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Box 1 Meds Flashcards

1
Q

Midazolam/Versed Class

A

Benzodiazepine

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2
Q

Midazolam MOA

A

GABA agonist- open Cl channels longer, hyperpolarizes postsynaptic memrane (decreased excitability)

CNS depressant

**increases frequency of gaba mediated ion channel opening

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3
Q

Midazolam dosage

A

Induction: 0.1-0.2 mg/kg
Preop: 2-5 mg

IM: 0.07-0.08 mg/kg

Peds:
IV 0.025-0.05 mg/kg
PO 0.5 mg/kg

Spasm: 0.5-1 mg

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4
Q

Midazolam characteristics

A

O: 30-60 sec

P: 3-5 min

D: 15-80 min

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5
Q

Midazolam E/M

A

M: hepatic CYP450

E: urine

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6
Q

Midazolam considerations

A

Avoid in glaucoma

Decreases SVR, increases HR, Resp. Depression, decreases hypoxia drive

Reversal: Flumazenil

Give for postop stridor

Amnesiac effect, anticonvulsant, anxiety

Good for renal- no active metabolites

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7
Q

Fentanyl (Sublimaze) Class

A

Opioid agonist

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8
Q

Fentanyl MOA

A

Binds to opioid mu receptor, couples G proteins, causing hyperpolarization

No histamine release or CA depression

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9
Q

Fentanyl dosage

A

Ind: 50-100 mcg (1-2 mcg/kg)

Epid: 1-2 mcg/kg: 2-60 mcg/hr
Spinal: 0.1-0.4 mcg/kg

Ped: PO 15-20 mcg/kg

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10
Q

Fentanyl characteristics

A

O: immediate (2-5 min)

P: 3 min

D: 30-60 min

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11
Q

Fentanyl E/M

A

M: hepatic P450

E: renal

75% pulmonary uptake

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12
Q

Fentanyl considerations

A

Resp. Depression in neonate: crosses placenta
Can increase ICP in head injuries

Reversal: narcan

S/E: n/v/d, confusion

Decreases MAC requirement

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13
Q

Why give fentanyl preop

A

Decreases MAC requirement

Blunts SNS response so HR doesn’t increase for intubation and surgery

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14
Q

Fentanyl vial

A

100mcg/2ml or 250mcg/5ml

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15
Q

Propofol (Diprivan) class

A

Hypnotic/sedative

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16
Q

Propofol MOA

A

GABA agonist- keeps Cl channel open, hyperpolarizes postsynaptic membrane

98% protein bound

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17
Q

Propofol dosage

A

Adult induction: 1.5-2.5 mg/kg
Inf: 100-300 mcg/kg/min

Ped: 2.5-3.5 mg/kg

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18
Q

Propofol characteristics

A

O: <1 min

P: 1-2 min

D: 15-45 min

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19
Q

Propofol E/M

A

M: hepatic CYP450

E: renal

Clearance from plasma > hepatic blood flow
Lungs?

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20
Q

Propofol considerations

A

Supports growth of E. Coli

Anticonvulsant and amnestic

Pt >60 has decreased plasma cl. = lower ind. dose

No impairment of elim. In hepatic/renal dx

Can cause bronchoconstriction in asthmatic

Decreases CMRO2, CBF, ICP

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21
Q

Propofol vial

A

200 mg/ 20 ml = 10mg/ml

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22
Q

Rocuronium (Zemuron) class

A

Non-depolarizing NMB

Steroidal compound & intermediat acting mono-quaternary NMBD

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23
Q

Rocuronium MOA

A

Binds to nicotinic receptor- competitive antagonist of ACh

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24
Q

Rocuronium dosage

A

Adult & child intubation: 0.6-1.2 mg/kg
RSI: 1-1.2 mg/kg
DFasc: 10% (5-10mg)

Adult maintenance: 0.1-0.2 mg/kg
Ped maintenance: 0.08-0.12 mg/kg

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25
Rocuronium characteristics
O: 1-3 min P: 2 min D: 30-120 min
26
Rocuronium E/M
M: 80% hepatic / 20% renal E: biliary & renal
27
Rocuronium considerations
Renal/hepatic dx prolongs duration= give lower dose NO histamine release= good for non stable pt, NO CA effect Reversal: Sugammadex
28
Rocuronium vial
10mg/ml- 5ml vial= 50mg/vial
29
Succinylcholine (Anectine) Class
Depolarizing NMB
30
Succinylcholine MOA
Partial nicotinic agonist- depolarizers end plate that desensitizes nicotinic ACh receptors, inactivated Na channels at NMJ & increases K perm. Not broken down by AChE so channel remains open longer
31
Succinylcholine dosage
1-1.5 mg/kg Ped: 1-2 mg/kg IM 2-4 mg/kg DO NOT give < 5min apart= PROFOUND BRADYCARDIA— give atropine
32
Succinylcholine characteristics
O: 30-60 sec P: 2 min D: 5-10 min (Hammon says 2-3 min)
33
Succinylcholine E/M
E: cleared by plasma cholinesterase (PCe) 10% unchanged in kidneys
34
Succinylcholine considerations
not for kids <12= sudden CA arrest Increases ICP/IOP Trigger for MH + histamine release Do not give in muscle dx, glaucoma, paraplegics, burns, sepsis Causes hyperkalemia (0.5)
35
Succinylcholine supply
10ml/ vial- 20mg/ml= 200mg/10ml
36
Morphine (MS Continue) Class
Opioid
37
Morphine MOA
Binds to mu-opioid receptors acting as opioid agonist Increases threshold to pain & modifies perception of noxious stimuli such that it is no longer experienced as pain
38
Morphine dosage
Analgesia: IV 2.5-15mg Induction: IV 1mg/kg Epid: 2-5 mg bolus; 0.1-1mg/hr Ped: IV 0.05-0.2 mg/kg IM/subq 0.1-0.2 mg/kg
39
Morphine characteristics
O: IV immediate P: 15-30 min D: 2-7 hrs
40
Morphine E/M
M: conjugation w/ glucuronic acid in hepatic & renal E: urine, 7-10% biliary
41
Morphine considerations
Hyperventilation and alkalinization increase nonionized fraction enhancing passage into CNS Effects potentiated by alcohol, sedatives, antihistamines, MAOIs, TCAs, phenothazines
42
Vecuronium (norcuron) Class
Nondepolarizing NMB
43
Vecuronium MOA
Binds to nicotinic ACh receptor- competitive antagonist | Monoquaternary aminosteriod
44
Vecuronium dosage
Ind: 0.1 mg/kg Maint: 0.8-1 mcg/kg/min
45
Vecuronium characteristics
O: 3-5 min P: 2 min D: 20-50 min
46
Vecuronium E/M
Hepatic and renal
47
Vecuronium considerations
Reversal: Neostigmine and sugammadex Avoid in hepatic/renal dx Prepared as powder: unstable solution NO histamine release Women more sensitive so lower dose Sevo shortens onset
48
Vecuronium supply
10 or 20 mg powder. Once reconstituted solution pH 4.0 stable for 24 hrs at 25 C
49
Cisatracurium (Nimbex) Class
Benzylisoquinolinium nondepolarizing NMBD
50
Cisatracurium MOA
Binds to nicotinic cholinergic receptor. Competitive antagonist of ACh
51
Cisatricurium dosage
Int: 0.1mg/kg ED95 Adult: 50mcg/kg Infant: 43 mcg/kg Child: 41 mcg/kg
52
Cisatricurium characteristics
O: 2-4 min P: 3-5 min D: 30-60 min
53
Cisatricurium E/M
E: Hofmann elim. In plasma & tissues, nonspecific esterase hydrolysis, renal
54
Cisatricurium considerations
Agent of choice in pt w/ renal dx. And older adults Advantages: maint. Of CV stability, non-organ dependent elim. NO histamine release Caution in NM dx, Guillian-barre
55
Lidocaine (Xylocaine) Class
1B antiarrhythmic, Amide Local Anesthetic
56
Lidocaine MOA
Ionized form blocks Na channel Give with Epi to increase potency Blunts gag reflex
57
Lidocaine dosage
2mg/kg IV infusion 1-4 mg/min Epid: 50-300 mg
58
Lidocaine characteristics
O: 45-90 sec P: 10-20 min (1-2 min?) D: 30 min- 4 hr
59
Lidocaine E/M
Hepatic
60
Lidocaine considerations
Don’t give if bradycardia, hypokalemia, severe CKD, heart blocks Causes seizures, vertigo, tinnitus Used for vasospasm

Pharm (15 decks)

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