Box 2 Flashcards
Other name for Sufentanil?
Sufenta
Classification of Sufentanil?
Opioid Agonist
Sufentanil dose:
induction?
Epidural bolus?
Epidural infusion?
Induction: 1 to 30mcg/kg
Epidural bolus: 25-50mcg
Epidural infusion 5-30mcg/hr
MOA Sufentanil?
Opioids act as agonists at specific opioid receptors at sites in the CNS as well as the periphery. Opioids mimic the action of endogenous ligands by binding to opioid receptors, resulting in activation of pain-modulating system.
Sufentanil half life?
6 hours
Sufentanil
Onset?
Peak?
Duration?
Onset: 1-3 minute
Peak: 5.6 minutes
Duration: Dose Dependent.
Contraindications to Sufentanil use?
caution in elderly, hypovolemic, pt. taking sedatives or narcotics.
Crosses the placental barrier can cause resp. depression in neonate if used during labor.
Other name for Ketamine?
Ketalor
Ketamine classification?
Phencyclidine (PCP) derivative: Non-barbiturate dissociative anesthetic: NMDA (N-Methyl-D-Aspartate) receptor antagonist
Contraindications to Ketamine?
patients with CAD (inotropic effect increases cardiac myocardial O2 requirements)
pulmonary HTN
increased ICP
Ketamine dose:
analgesic?
Induction?
analgesic- 0.2-0.5mg/kg
Induction- 1-2mg/kg IV
Why would you give Ketamine for induction?
acts as an anesthetic (non-barbiturate anesthetic)
Ketamine MOA?
exact MOA is unknown; primarily a noncompetitive antagonist for NMDA receptors, also acts on opioid, monoaminergic, muscarinic and neuronal nicotinic Ach receptors. High lipid solubility, not significantly bound to plasma proteins therefore peak brain concentration may be 5x that of plasma concentrantion.
Ketamine IV:
Onset?
Peak?
Duration?
O: 30-60 sec. IV
P: 1 min IV
D: 10-20 min.
What patients would Ketamine be good for induction?
causes bronchodilation and may be useful in patients with ASTHMA
Does ketamine produce resp. depression?
No, does not produce significant resp. depression.
What does ketamine commonly cause?
nystagmus (also causes increased ICP)
What is ketamine known for upon emergence?
emergence delirium, can be prevented with a benzo such versed.
Patients that should not be given ketamine?
PTSD (patients who have trauma past)
What can giving a sub anesthesia dose of ketamine prevent?
opioid tolerance
Ketamine comes supplied as a vial concentration of?
500mg/10ml
Flumazenil trade name?
Romazicon
Classification of Flumazenil?
competitive benzodiazepine-receptor antagonist
Contraindications to Flumazenil?
avoided in patients who take chronic oral benzos and
those taking antiepileptic drugs chronically due to risk of having withdrawal seizure.
Flumazenil dose for adults?
Dose if person becomes
resedated?
Max dose for no repsonse to Flumazenil?
0.2-1.0 mg IV boluses titrated to the patient’s response; up to 3 mg per hour.
After an initial response, patients may become resedated once the effects of flumazenil have subsided, in which case an IV infusion of flumazenil may be administered (0.1-0.4 mg/hr) until the benzodiazepine effects have resolved.
Lack of patient response after 5mg suggests that benzodiazepines are not the cause of sedation.
MOA of flumazenil?
competitively inhibits the activity at the benzodiazepine recognition site on the GABA/benzodiazepine receptor complex.
Elimination of Flumazenil (half-life)?
Flumazenil is quickly metabolized by hydroxylation through hepatic microsomal enzymes to inactive metabolites with a half-life of about 1 hour.
Flumazenil:
Onset?
Peak?
Duration?
O: 1-2 minutes
P: 2-10 minutes
D: 30-60 minutes, depending on benzodiazepine plasma concentration.
Flamazenil and NMB, whats the deal?
Do not use flumazenil until the effects of neuromuscular blockade have been fully reversed.
If you do not have a patient response to Flamazenil and you have given 5mg, what does that mean?
No patient response by 5 mg total dose suggests that benzodiazepines are not the cause of sedation or cardiopulmonary depression.
Narcan, other name?
Naloxone
Classification of Narcan?
Nonselective competitive Opioid antagonist (MU, KAPPA, DELTA)
*greatest affinity to MU receptors
Contraindications to Narcan?
Use naloxone with caution in patients with pre-existing cardiac dz. (this is bc when you reverse opioids you may see tachycardia, hypertension, pulmonary edema, cardiac dysrhythmias, and even ventricular fib.)
Dose of Naloxone?
1-4mcg/kg IV pormptly reverses opioid-induced analgesia and depression of ventilation.
May repeat 2-3 minute intervals, response should occur with max dose of 1mg.
MOA Narcan?
Naloxone is an opioid antagonist that inhibits the uptake of opioids at the opioid receptor sites.
Elimination half time of Narcan?
60-90 min.
Naloxone:
Onset?
Peak?
Duration?
O: 2 minutes IV
P: 5-15 minutes
D: 30-45 minutes (the short duration of action is presumed to be due to its rapid removal from the brain)
Naloxone, does it cross the placenta, and what does this mean for the neonate?
easily crosses the placenta, thus if used in an opioid dependent parturient may produce acute withdrawal in the neonate.
Supply of Narcan in vial concentration?
0.4mg/ml
Ephedrine generic or trade name?
Just Ephedrine for both lol
Classification of Ephedrine?
Synthetic Noncatecholamine sympathomimetic
with mixed direct and indrect actions as well as CNS effects
Contraindications of Ephedrine?
Use cautiously in patients with hypertension and ischemic heart disease.
It has unpredictable effects in patients whom endogenous catecholamines are depleted.
Preferred sympathomimetic for the treatment of maternal hypotension?
Phenylephrine (Neo) is preferred choice of sympathomimetic for treatment of maternal hypotension. Studies demonstrated phenylephrine is associated with lower rates of fetal acidosis vs ephedrine .
What two drugs can potentiate the effects of ephedrine?
tricyclic antidepressants and MAOI
Dose of Ephedrine for perioperative hypotension
5-10 mg IV bolus (per push)
books will state 5-25mg, but over 10mg in one push is a bit much
Ephedrine can be used for more than just perioperative hypotension, what are two other uses? (not very common)
Oral for bronchial asthma due to Beta 2 adrenergic agonist.
IM for antiemetic effect (less sedation compared to droperidol)
MOA of Ephedrine?
indirectly stimulates alpha- and beta- adrenergic receptors; Direct stimulation of adrenergic receptors AND stimulation of release of endogenous norepinephrine (indirect acting)
Ephedrine:
Onset?
Peak?
Duration?
O: IV, immediate
P: IV, immediate
D: 10-60 min. IV
Ephedrine compared to epinephrine?
The CV effects of ephedrine resemble those of epinephrine, but its systemic blood pressure–elevating response is less intense and lasts approximately 10 times longer.
What happens with a 2nd dose of ephedrine?
Second dose produces a less intense CV response (tachyphylaxis)
Supply of ephedrine in vial (concentration)?
50mg/ml
**How will you dilute ephedrine from vial dose in order to use as a push?
**1ml diluted with 4ml of NS to make a final concentration of 10mg/ml.
Does ephedrine cause pupillary dilation?
Yes
Hyperglycemia and ephedrine?
ephedrine does not cause hyperglycemia, but epinephrine does (can).
Other name for Epinephrine?
Adrenaline
Epinephrine classification?
Endogenous catecholamine
Concentrations of Epi?
1:1000 (1mg/ml) 20kg =0.2ml
and
1:10,000 (0.1mg/ml) 20kg = 2ml
Anaphylaxis dose of Epinephrine?
100-300 mcg IV push.
greater than 10mcg/min- major alpha effects leading to vasoconstriction.
Dose limit for exogenous epinephrine?
6 mcg/kg for Iso, Des, Sevo.
Inotropic support with Epi dose?
2-20mcg/min or 0.1-1mcg/kg/min.
Elimination of epinephrine?
Renal per Dr. Hammon
Epinephrine:
Onset?
Peak?
Duration?
O: Immediate
P: 3 minutes
D: 5-10 minutes
What all can you use epinephrine for?
Used in cardiac arrest, anaphylaxis, Inotropic support, to increase duration of local anesthetics and for bronchodilation.
Carefully administer epinephrine to what patients?
patients with MI/angina (worsens), Hyperthyroidism and Diabetes.
What should you watch for after epinephrine administration?
Watch for arrhythmias and Hypertension. Hypokalemia due to the activation of the Na+/K+ ATPase.
Beta 2 effects would be?
Vasodilation, Smooth muscle relaxation in vascular and bronchial tree. Relaxes: blood vessels, tracheal and bronchial muscles and uterus. * Hyperglycemia due to gluconeogenesis
alpha 1 effects?
Peripheral Vasoconstriction; Contracts: blood vessels, renal arterioles, skin vasculature, skeletal muscle, iris radial muscle, ureters and bladder, GI sphincters, Uterus.
alpha 2 effects?
Postsynaptic -mimics α1 (vasoconstriction) and Presynaptic-Inhibits NE release -vasodilation, bradycardia and hypotension and α2 suppresses * Hyperglycemia due to suppression of Insulin release.
Beta 1 effects?
increased HR, increased contractility, increased CO
Brand name for Phenylephrine?
Neo-synephrine
What class is phenylephrine?
synthetic noncatecholamine, alpha 1 adrenergic agonist
Who would you use caution with for use of phenylephrine?
patients with hyperthyroidism, bradycardia, partial heart block, or severe arteriosclerosis
What is the push dose on phenylephrine?
Intravenous bolus 10-200mcg IV bolus (Range between all text books)
50-100mcg “majority of the time,” per Dr. Hammon
IV infusion dose of phenylephrine?
IV infusion 20-100mcg/min (Flood)
Phenylephrine can be given what other route than IV?
topical (nose spray/eye drops)
Phenylephrine MOA?
Stimulates alpha 1 adrenergic receptors by direct effect
Phenylephrine:
Onset?
Peak?
Duration?
O: Immediate
P: 1 minute
D: 15-20 minutes
Phenylephrine is supplied as a vial concentration of?
10 mg/mL
Does phenylephrine have any beta effects?
Minimal
What do you treat phenylephrine extravasation with?
phentolamine 5-10mg in 10mL of normal saline.
If you have a phenylephrine drip running and try to potassium load a patient what will happen?
the phenylephrine interferes with the movement of potassium ions across the cell membrane and into the cell.
Atropine sulfate’s trade name?
Atro-pen
Atropine classification?
Anticholinergic - competative acetylcholine antagonist.
When is atropine contraindicated?
- angle closure glaucoma
- acute hemorrhage
- tachycardia
- obstructive disease in the GI tract
Atropine dose for adults?
Atropine dose for pediatrics?
adult: 0.4-0.6 mg/kg IV
Pedi: 0.02 mg/kg
atropine MOA?
Antagonists of acetylcholine at muscarinic receptors by inhibiting the action of acetylcholine at postganglionic sites and inhibition of the action of neurotransmitters on postsynaptic receptors.
Atropine Onset?
1-2 minutes (30 sec per Dr. Hammon)
Atropine peak and duration?
peak: 2-4 minutes
Duration: 1-2 hours
Prototype anticholinergic is?
Atropine
Too much Atropine would cause?
anticholinergic syndrome.
“Red as a beet, blind as a bat, dry as a bone, mad as a hatter, and hot as a hare”
Antidote of atropine?
physostigmine 15 - 60 mcg/kg
Atropine is typically supplied as a vial concentration of?
0.4 mg/ml
