Medication Drug Boxes Flashcards
Order for induction meds
versed fentanyl Lidocaine Rocuronium Propofol Sux
How much Roc do you give as fasciulating dose?
5-10 mg
When do you give epherdrine
low HR and BP
when do you give neo
high HR and low BP
B/c circulation is slow in elderly, what do you need to do?
give more time to work
other name for versed
midazolam
versed class
benzo agonist
versed CI
galucoma, pregnancy, lactation, CNS depression
Versed caution:
liver dysfunction; protease inhibtiors; elderly
Versed dose fo adults
2-5 mg IV
versed IM dose
0.007-0.08(?) mg/kg
versed IV induction dose?
0.1-0.2 mg/kg
Versed peds PO preop dose
0.5 mg/kg
versed peds PO max
20 mg
versed peds IM dose
0.05-0.1 mg/kg
versed peds IV doee
0.025-0.05 mg/kg
versed vial
2 mg or 5 mg vials
versed route
IV IM PO nasal rectal
Versed MOA
increases binding affinity for GABA. WHen GABA occupies the site, increased frequency of Cl- channel opening which results in postsynaptic membrane hyperpolarization
versed elimination
hepatic (mainly) and renal
versed half life
1.7-2.6 hours
versed onset
30-60 seconds
versed peak
2,8-5.6 minutes
versed doa
15-80 min
whats the most common preop med for peds pt?
versed
Versed is preferred drug for what pts b/c no active metabolites?
renal
other names for fentanyl
sublimaze
fentanyl vial
250mcg/5 mL
100 mcg/2mL
fentanyl class
phenylpiperdine-derivative synthetic opioid agonist
when do you reduce fentanyl?
elderly, hypovolemic, high-risk surgical pts, contaminant use of sedatives
does fentanyl cross placenta?
yes
Fentanyl w/ head injury causes what?
6-9 mmHg increase in ICP
low dose fentanyl
1-2 mcg/kg IV
large dose for surgical anesthesia of fentanyl
50-150 mcg/kg
fentanyl dose for induction
1.5-3 mcg/kg IV
intrathecal max dose of fentanyl
25 mcg
oral transmucosal fentanyl dose
5-20 mcg
transdermal dose of fentanyl
75-100 mcg
Dr. Hammon’s IVP of fentanyl
50-100 mcg
fentanyl routes
IV intrathecal transmucosal transdermal epidural nasal subaracnoid IM
fentanyl MOA
binds to Mu receptor (1&2), then couples to G proteins, causing membrane hyperpolarization.
How are opioid effects mediated w/ fentanyl?
by inhibtion of adenylyl cyclase (reductions in intracellular cAMP concentrations) and activation of phospholipase C
inhibit Ca channels
opioids blunt ____
SNS
how is fentanyl cleared?
dependent upon hepatic blood flow
how is fentanyl metabolzied?
by n-demethylation to inactive metabolites
and P450
how is fentanyl excreted?
kidneys
onset of fent
2-5 min
peak of fent
20-30 min or 3.5 min???
doa fent
30-60 min
IM fent onset
7-15. min
IM fent peak
20-30 min
doa IM fent
1-2 hr
transmucosal fent onset
5-15 m
peak transmucousal fent
20-30 m
fent epidural onset
20-30 m
doa epidural fent
2-3 hr
transdermal fent peak
18 hr
how much more potent is fentanyl than morphine?
75-125 x
even w/ large amount of opioids, some ___ must be added to anesthetic to prevent movement
hyponotic
how much fent undergoes 1st pass pulm intake?
75%
fentanyl is avidly taken up by what in the body?
fat
other name for propofol?
diprivan
prop vial
200 mg/20 mL
prop class
sedative hypnotic
caution w/ generic formula of prop in what pts?
asthmatic (b/c can cause bronchoconstriction)
mixing what 2 drugs increases PE risk?
lidocaine + prop
adult induction dose of propofol
1.5-2.5 MG/kg
adult maintenance dose of prop
100-300 mcg/kg/m
peds prop dose
2.5-3.5 MG/kg
why is a large dose of propofol required for peds pt?
larger central distribution volume and clearance rate
prop route
IV
prop moa
GABA agonist causes pre and post synaptic inhibition of Cl- channels, leads to increased duration of Cl- channel opening
prop protein bound %?
98% HIGH
how is prop metabolized?
hpeatic P450
how is prop excreted?
renal
prop: clearance from plasma ___ hepatic blood flow
>
elimination 1/2 T of prop
0.5-1.5 hr
do you have imparied elimnation of prop with renal disease?with liver disease?
no and no
prop onset
<1 min
prop peak
2.2 m
prop doa
15-45 min
awakening with prop
5-15 min
prop has what characteristics?
anticonvulsant
amnestic
decrease prop dose by what w/ elderly?
25-50%
what patients require decreased prop dose?
elderly
why do elderly pts require decreased prop dose?
decreased plasma clearance
what type of effect does prop have on smooth muscle?
relaxant
b/c of the relaxant effect of prop, it is good for what pts?
COPD
PHTN
prop cv effects: \_\_\_ BP \_\_\_ HR \_\_\_ SVR \_\_\_\_ CO
↓ BP
↓HR
↓SVR
↓CO
propofol can cause what respiratory effect?
resp depression
prop head effects
___ CBF
____ CMRO2
____ ICP
lowers all
propofol can cause what in peds?
propofol infusion sydnrome
propofol infusion syndrome presents as ___ in peds?
unexpected tachycardia
Propofol infusion syndrome is assoicated w/ what metabolic disorder?
lactic acidosis
propofol infusion syndrome is associated w/ fatal ___ in peds
bradycardia
other name for Roc
zumuron
Roc class
ND NMBD
Roc is what type of NMBD
steroidal
roc is ____ acting
intermediate
what percent of dose of Roc do you give for defasiculating doese?
10%
adult induction dose of roc
0.6-1.2 MG/kg
