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Drug Box 6 Flashcards

1
Q

Phenergan name

A

Promethazine HCL;

Trade Names – Phenergan, Pentazine, Phenazine, Prothazine

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2
Q

Phenergan classification

A

Phenothiazine derivative: antiemetic, antivertigo agent, antihistamine (H1-receptor antagonist) sedative, or adjunct to analgesics

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3
Q

Phenergan contraindication

A

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)

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4
Q

Phenergan dose and route

A

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

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5
Q

Phenergan MOA

A

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

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6
Q

Phenergan Elimination

A

metabolized in liver, excreted in urine

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7
Q

Phenergan onset

A

Onset: IV – 2.5 mins; IM/PO/Rectal – 15 to 30 mins

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8
Q

Phenergan peak

A

Peak: 1.5 – 3 hrs

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9
Q

Phenergan duration

A

Duration: 2 – 5 hrs.

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10
Q

Isoproterenol name

A

Isoproterenol HCL (Isuprel)

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11
Q

Isoproterenol classification

A

Synthetic Sympathomimetic, nonspecific Beta-agonist

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12
Q

Isoproterenol contradications

A

Tachyarrhythmias, Tachycardia or hypertension

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13
Q

Isoproterenol dose and route

A

Dose IV 0.02- 0.06 mg Subcutaneous or Intramuscular 0.2 mg infusion: 2-20 mcg/min
Route: IV Subcutaneous or Intramuscular

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14
Q

Isoproterenol MOA

A

Beta 1 and Beta 2 agonist.

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15
Q

Isoproterenol Elimination

A

metabolized in liver by COMT

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16
Q

Isoproterenol Onset

A

IV immediately

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17
Q

Isoproterenol Duration

A

1-5 mins

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18
Q

isoproternol misc

A

2-3 times more potent than epinephrine and 100x more active than norepinephrine

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19
Q

Physostigmine name

A

Antilirium

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20
Q

Physostigmine classification

A

Acetylcholinesterase Inhibitor

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21
Q

Physostigmine contraindication

A
  1. Asthma
  2. Diabetes
  3. Mechanical obstruction of the intestine urogenital track
  4. Patients recovering from Choline Estes or depolarizing muscle relaxants
    Use with caution in patients with:
  5. Epilepsy
  6. Parkinsonian syndrome or
  7. Bradycardia
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22
Q

Physostigmine dose and route

A

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

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23
Q

Physostigmine MOA

A

Acetylcholinesterase Inhibitor

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24
Q

Physostigmine Elimination

A

metabolized by plasma cholinesterase

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25
Physostigmine Onset
3-8 minutes
26
Physostigmine Duration
0.5- 5hrs
27
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
28
Dantrolene names
Dantrium, Ryanodex
29
Dantrolene classification
Skeletal muscle relaxant
30
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
31
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,
32
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
33
Dantrolene Elimination
Urine and bile
34
Clopidogrel classification
Thienopyridine
35
Clopidogrel contraindication
Active pathological bleeding, such as peptic ulcer or intracranial hemorrhage
36
Clopidogrel dose and route
Dose - 75mg daily (plavix insert pg.1) 5.) Route- PO
37
Clopidogrel MOA
Mechanism of Action (MOA) - P2Y12 inhibitor. This inhibits ADP mediated platelet activation
38
Clopidogrel Elimination
Urine >Feces
39
Clopidogrel Onset
Dose-dependent. Effects can be seen 2 hours after oral dose of Plavix
40
Clopidogrel Peak
Steady state achieved between 3-7 days
41
Clopidogrel Duration
Platelets exposed to clopidogrel’s active metabolite are affected for the remainder of their lifespan (about 7 to 10 days).
42
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.
43
Metoclopramide name
Reglan
44
Metoclopramide classification
Dopamine receptor antagonist; antiemetic; stimulant of upper gastrointestinal motility Benzamide
45
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 (
46
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
47
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
48
Metoclopramide Elimination
renal
49
Metoclopramide Onset
1-3 mins
50
Metoclopramide Peak
40-120 mins
51
Metoclopramide Duration
2-3 hrs
52
Metoclopramide misc
May increase neuromuscular blocking effects of succinylcholine or mivacurium by inhibiting plasma cholinesterase.
53
Glucagon names
Glucagon/ GlucaGen
54
Glucagon classification
synthetic catabolic hormone p. 745 flood; antihypoglycemic
55
Glucagon contraindication
hypersensitivity to drug, use cation w/ pts w/ hx of insulinoma, pheochromocytoma p. 643 Nagelhout handbook 5th edition
56
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
57
Glucagon onset
< 5min
58
Glucagon peak
5- 20 min
59
Glucagon duration
10-30 min
60
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

Pharm 2 (13 decks)

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