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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
Q

What is the dose for Dobutamine?

A

2-20 mcg/kg/min IV/IO infusion

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26
Q

What is the Onset and Duration for Dobutamine?

A
  • Onset: 5 minute

- Duration: 10-20 minutes

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27
Q

List the Indications for Milrinone

A

Hypotension/Shock

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28
Q

Describe the Mechanism of Action for Milrinone

A

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
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29
Q

List the Contraindications for Milrinone

A
  • Hypersensitivity to Milrinone
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30
Q

What is the dose for Milrinone?

A

0.5 mcg/kg/min IV/IO infusion

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31
Q

What is the Onset and Duration for Milrinone?

A
  • Onset: 5 - 15 minute

- Duration: 2-3 hours

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32
Q

List the Indications for Epinephrine

A
  • Cardiac Arrest
  • Anaphylaxis/Severe Bronchospasm
  • Symptomatic Bradycardia refractory to other treatments
  • Hypotension/Shock
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33
Q

Describe the Mechanism of Action for Epinephrine

A
  • 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
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34
Q

List the Contraindications for Epinephrine

A
  • None in emergency setting
  • Uncorrected hypovolemia for hypotension
  • Uncorrected tachydysrhythmias
35
Q

What is the dose for Epinephrine?

A

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
Q

What is the Onset and Duration for Epinephrine?

A
  • Onset: 1 minute

- Duration: 5-10 minutes

37
Q

List the Indications for Phenylephrine

A
  • Hypotension/Shock

- Anesthesia induced hypotension

38
Q

Describe the Mechanism of Action for Phenylephrine

A
  • Pure A1 agonist with significant vasoconstriction

- No B1/B2 effects

39
Q

List the Contraindications for Phenylephrine

A
  • Hypersensitivity to Phenylephrine
  • Severe Hypertension
  • Uncorrected Tachydysrhythmias
  • Uncorrected Hypovolemia
40
Q

What is the dose for Phenylephrine?

A
  • 50 - 200 mcg IV/IO push q 5min PRN

- Mixing: 10mg/100ml N/S (100mcg/ml)

41
Q

What is the Onset and Duration for Phenylephrine?

A
  • Onset: < 1 minute

- Duration: 10-20 minutes

42
Q

List the Indications for Norepinephrine

A
  • Hypotension/Shock

- Preferred vasopressor in Septic/Cardiogenic/Neurogenic shock

43
Q

Describe the Mechanism of Action for Norepinephrine

A
  • 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
Q

List the Contraindications for Norepinephrine

A
  • Uncorrected Hypovolemia
45
Q

What is the dose for Norepinephrine?

A

5-200 mcg/min IV/IO infusion

46
Q

What is the Onset and Duration for Norepinephrine?

A
  • Onset: < 30 seconds

- Duration: 1-2 minutes

47
Q

List the Indications for Propofol

A
  • Induction of Anesthesia
  • Maintenance of Anesthesia
  • Anticonvulsant
48
Q

Describe the Mechanism of Action for Propofol

A
  • 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
Q

List the Contraindications for Propofol

A
  • Hypersensitivity to Propofol, egg products, soy bean oil or glycerol
50
Q

What is the dose for Propofol?

A

Push Dose: 2-2.5 mg/kg IV/IO

Infusion: 5-200 mcg/kg/min IV/IO

51
Q

What is the Onset and Duration for Propofol?

A
  • Onset: < 30 seconds

- Duration: 1-2 minutes

52
Q

List the Indications for Ketamine

A
  • Induction of Anesthesia
  • Maintenance of Anesthesia
  • Procedural Sedation
  • Analgesia
53
Q

Describe the Mechanism of Action for Ketamine

A
  • 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
Q

List the Contraindications for Ketamine

A
  • Hypersensitivity to Ketamine

- Conditions where increased blood pressure would be hazardous

55
Q

What is the dose for Ketamine?

A
  • 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
Q

What is the Onset and Duration for Ketamine?

A
  • Onset: < 30 seconds

- Duration: 5-10 minutes

57
Q

List the Indications for Fentanyl

A
  • Analgesia

- Junction to Anesthesia

58
Q

Describe the Mechanism of Action for Fentanyl

A
  • Binds to Mu, Kappa and Delta opioid receptors and causes hyperpolerization of the cell reducing the depolarization of neuronal cells
59
Q

List the Contraindications for Fentanyl

A
  • Hypersensitivity to Fentanyl
60
Q

What is the dose for Fentanyl?

A
  • Push Dose: 25 – 200 mcg IV/IO (1-2 mcg/kg)

- Infusion: 1 -2 mcg/kg/hr IV/IO

61
Q

What is the Onset and Duration for Fentanyl?

A
  • Onset: < 30 seconds

- Duration: 30-60 minutes

62
Q

List the Indications for Diazepam

A
  • Anticonvulsant

- Sedation

63
Q

Describe the Mechanism of Action for Diazepam

A

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
Q

List the Contraindications for Diazepam

A
  • Hypersensitivity to Diazepam
  • Acute narrow-angle glaucoma,
  • myasthenia gravis
  • severe respiratory or hepatic impairment
65
Q

What is the dose for Diazepam?

A

Push Dose: 2-10 mg IV/IO

66
Q

What is the Onset and Duration for Diazepam?

A
  • Onset: 1-5 minutes

- Duration: 15-60 minutes

67
Q

List the Indications for Lorazepam

A
  • Anticonvulsant
  • Sedation
  • Anxiolytic
68
Q

Describe the Mechanism of Action for Lorazepam

A

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
Q

List the Contraindications for Lorazepam

A
  • Hypersensitivity to Diazepam
  • Acute narrow-angle glaucoma,
  • myasthenia gravis
  • severe respiratory or hepatic impairment
70
Q

What is the dose for Lorazepam?

A

Tablet: 1-4 mg SL

71
Q

What is the Onset and Duration for Lorazepam?

A
  • Onset: 2-10 minutes

- Duration: 6-8 minutes

72
Q

List the Indications for Phenytoin

A
  • Anti-eleptic

- Anticonvulsant

73
Q

Describe the Mechanism of Action for Phenytoin

A
  • 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
Q

List the Contraindications for Phenytoin

A
  • Hypersensitivity to Phenytoin
  • Sinus Bradycardia
  • 2nd and 3rd degree heart block
  • Adams-Stokes syndrome
75
Q

What is the dose for Phenytoin?

A

Push Dose: 15 - 20 mg/kg IV/IO

76
Q

What is the Onset and Duration for Phenytoin?

A
  • Onset: 30-60 minutes

- Duration: variable

77
Q

Define “Chronotropic”

A
  • Increased rate of cardiac contraction
78
Q

Define “Inotropic”

A
  • Increased force of contraction of cardiac muscle
79
Q

Define “Dromotropic”

A
  • increased conduction through cardiac muscle
80
Q

Define “Lusitropic”

A
  • Increased relaxation of cardiac muscle
81
Q

What receptor(s) oppose GABA?

A
  • Glutamate receptors (NMDA and AMPA)
82
Q

What factors effect Blood Pressure?

A

Blood Pressure = Cardiac Output (Heart Rate x Stroke Volume [Preload x Contractility x Afterload]) x Systemic Vascular Resistance

83
Q

How do you check the level of paralysis in a patient who has been administered a Neuromuscular Blocker?

A
  • Electrical impulse stimulator (no response is ideal)

BCAS CCP Program (13 decks)

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