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Pharm > Box 2 Meds > Flashcards

Box 2 Meds Flashcards

1
Q

Etomidate (Amidate) MOA

A

GABA agonist- nonbarbiturate hypnotic

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2
Q

Etomidate dosage

A

0.2-0.4 mg/kg (2-5mg)

Use in patient with low BP that can’t tolerate propofol

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3
Q

Etomidate Characteristics

A

O: 30-60 sec

P: < 1 min

D: 5-15 min

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4
Q

Etomidate E/M

A

Hepatic/PCe (plasma cholinesterase)

E: 80% renal/ 20% bile

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5
Q

Etomidate Considerations

A

Avoid in sepsis/hemorrhage (adrenocortical suppression)

Painful inj.
No renal dose needed
C/I: hx of seizures

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6
Q

Etomidate vial

A

20mg/10ml

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7
Q

Ketamine (Ketalor) Class

A

PCP derivative: nonbarbiturate dissociative: NMDA Antagonist

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8
Q

Ketamine MOA

A

Noncompetitive NMDA antagonist, acts on opioid, muscarinic,and nicotinic receptors.

Highly lipid soluble but not protein bound = 5x higher brain concentration vs plasma

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9
Q

Ketamine Dosage

A 
Ind: 1-2 mg/kg
Sub. Anesth: 0.2-0.5mg/kg
IM: 4-8 mg/kg
Inf: 1-2 mg/kg/hr
PO: 10mg

Ped: 5-10mg/kg PO
2-10 mg/kg IM
1-2 mg/kg IV

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10
Q

Ketamine characteristics

A

O: 30-60 sec

P: 1 min

D: 10-20 min

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11
Q

Ketamine E/M

A

M: hepatic P450

E: Renal

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12
Q

Ketamine Considerations

A

Causes emergence delirium (always give versed), Bronchodilation ,nystagmus

Avoid in PTSD, dementia, CAD, Pt with increased ICP, glaucoma

Increased myocardial O2 demand; inotropic effect— increases HR/BP

Used in burn pts for dressing change d/t amnestic effect

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13
Q

Flumazenil (Romazicon) MOA

A

Benzodiazepine antagonist. Binds competitively to GABA

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14
Q

Flumazenil dosage

A

0.2 mg IV (8-15 mcg/kg IV)

Give 0.1 mg every 60 sec to total of 1 mg

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15
Q

Flumazenil characteristics

A

O: 1-2 min

P: 2-10 min

D: 30-60 min

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16
Q

Flumazenil considerations

A

If no response is seen after 5mg then benzos are not the cause of sedation

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17
Q

Naloxone (Narcan) class

A

Nonselective opioid antagonist

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18
Q

Naloxone MOA

A

Inhibits uptake of opioids at the opioid receptor site

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19
Q

Naloxone dosage

A

IV: 1-4 mcg/kg

Inf: 5mcg/kg/hr

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20
Q

Naloxone characteristics

A

O: IV: 2min, IM: 5 min

P: 5-15 min

D: 20-60 min

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21
Q

Naloxone E/M

A

M: liver in conjugation with glucuronic acid

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22
Q

Naloxone considerations

A

Can easily cross placenta- may produce withdrawal in opioid-dependent neonate

Pt with CV disease can develop pulmonary edema.

Increased SNS

23
Q

Ephedrine (Cophedra) Class

A

Synthetic noncatecholamine sympathomimetic

24
Q

Ephedrine MOA

A

Indirect/direct stimulates alpha & beta adrenergic receptors

Release endogenous NorEpi

25
Q

Ephedrine Dosage

A

5-10 mg IV bolus (up to 25 mg)

26
Q

Ephedrine characteristics

A

O: immediate (<1 min)

P: immediate (2-5 min)

D: 10-60 min

27
Q

Ephedrine E/M

A

Slow: 40% unchanged in urine

Small # liver

28
Q

Ephedrine considerations

A

Increases HR, BP, CO
Mydriasis & CNS stim.
Less BP effect in repeat doses: less intense effect than Epi but 10x longer lasting
No hyperglycemia like Epi

Caution in elderly & heart dz: increases effect c/ TCAD/MAOIs
Myocardial O2 consumption may be increased d/t positive inotropic effect

29
Q

Epinephrine (Adrenaline) class

A

Endogenous catecholamine

30
Q

Epinephrine MOA

A

Alpha 1-2, beta 1-2 adrenergic
More direct beta
Vasoconstriction
Activates Na/K atpase= lower K

31
Q

Ephedrine vial

A

50mg/ml

32
Q

Epinephrine vial

A

1: 1000 = 1mg/ml
1: 10,000 = 0.1mg/ml

33
Q

Epinephrine dosage

A

Inotropic: 2-20 mcg/min
Or 0.1-1mcg/kg/min

Dose limit for volatile IA is 6mcg/kg

34
Q

Epinephrine characteristics

A

O: immediate

P: 3 min

D: 5-10 min

35
Q

Epinephrine considerations

A

Increases HR/CO/contractility

Decreases potassium and increases glucose: glycogenesis and suppresses insulin

36
Q

Neo-synephrine (phenylephrine) Class

A

Synthetic non catecholamine

37
Q

Neo-synephrine MOA

A

Direct alpha 1 adrenergic agonist: minimal beta effect

Increases SVR, venoconstriction

38
Q

Neo-synephrine dosage

A

IV: 50-200 mcg (to treat systemic hypotension)

Infusion: 20-300 mcg/min

39
Q

Neo-synephrine E/M

A

Liver cytochrome P450

40
Q

Neo-synephrine characteristics

A

O: immediate

P: 1 min

D: 5-20 min

41
Q

Neo-synephrine considerations

A

Caution in elderly, hyperthyroid, bradycardia, partial HB, or severe CAD

Can interfere w/ K moving into cell (acts like NorEpi: less potent & longer acting)

Reflex bradycardia d/t baroreceptor stimulation

Phentolamine is used to tx toxicity

42
Q

Atropine Class

A

Systemic Cholinergic antagonist

43
Q

Atropine MOA

A

Antagonist of ACh at muscarinic receptors by inhibiting the action of ACh at postganglionic sites and inhibition of action of neurotransmitter on postsynaptic receptor M1, M2

44
Q

Atropine dosage

A

Adult: 0.4-0.6 mg

Ped: 0.02mg/kg

45
Q

Atropine E/M

A

M: 1/2 liver
E: 1/2 excreted unchanged in urine

46
Q

Atropine considerations

A

“Red as beet (flushing), blind as a bat (extreme mydriasis), dry as a bone (lack of secretions/dry mouth), mad as a hatter (confusion), host as a hare (hyperthermia)”

Tertiary amine so crosses BBB freely and can result in transient bradycardia

Contra: narrow angle glaucoma, acute hemorrhage, tachycardia

47
Q

Atropine characteristics

A

O: IV 1-2 min

P: 2-4 min

D: 1-2 hrs

48
Q

Sufentanil (Sufenta) class

A

Opioid agonist

49
Q

Sufentanil MOA

A

Mu opioid receptor agonist

50
Q

Sufentanil dosage

A

Analgesia: IV 0.1-0.4 mcg/kg

Induction: 2-10 mcg/kg

Infusion 5-30 mcg/hr

Rapid induction/earlier emergence/ext. 18.9 mcg/kg

51
Q

Sufentanil characteristics

A

O: 1-3 min

P: 5-6 min

D: 20-45 min

52
Q

Sufentanil considerations

A

Analgesia potency 5-10x > fentanyl (greater affinity for receptors)

Large doses can cause chest wall rigidity

Decrease in CMO2R and CBF

53
Q

Sufentanil E/M

A

M: liver- CYP450

E: urine & bile

60% first pass pulmonary uptake

Pharm (15 decks)

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