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Clinical Prep > Clinical Pharmacology > Flashcards

Clinical Pharmacology Flashcards

1
Q

Diazepam (Valium):
Dose?
Onset?
Duration?

A

Dose - 0.1 mg/kg IV, 0.2 mg/kg PO
Onset - 1-5 mins
Duration - 2-6 hours

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2
Q

Lorazepam (Ativan):
Dose?
Onset?
Duration?

A

Dose - 0.04 mg/kg (Post-Op = 1-4 mg)
Onset - 1-5 mins
Duration - 6-10 hours

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3
Q

Midazolam (Versed):
Dose?
Onset?
Duration?

A

Dose - 1-5 mg (0.05 mg/kg)
Onset - 1-5 mins
Duration - 15-80 minutes

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4
Q

Flumazenil (Romazicon)
Dosing?
Onset of action?
Duration?
Contraindications?

A

Dose - 0.2 mg IV, repeat 0.1 mg q 1 min
MAX - 3 mg
Onset - 1-5 mins
Duration - 30 mins
Contraindications: Seizure disorders

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5
Q

List the benzodiazepines in order from most potent to least potent:

A

Lorazepam > Midazolam > Diazepam

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6
Q

Morphine
Dosing: Intra-Op/Post-Op
Onset:
Duration:

A

Dosing: Intra-Op (1-10 mg)/Post-Op (5-20 mg)
Onset: 10-20 mins
Duration: 4-5 hours

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7
Q

What are Morphine’s two active metabolites?

A

Morphine-3-Glucoronide and Morphine-6-Glucuronide

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8
Q

Morphine can decrease _________ with high doses

A

PVR

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9
Q

Morphine has a prolonged half-life in which patient populations?

A

Elderly, liver failure, and renal failure

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10
Q

Fentanyl (Sublimaze)
Dosing:
Onset:
Duration:
Infusion:

A

Dosing: 1.5-3 mcg/kg induction dose, 1-5 mcg/kg for first hour of surgery
Onset: 30-60 seconds
Duration: 1-1.5 hours
Infusion: 3-6 mcg/kg/hour (Turn it off 60 mins before breathing)

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11
Q

T or F: Fentanyl is dosed on ideal body weight

A

True

IBW Formula
[Women = 45 + (2.3 x inches over 5 ft)]
[Men = 50 + (2.3 x inches over 5 ft)]

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12
Q

Sufentanil (Sufenta)
Dosing:
Onset:
Duration:
Infusion:

A

Dosing: Intra-Op (0.3-1 mcg/kg)
Onset: 30-60 seconds
Duration: 1-1.5 hours
Infusion: 0.5-1 mcg/kg/hr

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13
Q

Why would you choose Sufenta over other opioids like Fentanyl?

A

It’s CV stable

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14
Q

Remifentanil (Ultiva)
Dosing:
Onset:
Duration:
Infusion:

A

Dosing: Loading Dose (0.5-1 mcg/kg over 1 min)
Onset: 30-60 seconds
Duration: 6-8 mins
Infusion: 0.125-0.375 mcg/kg/min

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15
Q

Remifentanil is used for what cases?

A

Neuro, carotid endarterectomy, eye blocks, TIVA

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16
Q

There is up to _______ (percentage) decrease in MAC when using a Remifentanil drip

A

70% reduction

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17
Q

Meperidine (Demerol)
Indication:
Dosing:
Onset:
Duration:

A

Indication: Post-Op Shivering
Dosing: 12.5 mg
Onset: 5-15 mins
Duration: 2-4 hours

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18
Q

Demerol has affinity for which receptors?

A

Mu, kappa, and delta

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19
Q

Demerol is structurally similar to which drugs?

A

Atropine and local anesthetics

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20
Q

This active metabolite of Meperidine acts as a CNS stimulant and can result in seizure activity

A

Normeperidine

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21
Q

Meperidine blocks reuptake of serotonin and is contraindicated with what?

A

MAOIs

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22
Q

Hydromorphone (Dilaudid)
Dosing:
Onset:
Duration:

A

Dosing: Intra-Op (1-4 mg), Post-Op (1.5-4 mg)
Onset: 5-15 mins
Duration: 2-4 hours

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23
Q

Naloxone (Narcan)
Dosing:
Onset:
Duration:

A

Dosing: 40-80 mcg
Onset: 1-5 mins
Duration: 30 mins (May need to redose)

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24
Q

After giving Narcan, you may see _________ stimulation related to reversal of analgesia

A

Cardiac (HTN/tachycardia)

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25
Q

Propofol (Diprivan)
Induction:
Maintenance:
Onset:
Duration:

A

Induction: 1.5-2.5 mg/kg
Maintenance: 25-100 mcg/kg/min (sedation), 100-300 mcg/kg/min (TIVA)
Onset: 30-60 seconds
Duration: 1-8 mins

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26
Q

Children need an (increased/decreased) Propofol dose

A

Increased

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27
Q

Elimination half life of Propofol

A

0.5-1.5 hours (30-90 minutes)

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28
Q

What are some pros to using Propofol over other induction agents?

A

Bronchodilator
Anti-nausea properties
Suppresses the SNS response to laryngoscopy

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29
Q

Etomidate (Amidate)
Induction:
Onset:

A

Induction: 0.3 mg/kg
Onset: 1 min

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30
Q

Etomidate is a carboxylated imidazole, when the ring is open it is _________

The ring closes when the drug enters the body and it becomes ___________

A

Open = Water soluble
Closed = Lipid soluble

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31
Q

Adrenocortical suppression lasting 4-8 hours is a rare problem with which induction drug?

A

Etomidate

32
Q

Which induction agent has the highest incidence of PONV?

A

Etomidate (Vomitdate)

33
Q

Ketamine (Ketalar)
Induction:
Maintenance:
Onset:
Duration:

A

Induction: 0.5-1.5 mg/kg
Maintenance: 0.2-0.5 (Analgesia), 4-8 mg/kg IM given to calm a child
Onset: 1 min
Duration: 10-20 mins

34
Q

Ketamine depresses the neuronal function of the cortex and the thalamus, however, it stimulates the ________ system

A

Limbic (Behavior/emotions)

35
Q

At higher doses of Ketamine, what is a major concern?

A

Emergence Delirium

36
Q

What does Ketamine do to the following (increase or decrease):
SVR?
HR?
CO?
SNS outflow?
Epi/Norepi uptake?

A

Increases all

37
Q

Before giving Ketamine, what should you give?

A

Glycopyrrolate (Ketamine increases salivary secretions)

38
Q

Dexmedetomidine (Precedex)
Loading Dose:
Infusion:

A

Loading Dose: 1 mcg/kg over 10 mins
Infusion: 0.2-0.7 mcg/kg/hr

39
Q

Precedex works on which receptors?

A

Alpha2-A (Sedation, hypnosis)
Alpha2-B (Vasoconstriction, antipshivering, analgesia)
Alpha2-C (Learning, startle response)

40
Q

Drug and alcohol withdrawal is well offset with this drug…

A

Precedex

41
Q

Methohexital (Brevital)
Induction dose:
Indications:

A

Induction dose: 1.5 mg/kg
Indications: Electroconvulsive therapy, cardio version, mapping seizures, rapid procedures ‘

42
Q

Sevoflurane (Ultane)
MAC:
Blood:Gas
Vapor Pressure

A

MAC: 1.8
Blood:Gas = 0.69
Vapor Pressure: 157

43
Q

Desflurane (Suprane)
MAC:
Blood:Gas
Vapor Pressure

A

MAC: 6.6
Blood:Gas = 0.42
Vapor Pressure: 669

44
Q

Isoflurane (Forane)
MAC:
Blood:Gas
Vapor Pressure

A

MAC: 1.17
Blood:Gas = 1.46
Vapor Pressure = 238

45
Q

Nitrous
MAC:
Blood:Gas
Vapor Pressure

A

MAC: 104
Blood:Gas = 0.46
Vapor Pressure = Very high (38,770)

46
Q

MACawake
MACbar

A

MACawake = 0.3-0.5
MACbar = 1.7-2.0

47
Q

Highest MAC at what age?

A

6 months

48
Q

Which factors increase anesthetic requirements?

A

Chronic ETOH
Infants
Red hair
Hypernatremia
Hyperthermia

49
Q

Factors that decrease anesthetic requirements?

A

Acute ETOH
Elderly
Hyponatremia
Hypothermia
Anemia
Hypercarbia
Hypoxia
Pregnancy

50
Q

Drug of choice for obese patients (Due to its low solubility)
Airway irritant, increases HR, absorbs quickly, needs a special heated vaporizer

A

Desflurane

51
Q

Good for pediatric induction, but can cause emergence delirium in kids

A

Sevoflurane

52
Q

Very lipid soluble, very suitable for long cases where extubation is not expected

A

Sevoflurane

53
Q

Which gas do you absolutely NOT use in neuro and most bowel cases?

A

Nitrous

54
Q

Succinylcholine (Anectine)
Dose:
mg/ml:
Onset:
Duration:

A

Dose: 1-1.5 mg/kg
Supplied: 20 mg/ml
Onset: 30-60 seconds
Duration: 5-10 mins

55
Q

Cisatracurium (Nimbex)
Dose:
mg/ml:
Onset:
Duration:

A

Dose: 0.2 mg/kg
Supplied: 2 mg/ml
Onset: 2-3 mins
Duration: 40-75 mins

56
Q

Vecuronium (Norcuron)
Dose:
Supplied:
Onset:
Duration:

A

Dose: 0.1 mg/kg
Supplied: 1 mg/ml
Onset: 2-3 mins
Duration: 45-90 mins

57
Q

Rocuronium (Zemuron)
Dose:
Supplied:
Onset:
Duration:

A

Dose: 0.6 mg/kg (1.2 mg/kg = RSI dose)
Supplied: 10 mg/ml
Onset: 2-3 min (RSI dose = 1.5 min)
Duration: 35-75 mins

58
Q

Pancuronium (Pavulon)
Dose:
Supplied:
Onset:
Duration:

A

Dose: 0.1 mg/kg
Supplied: 2 mg/ml
Onset: 2-3 mins
Duration: 60-120 mins

59
Q

Which paralytic is the drug of choice for renal failure?

A

Cisatracurium (Nimbex)

60
Q

What are the commonly used reversal agents (anticholinesterase inhibitors)?

A

Edrophonium (Peds), Neostigmine, Pyridostigmine, Physostigmine

61
Q

Neostigmine (Prostigmine)
Dose:
Onset:
Duration:
Anticholinergic:

A

Dose: 40-70 mcg/kg (0.04-0.07 mg/kg)
Onset: 5-10 mins
Duration: 60 mins
Anticholinergic: Glycopyrrolate (0.2 mg per mg of Neostigmine)

62
Q

Sugammadex (Bridion)
Dose:
Onset:
Duration:

A

Dose: 2-16 mg/kg
Onset: 1-4 mins
Duration: 1.5-3 hours

63
Q

Glycopyrrolate (Robinul)
Dose:
Onset:
Duration:
Supplied:

A

Dose: 1:1 with neostigmine (3 mL of Neostigmine = 3 mL of Glyco)
Onset: 2-3 mins
Duration: 2 hours
Supplied: 0.2 mg/mL

64
Q

Ephedrine dose

A

5-10 mg (Usually supplied as 50 mg/mL)

65
Q

Neosynephrine dose

A

50-100 mcg (Usually supplied as 10 mg/ml)

66
Q

Hypertension Drugs:
Labetolol
Esmolol
Hydralazine

A

Labetolol: 5-25 mg (Tachycardia and HTN)
Esmolol: 10 mg (DOC for JUST tachycardia)
Hydralazine: 5-10 mg (HTN + Bradycardia)

67
Q

Droperidol
Dose:
Onset:
Duration:

A

Dose: 0.625 mg
Onset: 1-5 mins
Duration: 2-3 hrs

68
Q

Promethazine (Phenergan)
Dose:
Onset:
Duration:

A

Dose: 6.25-25 mg
Onset: 1-5 mins
Duration: 4-6 hrs

69
Q

Ondansetron (Zofran)
Dose:
Onset:
Duration:

A

Dose: 4-8 mg
Onset: 10 mins
Duration: 4-9 hrs

70
Q

Dexamethasone (Decadron)
Dose:
Onset:
Duration:

A

Dose: 4-16 mg
Onset: 10-30 mins
Duration: 2-10 hr

71
Q

Metoclopramide (Reglan)
Dose:
Onset:
Duration:

A

Dose: 10-20 mg
Onset: 10 min
Duration: 2 hrs

72
Q

Scopolamine
Onset:
Duration:

A

Onset: 2-4 hr
Duration:72 hours

73
Q

Propofol for N/V dose:

A

10-15 mg IV followed by 10 mcg/kg/min

74
Q

Non-Opioid Analgesics
Acetaminophen(Offirmev)
Ketorolac (Toradol)
Ibuprofen (Caldor)

A

Acetaminophen(Offirmev) - 1000 mg q4-6h (MAX 3-4 g)
Ketorolac (Toradol) - 15-30 mg q4h (60-120 mg qday MAX)
Ibuprofen (Caldor) - 200-800 mg q6h (3200 mg qd MAX)

75
Q

Signs/Symptoms of LAST?

A

Analgesia, lightheadedness, tinnitus, tongue/circumoral numbness, seizures, unconsciousness, respiratory arrest, CV arrest

76
Q

Lipid rescue for LAST:

A

20% Intralipids - BOLUS 1.5 ml/kg over 1 min, then start a drip at 0.25 mL/kg/min

77
Q
A

Clinical Prep (1 decks)

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