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Clinical Prep > Clinical Pharm > Flashcards

Clinical Pharm Flashcards

1
Q

What is the mechanism of action (MOA) of Propofol?

A

Direct GABA agonist > neuronal hyperpolarization

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2
Q

What is the induction dose of Propofol?

A

1.5-2.5 mg/kg IV

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3
Q

What is the infusion dose of Propofol?

A

25-200 mcg/kg/min

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4
Q

What is the onset and duration of Propofol?

A

Onset: 30-60 seconds
Duration: 5-10 min

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5
Q

What are the side effects of Propofol?

A

Decreased BP, SVR, myocardial contractility
Respiratory depression/apnea
Decreased CMRO2, CBF, ICP, IOP
No analgesia, burning on administration
Antiemetic

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6
Q

How is Propofol metabolized?

A

Lungs, liver (P450)

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7
Q

What is the MOA of Ketamine?

A

NMDA antagonist (antagonizes glutamate) > dissociates thalamus (sensory) from limbic (awareness)
Secondary receptors: opioid, MAO, serotonin, MAO, NE, muscarinic, Na+ channels

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8
Q

IV/IM induction dose for Ketamine?

A

IV: 1-2 mg/kg
IM: 4-8 mg/kg

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9
Q

What is the onset and duration of Ketamine?

A

Onset:
IV: 30-60 seconds
IM: 2-4 minutes
Duration: 10-20 min (up to 60-90 min to return to full orientation)

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10
Q

How is Ketamine metabolized?

A

Liver (P450)
Active metabolite: Norketamine (1/3-1/5 potency of ketamine)

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11
Q

What are the side effects of Ketamine?

A

Maintains resp drive
Increased oral secretions
Increased SNS tone/SVR/HR/CO
Increased ICP
Nystagmus
analgesia
Emergence delirium
Decreased seizure threshold

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12
Q

What is the MOA of Etomidate?

A

GABA-A agonist

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13
Q

What is the induction dose of Etomidate?

A

0.2-0.4 mg/kg IV
Common dose: 20 mg

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14
Q

What is the onset and duration of Etomidate?

A

Onset: 30-60 seconds
Duration: 5-15 minutes

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15
Q

How is Etomidate metabolized?

A

Liver (P450) and plasma esterase
(rapid awakening from redistribution > metabolism)

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16
Q

What are the side effects of Etomidate?

A

HD stable (minimal HR, SV, CO effect)
Decreased SVR (small BP decrease)
Does NOT block SNS response to laryngoscopy
Mild respiratory depression
Decreased CMRO2/CBF/ICP
No analgesia
Myoclonus
Adrenocortical suppression for 5-8 hours (maybe up to 24)
Vomiting

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17
Q

What is the MOA of Dexmedetomidine?

A

Alpha-2 agonist > decreased cAMP > inhibits locus coeruleus > sedation
Negative feedback loop > decreased NE release from pre-synaptic terminal > decreased SNS tone

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18
Q

What are the doses for Dexmedetomidine?

A

Loading: 1 mcg/kg
Maintenance infusion: 0.4-0.7 mcg/kg/hr

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19
Q

What is the onset and duration of Dexmedetomidine?

A

Onset: 5 minutes
Duration: 30 minutes

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20
Q

How is Dexmedetomidine metabolized?

A

Liver (P450)

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21
Q

What are the side effects of Dexmedetomidine?

A

Bradycardia and hypotension
No respiratory depression
Decreased CBF (no change in CMRO2/ICP)
Anti-shivering effect
Does not impair EPs
Analgesia
Rapid administration > HTN (from peripheral alpha2 vasoconstriction before centrally mediated alpha2 overpowers)

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22
Q

What is the concentration of Propofol?

A

10 mg/mL
20 mL vial

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23
Q

What is the concentration of Ketamine?

A

10 mg/mL
20 mL vial

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24
Q

What is the concentration of Etomidate?

A

2 mg/mL
10 mL vial

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25
Q

What is the concentration of Dexmedetomidine?

A

100 mcg/mL (2 mL vial)
DILUTE to 4 mcg/mL

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26
Q

What is the MOA of Midazolam?

A

GABA-A agonist
Increases frequency of channel opening (most GABA agonists increase time of opening)

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27
Q

What is the concentration of Midazolam?

A

1 mg/mL
5 mL vial

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28
Q

What are the doses for Midazolam?

A

IV analgesic dose: 1-2 mg
IV induction: 0.1-0.4 mg/kg
IV sedation: 0.01-0.1 mg/kg
PO sedation (children): 0.5-1.0 mg/kg (50% PO bioavailability)

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29
Q

What is the onset and duration of Midazolam?

A

IV onset: 30-60 seconds
PO onset: 15 minutes
Duration: 20-60 minutes

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30
Q

How is Midazolam metabolized?

A

Liver/intestine (P450)
Active metabolite: 1-hydroxymidazolam - rapidly conjugated to inactive compound except in liver failure

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31
Q

What are the side effects of Midazolam?

A

Sedation: minimal effects
Induction: decreased BP/SVR
Resp depression potentiated with opioids
Decreased CMRO2/CBF
Anterograde amnesia
Anticonvulsant
Anxiolysis
No analgesia

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32
Q

What is the MOA of Flumazenil?

A

Competitive GABA-A receptor antagonist

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33
Q

What is the duration of action of Flumazenil?

A

30-60 min

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34
Q

What is the dosing for Flumazenil?

A

0.2 mg IV titrated in 0.1 mg q 1 min
Redosing may be required as duration is shorter than some benzos

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35
Q

What is the Blood:Gas Coefficient of Sevo?

A

0.6

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36
Q

What is the Blood:Gas Coefficient of Des?

A

0.42

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37
Q

What is the Blood:Gas Coefficient of Iso?

A

1.4

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38
Q

What is the Blood:Gas Coefficient of Nitrous?

A

0.46

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39
Q

What is the Oil:Gas coefficient of Sevo?

A

47

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40
Q

What is the Oil:Gas coefficient of Des?

A

19

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41
Q

What is the Oil:Gas coefficient of Iso?

A

91

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42
Q

What is the Oil:Gas coefficient of Nitrous?

A

1.4

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43
Q

What does blood:gas solubility mean?

A

Low solubility = less likely to be taken up into the blood/more available agent for brain/alveoli = faster onset

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44
Q

What is the MAC of Iso?

A

1.2

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45
Q

What is the MAC of Sevo?

A

2.0

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46
Q

What is the MAC of Des?

A

6

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47
Q

What is the MAC of Nitrous?

A

104

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48
Q

What is MAC-bar?

A

Alveolar concentration required to block autonomic response to painful stimulus (= 1.5 MAC)

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49
Q

What is MAC awake?

A

MAC in which patient opens eyes
0.4-0.5 during induction
0.15 during recovery

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50
Q

At what MAC are awareness/recall prevented?

A

0.4-0.5

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51
Q

What is the MOA of volatile anesthetics?

A
  • Protein interactions within the brain/spinal cord.
  • Stimulate inhibitory receptors or inhibit stimulatory receptors
  • In brain GABA-A
  • In SC NMDA, glycine, and sodium channels
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52
Q

What are the cardiovascular effects of volatile anesthetics?

A
  • Decreased MAP
  • Decreased contractility
  • Decrease SVR
  • Iso/Des increase HR
  • N2O increases MAP/SVR (SNS activation)
  • Preserved CO
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53
Q

What are the neuro side effects of volatile agents?

A
  • Decreased CMRO2/Increased CBF = increased ICP/CBV
  • Isoelectric state at 1.5-2.0 MAC
  • N2O increased CMRO2 and CBF
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54
Q

What is the pKa of Lidocaine?

A

7.9

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55
Q

What is the pKa of Bupivicaine?

A

8.1

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56
Q

What is the MOA of local anesthetics?

A

Na+ channel blockade = decreased nerve conductance

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57
Q

How are ester local anesthetics metabolized?

A

Pseudocholinesterase
(Increased DOA with pseudocholinesterase deficiency)

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58
Q

How are amide local anesthetics metabolized?

A

Hepatic/P450

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59
Q

What dictates the onset of action, potency, and duration of action of local anesthetics?

A

Onset: pKA
Potency: Lipid solubility
Duration of action: Protein binding

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60
Q

What is the max dose and total dose of Bupivicaine?

A

Max dose: 2.5 mg/kg
Max total dose: 175 mg

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61
Q

What is the max dose and total dose of Bupivicaine with epinephrine?

A

Max dose w/epi: 3 mg/kg
Max total dose w/epi: 200 mg

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62
Q

What is the max dose and total dose of Lidocaine?

A

Max dose: 4.5 mg/kg
Max total dose: 300 mg

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63
Q

What is the max dose and total dose of Lidocaine with epinephrine?

A

Max dose w/epi: 7 mg/kg
Max total dose w/epi: 500 mg

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64
Q

What is the order of local anesthetic nerve blockade?

A

Autonomic, pain, temperature, touch, deep pressure, motor
C, A delta, A Beta

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65
Q

What are the T4/T10 doses for Bupivicaine spinal anesthetic?

A

T10: 10-15 mg
T4: 12-20 mg

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66
Q

What is the onset and duration of Bupivicaine spinal anesthesia?

A

Onset: 4-8 min
Duration: 130-220 min (2-3.5 hrs)
Duration + epi: +20-50% (3 - 5 hrs)

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67
Q

What factors determine spinal block height?

A

Dose, baricity, position

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68
Q

What is the primary determinant of epidural block height?

A

Volume

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69
Q

What is the initial and top-up dose of epidural?

A

Initial: 1-2 mL/segment to be blocked
Top-up: 50-75% of initial dose

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70
Q

What is the concentration, onset, and duration of Lidocaine epidural?

A

Concentration: 2%
Onset: 10-20 min
Duration: 60-120 min

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71
Q

What is the concentration, onset, and duration of Ropivicaine epidural?

A

Concentration: 0.1-0.75%
Onset: 10-20 min
Duration: 140-220 min

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72
Q

What is the concentration, onset, and duration of Bupivicaine epidural?

A

Concentration: 0.0625-0.5%
Onset: 15-20 min
Duration: 160-220 min

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73
Q

What type of receptors exist at the NMJ and where are they located?

A

Nicotinic acetylcholine receptors (nAChRs)
- prejunctional on the presynaptic nerve
- postjunctional on the motor endplate of the muscle

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74
Q

What binds to the postsynaptic nicotinic receptor?

A

2 ACh molecules bind to the 2 alpha subunits of the receptors

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75
Q

What is the pathophysiology behind hyperkalemia following succinylcholine administration?

A
  • Nerve injury leads to creation of extrajunctional fetal nicotinic receptors at the NMJ
  • These receptors are much more sensitive to succinylcholine and remain open longer allowing increased K+ to exit the cell
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76
Q

What is the MOA of non-depolarizing neuromuscular blockers (NDNMB)?

A

Block binding of ACh to pre and post-synaptic receptors at the NMJ

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77
Q

What is the MOA of depolarizing neuromuscular blockers?

A

Succinylcholine binds to the alpha subunits of the nAChR and depolarizes cell causing muscle contraction (sodium in/potassium out), continued binding = muscle paralysis

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78
Q

What are the side effects of Succinylcholine?

A

Bradycardia (children)/tachycardia (adults)
Histamine release?
Potassium release
Increased IOP/ICP/IGP
MH
Fasciculations
Post-op myalgia

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79
Q

What metabolizes acetylcholine and where is it located?

A

Acetylcholinesterase/NMJ

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80
Q

How is Succinylcholine metabolized?

A

Plasma cholinesterase/pseudocholinesterase

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81
Q

What condition prolongs succinylcholine duration and what is the test for it?

A

Atypical pseudocholinesterase
Heterozygous succ duration: 20-30 min
Homozygous succ duration: 4-8 hours
Dibucaine test (amide LA that inhibits normal plasma cholinesterase, no effect on atypical PCHe)

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82
Q

What is the onset and duration of action of Succinylcholine?

A

Onset: 30 seconds
DOA: 5-10 min

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83
Q

What conditions cause sensitivity to NDNMB?

A

muscular dystrophy, guillain-barre, MS, ALS, huntington chorea, myasthenia gravis

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84
Q

What is ED95?

A

Measure of potency = dose at which there is a 95% reduction in twitch height
Higher ED95 = lower potency/faster onset (d/t more molecules to fill NMJ)

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85
Q

What is the intubating dose vs. the ED95?

A

Intubating dose is 2-3x the ED95

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86
Q

What is the intubating dose of cisatracurium?

A

ED95: 0.04
Intubating dose: 0.1 mg/kg

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87
Q

What is the onset and duration of cisatracurium?

A

Onset: 5 min
Duration: 45 min

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88
Q

What is the intubating dose of vecuronium?

A

0.1 mg/kg

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89
Q

What is the onset and duration of vecuronium?

A

Onset: 5.2 min
Duration: 45 min

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90
Q

What is the ED95 and intubating dose of Rocuronium?

A

ED95: 0.3 mg/kg
Intubating dose: 0.6 -1 mg/kg (normal adult 80-100 mg)

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91
Q

What is the onset and duration of rocuronium?

A

Onset: 1.5 minutes
Duration: 40 minutes

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92
Q

What is the ED95 and intubating dose of succinylcholine?

A

ED95: 0.3 mg/kg
Intubating dose: 1.0 mg/kg

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93
Q

What is the concentration of cisatracurium?

A

10 mg/ml (200 mg/20 mL)

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94
Q

What is the concentration of rocuronium?

A

10 mg/mL (50 mg/5 mL)

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95
Q

How is cisatracurium metabolized?

A

Hoffman (organ independent)
Active metabolite: Laudanosine (causes seizures, but small quantity)

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96
Q

What is hoffman elimination and what is it dependent upon?

A

Organ independent base-catalyzed reaction dependent on normal pH/temp.
Slower with acidosis/hypothermia

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97
Q

What type of NDNMB is cisatracurium?

A

Benzylisoquinolinium
- end is -curium
- undergo hoffman elimination

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98
Q

How is rocuronium metabolized?

A

None
70% liver elimination unchanged

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99
Q

What type of NDNMBs are Rocuronium and Vecuronium?

A

Aminosteroids

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100
Q

What electrolyte factors potentiate NDNMBs?

A

Hypermagnesemia (decreased Ach release from presynaptic nerve)
Hypocalcemia (decreased Ach release from presynaptic nerve)
Hypokalemia (decreased resting membrane potential)

101
Q

What medication class is the most common cause of perioperative allergic reactions?

A

Neuromuscular blockers

102
Q

What is the MOA of Neostigmine?

A

Inhibits acetylcholinesterase to increase the concentrations of ACh at the NMJ

103
Q

What is the dose of Neostigmine?

A

.05 mg/kg (common adult dose = 2.5-3.5 mg)

104
Q

What is the onset and duration of Neostigmine?

A

Onset: 5-15 min
Duration: 45-90 min

105
Q

What are the side effects of Neostigmine?

A

Cholinergic (muscarinic) effects - SLUDGE + bradycardia

106
Q

Does Neostigmine cross the BBB?

A

No - quaternary

107
Q

What is the common adult dose of Neostigmine?

A

0.05 mg/kg (common adult dose = 2.5-3.5 mg)

108
Q

Does Neostigmine cross the BBB?

A

No - quaternary amine

109
Q

What TOF ratio indicates reversal with Neostigmine?

A

> 0.9

110
Q

What medication and dose can mitigate Neostigmine side effects?

A

Glycopyrrolate
0.01-0.02 mg/kg (or .2 mg/1 mg Neo)

Ex: 2.5 mg Neo, 0.5 mg glyco

111
Q

What is the MOA of Glycopyrrolate?

A

Blocks acetylcholine from binding to muscarinic receptors

112
Q

What is the dose of Glycopyrrolate for bradycardia?

A

0.1-0.2 mg

113
Q

What is the MOA of Sugammadex?

A

Binds/encapsulates aminosteroid NDNMBs

114
Q

What medications does Sugammadex reverse?

A

AMINOSTEROID NDNMBs (roc, vec, panc)

115
Q

What is the dosing for Sugammadex?

A

1:1 molar ratio between sugammadex/muscle relaxant, dose is calculated on degree of block
TOF 2/4 = 2 mg/kg
TOF 0/4 = 4 mg/kg
3 min after ROC admin (dose less than 1.2 mg/kg) = 16 mg/kg

116
Q

What are the side effects of Sugammadex?

A

Bradycardia
Decreased effectiveness of hormonal contraceptives up to 7 days

117
Q

What are the key features of Mu receptors?

A

Analgesia, bradycardia, respiratory depression, euphoria, physical dependence, itching, constipation

118
Q

What are the key aspects of Kappa receptors?

A

Analgesia, stops shivering, dysphoria, delirium, hallucinations

119
Q

What is the MOA of Opioids?

A

Bind to opioid receptors in the CNS/spinal cord/periphery and block transduction and perception of pain

120
Q

What is the MOA of Naloxone?

A

Competitively agonizes mu, kappa, and delta receptors

121
Q

What is the dose and concentration of Naloxone?

A

1-4 mcg/kg (give 20-40 mcg at a time)
Concentration: 0.4 mg/mL (could dilute in 10 cc and give 1 mL = .04 mg/mL (40 mcg/mL)

122
Q

What is the duration of Naloxone?

A

30-45 min

123
Q

What is the MOA of Atropine?

A

Ach antagonist, competes with Ach at smooth muscle muscarinic receptor sites

124
Q

Does Atropine cross the BBB?

A

Yes, it is a tertiary amine, can cause mild sedation

125
Q

What is the indication for Atropine?

A

Drug of choice for symptomatic bradycardia
Not effective: Second degree type 2 block, third degree block

126
Q

What is the dose of Atropine?

A

0.5 mg q 3-5 minutes (max 3 mg/6 doses)

127
Q

What is the onset and duration of Atropine?

A

Onset: 30-60 sec
Duration: 30-60 min

128
Q

What is the intrathecal/epidural dose of Fentanyl?

A

10-20 mcg/50-100 mcg

129
Q

What is the IVP/Sole surgical agent dose of Fentanyl?

A

IVP: 25-100 mcg (0.5-1.0 mcg/kg)
Sole surgical agent: 50-100 mcg/kg

130
Q

What is the onset and duration of Fentanyl?

A

Onset: 5 min
Duration: 30-60 min

131
Q

What is the IVP dose of Morphine?

A

2.5-10 mg

132
Q

What is the spinal dose of Morphine?

A

0.25-0.30 mg

133
Q

What is the dosing for Dilaudid?

A

0.5-1 mg q hr (in recovery)

134
Q

What is the onset and duration of Dilaudid?

A

Onset: 10 min
Duration: 3 hours

135
Q

What are the key facts about Remifentanil?

A
  • Organ independent metabolism
  • Ultra fast onset
  • Only used as IV gtt
136
Q

What is the onset and duration of Remifentanil?

A

Onset: 1 minute
Duration: 3-10 min after drip turned off

137
Q

What is the induction/gtt dosing for Remifentanil?

A

Induction: 1-3 mcg/kg over 1 min
Gtt: 0.5-1 mcg/kg/min

138
Q

What are the facts about Sufentanil?

A
  • Quick onset
  • Most potent opioid
  • Usually gtt
139
Q

What is the induction/gtt dose for Sufentanil?

A

Induction: 0.1-0.3 mcg/kg
Gtt: 0.2-0.5 mcg/kg/hour (0.2 = normal)

140
Q

What is the MOA of Metoprolol?

A

Selective B1 blockade

141
Q

What is the dose of Metoprolol?

A

2-5 mg q 5 min (max 15)

142
Q

What is the onset and duration of Metoprolol?

A

Onset: < 5 min
Duration: 5-8 hours

143
Q

What are the contraindications for Metoprolol?

A

Bradycardia, bronchoconstriction

144
Q

What is the MOA of Labetalol?

A

B1/B2 blocker and selective A1 blocker

145
Q

What is the Beta:Alpha blockade ratio of Labetalol?

A

7:1 IV, 3:1 oral

146
Q

What is the dose and max of Labetalol?

A

10-20 mg q 10 minutes
max: 300 mg

147
Q

What is the onset and duration of Labetalol?

A

Onset: 5 min
Duration: 4 hours

148
Q

What is the MOA of Esmolol?

A

Selective B1 blocker

149
Q

What is the indication for Esmolol?

A

Temporary tachycardia/HTN
Often given pre-induction

150
Q

What is the IVP/gtt dose of Esmolol?

A

IVP: 0.5 mg/kg (often 100-150 mg given pre-induction)
gtt: 50-300 mcg/kg/min

151
Q

What is the onset and duration of Esmolol?

A

Onset: 2 minutes
Duration: 10-30 minutes

152
Q

How is Esmolol metabolized?

A

Plasma hydrolysis

153
Q

What is the preferred drug for HTN with low/normal HR?

A

Hydralazine

154
Q

What is the preferred drug for elevated HR?

A

Beta Blocker (BB)

155
Q

What is the mechanism of action of Hydralazine?

A

Vasodilator - activates g cyclase to produce ARTERIOLAR relaxation

156
Q

What is the dose of Hydralazine?

A

10 mg (0.1-0.2 mg/kg)

157
Q

What is the onset and duration of Hydralazine?

A

Onset: 10-20 min
Duration: 3-6 hours

158
Q

What is the MOA of Phenylephrine?

A

Alpha agonist

159
Q

What is the dose and concentration of Phenylephrine?

A

Concentration: 100 mcg/mL (1 mg/10 mL)
Dose: 40-60 mcg (.5 mL)

160
Q

What is the onset and duration of Phenylephrine?

A

Onset: rapid
Duration: up to 20 min

161
Q

What is the MOA of Ephedrine?

A

Indirect and direct alpha/beta agonist

162
Q

What is the dose of Ephedrine?

A

5-10 mg (up to 50 mg)

163
Q

What is the indication for Ephedrine?

A

Hypotension
Has been used for bronchoconstriction

164
Q

What is the potency comparison of Ephedrine to Epinephrine?

A

Epinephrine is 250x more potent

165
Q

What is the onset and duration of Ephedrine?

A

Onset: 3-5 min
Duration: 10-15 min

166
Q

What is the MOA of Epinephrine?

A

Direct alpha/beta agonist

167
Q

What is the greatest receptor sensitivity of Epinephrine?

A

B2 > B1 > alpha

168
Q

What are 1:1000 and 1:10,000 Epi?

A

1:1000 = 1 mg/mL
1:10000 = 0.1 mg/mL (100 mcg/mL)

169
Q

What is the dose of Epinephrine for ACLS?

A

1 mg (this would be using 1:10000 epi)

170
Q

What is the gtt dosing for Epinephrine?

A

1-16 mcg/min or 0.1-1 mcg/kg/min
Concentration: 4 mcg/mL (1 mL in 250 bag - this would be using 1:1000 epi)

171
Q

What is the push-dose of Epinephrine?

A

5-20 mcg (0.5-2 mL) q 2-5 min

172
Q

How to make push-dose Epinephrine?

A

Take 1 mL of code syringe epi = 100 mcg/mL
Add to 9 mL NS
= 10 mcg/mL

173
Q

What is the duration and onset of Epinephrine?

A

Duration: 5 min
Onset: < 1 min

174
Q

What is the MOA of Calcium Chloride?

A

Calcium channels in cardiac cells modulate force of contraction also cause smooth muscle contraction

175
Q

What is the dose of Calcium Chloride?

A

250 mg-1 g

176
Q

What is the onset and duration of Calcium Chloride?

A

Onset: 5-15 min
Duration: 4 hrs

177
Q

What is the MOA of Amiodarone?

A

Class 3 anti-arrythmic (potassium channel blocker)
Prolongs phase 3 of cardiac action potential
= prolonged PR, QRS, QT
= decreased BP/HR/PVR

178
Q

What are the indications for Amiodarone?

A

Ventricular arryhtmias
VF/VT
PVCs

179
Q

What are the contraindications for Amiodarone?

A

2nd/3rd degree block

180
Q

What is the dose of Amiodarone?

A

Pulseless: 300 mg bolus, then 150 mg
W/pulse: 150 mg bolus then gtt

181
Q

What is the MOA of Heparin?

A

Binds to antithrombin 3, inactivating other clotting factors

182
Q

What is the onset and duration of Heparin?

A

Onset: immediate
Duration: 20-60 min (SQ), 3-5 hrs (IV)

183
Q

What is the onset and duration of Amiodarone?

A

Onset: 1 min
Duration: 30 min

184
Q

What is the dose of Heparin?

A

Therapeutic: 5000 U SQ
Bipass: 400 U/kg

185
Q

What is the MOA of Protamine?

A

Neutralizes effect of heparin through electrostatic binding

186
Q

What is the dose of Protamine?

A

1 mg/100 U heparin

187
Q

What is the MOA of Albuterol?

A

B2 agonist, relaxes bronchial smooth muscles

188
Q

What is the dose of Albuterol?

A

0.5 mL of 0.5% solution (2.5 mg)

189
Q

What are the side effects of Albuterol?

A

Pseudohypokalemia, tachycardia, HTN

190
Q

What is the onset and duration of Albuterol?

A

Onset: < 5 min
Duration: 4-6 hrs

191
Q

What is the MOA of Dexamethasone?

A

Glucocorticoid steroid reduces inflammation, improving pain, nausea not well understood

192
Q

What is the dose of Dexamethasone?

A

PONV prophylaxis: 4-8 mg
Airway edema: 0.5 mg/kg

193
Q

What is the onset and duration of Dexamethasone?

A

Onset: 10-30 min
Duration: 36 hours

194
Q

What is the MOA of Famotidine (Pepcid)?

A

H2 receptor antagonist, stops release of H+ from gastric parietal cells

195
Q

What is the dose of Famotidine?

A

20 mg IV

196
Q

What is the onset and duration of Famotidine?

A

Onset: < 1 hr
Duration: 0.5-4 hours

197
Q

What is the MOA of Ondansetron?

A

5HT3 antagonist, blocks serotonin at the chemoreceptor trigger zone
Does not cause other CNS effects

198
Q

What is the dose of Ondansetron?

A

4 mg

199
Q

What is the onset and duration of Ondansetron?

A

Onset: rapid
Duration: 6-12 hours

200
Q

What are the side effects of Ondansetron?

A

QT prolongation - EKG monitoring recommended

201
Q

What is the MOA of Haloperidol?

A

Antidopaminergic effects at the CTZ, relieving nausea
Also causes sedation by depressing CNS

202
Q

What is the dose and concentration of Haloperidol?

A

0.5-1 mg IV pre-induction
Concentration: 5 mg/mL (in 1 mL solution)

203
Q

What are the contraindications for Haloperidol?

A

CI in Parkinson’s patients
Increased mortality for elderly patients with dementia-related psychosis
Prolongs QT - TdP

204
Q

What is the onset and duration of Haloperidol?

A

Onset: seconds
Duration: 4 hours

205
Q

What is the dose of Droperidol?

A

0.625 mg IV pre-induction

206
Q

What is the onset and duration of Droperidol?

A

Onset: 3-10 min
Duration: 2-4 hours

207
Q

What are the other effects of Droperidol?

A

CNS - calming
Vascular dilation - can cause hypotension
Augments ventilator response to hypoxemia by blocking dopamine inhibition at carotid body (this is good for COPD patients who require carotid body drive for ventilation)

208
Q

What is the MOA of Furosemide?

A

Loop diuretic, inhibits reabsorption of Na, Cl, K, Ca, H2O, PO3 in the loop of Henle = diuresis

209
Q

What is the dose of Furosemide (Lasix)?

A

0.5 mg/kg (5-40 mg = usual range)

210
Q

What are the adverse effects of Lasix?

A

Ototoxicity, hypotension, hypokalemia, hypomagnesemia

211
Q

What is the onset and duration of Lasix?

A

Onset: <1 hr
Duration: 6-8 hours

212
Q

What is the MOA of Metoclopramide?

A

Gastrokinetic agent + dopamine receptor antagonist, stimulates GI motility, increased GE sphincter tone, relaxes pylorus

213
Q

What is the dose of Metoclopramide (Reglan)?

A

Standard dose = 10 mg (5 mg in elderly)

214
Q

What are the contraindications for Metoclopramide?

A

Parkinson’s
Seizure disorder
GI obstruction

215
Q

What is the onset and duration of Metoclopramide?

A

Onset: 1-2 min
Duration: 1-3 hours

216
Q

What is the MOA of Ketorolac?

A

NSAID, inhibits COX-1 and COX-2
= anti-inflammatory, analgesic

217
Q

What is the dose of Ketorolac?

A

30 mg < 65 yo with normal kidney function
15 mg > 65
(I think studies now show 15 mg is appropriate in everyone)

218
Q

What is the onset and duration of Ketorolac?

A

Onset: 10 min
Duration: 4 hours

219
Q

What is the narcotic equivalence of Ketorolac?

A

10 mg morphine

220
Q

What are the side effects of Toradol?

A

Maybe increases bleeding time (ASK surgeon first)
Decreases prostaglandins causes renal arteriole constriction = decreased RBF (avoid in hypovolemic patients/Cr >1)

221
Q

What are the contraindications for Toradol?

A

Kidney injury
Hypovolemia
Bleeding
Nasal polyps
Asthma
Rhinitis

222
Q

What is the MOA of Acetaminophen/Ofirmev?

A

Not fully understood, maybe inhibits Cox, but minimal anti-inflammatory effects, metabolized and crosses BBB to act on brain and SC and provide analgesia

223
Q

What is the dose and max of Acetaminophen/Ofirmev?

A

1000 mg > 50 kg
15 mg/kg < 50 kg
Max: 4 g/day

224
Q

What are the contraindications for Acetaminophen?

A

Liver issues - caution with alcoholism/malnutrition
Taken other medications containing Tylenol

225
Q

What is the onset and duration of Acetaminophen/Ofirmev?

A

Ofirmev onset: 5-10 min
Acetaminophen onset: < 1 hr
Duration of both: 4-6 hours

226
Q

What is the MOA of Oxytocin?

A

Natural hormone, simulates smooth muscle contractions

227
Q

What is the dose of Oxytocin?

A

20 u/1L NS
(run this wide open after cord is clamped, followed by second bag slowly)

228
Q

What is the MOA of Methylergonovine (Methergine)?

A

Acts directly on smooth muscle of uterus to increase tone, rate, amplitude

229
Q

What is the dose of Methylergonovine?

A

0.2 mg IM

230
Q

What are the side effects/risks of Methylergonovine?

A

Risk of severe HTN/CVA (why it isn’t given IV)

231
Q

What is the MOA of Carboprost (Hemabate)?

A

Synthetic prostaglandin that mimics PGF2 alpha, stimulating uterine contractions

232
Q

What is the dose of Hemabate?

A

250 mcg IM q 15 min

233
Q

What are the side effects/contraindications of Hemabate?

A

Caution with asthmatics, may cause severe bronchospasm
DO NOT give IV

234
Q

What effect do volatile agents have on CO?

A

Generally preserve CO

235
Q

What BIS level indicates deep sedation?

A

<40

236
Q

What is the dose of Dobutamine?

A

0.5-20 mcg/kg/min

237
Q

What is the MOA of Dobutamine?

A

Inodilator
Primarily B1 agonist (increased contractility/rate)

238
Q

What are the side effects and contraindications of Hemabate?

A

Caution with asthmatics, may cause severe bronchospasm. DO NOT give IV.

239
Q

What effect do volatile agents have on cardiac output (CO)?

A

Generally preserve CO

240
Q

What is the dose range for Dobutamine?

A

0.5-20 mcg/kg/min

241
Q

What is the mechanism of action (MOA) of Dobutamine?

A

Inodilator; Primarily B1 agonist (increased contractility/rate), also B2 (vasodilator), some alpha 1

242
Q

What is the dose and maximum dose of Dantrolene?

A

2.5 mg/kg IV, repeat 1 mg/kg PRN, Max: 10 mg/kg

243
Q

What is the mechanism of action (MOA) of Dantrolene?

A

Binds to the ryanodine receptor, depresses excitation-contraction coupling in skeletal muscle decreasing intracellular calcium concentration.

244
Q

What is the concentration and reconstitution of Dantrolene (ryanodex)?

A

250 mg vial, reconstitute in 5 mL = 20 mg/mL

245
Q

What is the standard concentration of epinephrine added to local anesthetic to prolong duration of epidural block?

A

5 mcg/mL (1:200,000)

246
Q

What is the epidural test dose?

A

3 mL of 1.5% lidocaine (15 mg/mL) w/ 1:200,000 Epi (5mcg/mL) = 45 mg of lidocaine and 15 mcg of epi

247
Q

Ketamine Maintenance infusion and analgesia infusion dose

A

Analgesia infusion: 0.1-0.5 mg/kg

248
Q

Ketamine PO dose

A

10 mg/kg

Clinical Prep (1 decks)

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