.
- Hydroxocobalamin
Vitamin B12a precursor; cyanide binds to cobalt center of hydroxocobalamin → forms cyanocobalamin (B12) → renal excretion. Also scavenges nitric oxide → vasoconstriction.
- Octreotide
Long-acting somatostatin analogue → suppresses splanchnic blood flow, GI/pancreatic secretions, GH, glucagon, insulin, and serotonin/vasoactive-peptide release.
- Alvimopan
Blocks GI mu-opioid receptors WITHOUT crossing the blood-brain barrier → reverses opioid-induced gut slowing while preserving central analgesia. Accelerates return of bowel function.
- Phentolamine
Competitive, reversible α1 + α2 blockade → vasodilation. Short-acting.
- Inhaled Nitric Oxide
Inhaled NO diffuses to pulmonary vascular smooth muscle → ↑ cGMP → SELECTIVE pulmonary vasodilation only in VENTILATED lung units (improves V/Q matching). Inactivated by hemoglobin before reaching systemic circulation → no systemic hypotension.
- Digoxin Immune Fab
Ovine Fab fragments bind free digoxin → the complex is renally excreted → rapidly reverses digoxin/digitoxin toxicity.
Browse all classes: /reference/drugs
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
