Emergency Meds Flashcards
Phenylephrine: Review
• Synthetic non-catecholamine
• Primarily alpha _-adrenergic receptor stimulant
• Mostly direct acting
• ______ constriction >______ constriction
• ____ potent than norepinephrine
• _____ lasting
• Treat hypotension in OR due to various reasons
• ________ MAP, SBP, DBP, SVR
• ________ HR, CO
1 Venus constriction>arterial constriction Less Longer increase decrease
Phenylephrine: Dosing
IV= ________, can be used as continuous infusion (________)
Standard concentration in vial =
Standard concentration for administration =
Needs double dilution/or inject _ml of 10mg/ml in 100mL bag of saline
Double dilution: mix _ml saline + _ml of 10mg/ml phenylephrine then discard _ml and replace with _ml saline
50-200mcg, 20-50 mcg/min 10mg/ml 100mcg/ml 1 9, 1, 9, 9
Ephedrine: Review
• Synthetic non-catecholamine
• Indirect acting-stimulates _____ and _____ adrenergic receptors (with some _____ action at receptors as well)
• Treat ____________ in OR due to various reasons
• CV effects similar to , longer lasting (~__X)
• ___ effected minimally
• CV effects mostly due to increased __________ =
-increased or decreased MAP, SBP, DBP, HR, Coronary BF?
- increased or decreased renal, splanchnic BF?
beta, alpha, direct hypotension epinephrine, 10 SVR contractility increased decreased
Ephedrine: Dosing
• Dosage: _______ IV
• ______________ is common with this agent-due to indirect effect and occupying of receptors
• Dilute once
- _ml of 50mg/ml + _ml saline = 10mg/ml
OR
- _ ml of 50mg/ml in _ml saline = 5 mg/ml
5-25mg
Tachyphylaxis (rapidly diminishing response to successive doses of a drug, rendering it less effective. The effect is common with drugs acting on the nervous system)
1, 4
1, 9
***Dr B likes bc 5ml syringe, unlike 10ml with Phenylephrine
Atropine: Review
• Anticholinergic-antagonizes effect of Ach at cholinergic post ganglionic ___________ receptors.
• __________ receptors are present in: heart, salivary glands, smooth muscles of GU and GI tract.
• No/minimal effect at ___________ receptors.
• Tertiary amine-__________ occurring, is an alkaloid of belladonna plant.
• Resembles cocaine in structure, and has mild ________ activity.
• Combines reversibly with muscarinic receptors and prevents ___ from binding to these sites, __________ inhibitors.
muscarinic Muscarinic nicotinic naturally analgesic Ach, competitive
Atropine: Dosing
• Drug of choice for treating intra-op _____cardia
• Available in 2 “standard concentrations”
• Dose:
- IV =
- or _-_mg (max dose _ mg)
• Other effects:
brady
15-75mcg/kg
0.4-1mg (max dose 3 mg)
antisialagogue, bronchodilation, mydriasis, decreased GI motility and acid production, bronchodilation, sedation
Glycopyrrolate (Robinul)
• Similar to atropine.
• Quaternary ammonium-does or doesn’t easily cross BBB so ? sedative effects.
• Uses similar to atropine, similar effects, _____ potent antisialagogue, less potent at ________ HR.
• Dosage: ________ IV
• Combine with anticholinestrase drugs (i.e. ____________) for reversal, dose = ____________*** (or _cc of robinul for each cc of reversal drawn)
does not easily cross BBB so no sedative effects.
more potent antisialagogue, less potent at elevating HR.
Dosage: 0.2-0.4mg IV
Combine with anticholinestrase drugs (i.e. neostigmine) for reversal, 0.05-0.07mg/kg (or 1cc of robinul for each cc of reversal drawn)
Lidocaine: Review
• Amide _____ anesthetic
• Prevents transmission of nerve impulses by inhibiting passage of sodium ions through _______ gated sodium channels in nerve membranes.
• Slows the rate of _______________ such that the threshold potential is not reached and an action potential is not propagated.
• In the ________ conduction system and __________ muscle it reduces intracellular sodium activity and intracellular calcium activity (by the sodium-calcium exchange mechanism).
• Reduction of the “arrhythmogenic transient depolarization” and a reduction of __________ by decreasing the inward sodium current.
• Overdose causes _________________.
local voltage depolarization cardiac, myocardial contractility CNS toxicity/seizures
*pops on pops off, per Dr B?
Lidocaine: Dosing
•Used for local anesthetic activity, numbness of veins for propofol (about __mg), and ablating response to laryngoscopy (_mg/kg).
•Used as an anti-dysrhythmicsuppresses ventricular dysrhythmias, especially PVCs, and ventricular tachycardia-_mg/kg IV followed by infusion of _-_mg/min
•Max dose =
30 1 2 1-4 4 mg/kg, 7mg/kg*
Succinylcholine: Review
• ___________ muscle relaxant
• SCh attaches to each of alpha subunits of the ________ cholinergic receptor and mimics the action of ___, ___________ the postjunctional membrane.
• Hydrolysis of SCh is slower than ACh resulting in sustained ____________ of the receptor ion channels.
***used to break _____________, especially in _____
Depolarizing
nicotinic, ACh, depolarizing
depolarization
laryngospasm/cords shut (NOT bronchospasm), peds
Succinylcholine: Dosing • Dose = • Duration of action: _-_minutes • Used for emergency a/w situations (\_\_mg to break laryngospasm/cords shut), rapid sequence induction (_-\_\_mg/kg). • Can cause:****
0.5-1.5mg/kg 3-5minutes 0.5 1-1.5 dysrhythmias (bradycardia, arrest-acts at cardiac muscarinic receptors mimics ACh), hyperkalemia, myalgias, increased GI pressure, ICP and IOP.
*used to be go to for RSI, but now roc is more common bc it is more reversible now
Labetalol: Review
• ________ beta blocker as well as ____ blockade. • beta:alpha in a ratio of :.
• Bolus of ______-typical
• Can repeat q __ mins.
• ________________ IV dose is __-__ mg (usually titrate up to this with smaller boluses).
• Duration of action of _-__hrs
• Make sure patient has adequate __, do not give to _________.
Non selective, alpha 7:1 10mg 10 Hypertensive emergency, 40-80 2-18hrs HR(>60), asthmatics***
Esmolol: Review
• Beta-_ selective agent at ______ doses.
• Onset of _ minutes.
• E1/2 life of _ minutes-metabolized by non-specific _______________ found in the cytosol of RBCs.
• Bolus dose of _________ (IV loading dose)
• In OR we typically use ________, and then dose according to response.
1, small 2 9, plasma esterases 500mcg/kg 10-15mg
Ms Maid Slides 15 & 16
Ms Maid Slides 15 & 16
