Meds Flashcards
Isoflurane boiling point
48.5 *C
Isoflurane vapor pressure
238 mmHg
Isoflurane Blood:Gas coefficient
1.4
Isoflurane Oil:Gas coefficient
90.8
Isoflurane MAC
1.15
Isoflurane MAC-awake
0.49
Isoflurane MAC-BAR
1.3
Des fluorine molecular weight
168
Desflurane boiling point
23.5 *C
Desflurane vapor pressure
664 mmHg
Desflurane blood:gas coefficient
0.42
Desflurane oil:gas coefficient
18.7
Desflurane MAC
6%
Desflurane MAC-awake
2.5%
Desflurane MAC-BAR
1.3%
Sevoflurane molecular weight
200
Sevoflurane boiling point
58.5 *C
Sevoflurane vapor pressure
160 mmHg
Sevoflurane blood:gas coefficient
0.69
Sevoflurane oil:gas coefficient
47.2
Sevoflurane MAC
1.7%
Sevoflurane MAC-awake
0.62
Sevoflurane MAC-BAR
2.2
N2O Molecular Weight
44
N2O boiling point
-88 *C
N2O vapor pressure
39,000 mmHg
N2O blood:gas coefficient
0.47
N2O oil:gas coefficient
1.4
N2O MAC
104%
N2O MAC-Awake
0.68
Thiopental sodium (Pentothal) induction dose
3-5 mg/kg
Thiopental sodium (Pentothal) half life?
3-8 hours
Methohexital (brevital) induction dose
1-1.5 mg/kg
What receptor do barbiturates act on?
GABAa receptors
Etomidate induction dose?
0.2-0.3 mg/kg
What is a big draw back of etomidate?
Suppresses cortical adrenals leading to suppression of intrinsic steroid production.
What are some properties of Methohexital (Brevital)?
Ultra short acting, rapid redistribution, highly protein bound, very lipid soluble
If a drug is highly lipid soluble, will it have a faster or slower onset of action?
Faster
What is one downfall to Methohexital (brevital)?
Hangover effect
What type of drug is etomidate?
Non-barbiturate hypnotic
What are some properties of etomidate?
Highly lipid soluble, undergoes redistribution but rapid return to baseline
What side effect does etomidate have?
Can cause extra pyramidal movements due to the dis inhibitory effect on sub cortical structures - can cause myoclonus. Can also cause PONV
What type of drug is propofol?
2,6 diisoporopyl pheno
What are some properties of propofol?
Ultra short acting, rapidly cleared, highly lipid soluble
How is propofol metabolized?
Cytochrome P450 sx to 4-hydroxyl propofol (active) then glycerin ideation or sulfation. Clearance exceeds hepatic blood flow implying an extra hepatic mechanism that is not yet identified (pulmonary?)
What type of drug is ketamine?
Phencycidine (PCP) derivative
What are some properties of ketamine?
Slow onset, can be used for preemptive analgesia
Where does ketamine work?
Thalamus and limbic systems - no competitive antagonist at NMDA receptor.
What are some side effects of ketamine?
- Increased airway secretions
- dissociative hypnotic, vivid dreams, hallucinations possible
What are some possible benefits of ketamine?
Increases CPP via increases in MAP, bronchodilator
What type of drug is dexmedetomidine (preceded)?
Selective A2 agonist
How does dexmedetomidine work?
Decreases presynaptic NE levels (central), hyper polarizes post synaptic neural membranes (peripheral)
What is the loading dose of precedex?
1 mcg/kg given over 30 minuets
What is the infusion dose for precedex?
0.2-0.7 mcg/kg/hr
Thiopental distribution half life
2-4 min
What is the elimination half life of thiopental?
10-12 minutes
What is the clearance for thiopental?
3.5 ml/kg/min
What is the volume of distribution for thiopental?
2.5 L/kg
What is the protein binding for thiopental?
80%
What is the distribution half life for Methohexital?
5-6 min
What is the elimination half life for Methohexital?
2-4 min
What is the clearance rate of Methohexital?
10 ml/kg/min
What is the volume of distribution for Methohexital?
2.3 L/kg
What is the protein binding for Methohexital?
85%
What is the distribution half life for diazepam?
10-15 min
What is the elimination half life for diazepam?
20-50 min
What is the clearance rate for diazepam?
0.3 ml/kg/min
What is the volume of distribution for diazepam?
0.8-1.3 L/kg
What is the protein binding for diazepam?
98%
What is the distribution half life of midazolam?
7-15 min
What is the elimination half life of midazolam?
2-4 min
What is the clearance rate of midazolam?
7-11 ml/kg/min
What is the volume of distribution of midazolam?
1-1.7 L/kg
What is the protein binding of midazolam?
94%
What is the distribution half life of etomidate?
2-4 min
What is the elimination half life of etomidate?
2-5 min
What is the clearance rate of etomidate?
22.5 ml/kg/min
What is the volume of distribution for etomidate?
2.4-4.5 L/kg
What is the protein binding of etomidate?
75%
What is the distribution half life of propofol?
2-4 min
What is the elimination half-life of propofol?
1-5 min
What is the clearance rate of propofol?
25 ml/kg/min
What is the volume of distribution of propofol?
2-6 L/kg
What is the protein binding for propofol?
98%
What is the distribution half-life if ketamine?
11-17 min
What is the elimination half-life of ketamine?
2-3 min
What is the clearance rate of ketamine?
14.5 ml/kg/min
What is the volume of distribution for ketamine?
2.5-3.5 L/kg
How much of ketamine is protein bound?
12%
What is the induction dose of thiopental?
2-4 mg/kg
What is the induction dose of Methohexital?
1-2 mg/kg
What is the induction dose of etomidate?
0.2-0.3 mg/kg
What is the induction dose for propofol?
1-2.5 mg/kg
What is the induction dose of ketamine?
0.1-0.2 mg/kg
What is the induction dose of midazolam?
0.1-0.2 mg/kg
Of the 3 bentos, what is the shortest acting?
Midazolam
Of the 3 benzos, which is the longest acting?
Diazepam
Of the 3 benzos, which is the intermediate acting?
Lorazepam
What are some key points of midazolam?
- highly lipid soluble
- Rapid onset
- short duration of action due to lipid solubility
- Rapid redistribution
- hepatic bio transformation
What receptor does midazolam act on to produce sedation?
GABA
Opioids act at which receptor?
Mu1 receptors
Are opioids act as agonists or antagonists at receptor to provide analgesia?
Agonists
What are the side effects at mu2 receptors?
- respiratory depression
- Brady cardia
- Dependence
- Illeus
What do analgesics do?
Provide pain relief, blunt autonomic response to stress, produce CNS depression
What are some properties of ketorolac?
- inhibits prostaglandins
- 30 Times more potent than morphine
- Antiplatelet effects
What type of drug is ketorolac?
NSAID
What type of drugs are nalbuphine and butorphanol? What do they do?
Mixed agonist/antagonist.
- Agonist at kappa
- antagonist at mu
What do opioids do to the CO2 curve?
Shifts it to the right - causes less response to increases in CO2
Which is a more reliable form of amnesia and anesthesia between opioids and benzos?
Benzos
What are some other opioid properties/side effects?
- increase PONV
- decreased CBF and ICP
Histamine release is caused with which opioid?
Morphine
Which drug is 100 times as potent as morphine?
Fentanyl
Compared to morphine, does fentanyl have a faster or slower onset of action?
Faster because it’s more lipid soluble
Compared to morphine does fentanyl have a longer or shorter duration of action?
Shorter
Between fentanyl and morphine, which has the narrower therapeutic index?
Morphine
What are some side effects of fentanyl?
Truncal rigidity and bradycardia
Which drug is 10 times as potent as fentanyl and why?
Sufentanil - higher affinity for receptor
Is Sufentanil more or less lipid soluble than fentanyl? What does this mean?
More lipid soluble - faster onset and shorter duration
Does sufentanil of fentanyl have a wider therapeutic index?
Sufentanil
What are side effects of sufentanil?
Bradycardia and truncal rigidity
Which drug is 1/5-1/10 the potency of fentanyl? Why?
Alfentanil - low affinity for receptor
What is the onset of action of alfentanil?
Very rapid (1-2 min)
How much of alfentanil is unionized? What does this mean?
90%, allows it to rapidly cross the BBB
What allows alfentanil to have 1/3 as quick of a duration of action compared to fentanyl?
Because of the rapid redistribution and hepatic clearance
What is the onset of action, peak and duration of ketorolac?
Onset - 45-60 min
Peak - 1-2 hours
Duration 4-6 hours
How is ketorolac metabolized?
Glucagon if acid conjugation in the liver
How much of ketorolac is protein bound?
99%
Where is ketorolac eliminated?
Kidneys
What does ketorolac do to platelets?
Inhibits platelet thromboxane production via inhibition of prostaglandin synthesis
What can ketorolac cause in those sensitive to ASA?
Severe bronchospasm.
Ketorolac can cause renal insufficiency, how?
Inhibits synthesis of renal prostaglandins
What can be done to help prevent renal impairment when giving ketorolac?
Adequate fluid resuscitation.
Ages 16-64, what is the dosing of ketorolac? Max dose?
30 mg IV, IM or PO q 6 hours, not to exceed 120 mg/24 hours and not to exceed 5 days
Ages greater than 64 ketorolac dosing? Max dose?
15 mg IM, IV, or PO q 6 hours, not to exceed 60 mg/day for 5 days
Isoflurane molecular weight
184.5
