Doses Flashcards by Annie Camacho

Ephedrine

PO,IM,IV

10-25 mg IV
10-50 mg IM

onset immediate
doa 1 hrs
E1/2T: 3 hrs

40% unchanged in urine

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Epinephrine

SQ, IV

Onset: 1 min IV, 8 min SQ
DOA: 10 min (need infusion)

Resuscitation bolus: 10 mcg/kg
Start with 2-8 mcg/kg

1-2 mcg/min= B2
4-5 mcg/min= B1
10-20 mcg/min= A & B

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Norepi

4-16 mcg/min

onset rapid
doa 10 mins
e1/2 2 mins

MAO, COMT

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Dopamine

1-3 mcg/kg/min D1
3-10 mcg/kg/min B1
>10 mcg/kg/min Alpha

onset rapid
doa 10 mins
e1/2t 1 min

MAO, COMT to 75% inactive and 25% NE

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neostigmine

0.05-0.07 mg/kg

onset 3 min
doa 1 hr
e1/2t 1 hr

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edrophonium

0.5-1 mg/kg
onset 1 min
doa 1 hr

1/10th as potent as neostigmine

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pyridostigmine

0.2 mg/kg
onset 15 mins
doa 1 hr
e1/2t 1.5 hrs

water soluble

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physostigmine

15-60 mcg/kg Q 1-2 hrs
onset 5 mins
doa up to 5 hrs
e1/2t 30 mins

ester linkage
can cause cholinergic crisis

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morphine

preop 2.5-15 mg IV
intraop 0.1-1 mg/kg

onset <5 mins
doa 4 hrs
peak 20 mins
pB 30%
%nonionized 20%
E1/2t 3 hrs
30% lipid soluble

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Hydromorphone

0.5-2 mg IV Q2-6 hrs
2-4 mg PO Q4-6

onset <30 sec
doa 4 hrs
peak 5 mins
pb 10%
high LS
E1/2t 2 hrs
-
5x more potent than MSO4

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Meperidine

50-150 mg IM/PO/SQ
5 mg IV Q 5 mins
12.5-50 mg IV shivering

onset <1 min
doa 3 hrs
peak 10 mins
E1/2t 3 hrs
7% nonionized
moderate PB, LS
redistribution 10 mins

1/10th as potent as MSO4

*65% pulmonary first pass

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Fentanyl

premed 25-100 mcg IV
analgesia 1-2 mcg/kg
infusion 0.01-0.5 mcg/kg/min

onset 1 min
doa 30-60 mins
peak 3 mins
e1/2t 5 hrs
high LS, highly pb (80%)
20% nonionized
redistributes in 13 mns

100x MSO4

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Alfentanil

induction 50-200 mcg/kg
analgesia 10-20 mcg/kg
infusion 0.4-1.7 mcg/kg/min

onset rapid
doa 30-60 mins
peak 5 mins
e1/2t 90 mins
90% pb
90% nonionized (rapid)
highly lipid soluble

10x more potent than MSO4

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Sufentanil

analgesia 0.1-1 mcg/kg
1-2 mcg/kg minor
2-8 mcg/kg moderate
8-50 mcg/kg sole anesthetic

onset 1 min
doa 1 hr 
peak 3 mins
e1/2t 2 hrs
90% pb, 20% nonionized
highest lipid solubility
redistributes in 17 mins

60% pulm first pass

1000x more potent than MSO4

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Remifentanil

induction 0.5-1 mcg/kg over 1 min
infusion .05-2 mcg/kg/min

onset 1 min
doa 10 mins
peak2 mins
e1/2t 10 mins
80% pb
60% nonionized
60% lipid soluble

equianalgesic to fentanyl (100x more than MSO4)

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Rocuronium

steroid type

intubation 0.6-1.2 mg/kg
top-off 0.1 mg/kg Q 45 mins (per pNS)

onset 90 sec
doa <30 min or 30-60 mins
50% pb
e1/2t 2 hrs

30/30/30

Vecuronium

monoquarternary aminosteroid type

intubation 0.1 mg/kg

onset 3 mins
doa 30 mins
e1/2t 1 hr
70% pb

30/30/30
active metabolic 1/2 as potent

Atracurium
benzylisquinolone bisquaternary structure
intermediate acting

intubation 0.5 mg/kg

onset 3 mins
doa 30-60 mins
80% pb
e1/2t 20 mins

1/3 hoffman, 2/3 ester hydrolysis

laudanosine

Cisatracurium
benzylisquinolone
stereoisomer of Atracurium
intermediate acting

intubation 0.2 mg/kg

onset 3 mins
doa 30-60 mins
e1/2t 30 mins

hoffman elimination
1/5 the amt of Laudanosine

Pancuronium
bisquaternary aminosteroid type
long acting

intubation 0.1 mg/kg

onset 3 mins
doa 2 hrs
e1/2t 2 hrs

80% excreted unchanged renally
20% hepatic metabolism
3 active metabolites, one is 1/2 as potent

must be stored in fridge

SNS activation
Vagalytic (inc HR, MAP, CO)
bronchospasm, salivation

Lidocaine
amide local, class 1b

4mg/kg or 7 mg/kg
30-100 mg spinal max
1-2 mg/kg SNS blunt (similar anti-arrhythmic dose)

onset rapid
duration moderate 90 mins
e1/2t 1.5 hr
65% pb
pKa 7.9
24% nonionized
low lipid solublity (low potency)

Bupivacaine

amide local

2.5 mg/kg max
spinal 15-20 mg 0.75%

onset moderate
doa long 4-8 hrs
e1/2t 4 hrs
95% protein bound
pKa 8.1
17% nonionized
highly lipid soluble

Propofol

1-2.5 mg/kg
10 mg N/V
100-300 mcg/kg/min GA
25-100 mcg/kg/min

onset 30 sec
doa 10 mins
e1/2 30 mins-1 hr
highly lipid soluble

Etomidate

Carboxylated imidazole derivative

inductiojn 0.3 mg/kg
maint 10 mcg/kg/min with N20+opioid

onset 1 min
doa 10 mins
e1/2t 4 hrs
highly lipid soluble
75% pb

terminated by redistribution

ketamine phencyclidine derivative

induction 1-2 mg/kg IV or 4-6 mg/kg IM infusion 1-2 mg/kg/hr ``` onset 30 sec doa 10 mins e1/2t 3 hrs highly lipid soluble 12% pb ```

Dexmedetomidine selective alpha-2 agonist

1 mcg/kg bolus over 10 0.2-1 mcg/kg/hr infusion hypnosis, sedation, anxiolysis, analgesia ``` onset <5 mins doa 2 hrs e1/2t 3 hrs highly lipid soluble 90% pb ``` inhibits cyp450 Atipamezole no change in CO2 responsiveness depresses thermoregulation and masks shivering

Diazepam benzene ring fused 7-member diazepine ring

preop 0.2 mg/kg or 10-15 mg PO (dec MAC%) induction 0.5-1 mg/kg anticonvulsant 0.1 mg/kg IV (inhibits activity in hippocampus and limbic system) onset 1 hr doa determined by rate of metabolism and elimination e1/2t 21-37 hrs highly lipid soluble, highly protein bound active metabolite e1/2t is 48-96 hrs

midazolam imidazole ring (pH <4 ring open and H20-soluble, ring closes at pH 7.4 and lipid soluble)

preop 1-2.5 mg (max 5 mg) induction 0.1-0.2 mg/kg ``` onset 30 sec doa e1/2 4 hrs highly lipid soluble at physio pH, highly PB 2x more potent than diazepam ``` extensive 1st pass 1-hydroxymidaz is 1/2 as potent

lorazepam benzene ring fused 7-member diazepine ring

preop 50 mcg/kg (max 4 mg) not for induction most potent ``` onset very slow- limits use doa e1/2t 10-20 hrs highly lipid soluble, highly pb 5x more potent than diazepam ``` no active met

glycopyrrolate quaternary ammonium

reversal .01-.02 mg/kg preop/bradycardia 0.1-0.2 mg IV onset 2 mins doa 1 hr e1/2t 1 hr poorly lipid soluble 85% excreted unchanged by kidneys CI: MH, neonates

atropine ``` tertiary amine natural anticholinergic (bella donna) ```

reversal .01 mg/kg bradycardia 0.4-1 mg (less than 0.4 can yield paradoxical effect) 1 mg Q 3- 5 mins for PEA, asystole Neb: 2 mg in 5 mL NS ``` onset 1 min doa 1 hr e1/2t 2 hrs 40% pb 18% eliminated unchaged in urine ``` can cause central anticholinergic syndrome CI in glaucoma, renal disease

Scopolamine tertiary amine can cross placenta

peop 0.3-0.6 mg IV Q4 hrs onset 10 mins doa 2 hrs e1/2t 5 hrs lipid soluble delays awakening, can cause postop delirium CI: glaucoma, decreases effect of levodopa and digoxin

dobutamine synthetic catecholamine selective B1 agonist

2-10 mcg/kg/min <5 mcg/kg/min B1 >5 mcg/kg/min wake A1

Vasopressin exogenous ADH peptide, vasopressor

0.04 u/min shock 40 u IVP cardiac arrest 20 u IVP esophageal varices e1/2t 10 mins tissue peptidase metabolism

Isoproterenol synthetic catecholamine B1>B2

0.5-10 mcg/min onset rapid doa 10 mins e1/2t 5 mins COMT in liver and lungs, 50% excreted unchanged by kidney

Phenylephrine synthetic direct acting non-catecholamine selective A1

50-200 mcg IVP 20-50 mcg/min onset rapid doa 20 mins 90% pb MAO and excreted in urine 90%