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Pharm > Box 1 Meds > Flashcards

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
Q

Rocuronium characteristics

A

O: 1-3 min

P: 2 min

D: 30-120 min

26
Q

Rocuronium E/M

A

M: 80% hepatic / 20% renal

E: biliary & renal

27
Q

Rocuronium considerations

A

Renal/hepatic dx prolongs duration= give lower dose

NO histamine release= good for non stable pt, NO CA effect

Reversal: Sugammadex

28
Q

Rocuronium vial

A

10mg/ml- 5ml vial= 50mg/vial

29
Q

Succinylcholine (Anectine) Class

A

Depolarizing NMB

30
Q

Succinylcholine MOA

A

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
Q

Succinylcholine dosage

A

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
Q

Succinylcholine characteristics

A

O: 30-60 sec

P: 2 min

D: 5-10 min (Hammon says 2-3 min)

33
Q

Succinylcholine E/M

A

E: cleared by plasma cholinesterase (PCe)

10% unchanged in kidneys

34
Q

Succinylcholine considerations

A

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
Q

Succinylcholine supply

A

10ml/ vial- 20mg/ml= 200mg/10ml

36
Q

Morphine (MS Continue) Class

A

Opioid

37
Q

Morphine MOA

A

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
Q

Morphine dosage

A

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
Q

Morphine characteristics

A

O: IV immediate

P: 15-30 min

D: 2-7 hrs

40
Q

Morphine E/M

A

M: conjugation w/ glucuronic acid in hepatic & renal

E: urine, 7-10% biliary

41
Q

Morphine considerations

A

Hyperventilation and alkalinization increase nonionized fraction enhancing passage into CNS

Effects potentiated by alcohol, sedatives, antihistamines, MAOIs, TCAs, phenothazines

42
Q

Vecuronium (norcuron) Class

A

Nondepolarizing NMB

43
Q

Vecuronium MOA

A

Binds to nicotinic ACh receptor- competitive antagonist

Monoquaternary aminosteriod

44
Q

Vecuronium dosage

A

Ind: 0.1 mg/kg

Maint: 0.8-1 mcg/kg/min

45
Q

Vecuronium characteristics

A

O: 3-5 min

P: 2 min

D: 20-50 min

46
Q

Vecuronium E/M

A

Hepatic and renal

47
Q

Vecuronium considerations

A

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
Q

Vecuronium supply

A

10 or 20 mg powder. Once reconstituted solution pH 4.0 stable for 24 hrs at 25 C

49
Q

Cisatracurium (Nimbex) Class

A

Benzylisoquinolinium nondepolarizing NMBD

50
Q

Cisatracurium MOA

A

Binds to nicotinic cholinergic receptor. Competitive antagonist of ACh

51
Q

Cisatricurium dosage

A

Int: 0.1mg/kg

ED95
Adult: 50mcg/kg
Infant: 43 mcg/kg
Child: 41 mcg/kg

52
Q

Cisatricurium characteristics

A

O: 2-4 min

P: 3-5 min

D: 30-60 min

53
Q

Cisatricurium E/M

A

E: Hofmann elim. In plasma & tissues, nonspecific esterase hydrolysis, renal

54
Q

Cisatricurium considerations

A

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
Q

Lidocaine (Xylocaine) Class

A

1B antiarrhythmic, Amide Local Anesthetic

56
Q

Lidocaine MOA

A

Ionized form blocks Na channel

Give with Epi to increase potency

Blunts gag reflex

57
Q

Lidocaine dosage

A

2mg/kg IV infusion 1-4 mg/min

Epid: 50-300 mg

58
Q

Lidocaine characteristics

A

O: 45-90 sec

P: 10-20 min (1-2 min?)

D: 30 min- 4 hr

59
Q

Lidocaine E/M

A

Hepatic

60
Q

Lidocaine considerations

A

Don’t give if bradycardia, hypokalemia, severe CKD, heart blocks

Causes seizures, vertigo, tinnitus

Used for vasospasm

Pharm (15 decks)

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