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STT > Good Sam Basic Pharmacology > Flashcards

Good Sam Basic Pharmacology Flashcards

1
Q

cardiac patient with CP
SBP>100, HR>60
pain unrelieved by NTG

A 
metoprolol 
5mg over 2min 
q 5min 
pay repeat twice 
MAX 15mg
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2
Q

pain relieved by NTG SL

A

NTG infusion
5mcg / min
titrated for SBP>90

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3
Q

Bradydysrhythmias

First line medication

A

Dopamine

5-10 mcg/kg/min IVPB

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4
Q

Bradydysrhythmias

CCT medication

A

Epinephrine
2-10 mcg/min
IV infusion titrated to response

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5
Q

SVT

CCT medication

A

metoprolol
5mg IVP over 2min
may repeat to a total of 15mg

diltiazem
.25mg/kg IVP over 2min
may repeat in 15min with .35mg/kg IVP over 2min

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6
Q

rapid atrial dysrhythmias

stable

A

diltiazem

  • -.25mg/kg IVP over 2min
  • -may repeat in 15min with .35mg/kg IVP over 2min
  • -maintenance infusion of 5-15mg/h
  • —titrated to HR control and SBP>90mmHg
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7
Q

rapid atrial dysrhythmias

unstable

A 
Versed for sedation (2mg up to 10mg) 
-atrial fibrillation @200J 
-atrial flutter @100J 
repeat sync cardioversion @200, 300, 360J 
-no response, consider cardiogenic shock
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8
Q

When giving Diltiazem….

A

do not give it in the same IV as furosemide

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9
Q

rapid atrial dysrhythmias

post-conversion continuous infusion

A

Diltiazem

5-15mg/h IV infusion

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10
Q

rapid atrial dysrhythmias

critical care contact medication control for orders

A

amiodarone
150mg IV over 10min
—-followed by 1mg/min infusion

metoprolol
5mg IVP over 2 min
–may repeat q 5min to a total of 15mg

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11
Q

persistent V-Tach w/ pulse that is unresponsive to previous therapy

A

magnesium sulfate

2G in 10mL NS IV over 2 min

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12
Q

persistent V-Tach w/ no pulse that is unresponsive to previous therapy

A

magnesium sulfate

2G in 10mL NS IV over 2 min

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13
Q

induction of hypothermia after ROSC requires what infusion

A

2 L chilled .9% NS

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14
Q

pulmonary edema

stable

A 
BP >100 mmHg
--NTG .4mg SL 
---repeat q5 min 
----limit???
NTG infusion 
5mcg/min 
---titrate for relief, maintain SBP>90mmHg 
---if SBP>100mg, & hx of pulmonary edema: contact medical control for furosemide 40mg IV/IO
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15
Q

pulmonary edema

unstable

A

<60 HR bradydysrhythmia SOP

>59 HR cardiogenic shock SOP

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16
Q

pulmonary edema

critical care standing medical orders

A 
NTG 
--5mcg/min 
---titrate for relief, maintain SBP>90mmHg
Dobutamine
--2-20mcg/kg/min
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17
Q

pulmonary edema

critical care common continuation medications

A 
milrinone 
--.375 - .77 mg/kg/h 
----max 1.13 mg/kg/24h 
inamrinone 
--5-10 mcg/kg/min 
----max 18mg/kg/24h
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18
Q

Adult cardiogenic shock

HR >99, and only inotropic support is needed

A

dobutamine
5 mcg/kg/min
titrate q 2min to achieve SBP>89
—max 20 mcg/kg/min

19
Q

adult cardiogenic shock

hypotension unresponsive to fluid boluses and initial vasopressor administration

A

epinephrine
— .1 mcg/kg/min
— titrate q 2min to achieve SBP>89mmHg
—maximum 20mcg/kg/min
vasopressin
— begin .4 units/min IV
—once SBP>89, titrate q 5min to .01 units/min

20
Q

note about Vasopressin. p26

A

“preferred second-line vasopressor for septic shock and should be the last vasopressor to be discontinued once started”

21
Q

adult cardiogenic shock

critical care common continuation medications

A

epinephrine
– 5mcg/min
– titrated q2min up to 15mcg/min to maintain BP
norepinephrine
– 10mcg/min
—titrated q2min up to 30mcg to maintain BP
– .1 - .5 mcg/kg/min for weight-based dosing
phenylephrine
– 100mcg/min
—titrated q 2min up to 180mcg/min to maintain BP
– .5 - 2mcg/kg/min for weight based dosing
—may be given as IV bolus of .1 - .5mg q 10min

22
Q

adult drug assisted intubation-rapid sequence
Pre-Medicate
1) head injury/CVA
2) bradycardia

A

1) lidocaine
- - 1mg/kg
- –max dose 100mg
2) atropine
- - .5mg
- – .5mg

23
Q

adult drug assisted intubation-rapid sequence

Sedate (two options)

A

midazolam
– 5mg IV/IO
Etomidate
– .5mg/kg

24
Q

adult drug assisted intubation-rapid sequence

defasiculating dose administered 1-3min prior to succs

A

Vecuronium
– .01 mg/kg
Rocuronium
– .05-.06 mg/kg IV/IO

25
Q

adult drug assisted intubation-rapid sequence

succinylcholine dose

A

1mg/kg

26
Q

adult drug assisted intubation-rapid sequence

paralysis maintenance

A 
vecuronium 
-- .1mg/kg 
---up to 10mg 
rocuronium 
-- .1-.2 mg/kg PRN
27
Q

adult continued sedation for the intubated patient
what four drugs for sedation?
what two drugs for analgesia?
what two drugs for maintenance of paralysis?

A

Versed, Ativan, Propofol, Precedex

Morphine, Fentanyl

Rocuronium, Vecuronium

28
Q

adult continued sedation for the intubated patient

sedation…

A

Versed
– bolus: 2-5mg max:10mg
– infusion: .05-.1 mg/kg/h q5min until sedation
Ativan
– bolus: 2-4mg
– infusion: .05-.1 mg/kg/h q5min until sedation
Propofol
– bolus: none
– infusion: 5-25mcg/kg/min q 5min by 5-10mcg/kg/min
Precedex
– bolus: none
– infusion: .2-.7mcg/kg/hr q 5min until sedation

29
Q

adult continued sedation for the intubated patient

analgesia

A

morphine
– bolus: 2-5mg q5min to max of 10mg
– infusion: 1-10mg/h until pain level decreases
fentanyl
– bolus: .5mcg/kg up to 2mcg/kg q30min
– infusion: .7-10mcg/kg/h until pain level decreases

30
Q

adult continued sedation for the intubated patient

maintenance of paralysis

A 
vecuronium
-- bolus: .1mg/kg q35-40min 
---max single dose 10mg 
-- infusion: .8-1.2 mcg/kg/min 
---titrated q 10min for continued paralysis 
rocuronium
-- bolus: .45-.6mg/kg 
---PRN based on patient condition 
-- infusion: 10-12mcg/kg/min
--- titrated q 10min for continued paralysis
31
Q

Adult cardiogenic shock

HR >99, and only inotropic support is needed

A

dobutamine
5 mcg/kg/min
titrate q 2min to achieve SBP>89
—max 20 mcg/kg/min

32
Q

adult cardiogenic shock

hypotension unresponsive to fluid boluses and initial vasopressor administration

A

epinephrine
— .1 mcg/kg/min
— titrate q 2min to achieve SBP>89mmHg
—maximum 20mcg/kg/min
vasopressin
— begin .4 units/min IV
—once SBP>89, titrate q 5min to .01 units/min

33
Q

note about Vasopressin. p26

A

“preferred second-line vasopressor for septic shock and should be the last vasopressor to be discontinued once started”

34
Q

adult cardiogenic shock

critical care common continuation medications

A

epinephrine
– 5mcg/min
– titrated q2min up to 15mcg/min to maintain BP
norepinephrine
– 10mcg/min
—titrated q2min up to 30mcg to maintain BP
– .1 - .5 mcg/kg/min for weight-based dosing
phenylephrine
– 100mcg/min
—titrated q 2min up to 180mcg/min to maintain BP
– .5 - 2mcg/kg/min for weight based dosing
—may be given as IV bolus of .1 - .5mg q 10min

35
Q

adult drug assisted intubation-rapid sequence
Pre-Medicate
1) head injury/CVA
2) bradycardia

A

1) lidocaine
- - 1mg/kg
- –max dose 100mg
2) atropine
- - .5mg
- – .5mg

36
Q

adult drug assisted intubation-rapid sequence

Sedate (two options)

A

midazolam
– 5mg IV/IO
Etomidate
– .5mg/kg

37
Q

adult drug assisted intubation-rapid sequence

defasiculating dose administered 1-3min prior to succs

A

Vecuronium
– .01 mg/kg
Rocuronium
– .05-.06 mg/kg IV/IO

38
Q

adult drug assisted intubation-rapid sequence

succinylcholine dose

A

1mg/kg

39
Q

adult drug assisted intubation-rapid sequence

paralysis maintenance

A 
vecuronium 
-- .1mg/kg 
---up to 10mg 
rocuronium 
-- .1-.2 mg/kg PRN
40
Q

adult continued sedation for the intubated patient
what four drugs for sedation?
what two drugs for analgesia?
what two drugs for maintenance of paralysis?

A

Versed, Ativan, Propofol, Precedex

Morphine, Fentanyl

Rocuronium, Vecuronium

41
Q

adult continued sedation for the intubated patient

sedation…

A

Versed
– bolus: 2-5mg max:10mg
– infusion: .05-.1 mg/kg/h q5min until sedation
Ativan
– bolus: 2-4mg
– infusion: .05-.1 mg/kg/h q5min until sedation
Propofol
– bolus: none
– infusion: 5-25mcg/kg/min q 5min by 5-10mcg/kg/min
Precedex
– bolus: none
– infusion: .2-.7mcg/kg/hr q 5min until sedation

42
Q

adult continued sedation for the intubated patient

analgesia

A

morphine
– bolus: 2-5mg q5min to max of 10mg
– infusion: 1-10mg/h until pain level decreases
fentanyl
– bolus: .5mcg/kg up to 2mcg/kg q30min
– infusion: .7-10mcg/kg/h until pain level decreases

43
Q

adult continued sedation for the intubated patient

maintenance of paralysis

A 
vecuronium
--bolus: .1mg/kg
---q35-40min 
---10mg
--infusion: .8-1.2mcg/kg/min
---q10min 
rocuronium 
--bolus: .45-.6mg/kg IV/IO
--- PRN  
--infusion: 10-12mcg/kg/min 
---q10 min
44
Q

Mannitol

Indications

Type

Pharmacology

Administration

Caution

A

Elevated intracranial pressure due to cerebral edema. Also for intraocular pressure.

Osmotic diuretic

Hinders tubular reabsorption of H2O and enhances Na and Cl excretion. Move H2O from intracellular space to extracellular and vascular space.

1 G / kg (max 200G) < 30 min
With special tubing.

Do not give with blood products or potassium chloride.

Contraindications: severe pulmonary vascular congestion or pulmonary edema, active intracranial bleeding, anuria, hypovolemia.

STT (7 decks)

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