Drug Box Flashcards
1
Q
What is the brand name of atropine?
A
Atropen
2
Q
What type of drug is atropine?
A
anticholinergic
3
Q
What receptors do atropine work on?
A
Antagonist of Ach at M1 and M2 receptors
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
5
Q
What is atropine used for?
A
bradycardia; NMBD reversal
6
Q
Atropine is given w/ what reversal?
A
edrophonium
7
Q
What is the dose of atropine for bradycardia?
A
0.4-0.6 mg
8
Q
What is the pediatric dose of atropine?
A
0.02 mg/kg
9
Q
What is the dose of atropine when used for NMBD reversal?
A
7-10 mcg/kg
10
Q
What is the onset of IV atropine?
A
1-2 minutes
11
Q
What is the peak of IV atropine?
A
2 to 4 minutes
12
Q
What is the half life of atropine?
A
4 hours
13
Q
What is the DOA of atropine?
A
1-2 hours
14
Q
How is atropine eliminated?
A
eliminated mostly unchanged in urine
15
Q
What is the metabolism of atropine?
A
Liver (50%)
16
Q
What are a/e of atropine?
A
flushing, mydriasis, dry mouth, confusion, hyperthermia
17
Q
What is atropine’s effect on the eyeballs?
A
mydriasis - dilates
18
Q
What is the atropine’s makeup?
A
tertiary amine
19
Q
Can atropine cross the BBB?
A
yes
20
Q
Why can atropine cross the BBB?
A
b/c it is a tertiary amine
21
Q
What is a s/e of atropine w/ inadequate dosing?
A
transient bradycardia
22
Q
When is atropine C/I?
A
Narrow angle glaucoma
Acute hemorrhage
Tachycardia
GI obstruction
23
Q
Additive anticholinergic effects can occur when atropine is adminsitered with ____, _____, ____, ____, and some ______.
A
meperidine, antihistamines, phenothiazines, TCAs, and some antiarrhythmics
24
Q
What is the brand name of Glycopyrrolate?
A
Robinul
25
What class is Glycopyrrolate?
synthetic anticholinergic
26
What is the MOA Glycopyrrolate?
Acts on M1 and M3 to reduce tone by decreasing Ca+ release from intracellular stores?
27
What receptors does Glycopyrrolate work on?
M1 and M3
28
What is glycopyrrolate used for?
bradycardia, secretions, NMBD reversal
29
What reversal is glycopyrrolate given with?
Neostigmine
30
What is the dose of Glycopyrrolate for reversal?
7-15 mcg/kg
31
What is the dose of Glycopyrrolate to treat vasovagal response/bradycardia?
0.2-0.4 mg
32
Per the book, Glycopyrrolate should be administered over ____ minutes.
2-5
33
What is the onset of IV Glycopyrrolate?
1-2 minutes
34
What is the DOA of Glycopyrrolate?
2-4 hours
35
What is the peak of Glycopyrrolate?
30-45 minutes
36
What is the half-life of Glycopyrrolate?
50 minutes
37
What two ways is Glycopyrrolate eliminated?
urine and feces
38
THe majority (85%) of Glycopyrrolate is eliminated via what?
urine
39
What percent of Glycopyrrolate is eliminated through the feces?
15%
40
Glycopyrrolate is eliminated within ___ hours.
48
41
How is Glycoprryolate metabolized?
small amounts are metabolized into inactive metabolites
42
What are the a/e of Glycopyrrolate?
Tachycardia
HA
Urinary hesitancy/retention
Decreased sweating
Dry nose and mouth
constipation
43
Can Glycopyrrolate cross the BBB?
No
44
Does Glycopyrrolate cause anticholinergic syndrome?
Unlikley
45
When is Glycopyrrolate C/I?
Acute angle glaucoma
GI obstruction
Obstructive uropathy
paralytic ileus
intestinal atony
acute hemorrhage
PUD
mitral stenosis
CV instability
Myasthenia gravis
46
What is the brand name of Scopolamien?
Transderm Scop
47
What type of class if Scopolamine?
Anticholinergic
48
What is the MOA of scopolamine?
inhibits muscarinic activity of Ach
49
What is the MOA of scopolamine patch?
blocks transmission from impulses arising from overstimulation of the vestibular apparatus of the inner ear to the medulla
50
What is the use of scopolamine?
prevents moition induced N/V and PONV
51
What is the IV/IM dose of scopolamine?
0.3-0.5 mg
52
How much does a scopolamine patch deliver?
5 mcg/hr for 72 hours
53
What is the total dose scopolamine patch delivers in 72 hours?
1.5 mg
54
What is the onset of scopolamine patch?
4 hours (so place prior to stimuli)
55
What is the onset of scopolamine PO/IM/SQ?
30 minutes
56
What is the onset of scopolamine IV?
10 minutes
57
What is the DOA of scopolamine patch?
72 hours
58
What is the DOA of scopolamine PO/IM/SQ?
4-6 hours
59
What is the DOA of scopolamien IV?
2-4 hours
60
When does scopolamien peak (All routes)?
1 hour
61
After scopolamine patch removal, the half-lief is ____
9 hours
62
How is scopolamine excreted?
small amount in urine (<5%)
63
How is scopolamine metabolized?
hepatic conjugation
64
What are a/e of scopolamine?
red as beet, blind as a bat, dry as a bone, mad as a hatter, hot as a hare
65
What can scopolamine patch do to the eyes?
mydriasis and visual disturbanes
66
What is an a/e of low dose scopolamine?
paradoxical bradycardia
67
Why are IV and PO routes of scopolamine not used?
They require large doses that produce undesirable s/e
68
Can scopolamine cross the BBB?
yes
69
What meds create a risk for anticholinergic syndrome?
scopolamine
Atropine
70
What are signs of anticholinergic syndrome?
restless
hallucinations
unconsciousness
71
What is the treatment for anticholinergic syndrome?
Physostigmine15-60 mcg/kg
72
You should use Scopolamine with caution in what pt population?
elderly
73
When should you avoid scopolamine?
angle closure glaucoma
acute hemorrhage
tachycardia
GI obstruction
hyperpyrexia states
74
What is the brand name of neostigmine?
prostigmine
75
What is the vial concentration of neostigmine?
1 mg/mL
76
What is the class of neostigmine?
anticholinesterase inhibitor
77
How does neostigmine work?
inhibits acetylcholinesterase enzyme and prevents the breakdown of Ach so Ach accumulates at the NMJ to compete w/ residual NMBD
78
What is neostigmine used for?
ND NMBD reversal
79
What is required before you can give neostigmine?
1 twitch
80
What is the dose of neostigmine?
40-70 mcg/kg
81
hat is the max dose of neostigmine?
5 mg
82
Why does neostigmine have a max dose?
ceiling effect
83
What must you give when administering neostigmine?
Robinul
84
Why are Robinul and neostigmine given together?
both have slower onset
85
What is the dose of neostigmine to treat myasthenia gravis?
PO 15-375 mg/day
86
What is the IM dose of neostigmine?
0.5 to 2 mg
87
What is the onset of neostigmine?
5 - 10 minutes
88
What is the DOA of neostigmine?
45 to 90 minutes
89
What is the peak of neostigmine?
successful reversal occurs within 10 minutes
90
What is the half-life of neostigmien
70 to 80 minutes
91
How is neostigmine excreted?
renal
92
What percent of neostigmine is excretted renally?
50%
93
How is neostigmine metabolized?
hydrolysis by plasma esterase and hepatic metabolism
94
What are a/e of neostigmine?
bradycardia or tachycardia
long QTi
AV block
Hypotension
bronchospasm
respitory depression
seizures
dysarthria
HA
N/V
flatulence
Increased peristalsis
Urinary frequency
95
What is neostigmine's effect on PONV?
may increase
96
When should you avoid neostigmine?
bradycardia
asthma
epilepsy
cardiac arrhtyhmias
PUD
peritonitis
GI obstruction
97
What is the brand name of edrophonium?
chloride (tensilon)
98
What is the class of edrophonium?
acetylcholinesterase inhibitor
99
What is the MOA of edrophonium?
binds reversibly w/ negatively charged enzyme sites to prevent catalytic binding w/ Ach for the short time the site is occupied
100
What is the use of Edrophonium?
reversal of ND NMBD
101
What must you administer w/ Edrophonium?
Atropine
102
Why are atropine and edrophonium given together?
both have rapid onsets
103
Edrophonium is not recommended for ____/
deep blocks
104
what is the dose of edrophonium?
0.5-1.5 mg/kg
105
what is the max dose of edrophonium?
40 mg
106
What is the dose of atropine when adminsitered w/ Edrophonium?
7-15 mcg/kg
107
What is another use for edrophonium besides NMBD reversal?
to assess for myasthenia gravis or cholinergic crisis
108
What ist he dose of edrophonium to assess for myasthenia gravis or cholingergic crisis?
1 mg Q1-2 minute until sign/symptom change
109
what is the max dose of edrophonium when using it to assess for myasthenia gravis or cholinergic crisis?
10 mg
110
what is the IM dose of edrophonium?
10 mg
111
what is the onset of edrophonium?
30-60 seconds
112
What is the DOA of edrophonium?
20-40 minutes
113
what is the half life of edrophonium?
110 minute
114
How is edrophonium excreted?
renal (75%)
115
How is edrophonium metabolized?
hepatic metabolism (30%)
116
What are a/e of edrophonium?
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
when is edrophonium C/I?
bradycardia
asthma
cardiac arrhythmia
PUD
peritonitis
GI obstruction
Urinary tract obstruction
118
What is the brand name of physostigmine?
antilirium
119
What is the class of physostigmine?
anticholinesterase inhibitor
120
What is the MOA of physostigmine?
Tertiary amine that readily crosses the BBB and inhibits acetylcholinesterase in the CNS untilatey increased Ach in CNS
121
What is the make up of physostigmine?
tertiary amine
122
Can physostigmien cross the BBB?
yes
123
What are the uses of physostigmine?
anticholinergic OD and central anticholinergic syndrome
124
What is the dose of Physostigmine for anticholinergic syndrome?
15-60 mcg/kg Q1-2 H
125
What is the dose of Physostigmine for anticholinergic psychosis?
0.5-2 mg IV O10-30 minutes (10-20 mcg/kg)
126
How fast do you administer Physostigmine?
1 mg per minute
127
What is the onset of PHysostigmine?
3-8 minutes
128
What is the DOA of physostigmine?
30 minutes to 5 hours
129
What is the half life of Physostigmine?
23 minutes
130
How is Physostigmien metabolized?
rapidly by plasma cholinesterase
131
What are a/e of physostigmine?
bradycardia
bronchospasm
dyspnea
respiratory paralysis
seizures
salivation
N/V
miosis
132
Why do you not administer physostigmine rapidly?
It can cause bradycardia and hypersalivation, leading ot respiratoyr problems or possible seizures
133
High doses of Physostigmine can cause:
tremors
ataxia
muscle fasiculations
134
High dose of Physostigmine can ultimately cause ____.
depolarization block
135
What is the antidote for cholinergic crisis?
Atropine 2-4 mg @3-10 minutes
136
When should you be cautious giving PHysostigmine?
epilepsy
parkinsonian syndrome
bradycardia
137
hen should you avoid giving physostigmine?
asthma
DM
GI or urinary tract obstruction
cholinesterase or depolarizing NMBD
138
What is the brand name of pyridostigmine?
Mestinon
139
What is the class of pyridostigmine?
anticholinesterase inhibitor
140
What is the MOA of pyridostigmine
carbamoyl ester that is a quaternary compound that blocks action of acetylcholinesterase, preventing the breakdown of Ach and increasnig Ach at receptor sitesd
141
What is the makeup of pyridostigmine
carbamoyl ester
142
what is the use of pyridostigmine
reversal of NMBD; myasthenia gravis treatment
143
does pyridostigmine cross teh BBB?
no
144
Can pyridostigmine be given for anticholinergic syndrome?
no b/c it does not cross teh BBB
145
Why is pyridostigmine rarely used?
longer onset than neostigmine
146
what is the reversal dose of pyridostigmine
10-30 mg (0.1-0.25 mg/kg)
147
what do you administer w/ pyridostigmine
aropine 15 mcg/kg or robinul 10 mcg/kg
148
pyridostigmine is prefered to be administered with ____ due to its onset
robinul; (slower onset)
149
waht is the onset of pyridostigmine
2-5 minutes
150
what is the DOA of pyridostigmine
1-2 H
151
what is the peak of pyridostigmine
2 hours
152
What is the half life of pyridostigmine
30 minutes to 1.5 hours
153
how is pyridostigmine excreted?
renal (75%)
154
how is pyridostigmine metabolized?
hydrolyzed by cholinesterase
155
what are a/e of pyridostigmine
bradycardi
AV block
nodal rhythm
hypostenion
increased scretion
respiratory depression
N/V/D
abdominal cramping
increased peristalsis
muscle cramps
fasciuclations
weakness
miosis
diaphoresis
156
What happens w/ OD of pyridostigmine
cholinergic crisis - N/V, bradycardia or tachycardia, excessive salivation, sweating, bronchospasm, weakness, paralysis
157
What is the treatment of pyridostigmine OD
D/c drug and adminsiter Atropine 10 mg/kg(??? -does not seem right) Q3-10 minutes until s/s disappear
158
when should you use pyridostigmine cautiously?
bradycardia
asthma
cardiac arrhythmias
PUD
CI or urinary obstruction
159
What is the brand name of droperidol
inapsine
160
what is the class of droperidol
dopamine (D2) antagonist
161
What is the MOA of droperidol
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
what is the use of droperidol
antiemetic
163
what ist he dose of droperidol
0.625 to 1.25 mg IV
164
what is the onset of droperidol
3-10 minutes
165
what is the DOA of droperidol
up to 12 hours
166
what is the peak of droperidol
30 minutes
167
waht is the half life of droperidol
2-4 hours
168
how is droperidol eliminated?
urine and feces
169
can droperidol cross teh BBB?
yes
170
what are a/e of droperidol
hyptension
extrapyramidal s/e
delirium
hyperprolactinemia
171
what warning exists for droperidol?
black box warning
172
What is the black box warning for droperidol
sudden death from QT prolongation
173
what dose does qt prolongation occur with droperidol
>25 mg
174
What is required by the FDA prior to givin droperidol
12 lead EKG
175
When is droperidol C/I
parkinsons
prolonged QTi
176
What does droperidol have to do with pheochromocytoma?
enhances catecholamine release
177
droperidol enhances catecholamine release in ____
pheochromocytoma
178
Administration of droperidol and ____ can cause _____
levodopa; severe skeletal muscle rigidity and pulmonary edema d/t antagonism of dopamine
