DOSES only Induction agents Flashcards
Propofol IV induction dose is ______
1-2 mg/kg
Propofol IV maintenance dose is
20-200mcg/kg/min
Ketamine IV induction dose is
1 - 2mg/kg
Propofol antiemetic dose
10-20mg IV
Ketamine IV maintenance dose
1-3 mg/min
Ketamine analgesia dose
0.1-0.3 mg/kg
Ketamine IM dose is
4-8 mg/kg
Ketamine PO dose is
10mg/kg
Low dose OPIOD sparing effect of Ketamine
0.1 - 0.3mcg/kg/min
What is the intubation dose of Rocuronium?
0.6 - 1.2mg/kg
Atracurium intubation dosage
0.5 mg/kg
Cisatracurium intubation dosage
0.1 mg/kg
Neosynephrine (phenylepherine) infusion rate range?
0.15–0.75 µg⋅kg/min
Norepinephrine infusion rate
Start 0.01 µg⋅kg/min then titrate to effect
Vasopressin
0.01–0.04 units⋅min−1
Beta only dose EPI
0.01–0.03 µg⋅kg−1⋅min−1
Alpha and Beta EPI dose
0.03–0.1 µg⋅kg−1⋅min−1
Alpha and Beta EPI dose
0.03–0.1 µg⋅kg−1⋅min−1
More alpha Epi dose
> 0.1 µg⋅kg−1⋅min−1
Nitroprusside
0.5–10 µg/kg/min (bolus 1–2 µg/kg)
Nicardipine
5–15 mg/hr
Nitroglycerin
Initial infusion rate is typically 5 to 10 µg/min, and it is titrated in additional increments of 5 to 10 µg/min every 10 min to effect.
Diltiazem : intravenously as a bolus dose of
0.25 mg/kg, followed by a continuous infusion of 5 to 15 mg/min for the treatment of supraventricular tachycardia or atrial arrhythmias.
Dobutamine
2–20 µg⋅kg/min
Milrinone
Loading dose of 20–50 µg⋅min–1, then 0.25–0.75 µg⋅kg–1⋅min–1
Isoproterenol
> 0.15 µg⋅kg/min
Ephedrine
5mg IVP for hypotension
Metoprolol
5mg IVP
Succinylcholine
Low dose
High dose
1-2 mg/kg
3-4 mg/kg
Atropine dose for Bradycardia
0.5 mg Every 3-5 minutes
Max is 3 mg
Ondansetran
4mg IV , 8mg Max for cardiac
Naloxone (Narcan dose)
How do you mix
Duration is
half life
0.4mg in mL Aspirate the 1ml from vial add to 9ml of NS give you 40mcg/ml 30-45 mns 1 hour
Calcium Chloride
20mg/kg for CCB and Beta Blockers overdose
Cardiac arrest 1-2g
Vecuronium
0.8-1.2mg/kg
Esmolol
500mcg/kg loading dose over 1 min followed by 50
mcg/kg/min infusion for 4 mins
Flumazenil
0.2 mg q 2min Max 1 mg
Glucagon
1mg q15 min
Calcium Chloride 2 uses and doses
20mg/kg for CCB and Beta Blockers overdose
Cardiac arrest 1-2g
Precedex
1mcg/kg
Sevo MAC
0.65
Des MAC
6.6
N2O
104
Albuterol class and use
Beta Adrenergic agonists, most potent bronchodilator, for asthma and COPD
Ipratropium
Anticholinergic , superior to SABA in patients with COPD
Dopamine (dosing scheme)
onset
Peak
Duration
D B A Dopamine Dose 2-5 mcg/kg/min Beta Dose Dose 5-10 mcg/kg/min Alpha dose 10-20 mcg/kg/min Half life : 2 min O 5 min P D <10min
Ephedrine
synthetic non-catecholamine
5 mg
Require 250X than epinephrine for the same response
LAST LONGER
Epinephrine
1ml in 250 ml bag –> 4 mcg/ml
Drips is 1-16 mcg/kg/min
Glycopyrolate
0.01 - 0.02mg/kg IV
REVERSAL (0.2mg per 1 mg of Neostigmine)
Neostigmine
- 04mg/kg for 2 TOF twitches
0. 07 mg/kg for 4 TOF twitches
Nitroglycerine what about nipride? Concentration is Initial start dose How to titrate?
Venous dilator Nipride dilates both 25 mg in 250 ml bottle INITIAL DOSE IS 0.2 mcg/kg/min Titrate 0.1mcg /kg/min q3-5min
Nitroprusside
Concentration
Dose
Toxicity
Arteriolar and veno vasodilator
50 mg in 250 ml
0.25- 5 mcg/kg/min
Thiocynate Toxicity with > 3 mcg/kg/min
Norepinephrine
Initial dose
Bag concentration
Alpha vs Beta
8mcg/min, titrate 2mcg/min q 5mins
4 mg in 250 ml = 16mcg/ml
8 mg in 250 ml = 32 mcg/ml
ALPHA > BETA
Phenylephrine
Most common infusion rate appears to be
SPECIAL Because
Effects on blood flow
40-80mcg/min
Increases both arterial and venous blood vessels increasing SVR without changing cardiac dynamics.
Decrease Blood flow to all organs
Do not give with BRADYCARDIA cause it slows the HR
Alfentanil onset , peak , potency, duration, induction dose and intubation dose.
Onset is 1.4 minutes , 3-5 minutes
Duration 30-60 minutes
Less potent than remifentanyl, less apnea than remifentanyl
Induction dose is 15 mcg/kg before direct laryngoscopy
Intubation dose is 30mcg/kg to BLOCK the catecholamine response.
FENTANYL Equivalence to morphine Onset and duration Lipid solubility Half life Metabolism Excretion May cause this?
Most common use 100x more potent than morphine Rapid onset and short duration of action , 30-60mins Highly lipid soluble 2-4 hours Metabolism: Liver Excretion : Kidneys Chest wall rigidity
Hydromorphone
Dose, onset, duration, potency when compared to morphine
Receptors.
Contraindications
Status asthmaticus, Increased ICP and intracranial lesions. Mu and Kappa 0.5 to 1 mg/hr IVP 2-5 min onset Duration 2-4 hours Half life is 2.3 hours
Labetalol
Clinical dose
Beta to alpha ratio is (oral or IV)
Half time is _______
10-20 mg q10 mins
7: 1 IV
3: 1 oral
Metoprolol
k
Remifentanyl: Potency
Onset, peak, duration,dose, solubility
Always use as a
19 x more potent than alfentan Rapid and Ultra short duration of action Onset 1.1 minutes Peak 2 minutes Less soluble than other 1-3 mcg/kg over 1 minute Continuous drip
Sodium Bicarbonate
Cardiac arrest 1 meq/kg/dose
For metabolic acidosis with ph<1
Induction dose of Esmolol
Induction dose is ____
Rapid onset, short duration of action
0.5mg/kg over 1 min
Induction 100-150mg 2 min before laryngoscopy
When mixing phenylephrine: BAG mixing
Mix 10 mg vial in 250 ml of NS or D5W = 40 mcg/ml Mix 2 (10mg) vials in 250 ml of NS or D5W= 80mcg/ml
Half life for propofol infusion up to 8hrs
<40 minutes
Propofol is metabolized by
active metabolites?
Glucuronidation in the liver into inactive metabolites
no
Propofol time to peak
90-100 second (2mns)
Propofol onset
30 seconds
Propofol protein binding
98%
Vd of propofol
3-4L/kg
Propofol is made up of
Soybean oil
glycerol
egg
Propofol acid or base
Acid pka 11
Succinylcholine dose
0.5 - 1 mg/kg
Succinylcholine onset
30-60 sec
Succinylcholine Duration
3-5 minutes
Succinylcholine metabolism
Plasma cholinesterase
Side effects of succinylcholine
Bradycardia (most likely to be seen with a second dose)
How much do succ increase K
0.5 mEq
People who can metabolize succ
Atypical cholinesterase
Test done for people with atypical cholinesterase is
Dibucaine test
Normal dibucaine test is
80% (inhibit activity of plasma cholinesterase by 80%
Heterozygous dibucaine
40-60
homozygous dibucaine
20
Dibucaine number only refer to ____Not ____
Quality not quantity
What pressure do succinylcholine increases
IOP (ocular)
IAP (abdominal)
ICP (cranial)
Rocuronium onset
1-2 minutes
Rocuronium PEAK
60-90 seconds
Rocuronium duration
20-35 minutes
Rocuronium excretion
liver 70%
Renal 30%
Etomidate intubation dose
0.3-0.6mg/kg
Etomidate onset
30-60 seconds
Etomidate peak
1 minutes
Etomidate duration
3-10 minutes
Etomidate half time
2-5 hours
Etomidate Protein binding
76%
Limiting factor of etomidate
Adrenocortical function depression
PONV
ADvantage of etomidate
minimal changes with hemodynamics
How does etomidate causes adrenocortical suppresion?
Inhibits the enzyme 11-beta hydroxylase for 4-8 hours after induction. That enzyme converts cholesterol to cortisol, which patient needs to properly response to stress.
Ketamine causes at post op
Emergence delirium
Ketamine and airway
upper airway reflexes remain intact
Ketamine active metabolites
Yes , norketamine 1/3 as potent
Ketamine and bronchioles
Bronchodilation
Ketamine class
Binds noncompetitively to NMDA receptor
Ketamine onset
30 seconds
Ketamine peak
3-5 minutes
Ketamine duration
8-15 minutes
Vecuronium class
Monoquartery aminosteroid
Vecuronium intubation dose
0.08-0.1 mg/kg
Vecuronium onset
3-5 minutes
Vecuronium peak
3-5 minutes
Vecuronium duration
20-35 minutes
Vecuronium excretion
Liver 80%
Kidney 20%
Rocuronium class
Monoquartery aminosteroid
Cistracurium class
benzylisoquinolinium
CisAtracurium other name
Nimbex
Cisatracurium onset
1-5 minutes
Cisatracurium peak
3-5 minutes
Cisatracurium duration
25-35 minutes
Cisatracurium metabolims
Hoffman elimination
Cisatracurium metabolites
Laudnosine
Cistatracurium metabolizes to laudanosine which can cause
Seizures.
Duramorph is
derivatives free morphine
Duramorph intrathecal dose is
0.1-0.5 mg
Bupivacaine onset is
FAST
Max dose bupi without epi
175 mg (70 mls)
Max dose bupi with epi
225 ml (90mls)
Bupivacaine duration is
2-8 hours
Bupivacaine class
amide LA
What is the ED95 dose of Rocuronium?
0.3mg/kg
What is the ED95 dose of succinylcholine?
0.3mg/kg
What is the ED95 dose of Atracurium?
0.25mg/kg
What is the ED95 dose of Cisatracurium?
0.05mg/kg
What is the ED95 dose of Vecuronium?
0.05mg/kg