Master Drug Cart Flashcards
Neostigmine
Cholinesterase inhibitor
Concentration: 10mg/mL
0.04-0.08 mg/kg
MAX 6mg (usually give 5mg d/t vial amount)
Do not give until at least 2 twitches on TOF
Onset: 3-5 min
DOA: 40-60 min
Must give Robinul
Does not cross BBB
Causes PONV
Also used for MG
Hydrolysis by plasma esterase & the Liver
Albuterol
Proventil, Ventolin
B2-receptor agonist
Nebulizer: 2.5 - 5 mg in 3 mL saline q6hr
Causes tachycardia (if an issue use Atrovent) Causes HTN, chest pain, HA, increased blood glucose,
Propofol
GABA agonist
Concentration: 10mg/mL
Induction: 1-2.5 mg/kg
Infusion: 100-200 mcg/kg/min
Conscious sedation: 25-100 mcg/kg/min
Metabolized CYP450 & some lung clearance
Lidocaine
Amide LA
Class 1A anti-arrhythmic
Na Ch Blocker
Concentration: 1%: 100mg/10mL
Induction: 0.5-1.5 mg/kg
MAX 100 mg
Decreases burning sensation from Propofol
CYP450 metabolism
Ephedrine
Sympathomimetic
Mixed agonist
(a1, B1, B2)
Concentration: 50mg/mL
Dilute: add 4cc to = 10mg/mL
add 9cc = 5mg/mL
Hypotension: 2.5-10 mg
Bolus: 5-10 mg each
Onset: < 1 min
Increase BP & HR
Tachyphalaxis
Midazolam (Versed)
Benzodiazepine
GABA agonist
Concentration: 1mg/mL
Anxiolytic: 1-2 mg (up to 5mg)
Induction: 0.1-0.2 mg/kg
Sedation: 0.01-0.1 mg/kg
Anterograde amnesia
Increase seizure threshold
Decreases emergence delirium with ketamine
Avoid: in elderly
Caution: in COPD, CHF, CRF
CYP450 & small intestine metabolism
Glucagon
Gluconeolysis
< 20 kg = 0.5 mg
> 20 kg= 1 mg
Onset: 1 min
Overdose can lead to N/V
Pos. Hypokalemia
Meperidine (Demerol)
Opioid agonist
Dose: 1mg/kg
Shivering: 25 mg
Anticholinergic effects
Increases HR
Contraindicated: in pts taking MAOI
Histamine release
Normeperidine metabolite
May accumulate in renally impaired & cause seizures
Rocuronium (Zemuron)
Aminosteroidal
Competitive Non-depolarizing NMBD
Induction: 0.6 mg/kg
RSI: 1.2 mg/kg
Defasciculating: 5 mg (1.5mg/kg)
Onset: 2-3 min
DOA: 30-60 min
Phase II block
70% biliary excretion
Glycopyrrolate
Robinul
Quaternary Amine
Competitive inhibitor of M-receptor
Anticholinergic/Antimuscarinic
Reversal: 0.2 mg for each 1 mg of Neostigmine (1:1)
Pre-op: 0.1-0.3 mg
Onset: 1 min
Only slight tachycardia
Must be given before Neostigmine
Antisalagoge - give with ketamine
Phenylephrine
Sympathomimetic
Selective a-1 agonist
Supplied: 100mcg/mL
Dilute to 10mg/mL
Add 0.1 mL Neo to 9.9 mL of NS
Or add 1 mL of Neo to 99 NS
Hypotension: 50-100 mcg (0.5 - 1.0 mcg/kg)
Onset: < 1 min
Increases BP but CO reduced d/t reflex bradycardia
Metabolized by MOA
Concurrent MAOI and TCAs can potentiate acute HTN episode
Flumazenil (Romazicon)
Benzodiazepine reversal
Competitive GABA antagonist
Concentration: 0.1 mg/mL
0.2 mg IV over 15 sec
May repeat 0.1 mg q1min
MAX 1 mg
Onset 2 min
If long term Benzodiazepine use can cause WD & seizures
99% hepatic elimination
Etomidate
GABA agonist
Concentration: 2mg/mL
Induction: 0.2-0.4 mg/kg
Causes adrenal suppression, avoid in septic shock, hemorrhage, & Addisons ds.
CYP450 & plasma esterase metabolism
Ondansetron
Zofran
5HT3 antagonist (1st gen) Concentration: 2mg/mL
Dose: 4mg
Onset: 30 min
DOA: 4-24 hrs
More effective at the end of the case for PONV
Side effects: HA, constipation, increased QT
CYP450 metabolism
Diphenhydramine (Benadryl)
H1 receptor antagonist
Given for allergic reactions
Dose: 20-50 PO/IM/IV q4-6 hr
For anaphylaxis: 0.5-1 mg/kg
Hives: 12.5 mg (give less to avoid lethargy)
Max 300mg/day
More effective in preventing vomiting than nausea
Rapid 1st pass metabolism
Naloxone (Narcan)
Competitive inhibition of opioid agonists (binds to mu receptor)
Concentration: 0.4 mg/mL(dilute in 5/10 cc syringe to 40-80 mcg)
Reverse Resp depression: 40-80mcg
Opioid reversal: 0.4-2 mg
Cont IV: 5mcg/kg/hr
Onset: 1-2 min
Tachycardia Short DOA will need repeat admin Sudden hypertension (can cause pulm edema) N/V Crosses placenta
Vasopressin
Endogenous ADH Supplied: 20 u/mL Dilute: 1u/mL in a 10mL syringe Bolus: 1-2 units Cont IV: 1-6 u/hr Onset: 10-15 min
Released from posterior pituitary
Controls osmoregulation
Dialates renal afferent, pulm & cerebral arterioles
For hypotension unresponsive to Neo & Ephedrine d/t ACEi or ARB admin
Complications: GI ischemia, decrease CO, skin/digital necrosis, Cardiac arrest
Ketoralac (Toradol)
NSAIDs
Non-selective COX inhibitor
Concentration: 15mg/mL
Standard dose: 30mg (<65yo)
15 mg for elderly >65yo
IM: 60 mg
Onset: 10-30 min
DOA: 4-6hr
Post-op pain w/o resp depression
Contraindicated: pts w/ renal failure, bleeding
Metoprolol
B1-Blocker
Supplied: 1mg/mL
Dose: 2.5 - 5 mg q2-5 min
(1 mg increments)
MAX 15 mg
Adenosine
Agonism of adenosine receptors A1 & A2 reducing conduction time in the AV node
1st dose: 6 mg
2nd dose: 12 mg
Can repeat doses 2 min after first round
Indications: Antiarrhythmic, SVT
Caution: asthma pts
Can produce short-lasting 1st,2nd,3rd heart block
Morphine
Phenanthrene alkaloid
mu agonist
Dose: 0.1 mg/kg (adults & peds)
Or standard 2-5 mg
Used w/ pulm edema
Histamine induced hypotension
Caution: w/ renal failure d/t active metabolite M6G causing prolonged resp depression
Succinylcholine (Anectine)
Quanternary amine
Depolarizing NMB
NChr agonist
Concentration: 20mg/mL
Induction: 1-2 mg/kg
Onset: 30-60 sec
DOA: 4-6 min
Fasciculations
Phase I block, (phase II with a repeat dose d/t laryngospasm 20mg)
Slight tachycardia w/ abrupt bradycardia
Avoid in hyperkalemia (increases K+ 0.5-1 mEq)
MH trigger
Avoid in peds
Plasma Cholinesterase metabolism
Dexamethasone (Decadron)
Corticosteroid
Concentration: 4mg/mL
Dose: 4mg
Onset: 30 min
Anti-inflammatory & immunosuppressant
Prophylaxis PONV
More effective when given at the beginning of surgery
Assoc. w/ perineal burning & itching when given IV
Can raise blood sugar
Suggamadex (Bridion)
Encapsulates steroidal NMB
Concentration: 100mg/mL
2 TOF count: 2mg/kg
0 TOF, Post-tetanic 1-2: 4mg/kg
Profound Roc block: 16mg/kg
Time to TOF > 0.9 = 2-3 min
Avoid if CC < 30mL/min, & CICV pts
Adverse effects: Anaphylaxis, Bradycardia, Asystole
May reverse birth control
Non-organ dependent metabolism
Dexmedetomidine (Precedex)
Alpha2 agonist
Concentration: 100mcg/ml
Loading dose: 0.5-1 mcg/kg over 10 min
Infusion: 0.4-1.2 mcg/kg/hr
Minimal resp depression/ produces bronchodilation
Rapid admin = transient HTN
Common s/e: Bradycardia & Hypotension
Attenuates HD response w/ intubation
Pain on injection
Atropine
Anticholinergic/ Antimuscarinic
Competitive inhibitor
Concentration: 0.1mg/mL or 0.4mg/mL
Bradycardia: 0.4-2 mg
Reversal: 0.01-0.02 mg/kg
Onset: <1 min
Crosses BBB
Increases body temp
Least antisialogogue
Ketamine
NMDA antagonist
Also works at nAChr, muscarinic, monoaminergic pain pathway, Na gated ion Ch
Induction: 1.5 mg/kg
Sedation: 0.2-0.5 mg/kg
Low dose infusion: 0.1-0.3 mg/kg/min
Dart: 4-6mg
Dissociative amnesia, emergence delirium, increases HD response w/ induction (increase HR, BP, SVR)
Increases CMRO2, ICP, IOP
Drug of choice for bronchospasm
Avoid: pts w/ RHF d/t increase SV, CO, PVR
Norketamine metabolite
Fentanyl
Synthetic mu agonist
Concentration: 50 mcg/mL
Induction: 1-2 mcg/kg
Analgesia: 50-100mcg
PRN: 25-100 mcg
Attenuates HD/SNS response from intubation
Caution: chest wall rigidity
SAFEST narcotic in CKD, ESRD
Causes OIC
CYP450 & 1st pass in lungs
Vecuronium
Aminosteroidal
Competitive Non-depolarizing NMB
Have to reconstitute 10mg to 1mg/mL
Induction: 0.03 mg/kg
(Pretreat: 0.04-0.06 mg/kg)
Onset: 2 min
DOA: 20-35 min
Intermediate like Roc but more potent
No vagolytic like Panc
Increased hemodynamic instability: enhances bradycardia
3-OH metabolite can cause prolong blockade
Molecular instability only good for 24 hr once reconstituted
Norepinephrine (Levophed)
Naturally occurring catecholamine Sympathomimetic (a1, a2, B1, B2)
Supplied: 4mg/mL
0.02 - 0.04 mcg/kg/min
Low dose = B1= increase HR (chronograph), inotropy
High dose = alpha = increase SVR, BP, decrease HR via baroreceptor reflex
Ideal for sepsis (low SVR/afterload)
Avoid: in cardiogenic shock (d/t increasing afterload & MVO2
Extravasation
MAOIs May cause severe & prolong HTN
Combivent (Albuterol and Ipratropium)
Anticholinergic with Beta 2 agonist
MDI: 2 puffs q6h, each actuation delivers 18 mcg of Ipratropium & 103 mcg Albuterol from mouth piece
2 hr T1/2
More than 2 puffs can cause tachycardia
