Drugs: doses, MOA, etc Flashcards by Rebecca Dickinson

fentanyl dosing

1-2mcg/kg low dose; awake patients

2-20mcg/kg

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fentanyl MOA

binds to opioid receptors of the presynaptic and postsynaptic sites in the CNS and peripherally

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major advantages of fentanyl

no direct myocardial depression
no histamine release
suppresses stress response to surgery

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fentanyl side effects

respiratory depression
increased ICP
reflex coughing
decreases HR

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Propofol dosing

2-2.5mg/kg

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propofol MOA

GABA receptor agonist (enhances inhibition), hyperpolarizes cell membranes

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propofol common side effects

decreases HR, BP, RR, CMRO2, CBF, and ICP
injection site pain
inhibits platelet aggregation

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advantages of propofol

fast on/off with minimal residual effects
antiemetic
antipruritic
anticonvulsant

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Ketamine dosing

1-2mg/kg

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ketamine MOA

NMDA receptor antagonist; inhibits glutamate; inhibits catecholamine uptake in postganglionic nerves

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ketamine side effects

“increases everything”: ICP, BP, HR, O2 demands

-emergence delirium

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advantages of using ketamine

bronchodilating properties

- maintains spontaneous ventilation

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what 2 drugs are often administered with ketamine

glycopyrrolate and benzo for secretions and emergence delirium

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Etomidate dose

0.3mg/kg

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Etomidate MOA

mimics inhibitory effects of GABA by increasing the receptors affinity to GABA; depresses the reticular activating system; opens Cl channels

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avoid etomidate with what patients

seizure

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major disadvantages of etomidate

emetic

- adrenocortical suppression

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advantage of etomidate

good hemodynamic profile

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Dexmedetomidine dosing

loading dose: 0.5-1mcg/kg over 10min

infusion: 0.2-1.4mcg/kg/hr

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Dexmedetomidine MOA

alpha 2 agonist: hyperpolarizes cell w/ efflux of K, reduced NE release, decreased cAMP by inhibiting adenylyl cyclase

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Side effects of precedex bolus

bradycardia and HTN

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Midazolam dosing

1-2mg IV

0.3-0.5mg/kg PO

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midazolam MOA

causes increased binding of GABA to its receptor-> opening of Cl channel-> hyperpolarization

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cardioprotectant feature of versed

prolongs adenosine

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unique feature of versed

imidazole ring makes its lipid-soluble at pH >4

Lidocaine dosing

1-1.5mg/kg max w/o epi: 4.5mg/kg max w/ epi: 7mg/kg

rocuronium dosing

ED95: 0.3mg/kg | Intubating dose: 0.6mg/kg

non-depolarizing MOA

competes with Ach at nicotinic receptor alpha subunits, prevents the opening of Na ion channel, which prevents depolarization

depolarizing MOA

binds to alpha subunits on nicotinic receptor causing depolarization

roc metabolism

hepatic > renal

succinylcholine dosing

1-1.5mg/kg

succinylcholine metabolism

plasma cholinesterases

Cisatracurium dosing

ED95: 0.05mg/kg | Intubating dose: 0.2mg/kg

cisatracurium metabolism

Hoffman elimination

cisatracurium benefits over atracurium

less histamine release and less laudanosine formation

vec dosing

ED95: 0.05mg/kg | intubating dose: 0.1mg/kg

Neostigmine MOA

acetylcholinesterase inhibitor

Neostigmine dose

0.04-0.07mg/kg

What anticholinergic is used with Neostigmine

gylcopyrrolate

what drug is neostigmine often used for reversal

vec ( and roc i think)

Edrophonium MOA

acetylcholinesterase inhibitor

edrophonium dose

0.5-1mg/kg

anticholinergic given with edrophonium

atropine

edrophonium used to reverse what relaxant

atracurium

Sugammadex MOA

encapsulates steroidal NMB

Sugammadex dose

2-4mg/kg

dose of sugammadex to use if you have 0/4 twitches to immediately reverse in an emergency

16mg/kg

sugammadex is incompatible with what drugs

- verapamil - ondansetron - ranitidine

sugammadex metabolism

excreted unchanged by the kidneys

gylcopyrrolate MOA

anticholinergic; competes with Ach for muscarinic receptors

glycopyrrolate dose

0.015mg/kg

Atropine MOA

anticholinergic; competes with Ach for muscarinic receptors

atropine dose

0.03mg/kg

Phenylephrine drug class/ MOA

synthetic noncatecholamine | mostly alpha 1 by direct effect

phenylephrine effect on HR

decreases it

Epinephrine MOA

endogenous catecholamine. alpha and beta effects (dose-dependent) most potent alpha stimulant

Epi dosing

low: 1-2mcg/min (beta 2) moderate: 4mcg/min (beta 1) large: 10-20mcg/min (beta and alpha 1)

concentration of code dose epi

1:10,000 = 0.1mg/mL | 1 vial= 1mg

phenylephrine dosing

40-200mcg IV bolus

hydralazine MOA

vasodilator: interferes with Ca2+ ion transport. Hyperpolarizes smooth muscle; activates guanylate cyclase

hydralazine vasodilates arterial, venous, or both? How does this effect the HR?

arterial, increases it

hydralazine dose

10-20mg

hydralazine onset

10-20min ** dont immediately redose if you arent seeing effects

esmolol MOA

selective beta 1 antagonist, slows sinus rate, rate of conduction, and inotropy

esmolol dosing

0.5mg/kg IV over 60 seconds

esmolol metabolism

plasma esterase

beta-blocker overdose treatment

atropine 7mcg/kg | glucagon 1-10mg

metoprolol MOA

selective beta 1 antagonist

metoprolol dosing

HR > 80: 5mg HR 60-80: 2-5mg HR <60 or SBP < 100: hold

benefit of metoprolol

less likely to cause AE in pts with obstructive airway disease, PVD, diabetes

which is longer acting esmolol or metoprolol

metoprolol

Phenergan MOA

H1 blocker; anticholinergic effect- inhibition of dopamine and muscarinic receptors

Phenergan dosing

6.25mg- 12.5 mg IV

Phenergan side effects

sedation, lowers seizure threshold, hypotension

dont give phenergan to ___

seizure patients

metoclopramide (reglan) MOA

dopamine blockade in CTZ, cholinergic stimulus in GI

metoclopramide (reglan) dosing

10-20mg IV

metoclopramide primary effect

increases gut motility

metoclopramide contraindications

parkinsons and intestinal obstruction

Zofran MOA

5HT3 receptor antagonist, blocks peripheral receptors on intestinal vagal afferents and central receptors in the CTZ

Zofran dose

4-8mg

Dexamethasone MOA

inhibits prostaglandin synthesis centrally and controls endorphin release

Decadron dosing

4-12mg

Vancomycin antibiotic class

glycopeptide

vancomycin MOA

inhibits cell wall synthesis

vanc covers

gram +

cefazolin class

beta lactam- cephalosporin

cefazolin dose

2-3 grams

cefazolin covers

gram +; strep/staph

Metronidazole (Flagyl) interacts with

warfarin

Flagyl covers

gram -

Heparin MOA

potentiates action of antithrombin III

Heparin dose

300units/kg (for CV)

Albuterol MOA

beta 2 agonist that relaxes bronchial smooth muscle

Ephedrine MOA

direct effect on alpha and beta. Indirect effect causes release of NE

Ephedrine dose

5-10mg repeat up to 50mg

Ephedrine effect on HR

increases it