13 Drugs in the Drawer Flashcards
List all 3 emergency drugs?
1-Epinephrine
-Nonselective agonist for alpha-adrenergic and
beta-adrenergic receptors
2-Phenylephrine
-alpha1 agonist with very little beta effect
-Brings up BR and brings down HR (don’t use for HR < 70)
3-Ephedrine
-Agonist of alpha-1, beta-1 and beta-2-adrenergic
receptors
-Brings up both BR and HR up
Epinephrine comes in different concentrations, Identify them?
1 mg/ml 1:1,000 ampule
(dilute before IV administration)
- 1:10,000 for cardiac arrest
-1:100,000 for bronchospasm
Phenylephrine, comes in different concentrations, Identify them?
AKA (Neosynephrine)
-100 mcg/ml (5 ml syringe)
-10 mg/ml vial - dilute in 100 ml NS bag for 100 mcg/ml concentration
Indication of phenylephrine?
Reflex bradycardia- don’t give if HR is under 70
Ephedrine , comes in different concentrations, Identify them?
- 5mg/ml ( 5 cc syringe)
- 50 mg/ml vial- dilute to 5 mg/ml concentration
Indications of Ephedrine?
Tachyphylaxis- cant due infusion due to this
Atropine, comes in different concentrations, Identify them?
0.4 mg/ml (1 ml vial)
Indications of Atropine?
-Muscarinic agonist
-Tertiary amine
-Very strong reaction - Huge bump in HR
-Crosses the blood brain barrier and placental barrier
-Won’t work in heart transplant - Transplant heart isn’t connected to vagus nerve - De innervated heart
-Doesn’t last very long - Onset of IV atropine typically is rapid and duration of action generally short, ranging from 20–30 minutes
List the two common Neuromuscular blocking agents?
1-Succinylcholine
2-Rocuronium
What is the concentration of Succinylcholine ?
20mg/ ml (5 cc syringe)
-IV dose 1mg/kg
-IM dose 4 mg/kg
NOTE: K increase 0.5-1 mEq/L, pseudocholinesterase deficiency, MH
What is the concentration of Rocuronium?
10 mg/ml (5 or 10 cc vial or syringe)
- 0.45- 0.6 mg/kg intubation
- 0.6- 1.2 mg/kg RSI
-Allergy risk
-The onset of action is dose-dependent from 45—120
seconds, with a duration of action 30—90 minutes
Concentration of Sugammadex ?
100 mg/ml (2 ml and 5 ml vials)
16 mg/kg for fast reversal (~3 minutes after administration)
4 mg/kg for TOF = 0-1
2 mg/kg for TOF = 2
Side effects: Interferes with hormonal contraceptive, Bradycardia, Anaphylaxis
rapid onset - bite block before reversal
Concentration of Neostigmine ?
Neostigmine
1 mg/ml (5 ml syringe or 10 ml vial)
0.03 – 0.07 mg/kg depending on TOF
(0.05 mg/kg @ NYU)
Not used in kids
Onset of action is within 1 min, peak effect occurs in 10 min and duration of action is 20–30 min
give after fascia is closed
Concentration of Anticholinergics/ glycopyrrolate?
Glycopyrrolate (aka robinul)
0.2 mg/ml (1 ml or 5 ml vial)
Pair 0.2 mg with 1 mg neostigmine for reversal
0.1 – 0.2 mg dose for bradycardia, antisialagogue
Pediatric: 0.004 mg/kg not to exceed 0.1 mg in a single dose (2-3 min intervals)
onset of action within 1 minute; 2 to the 4-hour duration of action
vagal blocking effects persist for 2 to 3 hours and the antisialagogue effects persist up to 7 hours
Name two PONV drugs?
-Ondansetron (zofran)
-Metoclopramide (aka reglan)
what is the concentration of Ondansetron ?
2 mg/ml (2 ml vial)
-4 – 8 mg single dose adult
-0.1 mg/kg pediatric dose
4 mg max
causes QT prolongation; normal QT 350-400ms
what is the concentration of Metoclopramide?
5 mg/ml (2 ml vial)
-10 – 20 mg single dose adult
-2.5 – 5 mg 6–14 yrs old
-0.1 mg/kg <6 yr old
-Increases gastric emptying by increasing peristalsis
-dopamine antagonist - Don’t give with Parkinson
-Don’t give with bowel obstruction (SBO)
-Has CNS effects
List all three Beta blockers
Esmolol 10 mg/ml (10 ml vial)
Beta1-specific antagonism
Labetalol 5 mg/ml (20 ml vial)
Alpha and beta antagonism
Metoprolol 1 mg/ml (5 ml vial)
Beta1-specific antagonism
How does Esmolol work?
By blocking the adrenergic activity of epinephrine and norepinephrine
-It decreases inotropic contractility, heart rate, and conduction.
-onset is 60 - 120 sec and duration of action is
-extremely short, about 10 to 30 minutes
How does Labetalol work?
For acute hypertensive events (emergent/urgent), the IV formulation is indicated and an initial dose of a 10- to 20-mg IV push, with repeat boluses administered every 10 minutes until the systolic blood pressure is within the desired range
onset of action within 2 - 5 minutes, peak effects at 5 - 15 minutes, duration of action up 3-6 hours
how does Metoprolol work?
onset of action 5 min,, duration 5-8 hr
Examples of Vasodilators ?
Hydralazine
20 mg/ml vial
-5 – 20 mg
-Max dose 40 mg
How does Hydralazine work?
onset 5–20 minutes; BP-lowering effect lasts 2–6 hours
reduces peripheral vascular resistance (through IP3) and leads to a compensatory baroreceptor-mediated release of epinephrine and norepinephrine, which, as a result, increases venous return and cardiac output. Given hydralazine’s stimulation of the sympathetic nervous system, it consequently leads to tachyphylaxis and tachycardia. It is sometimes given with a beta-blocker or diuretic for better patient tolerance
What is the concentration of etomidate?
Etomidate
2 mg/ml (10 ml vial)
-0.3 mg/kg induction GA
Adrenal suppression 6-8 hours - Caution if pt is septic, old, on high dose steroids
side effects: PONV, burns on injection
Great for cardiac patients - Hemodynamically stable
