Advanced Pharmacology Flashcards
What is the onset of action for IV/IO administrated drugs
Onset: 30-60s
What is the onset of action for ETI administered drugs?
onset: 2-3min
Time of onset for IM and SC drug administration?
IM: 10-20Min
SC:15-30min
What is the “loading dose” for fentanyl in a patient presenting with severe pain? (IM/IV/IO)
-0.5-1.0mcg/kg to a max single dose of 100mcg. q-5 to a total of 300mcg
What is the intranasal dose for fentanyl?
-1.5 to 2.0mcg/kg.
Max single dose 100mcg
Max cumulative dose of 300mcg
When should ketamine be considered after fentanyl use?
-pain insufficiently managed after a total of 1-3mg/kg.
- High opioid tolerance?
- Patient request
What is the paediatric max single and cumulative dose of fentanyl IN/IV/IO
Max single IN: 100mcg
Max single IV/IO: 50mcg
Max cumulative dose: 200mcg
What is the SC dose for morphine?
0.1mg/kg SC or 2.5-5mg SC
May repeat every 10-30 min based on blood pressure >100mmHg
Describe the analgesic dose for Ketamine
IV/IO: 0.3mg/kg
-may repeat 1/2 (0.15mg/kg) after 5 min
IM-0.5mg/kg, may repeat 0.3mg/kg after 45 minutes
Describe the procedural sedation dose for ketamine
IV/IO: 0.1-0.5mg/kg slow push every 60 seconds to effect.
CONSIDER starting at 0.5mg/kg and use subsequent 0.25mg/kg doses as needed
Describe an induction dose of ketamine based on shock index
If SI is <1 use 2mg/kg
If SI is >1 use 1mg/kg
Half of induction dose every 10-15min as required
What are the doses for IM and IV/IO midazolam?
IV/IO 2-5mg
IM 5-10mg
MAX 30mg
What is the pediatric dose for midazolam?
IN 0.2mg/kg, max of 10mg
IV/IO 0.1mg/kg or max of 5mg
IM: 0.2mg/kg IM
Describe phase 0 of action potential
- Depolarization phase
- Rapid influx of Na+ and Ca+
what is the resting membrane potential of a cardiac myocyte?
-90mv
Describe Phase 1 of action potential
Phase 1 consists of a transient efflux of K+
Describe phase 2 of action potential
Phase 2 is the plateau phase, the efflux of K+ is balanced by the influx of Ca+
Describe phase 3 of action potential
Phase 3 is the depolarization phase with an Efflux of K+
Describe phase 4 of resting membrane potential
Consistent leak of K+
Describe class one of Vaughn Williams classification
- Sodium channel blockade
- Reduces phase 0 slope and peak of action potential
- broken up into 1A, 1B, 1C (moderate, weak, strong) Lido is 1B
Describe class 2 of VW
- Beta Blockade
- Block sympathetic activity; reducing HR and conduction.
Describe class 3 of VW
- Potassium channel blockade (Amio)
- Delays repolarization phase and increases action potential duration and the effective refractory period
Describe class 4 of VW
Blocks L-type Ca+ channels, calcium channel blockers are most effect at the SA and AV nodes causing reduced HR and conduction.
Describe MOA for Amioderone
Mainly a class 3 agent but has 1,2,4 class properties.
-Amio primarily blocks potassium channels lengthening the refractory period in all cardiac tissues
Name three “Inoconstrictors”
Subset 1
Norepinephrine
Epinephrine
Dopamine
Name two vasoconstrictors
Phenylephrine
Vasopressin (ADH)
subset 2
Name three inodilators
Dobutamine
Milrinone
subset 3
Name 3 Vasodilators
Nitroglycerin
Nitroprusside
Nesiritide
Subset 4
What are the three stages of anaesthesia
Induction
Maintenance
Emergence
