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620 Advanced Pharmacology > Master Drug Cart > Flashcards

Master Drug Cart Flashcards

1
Q

Neostigmine

A

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

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2
Q

Albuterol

A

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,
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3
Q

Propofol

A

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

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4
Q

Lidocaine

A

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

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5
Q

Ephedrine

A

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

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6
Q

Midazolam (Versed)

A

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

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7
Q

Glucagon

A

Gluconeolysis
< 20 kg = 0.5 mg
> 20 kg= 1 mg
Onset: 1 min

Overdose can lead to N/V
Pos. Hypokalemia

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8
Q

Meperidine (Demerol)

A

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

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9
Q

Rocuronium (Zemuron)

A

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

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10
Q

Glycopyrrolate

Robinul

A

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

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11
Q

Phenylephrine

A

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

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12
Q

Flumazenil (Romazicon)

A

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

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13
Q

Etomidate

A

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

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14
Q

Ondansetron

Zofran

A 
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

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15
Q

Diphenhydramine (Benadryl)

A

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

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16
Q

Naloxone (Narcan)

A

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
17
Q

Vasopressin

A 
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

18
Q

Ketoralac (Toradol)

A

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

19
Q

Metoprolol

A

B1-Blocker
Supplied: 1mg/mL

Dose: 2.5 - 5 mg q2-5 min
(1 mg increments)
MAX 15 mg

20
Q

Adenosine

A

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

21
Q

Morphine

A

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

22
Q

Succinylcholine (Anectine)

A

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

23
Q

Dexamethasone (Decadron)

A

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

24
Q

Suggamadex (Bridion)

A

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

25
Q

Dexmedetomidine (Precedex)

A

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

26
Q

Atropine

A

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

27
Q

Ketamine

A

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

28
Q

Fentanyl

A

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

29
Q

Vecuronium

A

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

30
Q

Norepinephrine (Levophed)

A

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

31
Q

Combivent (Albuterol and Ipratropium)

A

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

620 Advanced Pharmacology (9 decks)

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