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SUM'20 Drug Boxes > Box 1 > Flashcards

Box 1 Flashcards

1
Q

Generic name for Versed?

A

Midazolam

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2
Q

Classification of Versed?

A

Benzodiazepine

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3
Q

Contraindications for Versed?

A

GLAUCOMA!

lactation, pregnancy, CNS depression

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4
Q

Usual dose of Versed given before Intubation?

A

2-5mg

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5
Q

If Versed is used as the sole medication in intubation how much would you give?

A

0.1-0.2mg/kg IV

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6
Q

Versed dose for pre-op kids?

A

0.5mg/kg oral (20mg max)

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7
Q

Versed MOA?

A

binds to GABA receptor increases the frequency of chloride channel opening, resulting in postsynaptic membrane hyperpolarization and neuronal transmissions is inhibited.

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8
Q

Versed Elimination half-time?

A

Half-life 1-3 hours

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9
Q

Versed onset IV?

A

30-60 sec.

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10
Q

Versed Peak IV?

A

2-6 min.

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11
Q

Does Versed pass through the BBB?

A

Yes

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12
Q

Versed is supplied in the vial as what concentration?

A

5mg/ml or 2mg/ml

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13
Q

Reversal for Versed?

A

Flumazenil

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14
Q

If Versed is given for paradoxical vocal cord motion and/or strider post surgery, how much will you give?

A

0.5-1mg IV

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15
Q

How fast should you push Versed?

A

over 2 min (slowly)

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16
Q

Trade name for Fentanyl?

A

Sublimaze

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17
Q

Classification of Fentanyl?

A

Opioid Agonist

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18
Q

Contraindications to Fentanyl?

A

If elderly or hypovolemic, reduce dose.

Crosses the placenta and may produce depression of respiration in the neonate.

May have prolonged respiratory depression after cessation of TD patch.

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19
Q

Induction dose of Fentanyl?

A

50-100 IV mcg is normal

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20
Q

Why do we give Fentanyl before intubation?

A

attempt to blunt circulatory response to direct laryngoscopy.

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21
Q

Why is Fentanyl given before or during surgery?

A

blunt sudden changes in level of surgical stimulation.

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22
Q

Analgesia dose of Fentanyl for adults?

A

1 to 2 mcg/kg

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23
Q

Epidural bolus dose of Fentanyl, and infusion rate?

A

bolus: 1 to 2 mcg/kg (same as analgesic dose)
infusion: 2 to 60 mcg/hr

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24
Q

Spinal dose of Fentanyl?

A

one time dose of 0.1-0.4mcg/kg

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25
Q

Fentanyl MOA?

A

Opioids mimic the actions of enkephalins, endorphins, and dynorphins (endogenous ligands) by binding to opioid receptors, resulting in activation of pain-modulating (antinociceptive) systems.
Causes analgesia and anesthesia.

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26
Q

Fentanyl IV onset?

A

within 30 sec.

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27
Q

Epidural/Spinal onset of Fentanyl?

A

4-10 min.

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28
Q

Duration of Fentanyl:
IV
Epidural/spinal

A

IV 30-60 min.

Epidural/Spinal 4-8 hours

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29
Q

Reversal for Fentanyl?

A

Narcan 0.2 to 0.4 mg IV

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30
Q

Fentanyl typically comes supplied in a vial as what concentraiton?

A

250mcg/5ml

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31
Q

Trade name for Propofol?

A

Diprivan

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32
Q

Classification of Propofol?

A

Sedative/Hypnotic

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33
Q

Contraindications with Propofol?

A

lipid metabolism disorder

sensitivity to sodium metabisulfite (can cause anaphylasis)

Caution in the elderly, debilitated (low blood pressure obviously) and cardiac-compromised patient (L sided heart disorders)

if allergic to eggs, soy, or peanuts some controversy exists if those patients should have propofol

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34
Q

Propofol dose for Induction?

A

1.5-2.5mg/kg IV

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35
Q

Propofol maintenance Anesthesia dose?

A

100-300mcg/kg/min

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36
Q

Propofol dose if used for antiemetic or to treat neuropathic pain?

A

10-15 mg

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37
Q

MOA of Propofol?

A

Increases GABA affinity for GABAa receptor. This decreases the rate of disassociation of the inhibitory neurotransmitter GABA from the receptor and increases the duration of the GABA-activated opening of the chloride channel which leads to hyperpolarization of cell membranes (inhibition of the cell).

(keeps the chloride channel open longer)

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38
Q

Elimination half time of propofol?

A

30min. - 90 min.

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39
Q

Propofol Onset?

A

RAPID onset that is dose dependent, less than 1 min.

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40
Q

Peak: Propofol?

A

1 min.

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41
Q

Duration of Propofol?

A

15-45 min. depending on dose.

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42
Q

What may you want to tell someone before you IV push Propofol?

A

May cause burning or pain at injection site.

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43
Q

How long can you keep an ampule of propofol, when does tubing need to be changed and why?

A

Strongly supports growth of E-coli & Pseudomonas aeruginosa. It is recommended that the contents of an unused ampule be discarded after 6 hours, and in the ICU the tubing and any unused portion be discarded after 12 hours.

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44
Q

Renal and Liver issues in relation to Propofol use?

A

No evidence of impaired elimination in patients with liver cirrhosis.
Renal dysfunction does not influence the clearance of Propofol.

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45
Q

Color of urine with prolonged propofol use and why?

A

Prolonged infusions may result in excretion of green urine reflecting the presence of phenols. This does not alter renal function.

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46
Q

IOP and propofol use?

A

Propofol is associated with significant decreases in intraocular pressure that occur immediately after induction of anesthesia. (Intubation would increase IOP, so propofol lowering it is a good thing.)

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47
Q

With prolonged high dose infusion of propofol what metabolic issue can occur?

A

Lactic acidosis

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48
Q

Propofol is typically supplied in a concentration of what out the vial?

A

200mg/20ml

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49
Q

Rocuronium Trade name?

A

Zemuron

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50
Q

Rocuronium Classification?

A

Nondepolorizing NMB

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51
Q

Contraindications with Rocuronium?

A

Precaution in liver patients

Bromide hypersensitivity.

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52
Q

Dose of Rocuronium?

fasciculation dose, full intubating dose, and RSI dose

A

fasciculation dose is 10% of a full dose given before propofol dose when using succs.

intubating dose: 0.6-1.2mg/kg

RSI dose: 1.2mg/kg

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53
Q

MOA of Rocuronium?

A

Binds to nicotinic acetylcholine receptors at the POSTsynaptic muscle membrane. Competitive antagonist of Ach.

54
Q

Onset: Roc?

A

1-3 min.

55
Q

Peak: Roc?

A

1.7 min (min and a half)

56
Q

Duration: Roc?

A

30-120 min.

57
Q

Reversal agent for Rocuronium?

A

Sugammadex!

58
Q

When used with Desflurane which NMB has enhanced muscle relaxation?

A

Rocuronium

59
Q

Drug of choice for RSI if succ. is contraindicated?

A

Rocuronium

60
Q

If a patient is hemodynamically compramised which muscle relaxant will you most likely want to use? why?

A

Rocuronium, due to less or no histamine release.

61
Q

Rocuronium comes supplied as a concentration of what in the vial?

A

10mg/ml

62
Q

Trade name for Succinylcholine?

A

Anectine (also Quelicin)

63
Q

SCh Classification?

A

Depolorizing NMB

64
Q

Contraindications to SCh?

A

Do not use in pts. with hx of MH, cholinesterase deficiencies, muscular disorders, severe muscle trauma or wasting, neurologic injury, and acute narrow- angle glaucoma.

Do not use if burns over 25% or more of TBS (transient hyperkalemia)

Do not repeat doses in intervals of less than five min!

65
Q

SCh dose for intubation in Adults and in Children?

A

Adults: 1-1.5mg/kg
Children: 1-2mg/kg

66
Q

SCh MOA?

A

SCh binds to (at least one) the a sub units of the nicotinic acetylcholine receptor in the NMJ. Because SCh is not hydrolyzed by acetylcholinesterase, the channel remains open for a longer period of time than would be produced by acetylcholine, resulting in a depolarizing block (sustained depolarization prevents propagation of an action potential).

67
Q

Elimination half time of SCh?

A

47 sec.

68
Q

Onset: SCh

A

30-60 sec.

69
Q

Peak: SCh

A

2 min.

70
Q

Duration: SCh

A

5-10 min

71
Q

Why does SCh have such a short duration?

A

The short duration of action of succinylcholine is due to its rapid hydrolysis by butyrylcholinesterase (plasma cholinesterase) to succinylmonocholine and choline, such that only 10% of the administered drug reaches the neuromuscular junction.

Recovery from succinylcholine-induced blockade occurs as succinylcholine diffuses away from the neuromuscular junction, down a concentration gradient as the plasma concentration decreases.

There is little or no butyrylcholinesterase at the neuromuscular junction

72
Q

What can you pretreat with if you are going to use SCh and are worried about bradycardia?

A

Atropine

73
Q

When are cardiac dysrhythmias likely to occur with SCh use?

A

When a dose is given within 5min. of a prev. dose.

74
Q

What electrolyte issues can occur due to SCh?

A

Hyperkalemia, which is transient increase of 0.5mEq/dL, generally well tolerated by individuals with normal potassium to start with.

75
Q

IOP and SCh use?

A

increases IOP which peaks at 2-4 min. and returns to normal by 6 min.

76
Q

What can SCh cause, potentially limiting it’s use?

A

MH

77
Q

What supply does SCh typically come as, concentration in vial?

A

20mg/ml in the vial

78
Q

Classification of Morphine?

A

opioid agonist

79
Q 
Morphine Doses:
Adult Analgesia
PACU analgesia
Single dose Epidural
Epidural Bolus Adult
Infusion Epidural
A

Adult Analgesia (given 60 min prior to end of procedure) = 0.15-0.2 mg/kg

PACU Analgesia: 2 mg bolus q5-10 min

Single dose Epidural: 2-5mg

Epidural Bolus adult: 3-5 mg bolus

Infusion Epidural: 0.1-1mg/hr

80
Q

Onset: Morphine IV and epidural?

A

IV 20min
Epidural 60-90 min.

(PO is 60min. and IM is 30-60min.)

81
Q

Peak: Morphine IV and epidural?

A

IV 30-60min.
epidural 30-60min.

(IM is the same, and PO is 60min.)

82
Q

Duration: Morphine IV and Epidural?

A

IV 4-5 hr
epidural 8-24 hr

(PO and IM is 4-5hr)

83
Q

Morphine MOA?

A

Mu1 and Mu2 agonist, ↑ threshold to pain and modifies the perception of noxious stimulation, poor lipid solubility, K+ channel opening and inhibition of Ca++ channel causing inhibition of ascending pathway.

84
Q

Metabolism of Morphine?

A

Hepatic; conjugation forms morphine-3- glucuronide (75-85%) and morphine-6-glucuronide (5-10%)

Morphine 6 is stronger than normal Morphine.

85
Q

Adverse reactions to Morphine?

A

histamine release, hypotension, bradycardia, N/V, bronchospasm, spasm of sphincter of Oddi, confusion, sedation, constipation.

86
Q

Contraindications to Morphine?

A

hypersensitivity to morphine, acute/severe asthma, ↑ICP, pregnancy, severe respiratory depression, paralytic ileus, pruritus.

87
Q

If you have Renal dz, what will you do to the Morphine dose?

A

decrease dose with ESRD.

88
Q

Reversal for Morphine OD?

A

Narcan 2mg and up to 10mg.

89
Q

What is the equivalent of 1mg IV Morphine to PO dose?

A

1mg IV Morphine = 4mg PO Morphine

90
Q

Does Morphine given IV go into the CNS easily?

A

No, morphine is very water loving and does not pass the BBB much at all, only 0.1% of morphine IV enters the CNS.

91
Q

Trade name for Vecuronium?

A

Norcuron

92
Q

Classification of Vec.

A

(Nondepolarizing/ Steroidal Compound) Monoquarternary neuromuscular blocker

93
Q

Contraindications to Vec. use?

A

caution use in patients with decreased liver and kidney function.

94
Q

Intubating dose of Vec?

A

0.1 mg/ kg

95
Q

MOA of Vec.?

A

Works the same way as Rocuronium, competes with ACh for postsynaptic nicotinic receptors (cholinergic) and produces muscle relaxation.

96
Q

Elimination of Vec?

A

liver half life is 78 min

97
Q

Onset of Vec?
Peak of Vec?
Duration of Vec?

A

O: within 3 min.
P: 2.4 min.
D: 20-50 min.

98
Q

Is Vec less or more potent than pancuronium?

A

Less potent

99
Q

Does vecuronium have histamine release?

A

NO histamine release, more appropriate for those that are hemodynamically unstable.

100
Q

What can reverse Vecuronium?

A

Sugammadex

101
Q

Duration of a Vec. Block is dependent on what organ function?

A

liver function

102
Q

Vec. comes supplied in a vial concentration of?

A

1mg/1ml

103
Q

What neuromuscular blockers can be reversed with Sugammadex?

A

Rocuronium
Vecuronium
and

104
Q

Trade name for Cisatricurium?

A

Nimbex

105
Q

Classification of Cisatricurium?

A

Benzylisoquinoli-nium non-depolarizing Neuromuscular Blocking Drug

106
Q

Contraindications to Cisatricurium use?

A

Hypothermia

and use with caution in patients with neuromuscular dz (MG, Gullian-Barre)

107
Q

Inutbating dose of Cisatricurium?

A

0.1-0.2 mg/kg

same as Versed only intubating dose

108
Q

MOA of Cisatricurium?

A

Same as Roc and Vec.

Nondepolarizing neuromuscular blockers compete with acetylcholine for the active binding sites at the postsynaptic nicotinic acetylcholine receptor (also called competitive antagonists) , and therefore, not allowing depolarization to occur

109
Q

Elimination of Cisatricurium?

A

HOFMANN elimination, Hepatic.

110
Q

Onset
Peak
Duration
of Cisatricurium?

A

Onset: 2-4 mins Peak: 3-5 mins
Duration: Intermediate 20-50 min

111
Q

Does cisatricurium cause histamine release?

A

No!

112
Q

Histamine release is NOT associated with which NMB?

A

Cisatricurium
Vecuronium
Rocuronium (none/little)

113
Q

Cisatricurium is supplied as a vial concentration of what?

A

2mg/ml

114
Q

Lidocaine’s other name?

A

xylocaine

115
Q

Classification of Lidocaine?

A

Class 1b antiarrhythmic agent.

LA

116
Q

Contraindications of Lidocaine use?

A

Do Not give this drug when PVCs occur with bradycardia or escape rhythm.
(I assume this is in relation to IV dosing and not LA use?)

117
Q

What is the max dose of lidocaine when used as an Epidural or Local?

A

Epidural 50-300mg max dose.

Local 300mg max dose.

118
Q

Dose of Lidocaine for intubation, (and why are you giving it for intubation?)

A

1-1.5mg/kg (same as Sch dose)

blunts gag reflex and helps with laryngeal spasms.

119
Q

How many patches of Lidocaine can someone have in a 24 hour period?

A

3 patches

120
Q

Infusion rate and max dose of Lidocaine?

A

1.5mg/kg/hr

should not exceed 300mg/hr

121
Q

MOA of Lidocaine?

A

It is amide, binds to specific sites in voltage gated sodium channels blocking sodium current reducing excitability of neuronal, cardiac, CNS.

122
Q

Elimination of Lidocaine (hepatic or Renal?)

A

Hepatic

123
Q

Onset
Peak
Duration
of Lidocaine?

A

O: 45-90 sec.
P: 10-20 min.
D: 30 min. to 4 hours

124
Q

What can be given with Lidocaine to help increase potency and decrease systemic effects?

A

epinephrine

125
Q

Lidocaine typically comes supplied as a vial concentration of what?

A

dependent on the % lidocaine you use, For Matt it was 2% so 20mg/ml

126
Q

Etomidate trade name?

A

Amidate

127
Q

Classification of Etomidate?

A

Central nervous system agent; nonbarbiturate hypnotic without analgesic activity

128
Q

Contraindications to Etomidate use?

A

Causes Adrenal Suppression→inhibition of cortisol, avoid in sepsis & hemorrhage (they need cortisol)

129
Q

Dose for intubation with Etomidate?

A

0.2-0.4mg/kg

130
Q

MOA of Etomidate?

A

(Gaba- mimetic) Binds to GABAA receptors→increase inhibitory neurotransmitter effect.

131
Q

Etomidate
Onset:
Peak:
Duration:

A

Onset- 30-60 sec.
Peak- within 1 minute
Duration- 5-15 min.

132
Q

Etomidate is supplied in a concentration of?

A

2mg/1ml

SUM'20 Drug Boxes (6 decks)

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