anti-.... cholenergics, n/v,Oxytocin, octreotide

Question 1

MOA for Anticholinergics

Answer 1

Aromatic esters that competitively inhibit the effects of ACh at the muscarinic receptors thereby decreasing PNS activity (prevent c AMP and cGMP effects); used for symptomatic brady, anti-sialagogue, Gi spasms and decreases GI secretions, bronchodilation, pea, systole, promotes AW relaxation by inhibing the M2 and M3 causing bronchial SM relaxation and increase HR by blocking the ACh effects at SA node; use with NMB reversal agent

Question 2

Atropine PK

Answer 2

40%PB to alpha-1-glycoprotein, Vd=1.6L/KG, onset 1 min, peak 1-2min, Do a 30-60min, e1/2 2 hours, hydrolyzed in the liver to tropine and tropic acid and excreted 18% unchanged in the urine

Question 3

Atropine Se

Answer 3

sedation bc crosses bbb, increases HR, CO, IOP, arrhythmias, blurry vision, decrease secretions and GI motility, bronchodilation

Question 4

Atropine class

Answer 4

tertiary amine anticholinergic

Question 5

Atropine CI

Answer 5

glaucoma, patients that tachycardia would be harmful- such as-CAD, hyperpyrexia pts, mobitz type 2
avoid other sympathomimetics

Question 6

Atropine Dose

Answer 6

0.01mg/kg for reversal; 0.4-0.6 preop antisialagogue, 0.4-1mg for bradycardia; 1mg q3-5min for systole/PEA

Question 7

Glycopyrrolate class

Answer 7

synthetic quaternary ammonium anticholinergic

Question 8

Glycopyrrolate Pk

Answer 8

onset 2-3 min, peak 3-5min, DOA 2-4 hours, e1/2 1hour, liver metabolism and 85% excreted unchanged in the urine, poorly lipid soluble

Question 9

Glycopyrrolate SE

Answer 9

increase HR, CO, IOP, arrhythmias, H/A, blurry vision, decrease secretions and go motility, bronchodilation, MH, decreases sweating, anaphylactic reaction

Question 10

Glycopyrrolate CI

Answer 10

MH, neonates, CAD, HTN, CHF, glaucoma, hyperpyrexia pts

Question 11

Glycopyrrolate dose

Answer 11

reversal 0.01-0.02mg/kg IV

anti-sialagogue and bradycardia 0.1-0.2mg

Question 12

Scopolamine- class

Answer 12

tertiary amine anticholinergic

used for motion sickness, PONV, sedation, bronchodilation; biliary and ureteral SM relaxation, NOT USED FOR REVERSAL NMB

Question 13

Scopolamine Pk

Answer 13

lipid soluble, onset 10 min, DOA 2 hours, e1/2 4 hours, may last 3-7 days, metabolized by the liver with <1% excreted unchanged in the urine

Question 14

Scopolamine SE

Answer 14

increase HR, CO, IOP, OH. sedation, arrhythmias, blurry vision. decreases secretions and GI motility

Question 15

Scopolamine CI

Answer 15

glaucoma liver disease, GI/GU obstruction

Question 16

Scopolamine dose

Answer 16

0.3-0.6mg IV q4-6 hours

Question 17

Metoproclamide/reglan

Answer 17

antiemetic, dopamine receptor antagonist and serotonin receptor agonist

Question 18

Metoproclamide/reglan MOA

Answer 18

blocks the DA2 receptors in the chemo receptor trigger zone of the medullar preventing N/V; also a pro kinetic increasing gastric motility via serotonin increasing peristalsis and increases ACh at the muscarinic receptors post synaptically

Question 19

Metoproclamide/reglan PK

Answer 19

onset 1-3 min, DOA 1-2 HR, e1/2 2-4hours, metabolized in the liver and 40% excreted unchanged in the urine

Question 20

Metoproclamide/reglan SE

Answer 20

increase gastric motility, LES tone, decrease N/V, extrapyramidal SE, abd cramping, sedation, prolactin secretion, dry mouth, good for RSI

Question 21

Metoproclamide/reglan CI

Answer 21

Parkinsons, bowel obstruction, GI hemorrhage, sz, arrhythmias esp if administered with zofran, no phenothiazides

Increased sedative effects of Cns depressants

Question 22

Metoproclamide/reglan dose

Answer 22

10-20mg iv over 3-5min 15 min before induction
10mg preinduction pt with gastroparesis
0.15/kg mom ponv and kid

Question 23

Ondansetron/Zofran class

Answer 23

antiemetic, serotonin antagonist

Question 24

Ondansetron/Zofran MOA

Answer 24

blocks the serotonin receptors peripherally and in the CRTz- coupled to fast sodium channels and k channels

Question 25

Ondansetron/Zofran PK

Answer 25

onset 30min, DOA 4-8hours, e1/2 3-4 hours, metabolized in the liver with renal excretion 5% unchanged

Question 26

Ondansetron/Zofran SE

Answer 26

HA with rapid administration, sedation, arrhythmias, constipation, diarrhea, fatigue

Question 27

Ondansetron/Zofran CI

Answer 27

hypersensitivity, liver disease, SSRIs, MAOis

Question 28

Ondansetron/Zofran dose

Answer 28

4-8mg IV over 2-5min

Question 29

Promethazine/Phenergan class

Answer 29

antiemetic, H1 and Dopamine 2 antagonist.

Question 30

Promethazine/Phenergan MOA

Answer 30

blocks DA receptors and antagonizes H1 @ receptor. response decreases histamine mediated release in respiratory tract, GI and blood vessels

Question 31

Promethazine/Phenergan Pk

Answer 31

93%PB, onset 3-5min, DOA 2-4 hours, e1/2 9-16hours, metabolized in the liver by CYP450 and excreted in the urine

Question 32

Promethazine/Phenergan SE

Answer 32

extrapyramidal effects, anticholinergic effects, sedation, arrhythmias, neuroleptic malignant syndrome

Question 33

Promethazine/Phenergan CI

Answer 33

hypersensitivity, parkinson's on levodopa, rena/hepatic/pulmonary diseases, peds <2yrs

Question 34

Promethazine/Phenergan dose

Answer 34

6.25-25mg IB

Question 35

Omeprazole/Prilosec class

Answer 35

Antiemetic/ PPI

Question 36

Omeprazole/Prilosec MOA

Answer 36

prodrug that irreversibly inhibits H=/K= ATPase proton pump in the parietal cells decreasing gastric secretion

Question 37

Omeprazole/Prilosec PK

Answer 37

95% PB, onset 1hr, DOA 72 hr, metabolized in the liver by CYP 2C19 to inactive metabolites

Question 38

Omeprazole/Prilosec SE

Answer 38

HA, confusion, agitation, dizziness, N/V/D, abd pain

Question 39

Omeprazole/Prilosec CI

Answer 39

hyprsensitivity, prolongs metabolism of diazepam, warfarin, dilantin

Question 40

Omeprazole/Prilosec dose

Answer 40

40mg IV

Question 41

Octreotide class

Answer 41

somatostatin analog

Question 42

Octreotide MOA

Answer 42

binds to somatostatin receptor on carcinoid tumors to decrease the amount of serotonin released from tumors and decrease vasoactive amides; inhibits the production and release of GH, glucagon and insulin

Question 43

Octreotide pk

Answer 43

65% PB, onset rapid, peak 2 hours; E1/2 2 hours; liver metabolism and excreted 32% unchanged in the urine

Question 44

Octreotide SE

Answer 44

decrease glucose tolerance, hyperglycemia, N/V/C, decreases GI motility, gallstones, bradycardia, AV block

Question 45

Octreotide CI

Answer 45

hypersensitivity, decreases effects of codeine and cyclosporine

Question 46

Octreotide dose

Answer 46

50-100mcg/hr; 25-200mcg prn; 25-50mcg/hr for varices

Question 47

Oxytocin class

Answer 47

endogenous posterior pituitary hormone

Question 48

Oxytocin MOA

Answer 48

binds to oxytocin receptors on the uterus= SM contraction; used to induce or augment labor and contract the uterus post delivery and decrease chance of hemorrhage

Question 49

Oxytocin PK

Answer 49

onset 1 min, DOA 1hour, E1/2 3-5min; metabolized by the liver and kidney; broken down by plasma oxytocinase and metabolism in mammary gland

Question 50

Oxytocin SE

Answer 50

mom- anaphylaxis, N/V, PP hemorrhage, uterine rupture, arrhythmias and PVCs; baby- bradycardia, problematic fetal positioning, fetal distress

Question 51

Oxytocin CI

Answer 51

fetal distress, hypertonic contractions, hypersensitivity

Question 52

Oxytocin dose

Answer 52

10-40 units in 1L at 0.5-2mU/min ( increase gtt q15 min by 0.5-2mU/min until contractions are 2-3 min apart)