Exam 1 Drugs - BZDs and Pre-Op

Question 1

At which pH is Midazolam water-soluble? Lipid-soluble?

Answer 1

Water-soluble pH < 3.5 - Open ring
Lipid-soluble pH > 4.0 - Closed ring

Question 2

Midazolam (Versed):
pK
Peak
Elimination 1/2 Time
Vd

Answer 2

pK = 6.2
Peak: 20-30 mins (Peds), 5 minutes in adults
E 1/2 Time = 2 hours
Vd = 1-1.5 L/kg

Question 3

Active metabolite of midazolam?

Answer 3

1-hydroxymidazolam

Question 4

Midazolam sedation dose?

Answer 4

Peds: 0.25-0.5 mg/kg (Peaks in 20-30 mins)
Adults: 1-5 mg (Peaks in 5 mins)

Question 5

Midazolam induction dose?

Answer 5

0.1-0.2 mg/kg over 30-60 seconds

Question 6

Post-op Versed dose?

Answer 6

1-7 mg/hr

Question 7

Concerns for prolonged midazolam administration?

Answer 7

T-cell suppression

Question 8

Diazepam (Valium)
Onset
Peak
Elimination 1/2 Time
Vd

Answer 8

Onset: 1-5 mins
Peak: 1 hour (Adults), 15-30 mins (Peds)
Elimination 1/2 Time: 20-40 hours

Question 9

Valium active metabolites?

Answer 9

Desmethyldiazepam (lasts 48-96 hours) and oxazepam

Question 10

Diazepam (Valium) doses for…
Induction?
Seizures?

Answer 10

Induction = 0.5-1 mg/kg
Seizure = 0.1 mg/kg

Question 11

Why does valium burn upon injection?

Answer 11

It contains propylene glycol

Question 12

Lorazepam (Ativan)
Peak
Elimination 1/2 Time
Duration
Post-Op Dose

Answer 12

Peak: 20-30 minutes
E 1/2 Time: 14 hours
Duration: 6-10 hours
Dose: 1-4 mg

Question 13

List benzodiazepine duration of action from shortest to longest…

Answer 13

Midazolam < Diazepam < Lorazepam

Question 14

Romazicon (Flumazenil) is derived from…

Answer 14

1,4 imidazobenzodiazepine

Question 15

Romazicon (Flumazenil) dosage to reverse sedation? Complete reversal?

Answer 15

0.3-0.6 mg
Complete reversal = 0.5-1 mg

Question 16

Romazicon (Flumazenil) onset? Duration?

Answer 16

Onset = 2 mins
Duration = 30-60 mins

Question 17

Diphenhydramine (Benadryl):
Class
Receptor
E 1/2 Time
Dose

Answer 17

Class: H1 Antagonists
Receptor: Vestibular
E 1/2 Time: 7-12 hours
Dose: 25-50 mg

Question 18

Diphenhydramine inhibits what reflex?

Answer 18

Oculo-Emetic Reflex

Question 19

Promethazine (Phenergan)
Class
Receptor
E 1/2 Time
Onset
Dose

Answer 19

Class: H1 Antagonsist
Receptor: Vestibular
E 1/2 Time: 9-16 hrs
Onset: 5 minutes
Dose: 12.5-25 mg

Question 20

What is the most common bacterial infection associated with long-term H2 antagonist use?

Answer 20

Candida Albicans

Question 21

What is the dose for the H2 antagonist Cimetidine (Tagamet)?

Answer 21

150-300 mg (1/2 for renal impairment)

Question 22

What is the dose for the H2 antagonist Ranitidine (Zantac)?

Answer 22

50 mg diluted in 20 cc over 2 mins
1/2 dose for renal impairment

Question 23

What is the dose for the H2 antagonist Famotidine (Pepcid)? Half-time?

Answer 23

20 mg - 1/2 dose for renal impairment
1/2 Time = 2.5-4 hours

Question 24

What electrolyte should be monitored in a patient taking Pepcid?

Answer 24

Phosphorus

Question 25

PPIs _________ Warfarin metabolism

Answer 25

Inhibit

Question 26

PPIs block the enzyme that activate……

Answer 26

Plavix (Clopidogrel) - It doesn’t work as well

Question 27

Omeprazole (Prilosec)
Dose:
How long before surgery do you administer?

Answer 27

40 mg dilated in 100cc NS over 30 mins

> 3 hours prior to surgery

Question 28

Pantoprazole (Protonix)
Dose
Onset?

Answer 28

40 mg diluted in 100 cc NS over 2-15 mins
Onset - 1 hr

Question 29

PPIs decrease ____________ and increase ____________

Answer 29

Gastric volume
pH

Question 30

Particulate antacids are aluminum and magnesium based - Aspirating this is just as bad as aspirating…

Answer 30

Stomach acid

Question 31

Non-particulate antacids neutralize acids and consist of…

Answer 31

Sodium, Carbonate, CItrate
Bicarb based

Question 32

Sodium Citrate (Bicitra)
Onset
Duration
Dose

Answer 32

Onset - Immediate
Duration - 30-60 mins
Dose - 15-30 mL

Question 33

Metoclopramide (Reglan) is FDA approved for…

Answer 33

Diabetic gastroparesis

Question 34

Metoclopramide (Reglan) slows the metabolism of what?

Answer 34

Succinylcholine - Decreases plasma cholinesterase

Question 35

Metoclopramide (Reglan)
Dose
When do administer?

Answer 35

10-20 mg over 3-5 mins
Give 15-30 prior to induction

Question 36

What was the initial use for Droperidol?

Answer 36

Schizophrenia, psychosis

Question 37

Droperidol dose?

Answer 37

0.625-1.25 mg

Question 38

Ondansetron (Zofran)
Receptor
Dose
E 1/2 time

Answer 38

5-HT3
Dose - 4-8 mg
E 1/2 Time - 4 hours

Question 39

Dexamethasone (Decadron)
Onset
Dose
Duration
When do you administer this?

Answer 39

Onset: 2 hours
Dose: 4-8 mg; Give more (12-20 mg) for airway trauma
Duration: 24 hours

Administer at start of case or 2 hours before the end of a long case

Question 40

Scopolamine Patch
Class
E 1/2 Time
Onset
Peak
Dose

Answer 40

Class: Anticholinergic, Musarinic antagonist
E 1/2 Time: 24-72hours
Onset: 4 hours
Peak: 8-24 hours
Dose: The priming dose is 140 mcg, then over the next 72 hours 1.5 mg is absorbed through the skin