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Methods of Anesthesia > Cardiac Drug Card > Flashcards

Cardiac Drug Card Flashcards

1
Q

Class, effect and administration of dobutamine

A

Beta 1 agonist
Increases contractility and HR
Administered via peripheral line if no central line is available

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2
Q

Class, effect and administration of Milrinone

A
  • Phosphodiesterase inhibitor
  • Increases cAMP to increase cardiac contractility, decrease PVR and decrease SVR/BP
  • Administered via central line always
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3
Q

Indications of milrinone

A
  1. Low EF/cardiac output

2. Pulmonary hypertension

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4
Q

Class, effect and administration of epinephrine

A
  • Alpha and beta agonist
  • Increases contractility, HR and BP
  • Central line if possible
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5
Q

Class, effect and administration of dopamine

A
  • Dopaminergic agonist, alpha and beta agonist
  • Renal vasodilation, inc HR, inc BP
  • Administered centrally always!!!
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6
Q

Renal vasodilation dose for dopamine

A

2-5 mcg/kg/min

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7
Q

Dopamine dose for inc HR

A

5-10 mcg/kg/min

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8
Q

Dopamine dose for inc BP

A

> 10 mcg/kg/min

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9
Q

Class, effects, administration of Levophed

A
  • Alpha and beta agonist
  • Powerful vasoconstriction on alpha receptors
  • Inc contractility and HR
  • Central line only!
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10
Q

Dosing of levophed

A
  • 4mg in 250 mL bag for 16 mcg/mL concentration infusion

- 10 mL syringe of 16 mcg/mL bolus, 0.25-1L mL (4-16 mcg) bolus

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11
Q

Dosing of vasopressin

A

5 vials (100 units) into 100 mL bag for 1 unit/mL

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12
Q

Administration of vasopressin

A

Central line

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13
Q

Indications for calcium

A
  1. Treat hypocalemia (often due to massive blood transfusion)
  2. Inc cardiac contractility
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14
Q

Difference between calcium chloride and calcium gluconate

A
  • Calcium chloride should be given centrally, while calcium gluconate can be given peripherally
  • Calcium gluconate is 1/3 as potent as calcium chloride
  • Both should be given over 10 minutes
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15
Q

Dose of potassium chloride through central line

A

20 mEq/hr

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16
Q

Dose of potassium chloride through peripheral line

A

10 mEq/hr

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17
Q

Effects of NTG

A
  • Dec BP, short onset, short duration
  • Dec myocardial O2 demand
  • Inc myocardial O2 supply
  • Inc pulmonary shunting
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18
Q

Significance of Nipride

A
  • More potent than NTG
  • Emergency use only
  • Sensitive to light, so use UV protective bag
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19
Q

Calcium channel blocker that is a popular alternative to nitroglycerin

A

Cardene

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20
Q

Dose of cardene bolus

A

5mg (2mL) placed into 8mL NS (0.5mg/mL concentration)

-0.5-1mL or 0.25-0.5mg bolus dose

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21
Q

Dose of cardene infusion

A

25 mg vial into 250 mL saline (0.1 mg/mL)

infused at 5-15 mg/hr

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22
Q

Insulin vial concentration

A

100 units/mL

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23
Q

Insulin bolus tip

A

Use TB syringe

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24
Q

Insulin infusion tip

A

add 1mL (100 units) to a 100 mL bag of NS

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25
Q

When are antiarrhythmics given?

A
  1. Off pump CABGs prior to the surgeon lifting the heart

2. In CPB prior to cardioplegia washout

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26
Q

Tips for magnesium and amiodarone

A

Given slowly over 10 min

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27
Q

Amicar bolus dose

A 
1 vial (20 mL, 5g) is drawn into 20 mL syringe
5 or 10g depending on site
28
Q

Amicar infusion dose

A 
2 vials (10 grams) into 500 mL LR
infusion run at 50 mL (1g)/hr
29
Q

Purpose of DDAVP

A

Synthetic ADH

  • treat diabetes insipidus
  • certain coagulopathies during surgery
30
Q

Mechanism of DDAVP

A

Stimulates clotting factor release (vWF) from vascular endothelium and increases factor VIII concentration

31
Q

What can DDAVP stand for?

A

Deep down arterial venous pressure

32
Q

Why must DDAVP be administered slowly?

A

Bc of its potential to cause hypotension

33
Q

Concentration and infusion rate of dobutamine

A
  • Premixed 1mg/mL (250mg/250 mL D5W)

- 2-20 mcg/kg/min

34
Q

Concentration, bolus dose and infusion rate of epi

A
  • 16 mcg/mL (4mg in 250 mL bag)
  • bolus 10-50 mcg, up to 1 mg in emergency
  • infusion of 0.01-0.3 mcg/kg/min
35
Q

Concentration, loading dose, bolus and infusion rate of milrinone (Primacor)

A
  • 20 mg in 100mL D5W
  • Loading 50mcg/kg
  • Bolus 1-2 mg
  • Infusion rate 0.375-0.75 mcg/kg/min
36
Q

Concentration and bolus dose of calcium

A

100 mg/mL (10%)

-250 mg-1g

37
Q

Concentration and infusion rate of vasopressin

A

1 unit/mL (100 units in 100 mL bag)

-1-6 units/hr

38
Q

Concentration, bolus and infusion rate for norepi (levophed)

A

16 mcg/mL (4 mg in 250 mL bag)

  • bolus 4-16 mcg
  • infusion 0.02-0.2 mcg/kg/min
39
Q

Concentration and infusion rate for phenylephrine

A

80 mcg/mL (20 mcg/250 mL)

10-100 mcg/min

40
Q

Concentration, bolus dose and infusion rate for NTG

A

100 mcg/mL

  • 10-100 mcg
  • 0.1-2 mcg/kg/min initial and up to 5mcg/kg/min max
41
Q

Nipride concentration, bolus dose and infusion rate

A
  1. 2 mg/mL (50mg/250 mL bag)
    - Half NTG dose for emergencies
    - 0.1-2mcg/kg/min initial and up to 10 mcg/kg/min max
42
Q

Cardene concentration, bolus and infusion rate

A
  • 2.5 mg/mL in vial (0.5 mg/mL for bolus, 0.1 mg/mL infusion)
  • 0.25-0.5mg (0.5-1mL)
  • 5-15 mg/hr
43
Q

Amiodarone concentration and bolus dose

A
  • 50 mg/mL (3mL vial)

- 150 mg over 10 min

44
Q

Magnesium concentration and bolus

A

0.5 g/mL

1-2g over 10 min

45
Q

Insulin concentration, bolus and infusion rate

A

1 unit/mL (100 units/100mL bag)

  • sliding scale
  • 2-6 units/hr titrated PRN
46
Q

Dextrose concentration, loading dose, bolus

A

50% dextrose (500 mg/mL) 50 mL = 25g

  • 25g (1 amp 50%) loading
  • 0.5g/kg (1g raises BG 3-4 mg/dl)
47
Q

Amicar concentration, loading dose, infusion rate

A
  • 10g in 500 mL LR
  • 5g liberty, 10g at MAHI
  • 1g/hr, continue 4hrs in ICU
48
Q

Desmopressin (DDAVP) concentration, infusion rate

A
  • 4 mcg/mL

- 0.3 mcg/kg in 50 mL NS over 20 min

49
Q

Alternative to double lumen tube

A

Bronchial blocker

50
Q

How many ports does a bronchial blocker have?

A

4

51
Q

What is the bottom port of a bronchial blocker for?

A

The ETT

52
Q

What is the side port of a bronchial blocker for?

A

Connection of the ventilation circuit

53
Q

What is the top port of a bronchial blocker for?

A

Fiberoptic bronchoscope

54
Q

What is the angled side port of a bronchial blocker for?

A

The actual bronchial blocker itself

55
Q

What is another method for placement of a bronchial blocker?

A

A univent ETT

56
Q

Lumen of the univent ETT for the bronchial blocker

A

Anterior

57
Q

What is the posterior lumen of the univent ETT used for?

A

Ventilation and the fiberoptic bronchioscope

58
Q

Disadvantage to univent ETT

A

You cannot ventilate the pt until the scope is removed

59
Q

Which direction do you turn the bronchial blocker to block the R lung?

A

Clockwise

60
Q

The name of the blue lumen of a double lumen tube that sits in the bronchus

A

Bronchial lumen

61
Q

The name of the clear lumen of a double lumen tube that sits in the trachea

A

Tracheal lumen

62
Q

What are most double lumen tubes?

A

L double lumen tubes where the bronchial is designed to sit in the L mainstem

63
Q

Why shouldn’t you use a L double lumen tube for a R mainstem ventilation of the bronchial lumen?

A

The R lung has an upper lobe that wouldn’t be ventilated well by the L double lumen tube

64
Q

Where does the stylet go in a DLT?

A

In the bronchial lumen

65
Q

If the L DLT is placed and the bronchial lumen is clamped, where should you hear breath sounds?

A

On the R side

66
Q

If a L DLT is placed and the tracheal lumen is clamped, where should you hear breath sounds?

A

On the L side

67
Q

What is the size of the central line cordis?

A

8.5 F

Methods of Anesthesia (20 decks)

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