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BCAS CCP Program > CCP 109 - Pharmacology > Flashcards

CCP 109 - Pharmacology Flashcards

1
Q

IV Fluid Infusion Calculation

A

Amount to be infused (mL) x Drop set (gtts/mL) / Time (min) = (drops/min)

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2
Q

Drug Administration Calculation

A

Desired dose (mg) x Vehicle (mL) / Available Drug (mg) = mL

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3
Q

List and describe the function of the Adrenergic and dopamine receptors

A

A1 - Vasoconstriction (primary), bronchodilation (mild)
A2 - Inhibits norepinephrine release = vasodilation
B1 - Positive chronotropic/inotropic/dromotropic effects, increased automaticity
B2 - Bronchodilation (primary), peripheral vasodilation (mild)
B3 - Increased lipolysis in adipose tissue, skeletal muscle thermogenesis
Dopamine - vasodilation of renal/mesenteric/coronary and cerebral vessels - higher stimulation will promote norepinephrine release

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4
Q

Describe Half Life (T1/2)

A

The time for 1/2 the volume of a drug to be eliminated from the body.

Usually takes 6-7 half lives to completely eliminate the drug.

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5
Q

1mg/kg of succinylcholine will cause a temporary rise in serum _______ levels of _________ mMol/L.

A

1mg/kg of succinylcholine will cause a temporary rise in serum Potassium (K+) levels of 0.5-1.0 mMol/L.

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6
Q

Describe the difference between Depolarizing and Non-depolarizing neuromuscular blockers.

A

Depolarizing NMB - binds to ACh receptor keeping sodium channels “Open” creating Depolarizing cell and preventing repolarization, Fasciculations present, will cause potassium (K+) shift

Non-Depolarizing - binds to ACh receptor keeping sodium channels “closed” preventing depolarization, no fasciculation or potassium (K+) shift

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7
Q

List the Indications for Succinylcholine

A
  • RSI/RSS
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8
Q

Describe the Mechanism of Action for Succinylcholine

A
  • Depolarizing Neuromuscular Blocker - binds to ACh receptor keeping sodium channels “Open” creating Depolarizing cell and preventing repolarization
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9
Q

List the Contraindications for Succinylcholine

A
  • Hypersensitivity to Succinylcholine
  • Malignant Hyperthermia
  • Skeletal Muscle myopathy
  • Acute major burns
  • Multiple trauma (fasciculations causing increased trauma)
  • Hyperkalemia (Succinylcholine will raise Potassium by 0.5-1.0 mEq/L)
    *shift 1 mmol: 10 unit insulin + 25
    g dextrose
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10
Q

What is the dose for Succinylcholine?

A

0.5 - 1.5 mg/kg IV/IO push

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11
Q

What is the Onset and Duration for Succinylcholine?

A
  • Onset: 1 minute

- Duration: 5 minutes

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12
Q

List the Indications for Rocuronium

A
  • RSI/RSS
  • Decreasing muscle activity (shivering)
  • Reducing oxygen demand
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13
Q

Describe the Mechanism of Action for Rocuronium

A
  • Non-Depolarizing Neuromuscular Blocker - binds to ACh receptor keeping sodium channels “closed” preventing depolarization, no fasciculation or potassium (K+) shift
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14
Q

List the Contraindications for Rocuronium

A
  • Hypersensitivity to Rocuronium
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15
Q

What is the dose for Rocuronium?

A

0.6 - 1.2 mg/kg IV/IO push

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16
Q

What is the Onset and Duration for Rocuronium?

A
  • Onset: 1 minute

- Duration: 30 minutes

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17
Q

List the Indications for Dopamine

A

Hypotension/shock

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18
Q

Describe the Mechanism of Action for Dopamine

A

Dose dependant

  • Lower: dopaminergic (0.5-2 mcg/kg/min), dilation of mesenteric/renal/cerebral vasculature
  • Medium: add B1 (5-10 mcg/kg/min), Cardiac effects: chronotropic/Inotropic/dromotropic
  • High: add Alpha (10-20 mcg/kg/min), Vasoconstriction
  • > 20 mcg/kg/min: Potent vaso and arterial constriction similar to norepinephrine
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19
Q

List the Contraindications for Dopamine

A
  • Hypersensitivity to Dopamine
  • Pheochromocytoma
  • Uncorrected tachydysrhythmias
  • Uncorrected hypovolemia
  • CAUTION: Current use of MAO-I’s = HTN
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20
Q

What is the dose for Dopamine?

A

0.5-20 mcg/kg/min IV/IO infusion

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21
Q

What is the Onset and Duration for Dopamine?

A
  • Onset: 5 minute

- Duration: 10 minutes

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22
Q

List the Indications for Dobutamine

A
  • Hypotension/Shock

- Medication of choice for Cariogenic Shock and CHF

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23
Q

Describe the Mechanism of Action for Dobutamine

A

Primary B1 effects on increased chronotropic and isotropic effects, Mild effects on selective A1 (vasoconstriction) and B1 (vasodilation/smooth muscle relaxation) with A1 antagonism > than B1 causing net vasoconstriction

  • Preferred medication in Renal Failure
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24
Q

List the Contraindications for Dobutamine

A
  • Hypersensitivity to Dobutamine or Sulphites
  • Uncorrected Hypovolemia
  • CAUTION: Current use of MAO-I’s = HTN
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25
What is the dose for Dobutamine?
2-20 mcg/kg/min IV/IO infusion
26
What is the Onset and Duration for Dobutamine?
- Onset: 5 minute | - Duration: 10-20 minutes
27
List the Indications for Milrinone
Hypotension/Shock
28
Describe the Mechanism of Action for Milrinone
Phosphodiesterase Inhibitor (PDE-3), decreases the degradation if cAMP which increases the release of Protein Kinase A (PKA) which increases inotropic effects - Mild to no chronotropic effects - Vasodilatory proporties, preferred medication in Pulmonary Hypertension
29
List the Contraindications for Milrinone
- Hypersensitivity to Milrinone
30
What is the dose for Milrinone?
0.5 mcg/kg/min IV/IO infusion
31
What is the Onset and Duration for Milrinone?
- Onset: 5 - 15 minute | - Duration: 2-3 hours
32
List the Indications for Epinephrine
- Cardiac Arrest - Anaphylaxis/Severe Bronchospasm - Symptomatic Bradycardia refractory to other treatments - Hypotension/Shock
33
Describe the Mechanism of Action for Epinephrine
- Potent A1/B1/B2 effects including increased chronotropy/inotropy/dromotropy, vasoconstriction and bronchodilation - Able to inhibit the release of histamine in allergic and anaphylactic reaction through simulation of cAMP
34
List the Contraindications for Epinephrine
- None in emergency setting - Uncorrected hypovolemia for hypotension - Uncorrected tachydysrhythmias
35
What is the dose for Epinephrine?
Cardiac Arrest: 1 mg IV/IO every 3-5 minutes Anaphylaxis: 0.1 mg/kg up to 0.3 mg IM Infusion: 2 - 10 mcg/min IV/IO Push Pressor: 5-20 mcg IV/IO Push (can use: 50 – 100 mcg IV Push)
36
What is the Onset and Duration for Epinephrine?
- Onset: 1 minute | - Duration: 5-10 minutes
37
List the Indications for Phenylephrine
- Hypotension/Shock | - Anesthesia induced hypotension
38
Describe the Mechanism of Action for Phenylephrine
- Pure A1 agonist with significant vasoconstriction | - No B1/B2 effects
39
List the Contraindications for Phenylephrine
- Hypersensitivity to Phenylephrine - Severe Hypertension - Uncorrected Tachydysrhythmias - Uncorrected Hypovolemia
40
What is the dose for Phenylephrine?
- 50 - 200 mcg IV/IO push q 5min PRN | - Mixing: 10mg/100ml N/S (100mcg/ml)
41
What is the Onset and Duration for Phenylephrine?
- Onset: < 1 minute | - Duration: 10-20 minutes
42
List the Indications for Norepinephrine
- Hypotension/Shock | - Preferred vasopressor in Septic/Cardiogenic/Neurogenic shock
43
Describe the Mechanism of Action for Norepinephrine
- Potent A1 and B1 effects resulting in increased vasoconstriction (primary) and chronotropy/inotropy/dromotropy (mild) - Potential for rebound bradycardia as MAP improves - 10x more potent than phenylephrine
44
List the Contraindications for Norepinephrine
- Uncorrected Hypovolemia
45
What is the dose for Norepinephrine?
5-200 mcg/min IV/IO infusion
46
What is the Onset and Duration for Norepinephrine?
- Onset: < 30 seconds | - Duration: 1-2 minutes
47
List the Indications for Propofol
- Induction of Anesthesia - Maintenance of Anesthesia - Anticonvulsant
48
Describe the Mechanism of Action for Propofol
- Decreases the dissociation of GABA from the receptor site there by causing the Chloride (Cl-) channels to remain open causing hyperpolerization of the cell. - Some effects on NMDA and Sodium (Na+) channels
49
List the Contraindications for Propofol
- Hypersensitivity to Propofol, egg products, soy bean oil or glycerol
50
What is the dose for Propofol?
Push Dose: 2-2.5 mg/kg IV/IO | Infusion: 5-200 mcg/kg/min IV/IO
51
What is the Onset and Duration for Propofol?
- Onset: < 30 seconds | - Duration: 1-2 minutes
52
List the Indications for Ketamine
- Induction of Anesthesia - Maintenance of Anesthesia - Procedural Sedation - Analgesia
53
Describe the Mechanism of Action for Ketamine
- Selective non-competitive NMDA antagonist blocks the Calcium (Ca+) channel preventing depolarization - In sub-anesthetic dosing Mu and Delta analgesic receptors are stimulated causing some analgesia and synergistic effected when co-administered with narcotics
54
List the Contraindications for Ketamine
- Hypersensitivity to Ketamine | - Conditions where increased blood pressure would be hazardous
55
What is the dose for Ketamine?
- Push Dose: 0.5-2.0 mg/kg IV/IO - Infusion: 1.0-2.0 mg/min IV/O - Analgesia: 0.1-0.2 mg/kg IV/IO - Intranasal: 3-6 mg/kg IN
56
What is the Onset and Duration for Ketamine?
- Onset: < 30 seconds | - Duration: 5-10 minutes
57
List the Indications for Fentanyl
- Analgesia | - Junction to Anesthesia
58
Describe the Mechanism of Action for Fentanyl
- Binds to Mu, Kappa and Delta opioid receptors and causes hyperpolerization of the cell reducing the depolarization of neuronal cells
59
List the Contraindications for Fentanyl
- Hypersensitivity to Fentanyl
60
What is the dose for Fentanyl?
- Push Dose: 25 – 200 mcg IV/IO (1-2 mcg/kg) | - Infusion: 1 -2 mcg/kg/hr IV/IO
61
What is the Onset and Duration for Fentanyl?
- Onset: < 30 seconds | - Duration: 30-60 minutes
62
List the Indications for Diazepam
- Anticonvulsant | - Sedation
63
Describe the Mechanism of Action for Diazepam
Decreases the dissociation of GABA from the receptor site there by causing the Chloride (Cl-) channels to remain open causing hyperpolerization of the cell.
64
List the Contraindications for Diazepam
- Hypersensitivity to Diazepam - Acute narrow-angle glaucoma, - myasthenia gravis - severe respiratory or hepatic impairment
65
What is the dose for Diazepam?
Push Dose: 2-10 mg IV/IO
66
What is the Onset and Duration for Diazepam?
- Onset: 1-5 minutes | - Duration: 15-60 minutes
67
List the Indications for Lorazepam
- Anticonvulsant - Sedation - Anxiolytic
68
Describe the Mechanism of Action for Lorazepam
Decreases the dissociation of GABA from the receptor site there by causing the Chloride (Cl-) channels to remain open causing hyperpolerization of the cell.
69
List the Contraindications for Lorazepam
- Hypersensitivity to Diazepam - Acute narrow-angle glaucoma, - myasthenia gravis - severe respiratory or hepatic impairment
70
What is the dose for Lorazepam?
Tablet: 1-4 mg SL
71
What is the Onset and Duration for Lorazepam?
- Onset: 2-10 minutes | - Duration: 6-8 minutes
72
List the Indications for Phenytoin
- Anti-eleptic | - Anticonvulsant
73
Describe the Mechanism of Action for Phenytoin
- Stabilizes neuronal membranes at the cell body, axon, and synapse - Voltage gated sodium channels on axon allow Sodium into the neuron - Phenytoin will “close” the sodium channels and keep the Na+ in the cell there by slowing conduction
74
List the Contraindications for Phenytoin
- Hypersensitivity to Phenytoin - Sinus Bradycardia - 2nd and 3rd degree heart block - Adams-Stokes syndrome
75
What is the dose for Phenytoin?
Push Dose: 15 - 20 mg/kg IV/IO
76
What is the Onset and Duration for Phenytoin?
- Onset: 30-60 minutes | - Duration: variable
77
Define "Chronotropic"
- Increased rate of cardiac contraction
78
Define "Inotropic"
- Increased force of contraction of cardiac muscle
79
Define "Dromotropic"
- increased conduction through cardiac muscle
80
Define "Lusitropic"
- Increased relaxation of cardiac muscle
81
What receptor(s) oppose GABA?
- Glutamate receptors (NMDA and AMPA)
82
What factors effect Blood Pressure?
Blood Pressure = Cardiac Output (Heart Rate x Stroke Volume [Preload x Contractility x Afterload]) x Systemic Vascular Resistance
83
How do you check the level of paralysis in a patient who has been administered a Neuromuscular Blocker?
- Electrical impulse stimulator (no response is ideal)

BCAS CCP Program (13 decks)

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