Drug Box 6 Flashcards
Phenergan name
Promethazine HCL;
Trade Names – Phenergan, Pentazine, Phenazine, Prothazine
Phenergan classification
Phenothiazine derivative: antiemetic, antivertigo agent, antihistamine (H1-receptor antagonist) sedative, or adjunct to analgesics
Phenergan contraindication
patients with Parkinson’s disease, those receiving MAOIs (i.e. Nardil, Marplan, Parnate), children < 2 years old. Use with caution because of CNS and circulatory depressant actions of
alcohol, sedative-hypnotics, and anesthetics are potentiated/anesthetic recovery prolonged. Also use caution when giving IV because of hazard of phlebitis, necrosis, and gangrene of extremities (must dilute medication and give slowly)
Phenergan dose and route
Dose: Dosage Forms - IV: 25 and 50 mg/mL; Tablet:12.5, 25, and 50 mg; Syrup: 6.25 and 25 mg/5mL; Suppositories:12.5, 25, and 50 mg
Route: IV, IM, PO, Rectal
Phenergan MOA
H1 receptor antagonists (first generation). Note: H1-receptor antagonists are characterized as first-generation and second-generation receptor antagonists. First-generation drugs tend to produce sedation (which can lead to CNS toxicity), whereas second-generation is relatively non-sedating. First-generation H1 receptor antagonists may also activate muscarinic, cholinergic, 5-HT, or α-adrenergic receptors, whereas few of the second generation have any of these properties
Phenergan Elimination
metabolized in liver, excreted in urine
Phenergan onset
Onset: IV – 2.5 mins; IM/PO/Rectal – 15 to 30 mins
Phenergan peak
Peak: 1.5 – 3 hrs
Phenergan duration
Duration: 2 – 5 hrs.
Isoproterenol name
Isoproterenol HCL (Isuprel)
Isoproterenol classification
Synthetic Sympathomimetic, nonspecific Beta-agonist
Isoproterenol contradications
Tachyarrhythmias, Tachycardia or hypertension
Isoproterenol dose and route
Dose IV 0.02- 0.06 mg Subcutaneous or Intramuscular 0.2 mg infusion: 2-20 mcg/min
Route: IV Subcutaneous or Intramuscular
Isoproterenol MOA
Beta 1 and Beta 2 agonist.
Isoproterenol Elimination
metabolized in liver by COMT
Isoproterenol Onset
IV immediately
Isoproterenol Duration
1-5 mins
isoproternol misc
2-3 times more potent than epinephrine and 100x more active than norepinephrine
Physostigmine name
Antilirium
Physostigmine classification
Acetylcholinesterase Inhibitor
Physostigmine contraindication
- Asthma
- Diabetes
- Mechanical obstruction of the intestine urogenital track
- Patients recovering from Choline Estes or depolarizing muscle relaxants
Use with caution in patients with: - Epilepsy
- Parkinsonian syndrome or
- Bradycardia
Physostigmine dose and route
Dose: 15-60 µg/kg IV for central anticholinergic syndrome may repeat in 1-2 hrs (Flood p196)
2mg IV for scopolamine sedation (Flood hard copy p196)
0.5- 2mg IV for anticholinergic psychosis (Flood hard copy p828)
5.) Route IM/IV
Physostigmine MOA
Acetylcholinesterase Inhibitor
Physostigmine Elimination
metabolized by plasma cholinesterase
Physostigmine Onset
3-8 minutes
Physostigmine Duration
0.5- 5hrs
Physostigmine misc
Rapid IV administration may cause bradycardia and hypersalivation leading to respiratory problems or possibly seizures
Treat cholinergic crisis with mechanical ventilation, repeated bronchial aspiration and atropine 2-4 mg IV q 10 minutes until muscarinic symptoms disappear or signs of atropine overdose appear
Dantrolene names
Dantrium, Ryanodex
Dantrolene classification
Skeletal muscle relaxant
Dantrolene contraindication
Be cautious if pt. Has hepatic compromise. Pre-existing muscle disease. Calcium channel blockers should not be given with Dantrolene (may cause myocardial depression and hyperkalemia
Dantrolene dose and route
4.) Dose - 1 - 2.5 mg/kg IV repeated every 5 minutes up to 10 mg/kg (malignant hyperthermia) Nagelhout 831,832
Continued for a minimum of 24 hours 1mg/kg bolus every 4 to 6 hours or continuous infusion to prevent relapse.
5.) Route - IV or PO Nagelhout 831,832,
Dantrolene MOA
Exerts antispasmodic effects by inducing relaxation directly on muscle by decreasing calcium release through the binding of the ryanodine receptor from the sarcoplasmic reticulum
Dantrolene Elimination
Urine and bile
Clopidogrel classification
Thienopyridine
Clopidogrel contraindication
Active pathological bleeding, such as peptic ulcer or intracranial hemorrhage
Clopidogrel dose and route
Dose - 75mg daily (plavix insert pg.1)
5.) Route- PO
Clopidogrel MOA
Mechanism of Action (MOA) - P2Y12 inhibitor. This inhibits ADP mediated platelet activation
Clopidogrel Elimination
Urine >Feces
Clopidogrel Onset
Dose-dependent. Effects can be seen 2 hours after oral dose of Plavix
Clopidogrel Peak
Steady state achieved between 3-7 days
Clopidogrel Duration
Platelets exposed to clopidogrel’s active metabolite are affected for the remainder of their lifespan (about 7 to 10 days).
Clopidogrel misc
General anesthesia recommendations: Stop this medication 5-7 days prior to surgery. Plavix can be reversed with Platelet infusion or factor VII infusion.
Metoclopramide name
Reglan
Metoclopramide classification
Dopamine receptor antagonist; antiemetic; stimulant of upper gastrointestinal motility Benzamide
Metoclopramide contraindication
May increases pressure on suture lines following gut anastomosis or closure. Should not be used in patients with pheochromocytoma Should be used with caution if at all in patients with Parkinson’s disease, restless leg, or who have movement disorders related to dopamine inhibition or depletion (
Metoclopramide dose and route
Dose - Adults: 10mg IV slowly over 1-2 minutes, may repeat dose. Children 6-14 years: 2.5 to 5 mg IV, younger than 6: 0.1mg/kg (Nagelhout handbook p. 665)
Route- IV/Oral
Metoclopramide MOA
Stimulate the gastrointestinal tract via cholinergic mechanism, which results in contraction of the lower esophageal sphincter and gastric fundus, increased gastric and small intestinal motility and decreased muscle activity in the pylorus and duodenum
Metoclopramide Elimination
renal
Metoclopramide Onset
1-3 mins
Metoclopramide Peak
40-120 mins
Metoclopramide Duration
2-3 hrs
Metoclopramide misc
May increase neuromuscular blocking effects of succinylcholine or mivacurium by inhibiting plasma cholinesterase.
Glucagon names
Glucagon/ GlucaGen
Glucagon classification
synthetic catabolic hormone p. 745 flood; antihypoglycemic
Glucagon contraindication
hypersensitivity to drug, use cation w/ pts w/ hx of insulinoma, pheochromocytoma p. 643 Nagelhout handbook 5th edition
Glucagon dose and route
0.5-1 mg for hypoglycemia pg. 642 Nagelhout handbook 5th edition
1-10 mg IV bolus followed by 5 mg/hour - to reverse myocardial depression from B-blockers: p485 Flood;
1-5 mg bolus over 2-5 min – vasoactive drug dose pg. 191 Nagelhout Nurse Anesthesia 6th edition pg. 170
2 mg IV - reverse opioid-induced biliary smooth muscle spasm pg. 223 – Flood
Route IV, IM, SubQ
Glucagon onset
< 5min
Glucagon peak
5- 20 min
Glucagon duration
10-30 min
Glucagon misc
effective in life-threatening bradycardia & drug of choice to treat massive beta-adrenergic antagonist overdose. Pg 485 Flood
Enhanced myocardial contractility & more secretion of bile results when exogenous glucagon increases plasma concentration far above normal levels. Pg 745-746 Flood
Surgeon may request Glucagon for its spasmolytic effect in the GI system and ability to relax the sphincter of Oddi. >2 mg may cause nausea
