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ACP Study Cards > Drug Monographs > Flashcards

Drug Monographs Flashcards

1
Q

Classification of Ketamine?

A

Analgesic

Sedative

General anesthetic

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2
Q

What are the contraindications for Ketamine?

A

Hypersensitivity to ketAMINE

Unable to manage the adverse effects of ketAMINE

Conditions where elevated blood pressure may be harmful

ACP: Age < 6 months

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3
Q

What is the IN dosing for ketamine?

A

0.75 mg/kg (see intranasal ketamine dosing chart)

May repeat 0.5 mg/kg after 20 minutes

Maximum single dose 100 mg

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4
Q

What is the analgesia dosage for Ketamine for analgesia?

A

Intravenous/Intraosseous
0.3 mg/kg slow push
May repeat 0.15 mg/kg after 5 minutes
Maximum cumulative dose 0.6 mg/kg in 45 minutes

Intramuscular
0.5 mg/kg
May repeat 0.3 mg/kg after 45 minutes

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5
Q

What is the dose for ketamine for procedural sedation?

A

Intravenous/Intraosseous
0.1-0.5 mg/kg slow push every 60 seconds to effect
Consider starting at 0.5 mg/kg; use subsequent doses of 0.25 mg/kg or less as needed
Titrate to effect

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6
Q

What are the anasthesia doses for ketamine? (Induction and anesthesia)

A

ACP: Anesthesia Induction
Intravenous/Intraosseous: 2 mg/kg if shock index < 1
Intravenous/Intraosseous: 1 mg/kg if shock index ≥ 1

ACP: Maintenance of Anesthesia
Half of required induction dose every 10-15 minutes as required

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7
Q

What is the dosage of ketamine for treatment of excited delirium?

A

Intramuscular
4-5 mg/kg bolus
Maximum single/cumulative dose 500 mg
CliniCall consultation required if appropriate sedation is not achieved

Maximum volume of administration
Deltoid: 2 mL
Lateral thigh: 4-5 mL
Gluteal: 5 mL

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8
Q

What is the mechanism of action for ketamine?

A

Ketamine is a non-competitive NMDA receptor antagonist that blocks glutamate. Low doses produce analgesia and modulate central sensitization, hyperalgesia, and opioid tolerance. Reduces polysynaptic spinal reflexes.

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9
Q

What are the pharmacokinetics of ketamine?

A

Onset:

Intravenous: 30 seconds (anesthesia) Intramuscular: 3-4 minutes (anesthesia)
Intranasal: 5-10 minutes (analgesia)

Peak:
Intranasal: 20 minutes

Duration:

Intravenous: 5-10 minutes (anesthesia); recovery 1-2 hours
Intramuscular: 12-25 minutes; recovery 3-4 hours
Intranasal: 45 minutes (analgesia)

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10
Q

What are the adverse effects of ketamine?

A

Emergence phenomenon: confusion, delirium, excitement, hallucinations
Tachycardia and hypertension (> 10%)
Laryngospasm (< 1%)
Bradycardia and hypotension (1-10%)
Anaphylaxis (< 1%)
Hypersalivation (< 1%)
Extreme muscle rigidity or tone (< 1%)
Nystagmus, increased intraocular pressure
Apnea and respiratory depression (rare; transient reaction with rapid IV bolus dose)
Erythema, morbiliform rash, rash at injection site
Laryngospasm is a known and rare complication of ketAMINE administration; when it occurs, is usually transient

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11
Q

What are the warnings and precautions for ketamine?

A

Use with caution in:

Severe hypertension (systolic BP > 180 mmHg)
Subarachnoid hemorrhage or epidural hematoma with severe hypertension
Myocardial ischemia or cardiac arrhythmias

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12
Q

What is the classification for Midazolam?

A

Short-acting benzodiazepine

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13
Q

What are the indications for Midazolam?

A

ACP: Sedation of agitated patients

ACP: Control of seizures

ACP: Maintenance of anesthesia in intubated patients

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14
Q

What are the contraindications for Midazolam?

A 
Hypersensitivity to MIDAZOLam or other benzodiazepines
Acute narrow-angle glaucoma
Shock
Decreased level of consciousness
Hypotension
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15
Q

What are the adult doses for Midazolam?

A

All indications

2-5 mg IV/IO in increments to effect
5-10 mg IM
May repeat as required in small increments
Maximum dose from all sources is 30 mg

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16
Q

What is the mechanism of action for Midazolam?

A

Like other benzodiazepines, MIDAZOLam intensifies the activity of gamma aminobutyric acid, the major inhibitory neurotransmitter in the central nervous system. This action is believed to result in hyperpolarization of neuronal cells, which then take longer to reach threshold and depolarize.

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17
Q

What are the pharmacokinetics of Midazolam?

A

Onset: 3-5 minutes (IM); 1-3 minutes (IV)
Peak: 15 minutes (IM); 10 minutes (IV)
Duration: 30 minutes (IM); 20 minutes (IV)

18
Q

What are the potential adverse effects of Midazolam?

A 
Sedation, headache, blurred vision
Hypotension
Nausea and vomiting
Pain and tenderness if given IM
Respiratory depression
19
Q

How to manage a midazolam OD?

A

Benzodiazepine overdoses should be managed supportively, with oxygenation and ventilation supported as necessary, and fluids given to maintain an adequate blood pressure. Reversal agents are available in-hospital.

20
Q

What are the warnings for Midazolam?

A

Use with caution when administering other central nervous system depressants or narcotic analgesics.

21
Q

What are the notable drug interactions of midazolam?

A

Erythromycin, diltiazem, verapamil, ketoconazole, fluconazole, and itraconazole can significantly increase the bioavailability of MIDAZOLam and may produce prolonged sedation.

Ritonavir and nelfinavir may cause deep and prolonged sedation that may progress to respiratory depression.

Rifampin, carbamazepine, and phenytoin may markedly reduce the effectiveness of MIDAZOLam.

22
Q

What is the classification of epinephrine?

A

Catecholamine

Sympathomimetic

23
Q

What are the indications for epinephrine?

A

PCP: Anaphylaxis

PCP: Severe bronchospasm

PCP: Severe croup

ACP: Cardiac arrest

ACP: Peri-arrest hypotension

ACP: Significant bradycardia

24
Q

What are the contraindications for epinephrine?

A

There are no absolute contraindications to EPINEPHrine use in life-threatening situations such as anaphylaxis. IT WAS A TRICK QUESTION.

25
Q

What are the adult doses for Epi? (All indications)

A

Anaphylaxis: 0.5 mg IM every 5 minutes; may repeat up to 3 times
Severe bronchospasm with impending respiratory arrest: 0.5 mg IM every 5-20 minutes

Pre-arrest anaphylaxis or bronchospasm: 50-100 mcg IV/IO; may repeat as necessary

Cardiac arrest: 1 mg IV/IO every 3-5 minutes; suggested maximum dose 3-4 mg

Peri-arrest hypotension: 10 mcg IV/IO slow push every 2-3 minutes as required

Significant bradycardia: 2-10 mcg/minute IV/IO infusion

26
Q

What is the mechanism of action for epinephrine?

A

EPINEPHrine acts on alpha and beta-adrenergic receptors. Alpha-adrenergic activity produces vasoconstriction and reduces vascular permeability; beta-adrenergic activity results in bronchial smooth muscle relaxation, increased heart rate, and increased force of cardiac contractility. EPINEPHrine also inhibits histamine release.

27
Q

What is the mechanism of action for epi?

A

EPINEPHrine acts on alpha and beta-adrenergic receptors. Alpha-adrenergic activity produces vasoconstriction and reduces vascular permeability; beta-adrenergic activity results in bronchial smooth muscle relaxation, increased heart rate, and increased force of cardiac contractility. EPINEPHrine also inhibits histamine release.

28
Q

What are the pharmacokinetics of epi

A

Onset: 30-90 seconds (IM); 30 seconds (IV)

Peak: 4-10 minutes (IM); 3-5 minutes (IV)

Duration: 5-10 minutes (IM/IV)

29
Q

What are the adverse effects of epi?

A

Common reactions to systemically administered EPINEPHrine include anxiety, tremor, dizziness, sweating, palpitations, headache, and nausea

Rapid increases in blood pressure and heart rate can occur

Accidental injection of epinephrine into a digit, hands, or feet may result in a loss of blood flow to the area

30
Q

What are the effects of an epinephrine OD?

A

EPINEPHrine overdose may produce significantly elevated blood pressures and heart rate, which may in turn cause cerebral hemorrhage.

31
Q

What are the warnings for epi administration?

A

Patients with underlying coronary artery disease may develop signs and symptoms of angina or myocardial ischemia. Caution should be exercised in these cases.

Caution should be used in patients with significant tachydysrhythmias or in the context of hypothermia.

32
Q

What are the potential drug interactions of epi?

A

Arrhythmias can develop in patients taking antiarrhythmic medications. Beta-adrenergic blocking drugs can limit the effectiveness of EPINEPHrine’s bronchodilating and inotropic effects.

33
Q

What is the classification of ipratropium?

A

Anticholinergic bronchodilator

34
Q

What are the indications for ipratropium administration?

A

ACP: Severe bronchospasm in asthma and chronic obstructive pulmonary disease

35
Q

What are the contraindications to ipratropium administration?

A

Known hypersensitivity to ipratropium or any formulation components

36
Q

Adult dosages for ipratropium?

A

ACP: Severe bronchospasm in asthma or chronic obstructive pulmonary disease

160 mcg via metered-dose inhaler (8 x 20 mcg sprays)
Spacer use recommended, but not required

37
Q

What is the mechanism of action for ipratropium?

A

Ipratropium antagonizes the activity of acetylcholine in bronchial smooth muscle, producing bronchodilation and muscle relaxation.

38
Q

What are the pharmacokinetics of ipratropium?

A

Onset: 3-5 minutes
Peak: 1.5-2 hours
Duration: 6 hours

39
Q

What are the adverse effects of ipratropium?

A

Adverse effects are similar to other anticholinergics and can include atrial arrhythmias and blurred vision

Coughing is common

Paradoxical bronchospasm can occur during the use of inhaled bronchodilators; this is not the same thing as an inadequate response to treatment

40
Q

What are the risks of an overdose of ipratropium?

A

Very high doses of ipratropium (up to 1.2 mg) have been given to volunteers without the development of serious systemic side effects.

41
Q

What are the warnings and precautions for ipratropium?

A

Ipratropium is intended to act synergistically with salbutamol as part of a management plan for bronchospasm. It is not indicated for episodes of acute bronchospasm as monotherapy.

Avoid spraying ipratropium into the eyes of patients with narrow-angle glaucoma.

ACP Study Cards (6 decks)

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