Medication Drug Boxes Flashcards
1
Q
Order for induction meds
A
versed fentanyl Lidocaine Rocuronium Propofol Sux
2
Q
How much Roc do you give as fasciulating dose?
A
5-10 mg
3
Q
When do you give epherdrine
A
low HR and BP
4
Q
when do you give neo
A
high HR and low BP
5
Q
B/c circulation is slow in elderly, what do you need to do?
A
give more time to work
6
Q
other name for versed
A
midazolam
7
Q
versed class
A
benzo agonist
8
Q
versed CI
A
galucoma, pregnancy, lactation, CNS depression
9
Q
Versed caution:
A
liver dysfunction; protease inhibtiors; elderly
10
Q
Versed dose fo adults
A
2-5 mg IV
11
Q
versed IM dose
A
0.007-0.08(?) mg/kg
12
Q
versed IV induction dose?
A
0.1-0.2 mg/kg
13
Q
Versed peds PO preop dose
A
0.5 mg/kg
14
Q
versed peds PO max
A
20 mg
15
Q
versed peds IM dose
A
0.05-0.1 mg/kg
16
Q
versed peds IV doee
A
0.025-0.05 mg/kg
17
Q
versed vial
A
2 mg or 5 mg vials
18
Q
versed route
A
IV IM PO nasal rectal
19
Q
Versed MOA
A
increases binding affinity for GABA. WHen GABA occupies the site, increased frequency of Cl- channel opening which results in postsynaptic membrane hyperpolarization
20
Q
versed elimination
A
hepatic (mainly) and renal
21
Q
versed half life
A
1.7-2.6 hours
22
Q
versed onset
A
30-60 seconds
23
Q
versed peak
A
2,8-5.6 minutes
24
Q
versed doa
A
15-80 min
25
whats the most common preop med for peds pt?
versed
26
Versed is preferred drug for what pts b/c no active metabolites?
renal
27
other names for fentanyl
sublimaze
28
fentanyl vial
250mcg/5 mL
| 100 mcg/2mL
29
fentanyl class
phenylpiperdine-derivative synthetic opioid agonist
30
when do you reduce fentanyl?
elderly, hypovolemic, high-risk surgical pts, contaminant use of sedatives
31
does fentanyl cross placenta?
yes
32
Fentanyl w/ head injury causes what?
6-9 mmHg increase in ICP
33
low dose fentanyl
1-2 mcg/kg IV
34
large dose for surgical anesthesia of fentanyl
50-150 mcg/kg
35
fentanyl dose for induction
1.5-3 mcg/kg IV
36
intrathecal max dose of fentanyl
25 mcg
37
oral transmucosal fentanyl dose
5-20 mcg
38
transdermal dose of fentanyl
75-100 mcg
39
Dr. Hammon's IVP of fentanyl
50-100 mcg
40
fentanyl routes
```
IV
intrathecal
transmucosal
transdermal
epidural
nasal
subaracnoid
IM
```
41
fentanyl MOA
binds to Mu receptor (1&2), then couples to G proteins, causing membrane hyperpolarization.
42
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
43
opioids blunt ____
SNS
44
how is fentanyl cleared?
dependent upon hepatic blood flow
45
how is fentanyl metabolzied?
by n-demethylation to inactive metabolites
| and P450
46
how is fentanyl excreted?
kidneys
47
onset of fent
2-5 min
48
peak of fent
20-30 min or 3.5 min???
49
doa fent
30-60 min
50
IM fent onset
7-15. min
51
IM fent peak
20-30 min
52
doa IM fent
1-2 hr
53
transmucosal fent onset
5-15 m
54
peak transmucousal fent
20-30 m
55
fent epidural onset
20-30 m
56
doa epidural fent
2-3 hr
57
transdermal fent peak
18 hr
58
how much more potent is fentanyl than morphine?
75-125 x
59
even w/ large amount of opioids, some ___ must be added to anesthetic to prevent movement
hyponotic
60
how much fent undergoes 1st pass pulm intake?
75%
61
fentanyl is avidly taken up by what in the body?
fat
62
other name for propofol?
diprivan
63
prop vial
200 mg/20 mL
64
prop class
sedative hypnotic
65
caution w/ generic formula of prop in what pts?
asthmatic (b/c can cause bronchoconstriction)
66
mixing what 2 drugs increases PE risk?
lidocaine + prop
67
adult induction dose of propofol
1.5-2.5 MG/kg
68
adult maintenance dose of prop
100-300 mcg/kg/m
69
peds prop dose
2.5-3.5 MG/kg
70
why is a large dose of propofol required for peds pt?
larger central distribution volume and clearance rate
71
prop route
IV
72
prop moa
GABA agonist causes pre and post synaptic inhibition of Cl- channels, leads to increased duration of Cl- channel opening
73
prop protein bound %?
98% HIGH
74
how is prop metabolized?
hpeatic P450
75
how is prop excreted?
renal
76
prop: clearance from plasma ___ hepatic blood flow
>
77
elimination 1/2 T of prop
0.5-1.5 hr
78
do you have imparied elimnation of prop with renal disease?with liver disease?
no and no
79
prop onset
<1 min
80
prop peak
2.2 m
81
prop doa
15-45 min
82
awakening with prop
5-15 min
83
prop has what characteristics?
anticonvulsant
| amnestic
84
decrease prop dose by what w/ elderly?
25-50%
85
what patients require decreased prop dose?
elderly
86
why do elderly pts require decreased prop dose?
decreased plasma clearance
87
what type of effect does prop have on smooth muscle?
relaxant
88
b/c of the relaxant effect of prop, it is good for what pts?
COPD
| PHTN
89
```
prop cv effects:
___ BP
___ HR
___ SVR
____ CO
```
↓ BP
↓HR
↓SVR
↓CO
90
propofol can cause what respiratory effect?
resp depression
91
prop head effects
___ CBF
____ CMRO2
____ ICP
lowers all
92
propofol can cause what in peds?
propofol infusion sydnrome
93
propofol infusion syndrome presents as ___ in peds?
unexpected tachycardia
94
Propofol infusion syndrome is assoicated w/ what metabolic disorder?
lactic acidosis
95
propofol infusion syndrome is associated w/ fatal ___ in peds
bradycardia
96
other name for Roc
zumuron
97
Roc class
ND NMBD
98
Roc is what type of NMBD
steroidal
99
roc is ____ acting
intermediate
100
what percent of dose of Roc do you give for defasiculating doese?
10%
101
adult induction dose of roc
0.6-1.2 MG/kg
102
peds induction dose of roc
0.6-1.2 MG/kg
103
adult maintenance of roc
0.1-0.2 MG/kg
104
child maintenance of roc
0.08-0.12 mg/kg
105
roc route
IV
106
ROC moa
ND NMBD that acts as competitive antagonist that binds to the alpha subunits of nicotinic Ach receptors at postsynpatic membrane
107
roc elimination/excretion
liver/bile
108
is roc excreted at all in urine?
yes, 30%
109
onset of Roc
60-90 sec
110
peak of Roc
1-3 min
111
doa of roc
30-120 m
112
what prolongs Roc effect?
hepatic and renal disease
| elderly
113
does roc release histamine?
no
114
other names for Succ
anectine
| quelicin
115
succ vial
20 mg/mL
116
succ class
DEPOLARIZING(!!!) NMBD
117
what is suxx made up of?
2 Ach bound together
118
Suxx doa is classified as short, intermediate, or long?
short
119
avoid suxx in what pts?
```
hyperkalemia
burns
neuro injury
acute glaucoma
severe sepsis
prolonged immobilization
MH
duchenne
muscular dystrophy
```
120
What 2 things does sux increase?
ICP
| IOP
121
Age cut off for Sux
8 years
122
induction dose of sux
1 MG/kg
| 1-1.5
123
peds sux induction dose IV
1-2 MG/kg
124
peds sux induction dose IM
2-4 MG/kg
125
what is a sux dart?
1 mL atropine
| 2mL Sux
126
Time period in which sux can be given?
MUST WAIT 5 MINTUES BEFORE REPEAT dose
127
If you give Sux <5 minutes after previous dose, what happens?
profound bradycardia and asystole
128
how do you treat sux induced bradycardia?
0.4-0.6 MG atropine
129
Sux route
IV
| IM
130
SUx moa
depolarizes endplate region that desensitized nicotinic Ach receptors; inactives Na channels at NMJ, and increases K+ permeability
131
how is Suxx eliminated?
plasma cholinesterase through hydrolysis
132
Sux half life
47 seconds
133
onset sux
30-60 sec
134
peak sux
60 sec
135
doa sux
5-15 m
136
sux has what effect on which electrolyte?
increase K by 0.5
137
Sux can produce what common s/e?
muscle fasciculations
138
Sux w/ young kids can cause what?
CA
139
other names for morphine?
MS contin
Duramorph
Astramorph
140
morphine class
opioid
141
morphine cuastions:
elderly
hypovolemic
high-risk surgery
142
Can morphine cross placenta?
yes
143
morhpine IV dose
2.5-15 mg
144
morphine IM dose
2.5-20 mg
145
morphine PO dose
15-30 mg Q4H
146
Morphine rectal dose
5-20 mg Q4H
147
morhpine induction dose
1 MG/kg
148
morphine epidural bolus
2-5 MG
149
morphine epidural infusion
0.1-1 MG/hr
150
morphine spinal dose
0.2-1 MG
151
morphine peds IV dose
0.05-0.2 MG/kg
152
morphine peds IM dose
0.1-0.2 MG/kg
153
morhpine route
```
IM
SQ
IV
PO
inhaled
epidural
spinal
```
154
morphine moa
binds to Mu and acts as agonist; increases threshold to pain and modifies the perception of noxious stimuli
155
morhpine metabolism
conjugation with glucuronic acid in hepatic/extrahepatic sites, esp. kidneys
156
morphine excretion
urine (10% bile)
157
morphine IM onset
15-30m
158
morphine IV onset
immediate
159
morphine PO onset
<60 m
160
morphine epidural/spinal onset
1-60 m
161
morphine IM peak
45-90 m
162
morphine IV peak
15-30 m (or 90 m ??)
163
morphine epidural/spinal doa
24 hr
164
morphine IV/IM/SQ doa
2-7 hr
165
what increases the nonionized fraction of morphine?
hyperventilation and alkalinization of blood
166
CNS/CV depressant effects of morphine are potentiated by what?
```
alcohol
sedatives
antihistamines
phenothiazines
MOAIs
TCA
```
167
morphine releases what?
histamine
168
morphine reversal
naloxone
169
other name for Vec
norcuron
170
how do you prepare Vec?
reconstitute
171
Vec vial
10 or 20 mg
172
Vec class
ND NMBD
173
avoid Vec in what pts?
hepatic failure
174
Vec adult induction dose
0.1 MG/kg
175
Vec adult mainteance dose
0.8-1 mcg/kg/min
176
Vec neonate dose
47 mcg/kg
177
Vec infant dose
42-47 mcg/kg
178
Vec child dose
56-80 mcg/kg
179
Vec routes
IV
180
Vec MOA
comeptes w/ Ach for cholinergic receptor sites and binds w/ the nicotinc cholinergic receptor at postjunctional membrane
181
Vec excretion/metabolism?
renal and hepatic
182
Vec onset
1-3 m
183
Vec peak
2.4 m
184
Vec doa
30-60 m
185
Cisatracurium names
Nimbex
186
Cisatracurium vials
10 mg/5mL
20 mg/10 mL
200 mg/20 mL
187
What type of NMBD is Cisatracurium?
benzyl
188
Cisatracurium class
ND NMBD
189
which one is. more potent atracurium or cisatracurium?
cisatracurium
190
how much more potent is cisatracurium than atracurium?
4-5x
191
how is cisatracurium cleared?
hoffmans mostly
192
caution w/ cisatracurium in what pts?
NM diseases, MG, myasthenic syndrome, GB
193
nimbex dose for paralysis
0.05 MG/kg (50 mcg/kg)
194
nimbex intubating dose
0.1 MG/kg
195
infant nimbex dose
43 mcg/kg
196
child nimbex dose
41 mcg/kg
197
nimbex routes
IV
198
nimbex MOA
binds to nicotinic cholinergic receptor at muscle motor end plate; competitive antagonist for ach
199
how is nimbex eliminated?
hofmanns and nonspecific esterase hydrolysis
200
does nimbex release histamine
NO
201
pros to nimbex and atricurium elimination
non-organ dependent which is good for hepatic and renal disease
202
nimbex onset
2-4 m
203
onset of nimbex is faster in what pt population?
infates and kids
204
nimbex peak
3.1 min
205
nimbex doa
30-60 m
206
nimbex is classifed as a short, intermediate, or long acting NMBD?
intermediate
207
what NMBD is gent of choice in pts with renal and liver disease?
Nimbex/cisatracurium
208
what are advantages of Nimbex use?
CV stability
non-organ dependent elimination
lack of histamine release
209
Nimbex use in the elderly?
doa is not affected, making it the most predictable for elderly
210
Can Suggamadex reverse nimbex?
no
211
Can suggamadex reverse Roc?
yes
212
Does nimbex trigger MH?
no
213
what is lidocaines class?
amide LA
| Class 1B antiarrhythmic
214
lidociane is IC w/ what?
sinus brady
hypokalemia
severe CKD
heart block
215
Caution w/ Lidocaine when?
liver dysfunction
216
Initial administration of Lidociane
2 MG/kg IV
217
continuous infusion of Lidocaine
1-4 MG/min
218
Lidcaoine routes
```
topical
SQ
IV
PNB
epidural
spinal
```
219
Lidocaine MOA
block Na ion current, reduce excitablity of NEURONAL, CARDIAC, and CNS tissue
220
where is lidocaine metabolised
liver
221
Is lidocaine excreted renally?
no ??? <5%
222
lidocaine onset
45-90 sec
223
lidocaine peak
10-20 m
224
lidocaine peak for infiltration
30 m
225
lidocaine peak epidural
1-2 m
226
lidocaine doa
30 m - 4 hr
227
what does lidocaine prevent during induction?
laryngeal spasm and gag reflex
228
Why is lidocaine used during induction?
blunts gag reflex
prevents laryngreal spasm
decreases prop's burn
229
what patient population has an increased sensitivity to lidocaine?
Pregnant
230
When is elimination 1/2 T of Liodciane increased?
liver dysfunction
231
Liver dysfunction can increase 1/2T of Lidocaine by what amount?
5x
232
Lidocaine has ________ properties.
intrinsic vasodilator
233
other name for etomidate
amidate
234
etomidate class
sedative/hypnotic
235
caution etomidate
history of seizures and/or focal epilepsy
236
What might induce cardiac depression in elderly pt w/ hypotensino?
etomidate
237
Etomidate suppresses what?
adrenocortical
238
How does etomidate cause adrenocorticol suppression?
produces a dose-dependent inhibition of cholesterol to cortisol
239
Avoid etomidate in what pts?
sepsis
hemorrhage
or any who require intact cortisol resposne
240
etomidate dose
0.2-0.4 MG/kg IV
241
etomidate routes
iV
242
where does the anesthetic effect of etomidate come from?
R (+) isomer
243
etomidate - which isomer is more potent?
R (+)
244
how much more potent is the R isomer of etomidate than the S?
5x
245
Etomidate moa
relatively selective GABA modulator; site of action is GABAa
246
etomidates gaba effects are where?
gaba A
247
how is etomidate metaolibzed?
ester hydrolysis in the liver and plasma
248
what is etomidate metabolized into?
inactive carboxylic acid metabolites
249
etomidate onset
30 sec
250
etomidate peak
1 m
251
etomidate doa
5-15 m
252
etomidate cerebral effects?
direct cerebral vasoconstrictor
253
Etomidate:
| ____ CBF and CMRO2
decresaes by 35-45%
254
Etomidate produces what on an EEG?
pattern of excitatory spikes
