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Anesthesia Principles > Drug Box > Flashcards

Drug Box Flashcards

1
Q

What is the brand name of atropine?

A

Atropen

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2
Q

What type of drug is atropine?

A

anticholinergic

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3
Q

What receptors do atropine work on?

A

Antagonist of Ach at M1 and M2 receptors

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4
Q

What is the MOA of atropine?

A

inhibits the action of Ach at postganglionic sties and inhibits the action of NT on M1 and M2

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5
Q

What is atropine used for?

A

bradycardia; NMBD reversal

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6
Q

Atropine is given w/ what reversal?

A

edrophonium

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7
Q

What is the dose of atropine for bradycardia?

A

0.4-0.6 mg

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8
Q

What is the pediatric dose of atropine?

A

0.02 mg/kg

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9
Q

What is the dose of atropine when used for NMBD reversal?

A

7-10 mcg/kg

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10
Q

What is the onset of IV atropine?

A

1-2 minutes

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11
Q

What is the peak of IV atropine?

A

2 to 4 minutes

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12
Q

What is the half life of atropine?

A

4 hours

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13
Q

What is the DOA of atropine?

A

1-2 hours

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14
Q

How is atropine eliminated?

A

eliminated mostly unchanged in urine

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15
Q

What is the metabolism of atropine?

A

Liver (50%)

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16
Q

What are a/e of atropine?

A

flushing, mydriasis, dry mouth, confusion, hyperthermia

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17
Q

What is atropine’s effect on the eyeballs?

A

mydriasis - dilates

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18
Q

What is the atropine’s makeup?

A

tertiary amine

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19
Q

Can atropine cross the BBB?

A

yes

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20
Q

Why can atropine cross the BBB?

A

b/c it is a tertiary amine

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21
Q

What is a s/e of atropine w/ inadequate dosing?

A

transient bradycardia

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22
Q

When is atropine C/I?

A

Narrow angle glaucoma
Acute hemorrhage
Tachycardia
GI obstruction

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23
Q

Additive anticholinergic effects can occur when atropine is adminsitered with ____, _____, ____, ____, and some ______.

A

meperidine, antihistamines, phenothiazines, TCAs, and some antiarrhythmics

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24
Q

What is the brand name of Glycopyrrolate?

A

Robinul

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25
Q

What class is Glycopyrrolate?

A

synthetic anticholinergic

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26
Q

What is the MOA Glycopyrrolate?

A

Acts on M1 and M3 to reduce tone by decreasing Ca+ release from intracellular stores?

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27
Q

What receptors does Glycopyrrolate work on?

A

M1 and M3

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28
Q

What is glycopyrrolate used for?

A

bradycardia, secretions, NMBD reversal

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29
Q

What reversal is glycopyrrolate given with?

A

Neostigmine

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30
Q

What is the dose of Glycopyrrolate for reversal?

A

7-15 mcg/kg

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31
Q

What is the dose of Glycopyrrolate to treat vasovagal response/bradycardia?

A

0.2-0.4 mg

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32
Q

Per the book, Glycopyrrolate should be administered over ____ minutes.

A

2-5

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33
Q

What is the onset of IV Glycopyrrolate?

A

1-2 minutes

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34
Q

What is the DOA of Glycopyrrolate?

A

2-4 hours

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35
Q

What is the peak of Glycopyrrolate?

A

30-45 minutes

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36
Q

What is the half-life of Glycopyrrolate?

A

50 minutes

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37
Q

What two ways is Glycopyrrolate eliminated?

A

urine and feces

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38
Q

THe majority (85%) of Glycopyrrolate is eliminated via what?

A

urine

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39
Q

What percent of Glycopyrrolate is eliminated through the feces?

A

15%

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40
Q

Glycopyrrolate is eliminated within ___ hours.

A

48

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41
Q

How is Glycoprryolate metabolized?

A

small amounts are metabolized into inactive metabolites

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42
Q

What are the a/e of Glycopyrrolate?

A

Tachycardia
HA
Urinary hesitancy/retention
Decreased sweating
Dry nose and mouth
constipation

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43
Q

Can Glycopyrrolate cross the BBB?

A

No

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44
Q

Does Glycopyrrolate cause anticholinergic syndrome?

A

Unlikley

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45
Q

When is Glycopyrrolate C/I?

A

Acute angle glaucoma
GI obstruction
Obstructive uropathy
paralytic ileus
intestinal atony
acute hemorrhage
PUD
mitral stenosis
CV instability
Myasthenia gravis

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46
Q

What is the brand name of Scopolamien?

A

Transderm Scop

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47
Q

What type of class if Scopolamine?

A

Anticholinergic

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48
Q

What is the MOA of scopolamine?

A

inhibits muscarinic activity of Ach

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49
Q

What is the MOA of scopolamine patch?

A

blocks transmission from impulses arising from overstimulation of the vestibular apparatus of the inner ear to the medulla

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50
Q

What is the use of scopolamine?

A

prevents moition induced N/V and PONV

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51
Q

What is the IV/IM dose of scopolamine?

A

0.3-0.5 mg

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52
Q

How much does a scopolamine patch deliver?

A

5 mcg/hr for 72 hours

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53
Q

What is the total dose scopolamine patch delivers in 72 hours?

A

1.5 mg

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54
Q

What is the onset of scopolamine patch?

A

4 hours (so place prior to stimuli)

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55
Q

What is the onset of scopolamine PO/IM/SQ?

A

30 minutes

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56
Q

What is the onset of scopolamine IV?

A

10 minutes

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57
Q

What is the DOA of scopolamine patch?

A

72 hours

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58
Q

What is the DOA of scopolamine PO/IM/SQ?

A

4-6 hours

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59
Q

What is the DOA of scopolamien IV?

A

2-4 hours

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60
Q

When does scopolamien peak (All routes)?

A

1 hour

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61
Q

After scopolamine patch removal, the half-lief is ____

A

9 hours

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62
Q

How is scopolamine excreted?

A

small amount in urine (<5%)

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63
Q

How is scopolamine metabolized?

A

hepatic conjugation

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64
Q

What are a/e of scopolamine?

A

red as beet, blind as a bat, dry as a bone, mad as a hatter, hot as a hare

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65
Q

What can scopolamine patch do to the eyes?

A

mydriasis and visual disturbanes

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66
Q

What is an a/e of low dose scopolamine?

A

paradoxical bradycardia

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67
Q

Why are IV and PO routes of scopolamine not used?

A

They require large doses that produce undesirable s/e

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68
Q

Can scopolamine cross the BBB?

A

yes

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69
Q

What meds create a risk for anticholinergic syndrome?

A

scopolamine
Atropine

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70
Q

What are signs of anticholinergic syndrome?

A

restless
hallucinations
unconsciousness

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71
Q

What is the treatment for anticholinergic syndrome?

A

Physostigmine15-60 mcg/kg

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72
Q

You should use Scopolamine with caution in what pt population?

A

elderly

73
Q

When should you avoid scopolamine?

A

angle closure glaucoma
acute hemorrhage
tachycardia
GI obstruction
hyperpyrexia states

74
Q

What is the brand name of neostigmine?

A

prostigmine

75
Q

What is the vial concentration of neostigmine?

A

1 mg/mL

76
Q

What is the class of neostigmine?

A

anticholinesterase inhibitor

77
Q

How does neostigmine work?

A

inhibits acetylcholinesterase enzyme and prevents the breakdown of Ach so Ach accumulates at the NMJ to compete w/ residual NMBD

78
Q

What is neostigmine used for?

A

ND NMBD reversal

79
Q

What is required before you can give neostigmine?

A

1 twitch

80
Q

What is the dose of neostigmine?

A

40-70 mcg/kg

81
Q

hat is the max dose of neostigmine?

A

5 mg

82
Q

Why does neostigmine have a max dose?

A

ceiling effect

83
Q

What must you give when administering neostigmine?

A

Robinul

84
Q

Why are Robinul and neostigmine given together?

A

both have slower onset

85
Q

What is the dose of neostigmine to treat myasthenia gravis?

A

PO 15-375 mg/day

86
Q

What is the IM dose of neostigmine?

A

0.5 to 2 mg

87
Q

What is the onset of neostigmine?

A

5 - 10 minutes

88
Q

What is the DOA of neostigmine?

A

45 to 90 minutes

89
Q

What is the peak of neostigmine?

A

successful reversal occurs within 10 minutes

90
Q

What is the half-life of neostigmien

A

70 to 80 minutes

91
Q

How is neostigmine excreted?

A

renal

92
Q

What percent of neostigmine is excretted renally?

A

50%

93
Q

How is neostigmine metabolized?

A

hydrolysis by plasma esterase and hepatic metabolism

94
Q

What are a/e of neostigmine?

A

bradycardia or tachycardia
long QTi
AV block
Hypotension
bronchospasm
respitory depression
seizures
dysarthria
HA
N/V
flatulence
Increased peristalsis
Urinary frequency

95
Q

What is neostigmine’s effect on PONV?

A

may increase

96
Q

When should you avoid neostigmine?

A

bradycardia
asthma
epilepsy
cardiac arrhtyhmias
PUD
peritonitis
GI obstruction

97
Q

What is the brand name of edrophonium?

A

chloride (tensilon)

98
Q

What is the class of edrophonium?

A

acetylcholinesterase inhibitor

99
Q

What is the MOA of edrophonium?

A

binds reversibly w/ negatively charged enzyme sites to prevent catalytic binding w/ Ach for the short time the site is occupied

100
Q

What is the use of Edrophonium?

A

reversal of ND NMBD

101
Q

What must you administer w/ Edrophonium?

A

Atropine

102
Q

Why are atropine and edrophonium given together?

A

both have rapid onsets

103
Q

Edrophonium is not recommended for ____/

A

deep blocks

104
Q

what is the dose of edrophonium?

A

0.5-1.5 mg/kg

105
Q

what is the max dose of edrophonium?

A

40 mg

106
Q

What is the dose of atropine when adminsitered w/ Edrophonium?

A

7-15 mcg/kg

107
Q

What is another use for edrophonium besides NMBD reversal?

A

to assess for myasthenia gravis or cholinergic crisis

108
Q

What ist he dose of edrophonium to assess for myasthenia gravis or cholingergic crisis?

A

1 mg Q1-2 minute until sign/symptom change

109
Q

what is the max dose of edrophonium when using it to assess for myasthenia gravis or cholinergic crisis?

A

10 mg

110
Q

what is the IM dose of edrophonium?

A

10 mg

111
Q

what is the onset of edrophonium?

A

30-60 seconds

112
Q

What is the DOA of edrophonium?

A

20-40 minutes

113
Q

what is the half life of edrophonium?

A

110 minute

114
Q

How is edrophonium excreted?

A

renal (75%)

115
Q

How is edrophonium metabolized?

A

hepatic metabolism (30%)

116
Q

What are a/e of edrophonium?

A

bradycardia/tachycardia
AV blcok/nodal rhythmy
hypotension
increased secretion
bronchospasm
respiratory depression
seizures
dysarthria
headaches
lacrimation
miosis
N/V
flatulence
increased peristalsis
rash
urticaria

117
Q

when is edrophonium C/I?

A

bradycardia
asthma
cardiac arrhythmia
PUD
peritonitis
GI obstruction
Urinary tract obstruction

118
Q

What is the brand name of physostigmine?

A

antilirium

119
Q

What is the class of physostigmine?

A

anticholinesterase inhibitor

120
Q

What is the MOA of physostigmine?

A

Tertiary amine that readily crosses the BBB and inhibits acetylcholinesterase in the CNS untilatey increased Ach in CNS

121
Q

What is the make up of physostigmine?

A

tertiary amine

122
Q

Can physostigmien cross the BBB?

A

yes

123
Q

What are the uses of physostigmine?

A

anticholinergic OD and central anticholinergic syndrome

124
Q

What is the dose of Physostigmine for anticholinergic syndrome?

A

15-60 mcg/kg Q1-2 H

125
Q

What is the dose of Physostigmine for anticholinergic psychosis?

A

0.5-2 mg IV O10-30 minutes (10-20 mcg/kg)

126
Q

How fast do you administer Physostigmine?

A

1 mg per minute

127
Q

What is the onset of PHysostigmine?

A

3-8 minutes

128
Q

What is the DOA of physostigmine?

A

30 minutes to 5 hours

129
Q

What is the half life of Physostigmine?

A

23 minutes

130
Q

How is Physostigmien metabolized?

A

rapidly by plasma cholinesterase

131
Q

What are a/e of physostigmine?

A

bradycardia
bronchospasm
dyspnea
respiratory paralysis
seizures
salivation
N/V
miosis

132
Q

Why do you not administer physostigmine rapidly?

A

It can cause bradycardia and hypersalivation, leading ot respiratoyr problems or possible seizures

133
Q

High doses of Physostigmine can cause:

A

tremors
ataxia
muscle fasiculations

134
Q

High dose of Physostigmine can ultimately cause ____.

A

depolarization block

135
Q

What is the antidote for cholinergic crisis?

A

Atropine 2-4 mg @3-10 minutes

136
Q

When should you be cautious giving PHysostigmine?

A

epilepsy
parkinsonian syndrome
bradycardia

137
Q

hen should you avoid giving physostigmine?

A

asthma
DM
GI or urinary tract obstruction
cholinesterase or depolarizing NMBD

138
Q

What is the brand name of pyridostigmine?

A

Mestinon

139
Q

What is the class of pyridostigmine?

A

anticholinesterase inhibitor

140
Q

What is the MOA of pyridostigmine

A

carbamoyl ester that is a quaternary compound that blocks action of acetylcholinesterase, preventing the breakdown of Ach and increasnig Ach at receptor sitesd

141
Q

What is the makeup of pyridostigmine

A

carbamoyl ester

142
Q

what is the use of pyridostigmine

A

reversal of NMBD; myasthenia gravis treatment

143
Q

does pyridostigmine cross teh BBB?

A

no

144
Q

Can pyridostigmine be given for anticholinergic syndrome?

A

no b/c it does not cross teh BBB

145
Q

Why is pyridostigmine rarely used?

A

longer onset than neostigmine

146
Q

what is the reversal dose of pyridostigmine

A

10-30 mg (0.1-0.25 mg/kg)

147
Q

what do you administer w/ pyridostigmine

A

aropine 15 mcg/kg or robinul 10 mcg/kg

148
Q

pyridostigmine is prefered to be administered with ____ due to its onset

A

robinul; (slower onset)

149
Q

waht is the onset of pyridostigmine

A

2-5 minutes

150
Q

what is the DOA of pyridostigmine

A

1-2 H

151
Q

what is the peak of pyridostigmine

A

2 hours

152
Q

What is the half life of pyridostigmine

A

30 minutes to 1.5 hours

153
Q

how is pyridostigmine excreted?

A

renal (75%)

154
Q

how is pyridostigmine metabolized?

A

hydrolyzed by cholinesterase

155
Q

what are a/e of pyridostigmine

A

bradycardi
AV block
nodal rhythm
hypostenion
increased scretion
respiratory depression
N/V/D
abdominal cramping
increased peristalsis
muscle cramps
fasciuclations
weakness
miosis
diaphoresis

156
Q

What happens w/ OD of pyridostigmine

A

cholinergic crisis - N/V, bradycardia or tachycardia, excessive salivation, sweating, bronchospasm, weakness, paralysis

157
Q

What is the treatment of pyridostigmine OD

A

D/c drug and adminsiter Atropine 10 mg/kg(??? -does not seem right) Q3-10 minutes until s/s disappear

158
Q

when should you use pyridostigmine cautiously?

A

bradycardia
asthma
cardiac arrhythmias
PUD
CI or urinary obstruction

159
Q

What is the brand name of droperidol

A

inapsine

160
Q

what is the class of droperidol

A

dopamine (D2) antagonist

161
Q

What is the MOA of droperidol

A

butyrophenone w/ dopamine antagonist and alpha adrenergic block features that act at the brainstem CTZ, the floor of the fourth ventricle, and other central locations

162
Q

what is the use of droperidol

A

antiemetic

163
Q

what ist he dose of droperidol

A

0.625 to 1.25 mg IV

164
Q

what is the onset of droperidol

A

3-10 minutes

165
Q

what is the DOA of droperidol

A

up to 12 hours

166
Q

what is the peak of droperidol

A

30 minutes

167
Q

waht is the half life of droperidol

A

2-4 hours

168
Q

how is droperidol eliminated?

A

urine and feces

169
Q

can droperidol cross teh BBB?

A

yes

170
Q

what are a/e of droperidol

A

hyptension
extrapyramidal s/e
delirium
hyperprolactinemia

171
Q

what warning exists for droperidol?

A

black box warning

172
Q

What is the black box warning for droperidol

A

sudden death from QT prolongation

173
Q

what dose does qt prolongation occur with droperidol

A

> 25 mg

174
Q

What is required by the FDA prior to givin droperidol

A

12 lead EKG

175
Q

When is droperidol C/I

A

parkinsons
prolonged QTi

176
Q

What does droperidol have to do with pheochromocytoma?

A

enhances catecholamine release

177
Q

droperidol enhances catecholamine release in ____

A

pheochromocytoma

178
Q

Administration of droperidol and ____ can cause _____

A

levodopa; severe skeletal muscle rigidity and pulmonary edema d/t antagonism of dopamine

Anesthesia Principles (10 decks)

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