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Pharm 2 > Drug Box 6 > Flashcards

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
Q

Physostigmine Onset

A

3-8 minutes

26
Q

Physostigmine Duration

A

0.5- 5hrs

27
Q

Physostigmine misc

A

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
Q

Dantrolene names

A

Dantrium, Ryanodex

29
Q

Dantrolene classification

A

Skeletal muscle relaxant

30
Q

Dantrolene contraindication

A

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
Q

Dantrolene dose and route

A

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
Q

Dantrolene MOA

A

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
Q

Dantrolene Elimination

A

Urine and bile

34
Q

Clopidogrel classification

A

Thienopyridine

35
Q

Clopidogrel contraindication

A

Active pathological bleeding, such as peptic ulcer or intracranial hemorrhage

36
Q

Clopidogrel dose and route

A

Dose - 75mg daily (plavix insert pg.1)

5.) Route- PO

37
Q

Clopidogrel MOA

A

Mechanism of Action (MOA) - P2Y12 inhibitor. This inhibits ADP mediated platelet activation

38
Q

Clopidogrel Elimination

A

Urine >Feces

39
Q

Clopidogrel Onset

A

Dose-dependent. Effects can be seen 2 hours after oral dose of Plavix

40
Q

Clopidogrel Peak

A

Steady state achieved between 3-7 days

41
Q

Clopidogrel Duration

A

Platelets exposed to clopidogrel’s active metabolite are affected for the remainder of their lifespan (about 7 to 10 days).

42
Q

Clopidogrel misc

A

General anesthesia recommendations: Stop this medication 5-7 days prior to surgery. Plavix can be reversed with Platelet infusion or factor VII infusion.

43
Q

Metoclopramide name

A

Reglan

44
Q

Metoclopramide classification

A

Dopamine receptor antagonist; antiemetic; stimulant of upper gastrointestinal motility Benzamide

45
Q

Metoclopramide contraindication

A

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
Q

Metoclopramide dose and route

A

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
Q

Metoclopramide MOA

A

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
Q

Metoclopramide Elimination

A

renal

49
Q

Metoclopramide Onset

A

1-3 mins

50
Q

Metoclopramide Peak

A

40-120 mins

51
Q

Metoclopramide Duration

A

2-3 hrs

52
Q

Metoclopramide misc

A

May increase neuromuscular blocking effects of succinylcholine or mivacurium by inhibiting plasma cholinesterase.

53
Q

Glucagon names

A

Glucagon/ GlucaGen

54
Q

Glucagon classification

A

synthetic catabolic hormone p. 745 flood; antihypoglycemic

55
Q

Glucagon contraindication

A

hypersensitivity to drug, use cation w/ pts w/ hx of insulinoma, pheochromocytoma p. 643 Nagelhout handbook 5th edition

56
Q

Glucagon dose and route

A

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
Q

Glucagon onset

A

< 5min

58
Q

Glucagon peak

A

5- 20 min

59
Q

Glucagon duration

A

10-30 min

60
Q

Glucagon misc

A

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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