N926 Pharmacology Final Exam Second Half Flashcards
MOA of Butorphanol
antagonism at mu receptor and antagonist at kappa receptor
MOA of nalbuphine
Antagonism at mu receptor
Nalbuphine is 1/4 antagonist of
morphine
Acetaminophen has both
analgesic and antipyretic properties
PK of Acetaminophen
metabolized in the liver
damage to liver results from N-acetyl-p-benzoquinonemine
liver failure by depleting gluthathione
Dose of Acetaminophen
325-600mg PO q6h
Total not to exceed 4000mg/24 hr
2000mg for chronic alcoholics
IV-1000mg q6h
Acetaminophen Anesthetic considerations
use in multimodal approach but not in liver patients
MOA of Ibuprofen
nonselective COX inhibitor
Dosing of Ibuprofen
200-800mg PO q4-6h
Anesthetic Considerations of Ibuprofen
use in multi-modal approach
Ketorolac is common
used for perioperatively
Dosing of Ketorolac
15mg IV q6h
Ketorolac must be avoided
in renally compromised patients
MOA of Celecoxib
Selective COX 2 inhibitor
Dosing of Celecoxib
400mg PO preoperatively
200mg BID x 5 days post op
Risks of Celecoxib
increased cardiovascular risk
When is Celecoxib used?
ERAS protocol
Part of multi-modal pain management; give in pre-op
MOA of Succinylcholine
Depolarizing neuromuscular blocked on nACHr
partial agonist
PK of Succinylcholine
low Vd d/t quaternary ammonium (polar molecule)
metabolized by PChE (succinylmonocholine and choline)
first order kinetics
PD of Succinylcholine
Neuro: increases ICP/ IOP
Cardiac: may cause bradycardia, tachycardia, ventricular dysrhythmias, and increased BP, junctional rhythm sinus arrest (action on muscarinic receptors)
Side Effects of Succinylcholine
increase K level by 0.5mg/dl
Risk for MH and don’t administer to children
increasing intragastic pressure (GERD pts)
Myalgias
masseter spasm
Dosing of Succinylcholine
1mg/kg of IBW
When can you intubate after administering Succinylcholine
60 seconds
Recover to 90% muscle strength of Succinylcholine
9-13 minutes
MOA of Atracurium
benzylisoquinium non-depolarizing NMD (antagonist)
PK of Atracurium
racemic mixture of 10 isomers
metabolized by ester hydrolysis and Hoffman elimination
(Laudanosine active metabolite implicated in convulsions)
non-liver dependent for metabolism, okay to use in liver pts
Small volume of distribution
PD of Atracurium
Histamine Release
May block peripheral nACHr causing bradycardia and hypotension
Dosing of Atracurium
0.5 mg/kg (intermediate acting onset)
MOA of Cisatracurium
Benzlisoquinium non-depolarizing NMBD (antagonist)
PK of Cisatracurium
cis isomer of atracurium
metabolized by Hoffmann elimination (good for liver and kidney patients)
Dose of Cisatracurium
0.1mg/kg (intermediate onset and action)
MOA of Pancuronium
Steroidal compoound nondepolarizing NMBD (antagonist)
PK of Pancuronium
deacetylated by liver
Accumulation of 3-OH metabolite prolongs block)
Cleared by Kidney
- don’t use in renal patient s
PD of Pancuronium
vagolytic (inhibits the vagus nerve/ blocks muscarinic receptors) and PChE-inhibiting properties
may block peripheral nAChR causing bradycardia and hypotension
Dose of Pancuronium
0.08mg/kg with onset time of 2.9 minutes (not for RSI)
MOA of Vecuronium
Steroid compound non-depolarizing NMBD (antagonist)
PK of Vecuronium
Pancuronium without quaternized methyl group (increased lipid solubility)
metabolized principally by the liver (3-deacteyl metbolite has 80% of neuromuscular potency)
PD of Vecuronium
May block peripheral nAcHr causing bradycardia and hypotension
Dose of Vecuronium
0.1mg/kg wiht onset time of 2.4 minutes
MOA of Rocuronium
Steroid compound non-depolarizing NMBD (antagonist)
PK of Rocuronium
Primarily utilized by the liver (approximately 30% excreted in the urine)
NMBD with highest risk of allergic reactions
PD of Rocuronium
see more histamine release d/t having to give larger doses
may block peripheral nAchr causing bradycardia and hypotension
Dosing of Rocuronium
0.6-1.2mg/kg with onset time of 1.7 minutes (six times less potent then veco)
MOA of Edrophonium
Cholinesterase Inhibitor
Reversal Dose of Edrophonium
1-1.5mg/kg
Side Effects of Edrophonium
bradycardia, hypotension, brochoconstriction, salivation, defectation
Onset of Edrophonium
30 sec-1min
MOA of Neostigmine
Cholinesterase inhibitor
Reversal Dosing of Neostigmine
0.06-0.08mg/kg
Side effects of Neostigmine
bradycardia, hypotension, brochoconstriction, salivation, defectation
Onset of Neostigmine
5-15 minutes
MOA of Ondanestron
5HT-3 antagonist
Dosing of Ondanestron
4mg IV (0.1mg/kg if less then 40kg)
When do you administer ondanestron?
30 minutes prior to wake up
MOA of Promethazine
Anti-histamine (H1 antagonist) and anticholinergic effects responsible for antiemetic activity
Dosing of Promethazine
12.5-25mg q4-6hr
MOA of Reglan
Dopamine Receptor antagoinst
Dosing of Reglan
20 mg for PONV
MOA of Atropine
anticholinergic
Indications of Atropine
bradycardia or to prevent side effects of AChE inhibitors
Side effects of Atropine
mydriasis, cycloplegia, dry mouth, difficulty swallowing, photophobia, tachycardia, dry skin, flushed increase body temp
neuro-sedative effects
Dosing of Atropine
0.015mg/kg
MOA of Glycopyrrolate
Anticholinergic
Indications of Glycopyrroalte
decrease secretions or to prevent side effects of AcHe inhibitor
Side effects of Glycopyrroate
mydriasis, cycloplegia, dry mouth, difficulty swallowing, photophobia, tachycardia, dry skin, flushed increase body temp
Dosing of Glycopyrroate
0.01-0.02mg/kg
MOA of Scopolamine
Anticholinergic
Indications of Scopolamine
PONV, pre-op sedation
Side effects of Scopolamine
cerebral depression, sedation amnesia
watch for anticholinergic poisioning
decreased secretions/ drying, bronchodilation
tachycardia
decreased motility, constipation, prolonged gatric emptying time
decreased ureter and bladder tone (urine retention)
dry mouth, increased thirst, dry skin, dizziness, blurred vision, dilated pupils, light sensitivity, mydrasis, cyclopegia
Dosing of Scopolamine
1.5 mg topical patch behind ear
Half life of Scopolamine
4.5 hrs
MOA of Dexamethasone
Synthesis of proteins and target cells containing enzyme 11-beta hydroxysteroid dehydrogenase
Stress Dosing of Dexamethasone
4-8 mg
MOA of Acetaminophen
central analgesic effect thru activation of serontonergic pathways and antagonism of NMDA, substance P and nitric oxide pathways.
1/2 Life of Acetaminophen
2-3 hours
1/2 Life of Ibuprofen
2-2.5hr
PK of Ibuprofen
oxidation
Ketorolac is an
acid
1/2 life of Ketorolac
2.5-8.5 hr
PK of Ketorolac
Protein Bound
Metabolized through conjugation
1/2 Life of Celecoxib
11-16 hours
PK of Celecoxib
rapid GI absorption
increased protein binding
conjugation
1/2 Life of Pancuronium
130 minutes
1/2 Life of Roc
70 minutes
1/2 Life of Vec
80 minutes
1/2 Life of Cistracurium
less then 1 hour
Elimination 1/2 Time of Atracurium
20 minutes
1/2 Life of Succinylcholine
45 seconds
1/2 Life of Glycopyrrolate
2-3hours
1/2 Life of Atropine
2-3 hours
1/2 Life of Edrophorium
30-120 mins
Onset of Edrophorium
30seconds to 1 min
1/2 life of neostigmine
1 hour
onset of neostigimine
5-15 minutes