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N926 Exam 2 > JUST DOSES AND OTHER NUMBERS > Flashcards

JUST DOSES AND OTHER NUMBERS Flashcards

1
Q

pKa of fentanyl

A

8.4

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2
Q

onset of IV morphine

A

15-30 minutes (more nonionized than fentanyl but really not lipophilic)
ex: think about 9% of fentanyl being nonionized but 20% of morphine being nonionized

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3
Q

pKa of morphine

A

less than fentanyl (8.4)

7.9

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4
Q

active metabolite of morphine

A

(5-10% of metabolites) morphine-6-glucuronide

longer duration of action, 65x more potent than morphine

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5
Q

fentanyl onset

A

1-3 minutes

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6
Q

fentanyl potency compared to morphine

A

75-125x more potent

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7
Q

Vd of fentanyl

A

LARGE, >80% leaves the plasma in less than 5 minutes

(lowest ratio of nonionized to ionized, but highest lipophilicity)

3-4L

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8
Q

active metabolite of meperidine

A

90% demethylization to normeperidine (other one is hydrolysis to get meperidinic acid)

1/2 as active as meperidiine
T1/2 is 15 hrs! 30+ if renal failure pt!!

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9
Q

CS 1/2 time of fentanyl & sufentanil

A

increases with gtt >2 hrs

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10
Q

doses of fentanyl

A
  • to block SNS response to surgical stimulation, and induction/intubation: 1-3 ug/kg prior to induction
  • as sole surgical anesthetic (pure fentanyl induction - rare): 50-150 ug/kg

(transdermal patch applied preop and left for 24 hrs –> decreases IV requirements)

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11
Q

sufentanil dose

A

analgesia: think 5-10x more potent than fentanyl (so go with 1/10 dose)
0. 1-0.4 ug/kg

induction dose can cause chest wall rigidity (vs laryngeal?)

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12
Q

alfentanil pKa

A

6.5

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13
Q

alfentanil dose

A
  • 15 μg/kg IV – blunts stim of laryngoscopy
  • 30 μg/kg IV – catech response to noxious stim
  • 150-300 μg/kg IV – produces unconsciousness (induction)
  • Combo with inhaled anesthetic 15-150 ug/kg/hr
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14
Q

Vd of remifentanil versus fentanyl

A

fentanyl: 3-4 L/kg (large distribution)
remifentanil: 0.5 L/kg

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15
Q

remifentanil CS 1/2 time

A

4 minutes

plasma esterases in the bloodstream are always working

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16
Q

remifentanil dose

A

Remi is a tiny mouse, remi gets a tiny dose.

induction: 1 mcg/kg bolus, followed by gtt of 0.05-0.2 mcg/kg/min
analgesia: gtt same as induction gtt dose
sedation: 0.05-0.1 mcg/kg/min in combo with midaz 2 mg

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17
Q

drugs so far that have sz-like activity

A

etomidate, fentanyl, remifentanil, hydromorphone

tramadol may lower sz threshold

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18
Q

T1/2 methadone

A

12 hrs

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19
Q

hydromorphone dose

A

5x more potent than morphine, so ~2 mg?

slightly shorter duration of action

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20
Q

methadone dose

A

Think quarter and 20

for opioid w/d:

  • Can substitute for morphine at ¼ the dosage
  • 20 mg IV, produces postop analgesia >24 hours
  • But not as much euphoria
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21
Q

chronic pain medication use effect on opioid dosing

A

you might have to give HIGHER than the normal dosing range to get effect

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22
Q

nalbuphine use and dose, T1/2

A

true agonist-antagonist: chemically related to oxymorphone and naloxone
analgesic properties of morphine, 1/4 antagonist of nalorphone

T1/2 3-6 hours

aside: if given before opioid, it can reduce effects of morphine-like drugs intraop. If given after opioid, it can reverse depression of ventilation effects (up to 30 mg) but maintain analgesia

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23
Q

dose of naloxone

A

1-4 mcg/kg IV
5 mcg/kg/hr can fix depression of ventilation without affecting analgesia

“I would not give the whole dose at once”

PO 1/5 as effective bc of 1st pass in liver

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24
Q

T1/2 of naloxone

A

30-45 minutes

“effects of the reversal agent don’t last as long as the narcotic”

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25
Q

nalmefene dose

A

Nalme-fene, 15!

15-25 mcg IV until the effect is achieved

Max dose 1 mcg/kg

26
Q

neuraxial (intrathecal) dose of fentanyl

A

10-15 mcg TOTAL

goes through the dura, into the CSF

27
Q

dose of toradol

A

(non-selective NSAID)

15 mg IV or IM q6hr

decrease dosing (or just avoid it honestly) for renal pts

28
Q

celebrex (celecoxib) dose

A

(COX-2 inhibitor)

400 mg PO preop
200 mg BID x 5 days postop

29
Q

Vd of NSAIDs

A

LOW, 0.1-0.3 L/kg

30
Q

T1/2 of ketorolac

A

6 hrs

31
Q

dose of APAP

A

325-650 mg q4-6hr

Total: 4g/24hr
2g/24 hr for ETOH pts

IV prep 1g/6hrs
Ofirmev. Same total dose - 4g/24hr.

32
Q

gabapentin dosing (part of ERAS protocol)

A

1200 mg 1-2 hrs preop

600 mg q8hr x 14 days

33
Q

pKa of lidocaine

A

“just above physiologic pH”

weak base, not very lipophilic

34
Q

lidocaine dose (ERAS)

A

induction: 1.5 mg/kg IV bolus
(IBW bc this is not very lipophilic)
1-2 mg/kg/hr gtt

35
Q

Magnesium Sulfate dose (ERAS)

A

30-50 mg/kg bolus

10 mg/kg gtt

(2g is a normal bolus dose, don’t give it all at once, or do a 15-min bolus. 1g/hr is a normal gtt rate)

36
Q

ketamine dose (ERAS), ketamine dose for induction, ketamine dose for analgesia

A

ERAS: 0.5-1 mg/kg (but usually just do 0.5mg/kg), followed by gtt

INDUCTION: 1-2.5 mg/kg IV, takes 2-3 minutes to start working, IM 4-8 mg/kg, PO 10mg/kg

ANALGESIA: 0.2-0.5 mg/kg

analgesia < ERAS < induction dosing

37
Q

dexmedetomidine dosing (ERAS)

A

“0.5-2 mcg/kg”

really will give 4 mcg at a time

38
Q

drugs so far that are acids

A

propofol, barbiturates, NSAIDs

39
Q

dose of succinylcholine, time til paralyzed

A

1.0 mg/kg
(low Vd - based on IBW)

creates intubating conditions in ~60 seconds, laryx ~34 seconds, recovery of 90% muscle strength in 9-13 minutes

40
Q

T1/2 succinylcholine (from Stoelting)

A

47 seconds

41
Q

intubating dose of atricurium

A

0.5 mg/kg

42
Q

intubating dose of cisatricurium

A

0.1 mg/kg

43
Q

intubating dose of mivacurium

A

0.15 mg/kg

44
Q

intubating dose of pancuronium

A

0.08 mg/kg

onset time to maximal block - 2.9 minutes

45
Q

intubating dose of vecuronium

A

0.1 mg/kg

onset time to maximal block - 2.4 minutes

46
Q

intubating dose of rocuronium

A

0.6 mg/kg

onset time to maximal block - 1.7 minutes

47
Q

max effective dose of neostigmine

A

0.04-0.08 mg/kg (40-80 mcg/kg)

max dose 6mg
70 kg pt, 2-4 mg for reversal

48
Q

max effective dose of edrophonium

A

1.0-1.5 mg/kg

49
Q

glycopyrrolate dose

A

0.005-0.01 mg/kg (5-10 mcg/kg)

50
Q

atropine dose

A

0.007-0.01 mg/kg

51
Q

sugammadex dosing

A
  • TOF > 2 – 2 mg/kg
  • TOF 1-2 – 4 mg/kg
  • TOF 0 – 8-16 mg/kg
52
Q

plasma [ ] curve

A 
PK! Think ADME
-Y axis [vertical] = concentration 
-X axis [horizontal] = time 
-Know it’s IV bc no 1st-pass effect 
-Distribution 1st part - alpha
Drug that wears off bc of distribution: propofol, fentanyl, all the induction agents
  • Elimination - beta
  • Drug that is offset bc of this: morphine, diazepam (anything with an active metabolite)
53
Q

dose-response curve

A
  • Efficacy (y-axis) - effect
  • Potency (x-axis) - dose
  • Don’t know how potent the drug is, unless you have something to compare it to
  • Test: lots of dose-response curves and you’ll be asked questions about those drugs
  • Lipophilic drugs tend to wear off bc of redistribution. Nonlipophilic drugs tend to wear off bc of metabolism/elimination
  • Morphine has a longer half-life than ____
54
Q

What drugs have a low Vd?

A

remifentanil, NSAIDs, NMBDs

55
Q

draw an ester linkage

A

C (=O)OC

56
Q

phenylpiperidines

A

– just need to know that they’re phase I dealkylation processes
*No n versus o dealkyl….

57
Q

therapeutic index

A

LD50/ED50 “The Whole Index of the Drug”

58
Q

therapeutic window

A

TD50/ED50 “Window – where we live”

  • ED95 in between the ED50 an TD50
  • Captures top curve of the ED, bottom curve of TD

“Out of 100 pts, 95 will get pain relief, and only 5 will get constipation”

59
Q

drug that can be given to treat opioid-induced biliary spasm

A

glucagon 2 mg will reverse smooth muscle spasm without antagonizing analgesic effects (biggest culprit is morphine), but you really should just avoid it if your pt is having a cholecystectomy

60
Q

drug that you can give to combat GI SEs of opioids

A

narcan works everywhere, but methylnaltrexone works only in the gut

61
Q

what 2 drugs act on DA receptors to produce antiemetic effects?

A
  • butyrophenones, phenothiazines
  • this supports the claim that opioid-induced N/V is due to activation of DA-2 receptors in the chemoreceptor trigger zone of the medulla (other receptor is 5HT3-serotonin)
62
Q

T1/2 morphine

A

1.7-3.3 (stoelting)

N926 Exam 2 (4 decks)

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