iv drugs

Question 1

midazolam (versed)

Answer 1

benzo
does anxiolysis, amnesia, hypnosis, but no analgesia
minimal addiction potential
antiemitc, so good if they get nauseous from anesthesia
small dec. in BP
enhances GABA receptor mediated inhibition of CNS
highly lipophilic to cross blood brain barrier
most potent benzo. super fast.
p450 hepatic break down
dose - 2-5mg starting bolus. 1-2mg every 20 minutes prn
onset = 1-5 minutes
alpha half life = 4-18 min. beta half life = 2-2.5 hours

Question 2

diazepam / valium

Answer 2

benzo
transported in propylene glycol and ethyl alchol so it’s very painful to give IM
hepatic breakdown with active metabolites and LONG context sensitive half time so it accumulates
initial bolus = 2-10mg. give 2-10mg every 30 min prn
max = 30mg/8hr
onset is 1-5 min
alpha half life =15-60min. beta half life = 20-40h

Question 3

lorazepam / ativan

Answer 3

benzo
we don't use ths because the peak onset is 30-60 min
lowest lipid solubility
prolonged duration
best amnesic

Question 4

fentanyl / sublimaze

Answer 4

opioid
does anxiolysis, hypnosis, and analgesia
does not do amnesia
decreases respiration
highly lipophilic, fast onset
p450 hepatic breakdown
initial bolus = 50mcg/70kg.  we start at 25mcg
onset = 1-2 min. peaks in 5 min.   duration =30-60 min.
causes facial pruritis

Question 5

morphine

Answer 5

opiate
peak onset 10-30 min. duration = 3-4 h
histamine release can cause significant dec. in SVR
constipation
poorly lipophillic, low CNS potency. fentanyl more potent

Question 6

meperidine / demerol

Answer 6

opiate
don’t use because it can cause inc. CNS excitation and seizures
peaks in 5-10 min. lasts 2-4 h
giving to patient taking MAOI can be fatal
histamine release can cause significant release in SVR
can inc. heart rate due to atropine like structure
reversal is dangerous if metabolite complications present

Question 7

flumazenil / romazicon

Answer 7

benzo reversal
give if there is prolonged sedation or emergence delirium
give 0.2mg q 1-2min prn to max of 1mg
onset = 1-2 min. duration = 20 min.
can cause seizures, nausea, dizziness, anxietym,

Question 8

naloxone / narcan

Answer 8

opioid reversal agent
give for prolonged sedation or opioid induced respiratory depression
competitive opioid antagonist
dilution of 1:3
give .2-.4 mg over 30 sec. every 2-3 min to max of 1mg
can give IM dose soon after IV dose for longer duration of action
onset = 1-2 min. duration = 30 min. IV and 1-4hrs IM

Question 9

atropine

Answer 9

anticholinergic used to treat bradycardia
crosses BBB
mild sedative, amnesic, antisialogogue, and laryngospasm decreaser
increases heart rate!
competitive Ach antagonist at muscarinic receptors
give 0.4mg , if less then you get more bradycardia
0.4-1mg every 3-4min to max of 2mg
onset = 2-4 min duratin = 2-4 hours
can cause tacchycardia, PVCs, prostate dx, myasthenia gravis, narrow angle glaucoma, esophageal sphinctor issues

Question 10

glycopyrrolate / robinul

Answer 10

synthetic anticholinergic
used for bradycardia, antisialogogue, and can dec. laryngospasm
less potent than atropine for bradycardia!n doesn’t cross BBB
competitive antagonist of ACh at muscarinic receptors
excreted primarily through feces
give .1-.2mg to max of 2mg
onset 2-3 min. duration 2-3hrs vagal. 7hrs antisialogogue
can cause tacchycardia, PVCs, prostate dx, myasthenia gravis, narrow angle glaucoma, esophageal sphinctor issues

Question 11

ephedrine

Answer 11

vasopressor for tx of hypotension or bradycardia
inc. HR and BP
indirect acting sympathomimetic with effects due to NE release at sympathetic nerve endings
not metabolized by liver, excreted unchanged renally
dilution of 1:9
give 5-25mg IV q5-10 min to max of 150mg
acts in 2-10min with duration of 1h
concerns are hypertension, MI, CHF, narrow angle glaucoma, seizures, anxiety,
tacphylaxis (stops working) with repeated doses

Question 12

phenylephrine / neo-synephrine

Answer 12

vsaporessor used to treat hypotension
used before nasotracheal intubation nbeacuse it’s a nasal decongestant and vasoconstrictor
direct acting sympathomimetic
alpha1 adrenergic receptor agonist
1:99 dilution.
100-500mch IV q10-15min
onset 2-5 min. duration 20-40 min.
tissue infiltration can lead to necrosis and sloughing
concerned with hyperglycemia, distal extremity ischemia,

Question 13

epinephrine / adrenaline

Answer 13

increases BP, heart rate, and respiration
alpha and beta adrenergic agonist
in ACLS, helps develop the critical perfusion pressure for spontaneous cardiac output
heart stuff - give 0.1-1mg IV q3-5 min prn
bronchospasm/anaphylaxis - 0.01-0.25mg IV q3-5min prn
max - 0.2-0.25mg with local anesthetic
onset 1-2min. duration 5-15min IV. 20-30min SC

Question 14

labetalol/normodyne

Answer 14

mixed alpha and beta antagonist. blocker. not alpha2
controls hypotension to dec. bleeding in big surgery
decreases BP, heart rate, and respiration
onset is 5-10 min. duration is 4-6 hours

Question 15

hydralaine/apresoline

Answer 15

vasodilator used to treat hypertension
increases BP and heart rate
activates renin-angiotensin system
give 5-20mg IV q4hours or prn to max of 400mg/day
onset 15-20min. duration 3-8 hours.
slow onset, hypotension, and reflex tachycardia are concerns

Question 16

lidocaine/xylocaine

Answer 16

used to treat acute ventricuylar arrhythmias
can use if giving propofol IV to reduce the irritation
can also blunt reflex bronchoconstriction during intubation
causes rhythm dependent decrease in heart rate
calcium in atria, sodium in ventricles. lido works in ventricles.
increases ventricle threshold during diastole and shortens refractory period.

Question 17

succinylcholine / anectine

Answer 17

depolarizing neuromuscular blocker - paralysis
use for laryngospasms and during intubation
increases serum potassium by 0.5-1mEq/L which can cause Hs and Ts
laryngospasm - give 15-40mg bolus.
intubation - give 1-1.5mg/kg bolus to max of 150mg
onset - 30-90min. duration is 5-10min
have fasciculations when given. causes myalgia, trismus, increases pressure, not reversible

Question 18

dephenhydramine / benadryl

Answer 18

antihistamine, antiemetic, sedative
decreases tremors in parkinsons disease
histamine1 receptor antagonist
onset 10min. duration 4-8 hours

Question 19

dexamethasone/decaadron

Answer 19

corticosteroid for antiinflammatory after surgery
no mineralcorticoid effect for physiologic replacement
strong antimetic combo with zofran
8mg q8h for 24h for post op
for allergic reaction give 4-40mg IV to max of 80mg/day
have to give it slowly because it causes pruritis
onset is within minutes. duration is 2-3 days.

Question 20

ondansetron/zofran

Answer 20

antiemetic, good for chemo or post op
selective 5-HT3-receptor antagonist (serotonin)
give 2-4mg IV or 8mg PO
onset is 30 min. duration is 4-6 hours.

Question 21

procaine/novocaine

Answer 21

potent vasodilator and ester type local anesthetic
extravascular - 10-50mg IV flush
intraarterial - 10-20mg IV flush 
to max of 500mg infiltration 
onset is 2-5min.  duration is 45-60min

Question 22

albuterol/ventolin

Answer 22

bronchodilator for asthma, COPD
100mcg per puff
give 200-400mcg q2-6h prn to max of 800-1600mcg
onset is 1-2min. duration is 3-6 hours.

Question 23

nitroglycerin/nitroquick

Answer 23

vasodilator for MI and angina
the reduction in preload and to a lesser extent in afterload decreases the work load of the heart and lowers myocardial oxygen demand
give 400mcg po q5-min x 3 to max of 1200mcg
onset is 1-3min. duration is 20-40 min.
causes headaches, dependence, anemia, hypotension, tachycardia,
contraindications - viagra

Question 24

aromatic ammonia / amoply

Answer 24

respiratory and cerebral stimulant to prevent and treat fainting
increases respiration
stimulates the respiratory center of the medulla
0.3mg/crushable glass ampule
lasts less than 5 seconds
can cause cough, vomiting, diarrhea, headache