2- pharm Flashcards by Karin Lavie

comparing ativan, versed, and xanax for PK

Midazolam (Versed) – fast onset, short duration

Lorazepam (Ativan) – slowest onset, longest acting

Diazepam (Valium) – difficult to use for sedation, least commonly used

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propofol side effects

respiratory and CV depression,
apnea,
hypotension,
↑ triglycerides,

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propofol PK

rapid onset and short duration

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Propofol infusion syndrome

rare adverse effect after prolonged infusion, or with catecholamines or steroids

–> cardiac failure, bradycardia, rhabdomyolysis, severe metabolic acidosis, renal failure, and is often fatal

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Etomidate used for

sedative, anesthetic; used for rapid sequence intubation

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advantages/disadvantages of etomidate

Advantages – rapid onset (< 60 sec), reliable kinetics, cardiovascularly stable

Disadvantages – inhibits adrenal steroidogenesis by inhibiting 11-B-hydroxylase → ↓ response to ACTH

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MOA Dexmedetomidine (Precedex) –

alpha2 agonists in locus ceruleus and spinal cord; sedates by upregulating endogenous sleep promoting pathways and analgesia through spinal cord pathways

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precedex used for

for brief post-op sedation;

ventilator weaning difficulties

alcohol withdrawal to help them be less agitated

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advantages/disadvantages to precedex

Advantages – no respiratory depression

Disadvantages – bradycardia, vasodilation

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how does fentanyl compare to morphine

lipid soluble,
100x more potent than morphine,
more rapid onset,
no histamine release

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ketamine MOA

phencyclidine analog; sedative and dissociative anesthetic

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ketamine effects

potent bronchodilator;

may cause hypertension, hypertonicity, hallucinations, nightmares;

psychotic effects can be limited by treating with benzos or using lower dose

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ketorolac advantages/disadvantages

o Advantages – no respiratory depression

o Disadvantages – renal failure, thrombocytopenia, gastritis; ↑ in critically ill

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paralytic uses

facilitate mechanical ventilation, intubation, preventing ↑ ICP, decreasing metabolic demands, decreasing lactic acidosis in tetanus and NMS

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disadvantages to paralytics

no analgesia or sedation, prevent neuro exams, ↑ risk of DVTs, pressure ulcer, and nerve compression,

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Post-parayltic syndrome –

acute myopathy with flaccid paralysis, ↓ DTRs, normal sensation, and ↑ CPKs that persists after paralytic is gone; ↑ risk in combination with high dose steroids

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depolarizing vs polarizing agents

Depolarizing agents - succinylcholine

Polarizing agents – pancuronium, vecuronium, rocuronium, atracurium

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advantages/disadvantages succinylcholine

A: Rapid onset, short acting

D: ↑ K, ICP, IOP

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advantages/disadvantages Pancuronium

A: Inexpensive, long acting

D: Tachycardia

advantages/disadvantages Vecuronium

A: Less CV effects

D: Bradycardia

advantages/disadvantages: Atracurium

A: Hoffman elimination

D: Rash, histamine release

advantages/disadvantages Rocuronium

A: No hemodynamic effects

D: Expensive

dose effects of dopamine- medium vs high

Medium dose – 5-10 mcg/kg/min; stimulates B > A causing modest positive inotrope and ↓ BP

High dose – 10-20 mcg/kg/min; stimulates A > B causing vasoconstriction

disadvantages of dopamine

– tachyarrhythmias; may impair mesenteric perfusion more than NE

dobutamine MOA

strong B1 agonist, mild B2 agonist; dose at 5-15 mcg/kg/min Effects – ↑ SV → ↑ CO and possibly ↓ SVR

uses dobutamine and adverse effects

Uses – RHF, LHF, septic shock ADR – tachyarrhythmias

amrinone, milrinone MOA

PDE inhibitors positive inotrope and vasodilator, systemic and pulmonary; little effect on HR

uses and adverse effects of amrinone, milrinone

Uses – CHF Disadvantages – arrhythmogenic, thrombocytopenia

Norpinephrine (Levophed, leave them dead) MOA

potent A and B Effects – vasoconstriction, but spares brain and heart

Uses and adverse effects of NE

Uses – septic shock (increases SVR) Disadvantages – ↓ kidney perfusion (but least of all A agents), reflex vagal bradycardia

phenylephrine MOA

strong, pure A agent; Effects – vasoconstriction with minimal ↑ in HR or contractility

Uses and adverse effects of phenylephrine

switch to this from NE if pt has tachycardia adverse: reflex bradycardia, does not spare brain or heart, BP at the expense of perfusion

epinephrine MOA

B and A agonist Effects – similar to NE, but more mesenteric ischemia, more effects on inflammation and metabolic rate

epi uses and adverse effects

Uses – anaphylaxis Disadvantages – arrhythmogeic, coronary ischemia, renal vasoconstriction, ↑ metabolic rate

Ephedrine

releases tissue stores of epinephrine; longer lasting but less potent than epinephrine; used mostly by anesthesiologists

vasopressin effect

released in response to hypovolemia, ↑ osmolarity, causes vasoconstriction of vascular smooth muscles using V1 receptors

vasopressin use

septic shock in addition to NE since most patients quickly become physiologically deficient in vasopressin

labetalol MOA

a1 and non-selective B blocker ↓ SVR and BP without causing tachycardia; does not ↑ ICP

labetalol dose for HTn emergencies and dissection

20 mg bolus, 2 mg/min infusion

nitroglycerine effect low vs high dose

o Low doses – < 40 mcg/min; venodilation o High doses - > 200 mcg/min; arteriolar dilation

nitroglycerine PK

o Rapid onset, short duration, tolerance

nitroglycerine Disadvantages

tolerance; inhibits platelet aggregation ↑ ICP, headache

Nitroprusside MOA and PK

balanced vasodilator, rapid onset, short elimination time; 0.2-10 mcg/kg/min

Nitroprusside uses

HTN emergency, severe CHF, aortic dissection

nitroprusside disadvantages

cyanide poisoning- ↓ CO, lactic acidosis, seizures; accumulates in renal and hepatic dysfunction ↑ ICP