Medications Flashcards
Q: What are the equivalent doses for oral Opioids [?]
- Hydromorphone (Dilaudid) 1 mg PO. ( PO/IV 5/1)
- Oxycodone 2.5 mg PO
- Morphine 5 mg PO. ( PO/IV 3/1)
- (Empracet) Codeine 30 mg PO
HOME is 1, 2.5, 5, 30; IV/SQ doses are generally half
Q: Conversion of Morphine to Fentanyl patch [?]
1- Calculate the total 24h morphine dose (or morphine equivalent)
2- Divide by 2
3- Fentanyl patch = mcg/h
- Ex. Morphine 50mg PO = Fentanyl patch 25mcg/h
As per emedicine:
(i) Calculate total 24h morphine dose
(ii) divide by 100 (100x potency of fentanyl)
(iii) divide by 24h ( to convert to mcg/h)
(iv) reduce dose by 25-50% due to incomplete cross toleranace
Q: Calculation for Breakthrough Opioids doses [?]
- Prescribe 10% of the Total Daily Dose q1h
- When using Fentanyl, calculate 10% for the Breakthrough dose of Morphine SQ q1h, or multiply by 2 for Morphine PO q1h
- For Fentanyl 25 mcg/h, Breakthrough = Morphine 2.5 mg SQ or 5 mg PO q1h
Q: Calculation for Long-Acting Opioids [?]
Add up Total Daily Opioid Dose including Regular and Breakthrough, and divide by 2;
Prescribe L.A. form q12h
Q: What are the equivalent doses for Steroids and Half Life [?]
ED. HL
Dexamethasone (Decadron) 0.75mg 48h
Triamcinolone (Kenalog) 4mg 24h
Methylprednisone (Solumederol) 4mg 24h
Prednisone/Prednisolone 5mg 24h
Hydrocortisone (Solycortef). 20mg 12h
Cortisone. 25mg 12h
Q: Thirteen Side effects of corticosteroids [?]
- Behavioral disturbances
- Acne
- Hirsutism
- Cataracts
- Central obesity/Cushingoid habitus
- Osteoporosis
- Avascular necrosis of the hip
- Hyperglycemia
- Electrolyte disturbances
- Glycosuria
- Fluid imbalance
- Hypertension
- Susceptibility to infections
- Peptic ulcer disease
Q: Interferons: Actions, types, and SE [?]
- Immunomodulatory secretory proteins:
- Antitumor cytotoxicity
- Inhibition of cell proliferation
- Gene activation (p53)
- Modulation of cell surface antigens
- Stimulation of other cytokines and immune modulator
- Immune cell activation
- Decrease permeability of cell membrane to virus penetration
*Type 1: IFN-α (produced by leukocytes) and IFN-ß (produced by connective tissue cells)
- Production is stimulated by viral infection or exposure or dsRNA
- Anti viral effects → decreased viral replication, increase cell membrane proteins,
decreased lymphocyte mitogenesis
*Type 2: IFN-γ (produced by T-lymphocytes)
- Production stimulated by antigenic stimuli
- More potent immunomodulatory effect → increased cell membrane antigen
expression (MHC1, MHC2, Fc receptors)
*Side Effects:
- Early constitutional – Fatigue, headache, nausea, fever, chills
- Delayed – Leukopenia, alopecia, neurotoxicity, polymyalgia, arthralgia, growth
retardation
-Rare – Spastic diplegia
Q: Name 8 topical decongestants [?]
- Epinephrine
- Phenylephrine
- Oxymetazoline
- Xylometazoline ( MOA: alpha-1 adrenergic receptor agonist acting as a sympathomimetic with vasoconstriction)
- Cocaine
- Naphazoline
- Tetrahydrozoline
- Propylhexedrine
Q: Name 3 systemic decongestants [?]
- Phenylephrine
- Pseudoephedrine
- Phenylpropanolamine
Q: Discuss the three Belladonna derivatives [?]
1- Scopolamine, Glycopyrrolate, Atropine
2- Antimuscarinics
- Scopolamine & glycopyrrolate potent anti-sialogogues
- Atropine the most vagolytic, produces greatest increase in HR
Q: Name 3 augmented penicillins [?]
- Clavulanate = amoxicillin + clavulanic acid
- Tazobactam = part of the Pip/Tazo family
- Sulbactam: irreversible inhibitor of beta=lactamase
Q: Name 4 antibiotics which can cross the blood-brain barrier [?]
- Ampicillin: broad spectrum penicillin (gram neg+ pos coverage); bacteiocidal - Ceftriaxone: 3rdG cephalosporin
- Flagyl: anerobic coverage
- Chloramphenicol
Q: What are the genetic mechanisms for antimicrobial resistance (4)[?]
1-Reduced intracellular accumulation of Abx
- Decreased influx/permeability of antibiotic
- Increased efflux (active) of antibiotic
2- Inactivation or modification of Abx by bacterial enzymes
3- Alterations of antibiotic target site → reduction in binding capacity
4-Modification of metabolic pathways to circumvent antibiotic effects/target amplification
Methods:
- Vertical evolution: mutation of preexisting genes
- Horizontal gene transfer: acquire new genes from other strains or species
Q: What are the contraindications to Ciprofloxacin [?]
- Allergy
- Concurrent use of tizanidine (Increase concentrations)
- Older patients
- Children
- Pregnancy
- Seizure disorders
- Organ transplant
- Steroid Use
- Renal failure
- MG
- Prolonged QT interval
Q: Mechanism of action for Ciprofloxacin [?]
- DNA gyrase (topoisomerase II and IV) inhibitor → inhibit cell division
Q: Name 5 Ester anaesthetics and metabolism [?]
Metabolized by (i)plasma and (ii) liver cholinesterases Decreased local uptake vs amide anaesthetics
- Cocaine (inhibits NE and dobutamine)
- Procaine
- Tetracaine
- Benzocaine
- Chloroprocaine
Q: Name 7 Amide anasthetics and metabolism [?]
Metabolized via liver dealkylation
- Bupivicane
- Prilocaine (causes methemoglobinemia with doses > 600mg)
- Ropivicaine
- Dibucaine
- Mepivicaine
- Etidocaine
Q: (LK) What are the maximum dosages of local anaesthetics (and durations) [?]
Q (DO): Calculating Local anaesthetic concentration, amounts, etc…?
- Lidocaine 1% = 1g/100cc = 10mg/cc
- Lidocaine 2% = 2g/100cc = 20mg/cc
- Epinephrine 1:100 000 = 1000mg/100 000cc = 0.01mg/cc
Q: Ingredient in Hurricaine spray [?]
20% benzocaine in polyethylene glycol base
Q: Contents of EMLA [?]
- Eutiectic mixture of local anaesthetics
- Emulsified Prilocaine and Lidocaine, reliability increases if applied for >1hr
Q: Mechanism of action of miscillaneous medications
Q: Xylocaine toxicity (plasma level), effect [?]
- CNS stimulation (3mcg/mL)
- CNS depression (5mcg/mL)
- Cardiovascular depression (8mcg/mL)
Q: 5 measure in initial management of xylocaine toxicity
- Maintain ventilation
- Give oxygen
- Place IV
- Fluids/pressors PRN
- Anti-seizure meds (diazepam) PRN
