Additional Important Drugs Flashcards
Octreotide
CLASS= synthetic analog of endogenous polypeptide hormone somatostatin (produced by the delta cells of the pancreas)
MOA= binds to somaostatin receptors on carcinoid tumors to decrease amount of serotonin released from tumor & decrease vasoactive amines; also inhibits release of GH, VIP, glucagon & insulin; selective vasoconstriction of splanchnic vasculature to redistribute blood flow (tx. esophageal varices)
Pharmacokinetics= 65% PB; onset- rapid; peak- 2 hrs; E1/2- 2 hrs; liver metabolism & excreted 30% unchanged in the urine
SE=decrease glucose tolerance, hyperglycemia, ecreased GI motility, N/V, bradycardia & heart block possible w/ IV boluses
CI= hypersensitivity; caution in DM (exacerbation)
Dose= carcinoid crisis- 50-100 mcg/hr; 25-200 mcg bolus PRN; 25-50 mcg/hr for bleeding varices
Omeprazole
CLASS= PPI
MOA= prodrug that irreversibly inhibits H+/K+ ATPase proton pump in gastric parietal cells thereby decreasing gastric acid secretion
Pharmacokinetics= 95% PB; onset- 1 hr; DOA- 72 hrs; metabolized in the liver by CYP450 to inactive metabolites
SE= Crosses BBB=HA, confusion, agitation, dizziness; N/V/D, abdominal pain
CI= hypersensitivity, prolongs the metabolism of diazepam, warfarin, Dilantin
Dose= 40 mg IV
Sugamamadex?
CLASS: novel modified cyclodextrin molecule- arranged in a ring shape
MOA: Cycodextrin with 8 sugars arrange in a ring, with a hydrophobic cavity which encapsulates and forms complexes with nondepolarizing NMB rocuronicum and vecurionium,. Has a very high association rate and low dissasociation rate. Can be used to reverse even a deep bockade (1-2 Post tetanic contraction (PTC)
PK: Vd 30L/kg; E1/2 T= 2 hours; metabolism of sugammadex is very limited; excreted predominately unchanged by the kidneys.
S/E: Hypersentiviity, inadeqaute dose can lead to delayed manifesatation of residual block; bradycardia, N/V, hypotension, pain, HA
CI: Renal impairment (avoid in pt with CrCl <30 mL/.min); known hypersensitivity, safety and FDA approval not established for children under 17 (recently ok’ed 2-17 yo). Hormonal contraceptives can be less effective; contraceptive back up needed for 7 days
DOSE: Dependent on level of blockade
- 2mg /kg recommended if 2/4 twitches present on TOF
- 4mg/kg recommneded if 1-2 PTC twitches and no twitch responses to TOF stimulation (deep blockade)
- 16 mg/kg with profound blockade induced by RSI dose of Rocuronium (1.2 mg/kg)
Milrinone
CLASS= bypyridine inotropic/vasodilator agent with phosphodiasterase inhibitor activity
MOA= inhibition of PDE III, which inhibits the degradation of cAMP causing increase intracellular Ca2+ which increase contractility; inhibits the degradation of cGMP causing A&V vasodilation and thus decrease preload & afterload; combined effect cause increase inotropy &decrease SVR = increase CO; decrease PVR- mild bronchodilator
Pharmacokinetics= onset- 5-20 min; peak- 5 min; E1/2- 2 hrs; metabolized by CYP450 in liver & 80% excreted unchanged in the urine
SE= arrhythmias, mild tachycardia, hypotension, angina, HA, hypokalemia, tremors
CI= aortic or pulmonic valve disease, acute MI, no with digoxin, decrease dose in RF
Dose= 50 mcg/kg IV over 10 min then 0.5 mcg/kg/min gtt
Nifedepine
CLASS= dihydropyridine CCB
MOA= binds to the alpha subunit of the L type voltage gated Ca2+ channels in the inactive or closed state & blocks the inward flux of Ca2+ causing preferential peripheral & CA vasodilation to decrease SVR & BP w/ minimal effects on AV & SA conduction
Pharmacokinetics= 90% PB (highly); onset- rapid, E1/2- 3-7 hrs (prolonged in elderly); metabolized by the liver & renal clearance 70% & rest is cleared in bile
SE= reflex tachycardia, flushing, constipation, parenthesis & skeletal muscle weakness, vertigo, HA, potentiate NMB, peripheral edema
CI= abrupt cessation has been associated with CA vasospasm, preexisting hypotension, CHF/HF, renal dysfunction, dantrolene, caution w/ BBs
Dose= 5-15 mcg/kg IV
Amiodarone?
CLASS= class III K+ channel blocker antiarrhythmic with class I, II & IV properties
MOA= blocks Na+/K+/Ca2+ channels prolonging AP duration & repolarization - decrease general excitability; slowing AV node conduction; alpha & beta adrenergic antagonist; can use for refractory VT, vfib, afib, SVT; 1st line treatment for VT & VF when resistant to defibrillation
Pharmacokinetics= high PB; large Vd; E1/2- 30-100 days; CYP450 hepatic metabolism to active metabolite- N desmethyl amiodarone (DEA) & biliary excretion
SE= hypotension, arrhythmias, AV block, prolonged QTI, torsades de pointes, pulmonary fibrosis, liver toxicity, nephrotoxicity, corneal deposits, photosensitivity, nightmares, thyroid abnormalities, CYP450 inhibitor reducing the clearance of digoxin, warfarin
CI= AV block, iodine allergy, patients on ßB, CCBs, lidocaine, halothane
Dose= 150-300 mg bolus then 1 mg/min x 6 hrs then 0.5 mg/min x 18 hrs
Verapamil
CLASS=non-dihydropyridine (phenylalkamine) CCB & class IV anti-arrhythmic.most potent
MOA= binds to the alpha subunit of the L-type voltage gated Ca2+ channel in inactive or closed state & blocks the slow inward flux of Ca2+ into myocardial & VSM cells. It is more selective for Ca2+ channels in the heart, thus decrease SA & AV node conduction & decreaseHR & contractility & conduction velocity; also a CA & systemic vasodilator; tx SVT, afib, aflutter, prizmentals angina, HTN
Pharmacokinetics= 90% PB (highly); onset- IV 15 min, PO 30-45 min; E1/2- 6-8 hrs; liver metabolism & excreted 70% unchanged in the urine & bile. active metabolist norverapamil
SE= hypotension, bradycardia, AV block, CV depression, esp with IA’s, AV block, exacerbates HF, nausea, constipation, syncope, gingival hyperplasia, potentiates NMB, can increase LA toxicity, with dantrolene can cause hyperkalemia and CV collapse.
CI**= HF/HB (especially when combined with ßB)**; sick sinus syndrome, acute MI/CHF, contraindicated with dantrolene (increase K+) & ßB (CV depression); can increase digoxin levels, NO in VT; myocardial depressiona nd vasodilation with VA
Dose= 2.5-5 mg IV over 2 min then 5-10 mg IV over 15-30 min to max of 20 mg
Diltiazem?
CLASS non-dihydropyridine CCB (Modified benzothiazepines) & class IV anti-arrhythmic (Less CV depression than Verapamil)
MOA= binds to the alpha subunit of the L-type voltage gated Ca2+ channel in inactive or closed state & blocks the inward flux of Ca2+ into myocardial & VSM cells. It is more selective for Ca2+ channels in the heart, thus decreaseSA & AV node conduction & decrease HR & contractility; also a CA & systemic vasodilator; tx SVT, afib, aflutter, variant angina, HTN
Pharmacokinetics= 70% PB (highly); onset- rapid; E1/2- 4-6 hrs; extensive liver metabolism by CYP450 & excreted 30% unchanged in the urine
SE= hypotension, bradycardia, AV block, CV depression (esp with IA’s), exacerbates HF, nausea, constipation, syncope, potentiates NMB, can increase LA toxicity, with dantrolene can cause hyperkalemia
CI= HF/HB (especially when combined with ßB), sick sinus syndrome, acute MI/CHF, contraindicated with dantrolene (increase K+) & ßB (CV depression); can increase digoxin levels
Dose= 0.25 mg/kg bolus over 2 min then 5-15 mg/hr
Adenosine
CLASS= endogenous nucleotide not belonging to a specific anti-arrhythmic class
MOA= binds to A1 purine nucleotide receptors & activates G protein coupled adenosine receptors to open K+ channels & increase K+ currents thus hyperpolarizing cardiac tissue; slows SA & AV nodal conduction (SVT); used to terminate SVT or for diagnosis of VT
Pharmacokinetics= very rapid onset & termination of action_; E1/2- <10 sec_; eliminated by plasma & vascular endothelial cell enzymes
SE= chest pain, dyspnea, facial flushing, hypotension, asystole, nausea, bronchospasm, excessive SA or AV node inhibition
CI= asthma, AV HB, sick sinus syndrome
Dose= 6 mg rapid IVP then repeat in 3 min 6-12 mg
Digoxin
CLASS= cardiac glycoside
MOA= inhibits Na+/K+ ATP pump causing increase intracellular Na+ & Ca2+ thereby incease contractility & decrease HR through increase PNS activity & decrease SA/AV node conduction; decrease HR, preload & afterload; good for management of afib, a flutter (controls the ventricular rate especially when HF); decrease renal reabsorption of Na+ & works synergistically with CCB & ßB
Pharmacokinetics= low PB; large Vd; onset- 30-60 min; E1/2- 36 hrs; excreted in the kidneys 90% unchanged; decrease dose in elderly
SE= prolonged PRI, ST depression, T wave changes, HB, N/V/D/A, HA, hypokalemia, AV block, abx increase absorption, verapamil, amiodarone & quinidine increase digoxin levels
CI= VF/VT, HB, hypertrophic cardiomyopathy, digoxin toxicity potentiated by decrease K+, decreaseMg2+ & increaseCa2+; caution K+ wasting diuretics; do not use in renal disease
Dose= 0.5-1 mg IV over 12-24 hrs; therapeutic window- 0.5-1.2 ng/ml
Procainamide
CLASS= class IA (intermediate) Na+ channel blocker
MOA= depresses phase 0 of AP by blocking Na+ channels which decrease the rate of depolarization & slows conduction velocity, prolonging repolarization & lengthening refractory period; decrease automaticity; decrease contractility & conduction velocity & cardiac excitability; 1st line treatment for VT; used for tachyarrhythmias (a fib, a flutter, WPW syndrome, stable polymorphic VT, stable monomorphic VT, atrial or ventricular in origin)
Pharmacokinetics= low PB; onset- immediate; E1/2- 3 hrs; metabolized to active metabolite N-acetyl procainamide (NAPA) which has class III action & E1/2- 6-8 hrs then excreted 60% unchanged in urine
SE= hypotension, arrhythmias, N/V/D, myocardial depression, blood dyscrasia, wide QRS
CI= AV block, prolonged QTI, hypersensitivity to procainamide or other amide LA, myasthenia gravis, black box warnings- can cause SLE syndrome, don’t use with life threatening arrhythmias, fatal blood dyscrasias & with myocardial depression
Dose= 1-4 mg/min
Flumazenil?
Class? MOA? Pharmacokinetics? SE? CI? Dose?
CLASS= benzodiazepine antagonist; imidazobenzodiazepine derivative
MOA= competes with benzos for binding to the GABA-A receptor effectively reversing sedation & ventilatory depression effects; also used for differential diagnosis of coma- has high affinity & specificity for GABA-A receptor
Pharmacokinetics= 50% PB; Vd- 0.5L/kg; onset- 1-2 min; DOA- 30-60 min; metabolized by the liver & excreted in the urine; E1/2- 1 hr; can cause re-sedation b/c of short DOA may need to re-dose
SE= sweating, HA, dizziness, confusion, euphoria, abnormal vision, N/V, pain on injection; no change in HR, BP, or neuroendocrine response
CI= hypersensitivity, DO NOT USE in seizure disorders
Dose= 0.2 mg IV- wait 2 min then repeat at 0.1 mg q 60 sec to a max of 3 mg
Naloxone?
MOA? Pharmacokinetics? SE? CI? Dose?
Naloxone/Narcan- nonselective competitive opioid antagonist @ mu, kappa & delta receptors
MOA= reverses narcotic depressant effects & biliary tract spasm by binding to the mu, kappa & delta opioid receptors to reverse respiratory depression sedation & analgesia
Pharmacokinetics= onset- 1-2 min, DOA- 30-60 min; E1/2- 1 hr; metabolized by the liver to form naloxone-3-glucuronide & excreted in the urine
SE= crosses placenta, HTN, tachyarrythmias, severe pain, N/V, PULMONARY EDEMA, seizures
CI= CHF, pregnancy, opioid dependent patients
Dose= 0.1-2 mg IV q 2-3 min- titrated slowly to decrease adverse effects
Nalbuphine
CLASS= opioid agonist-antagonist
MOA= Mu antagonist & full or partial agonist at the kappa receptor to help with mild-moderate pain w/o respiratory depression effects; can reverse SOO spasm
Pharmacokinetics= onset- 2-3 min; DOA- 3-6 hrs; liver metabolism
SE= analgesia, sedation, N/V/C, pruritus, urinary retention, dose dependent decrease HR, BP, SVR; dysphoria; low probability of dependence; can reverse respiratory depression in opioid OD
CI= allergy, decrease dose in peds & elderly, caution in hypovolemia, pregnancy
Dose= 0.1-0.3 mg/kg
Butorphenol
CLASS= opioid agonist/antagonist
MOA= Mu antagonist or partial agonist; & agonist at kappa
Pharmacokinetics= DOA- 2-4 hrs; liver metabolism
SE= analgesia, sedation, N/V/C, pruritus, urinary retention, dose dependent ê HR, BP, SVR;
CI=allergy,decrease dose in peds & elderly, opioid dependent patients, pregnancy
Dose= 0.01-0.04 mg/kg