Drug box 5 Flashcards
Methergine Name
Methylergonovine Maleate
Methergine Classification
Ergot Derivative
Methergine Contraindication
IV administration is NOT recommended because of sudden hypertensive and cerebrovascular accidents., CAD; Breastfeeding.
Methergine Dose and Route
Dose: 0.2mg
Route: IV & IM
Methergine Mechanism of Action (MOA)
Acts directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of rhythmic contractions.
Methergine Elimination
Hepatic metabolism and excretion
Methergine Onset
IV;Immediate, IM: 2-5 minutes, PO: 5-10 minutes
Methergine Duration
20-30 mins
Famotidine name
Pepid
Famotidine Classification
H2 (Histamine) receptor antagonist
Famotidine contraindication
Pregnancy: drug will be present in breast milk and can cross the placenta and blood brain barrier. (use cimetidine for pregnancy). Renal failure increases the elimination half life therefore decreased dose is recommended. Decrease dose in patients with acute burns. Decrease dose in elderly related to increased elimination half-life up to twofold in elderly patients. Famotidine interferes with phosphate absorption and can lead to hypophosphatemia in chronic uses.
Famotidine dose
20mg iv or 20-40mg po
Route: Rapid oral absorption: 50% hepatic first pass effect: Can be given IV
Famotidine MOA
Famotidine competitively and selectively antagonizes/blocks histamine from binding to the H2 recepto
Famotidine Elimination
elimination half life 2.5-4 hours: combination of hepatic metabolism (principal mechanism for oral route) and renal. Renal clearance is typically 2-3x > creatinine clearance (extensive renal tubular secretion). Only 10-20% of the drug would be cleared by hemodialysis. Hepatic dysfunction does not have a significant effect on elimination.
Famotidine Onset
rapid iv
Famotidine Peak
1-3.5 hr
Famotidine Duration
10 hrs
Valium name
Valium, diazepam
Valium classification
Benzodiazepine/Anticonvulsant/Anxiolytic
Valium contraindication
Glaucoma; During or within 14 days of MAOI therapy
Valium dose and route
4.) Dose
0.5-1mg/kg IV for induction of anesthesia
0.1mg/kg IV to abolish seizures
Flood pg 179-180 ebook
5.) Route
PO, IV, IM
Valium MOA
GABA receptor agonist
Valium Elimination
Liver
Valium Onset
po 30- 60min
IM 15-30 min
IV 1-5 min
Valium Peak
1-2 hrs
Valium Duration
iv 15min-1hr
po up to 3 hrs
Valium misc
Miscellaneous
Reversal Flumazenil
Reduces requirements of volatile anesthetics.
Dilaudid name
Hydromorphone
Dilaudid classification
Semisynthetic Opioid
Dilaudid contraindication
Hypersensitivity to morphine, acute/severe asthma, Increase ICP, pregnancy, severe respiratory depression, paralytic ileus, pruritus
Dilaudid Dose and Route
Dose:
Adult Analgesia: 0.5-1 mg (Miller’s Anesthesia Vol 2 pg. 2992)
Epidural Cont. Infusion: 0.1-0.2 mg/hr (Miller’s Anesthesia Vol 2 pg. 2992)
** 7-8 times more potent than morphine
Route: IV, PO
Dilaudid MOA
Mu1 and Mu2 agonist
Dilaudid Elimination
Elimination is via hepatic conjugation. Unlike morphine, it lacks the active metabolite M6G, therefore, administration is safe in renal patients
Dilaudid Onset
15-30 min
Dilaudid peak:
30-90min
Dilaudid Duration
4-5 hr
Pancuronium name
Pavulon
Pancuronium classification
Nondepolarizing skeletal muscle relaxant
Pancuronium contraindiation
MG, Bromide Hypersensitivity & pts unable to handle tachycardia.
Pancuronium dose and route
Dose-0.04-0.1mg/kg
Route: IV
Pancuronium MOA
Steroidal, potent long-acting neuromuscular blocking drug with both vagolytic and butyrylcholinesterase-inhibiting properties
Pancuronium Elimination
40% to 60% is cleared by the kidney; 11% is excreted in the bile; 15% to 20% is metabolized, mainly by deacetylation in the liver.
Pancuronium Onset
1-3 min
Pancuronium Peak
2.9 Minutes
Pancuronium Duration
40-65 min
Pancuronium Misc
Miscellaneous-reverse with anticholinesterase
Bottle- 1mg/ml in 10ml vial
Glucophage name
Metformin ( Generic)
Glucophage classification
Biguanide
Glucophage contraindication
Should not be prescribed in patients with lactic acidosis, acute kidney injury, GI intolerance, and acute hepatic disease.
Glucophage route
po
Glucophage MOA
Decreases hepatic glucose production and increases peripheral
insulin sensitivity.
Glucophage Elimination
Renal
Glucophage Onset
1-3 hrs
Glucophage peak
2 hrs
Glucophage duration
17 hrs
Glucophage misc
The most serious side effect is lactic acidosis. For this reason, some have recommended discontinuing metformin 48 hours or longer before elective operations
Hemabate name
carboprost tromethamine
Hemabate classification
Oxytocic Synthetic prostaglandin
Hemabate contraindication
Hypersensitivity, Acute pelvic inflammatory disease, active cardiac, pulmonary, renal, or hepatic disease.
Hemabate dose/ route
Dose- Initial dose of 250mcg IM. Can give successive doses 15-90 minutes apart for a total of up to 2mg or 8 total doses.
Route: IM
Hemabate MOA
binds to prostaglandin E2 receptor and stimulated uterine contraction
Hemabate Elimination
Metabolized by lungs and liver. excreted via kidneys
Hemabate Misc
Stimulation of smooth muscle can cause diarrhea, vomiting, hypertension. Can be used for abortions in fetuses aged 13-20 weeks
Bicitra name
Sodium Citrate and Citric Acid
Bicitra classification
Nonparticulate neutralizing buffer
Bicitra contraindication
- Severe renal impairment (oliguria, azotemia, anuria)
- Addison’s Disease
- Severe heart disease
- Heat cramps
- Acute dehydration
- Adynamic episodica hereditaria
Bicitra dose and route
Dose:
Adults: 15 ml diluted in 15 ml of water administered within 60 minutes of surgery
Children: 5 – 15 ml diluted in 5 – 15 ml of water
Route: PO
Bicitra MOA
converted to bicarbonate in the body to increase blood pH (raises blood pH by 2.5 in most patients)
Bicitra Elmination
kidneys
Bicitra Onset
2-10min
Bicitra duration
60-90min (30mins per dr hammon)
Bicitra misc
- Useful for patients at high risk of aspiration; given to increase blood pH in treatment of metabolic acidosis and buffering pH of gastric secretions to prevent aspiration pneumonitis associated with intubation and anesthesia
- S/E: metabolic alkalosis and saline laxative effect