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Clinical Meds > Neuraxial Drugs > Flashcards

Neuraxial Drugs Flashcards

1
Q

What opioids (with respective doses) are often used in spinal anesthesia?

A
  • Morphine 100 - 400 mcg
  • Fentanyl 10 - 25 mcg
  • Sufentanil 2.5 - 10 mcg
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2
Q

What opioids (with respective doses) are often used in epidural anesthesia?

A
  • Morphine 3 - 5 mg
  • Fentanyl 50 - 100 mcg
  • Sufentanil 10 - 25 mcg
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3
Q

How is neuraxial pruritis treated?

A
  • Diphenhydramine 25 - 50 mg IV
  • Naloxone 0.1 mg IV (best but reverses pain control)
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4
Q

How is neuraxial pruritis prevented?

A
  • Minimize morphine dose
  • Ondansetron 4 mg IV
  • Nalbuphine 2.5 - 5 mg IV
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5
Q

Morphine doses of < 100mcg will have a lower incidence of _______.

A

PONV

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6
Q

What is the epi wash dose?
Why is it used?

A
  • 0.2 - 0.3 mg
  • Used to prolong duration of neuraxial medication.
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7
Q

What is the neo wash dose?

A

2 - 5 mcg

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8
Q

What drug exhibits a much more profound increase in duration when vasopressors are used with it?

A

Tetracaine

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9
Q

What is the neuraxial dose of clonidine?

A

15 - 45 mcg

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10
Q

What is the neuraxial dose of dexmedetomidine?

A

3 mcg

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11
Q

What is the dose for lipid rescue?

A

1.5 mL/kg bolus
0.25 mL/kg gtt

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12
Q

What dose of caffeine is given for PDPH?

A

300 - 500mg PO or IV

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13
Q

Local Anesthetic Dosing/ Duration Chart

A
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14
Q

Name the dosage of the following adjunct agent for a spinal block:

Morphine
Fentanyl
Sufentanil

A
  • Morphine 100-400 mcg (24 hrs)
  • Fentanyl 10-25 mcg
  • Sufentanil 2.5-10 mcg
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15
Q

Name the dosage of the following adjunct agent for an epidural block:

Morphine
Fentanyl
Sufentanil

A
  • Morphine 3-5 mg (24 hrs)
  • Fentanyl 50-100 mcg
  • Sufentanil 10-25 mcg

Higher doses required when given by the epidural route

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16
Q

What are the treatments for pruritus from neuraxial opioids?

A
  • Benadryl 25-50 mg IV
  • Naloxone 0.1 mg IV (best)
  • Buprenex (mixed agonist/antagonist)

Although Naloxone is the best treatment for pruritus, it will also reverse the analgesic properties of the opioid resulting in the patient being in pain.

17
Q

What are prophylactic managements for pruritus from neuraxial opioids?

A
  • Minimize the dose of morphine to < 300 mcg
  • Ondansetron 4 mg IV
  • Nubain 2.5-5.0 mg IV
18
Q

Neuraxial opioids can be reversed with what medication?

A
  • Naloxone 0.1-0.2 mg
19
Q

PONV from neuraxial opioids is very dose-dependent. What is the recommended neuraxial dose of morphine?

A
  • < 300 mcg
  • At less than 100 mcg N/V will almost be absent
20
Q

What is the treatment for PONV from neuraxial opioids?

A
  • Ondansetron (5 HT antagonist) 4-8 mg
  • Naloxone 0.1 mg
  • Phenergan 12.5- 25 mg IM
21
Q

What is the dose for an “epi wash”?
What is the dose for a “neo wash”?

A
  • Epinephrine 0.2 - 0.3 mg
  • Neosynephrine 2-5 mcg
22
Q

If a craniotomy requires a trans-ethmoidal approach, what medication can be given to prevent the VX Mechansim?

A
  • Glycopyrrolate, Rubinol (↑ HR)
23
Q

α2-adrenergic agonist neuraxial dosage
Clonidine
Dexmedetomidine

A

α2-adrenergic agonist neuraxial dosage
Clonidine 15-45 mcg
Dexmedetomidine 3 mcg

24
Q

Opioid neuraxial dosage
Morphine
Fentanyl
Sufentanil

A

Opioid neuraxial dosage
Morphine 0.1-0.4 mg
Fentanyl 10-25 mcg
Sufentanil 2.5-10 mcg

25
Q

Vasoconstrictor neuraxial dosage
Epinephrine
Phenylephrine

A

Vasoconstrictor neuraxial dosage
Epinephrine 0.2-0.3 mg
Phenylephrine 2-5 mcg

26
Q

Dosing of Hyperbaric SAB in Non-Obstetric Patient

T4:
T10:
Sacral Level:

A

Dosing of Hyperbaric SAB in Non-Obstetric Patient

T4: 2 mL (usually 0.75% bupivacaine)
T10: 1.5 mL
Sacral Level: 1 mL

27
Q

The estimated ED50of hyperbaric bupivacaine with or without opioids ranged from ________.

A
  • 4.7 mg to 9.8 mg.
28
Q

The calculated ED95 of hyperbaric bupivacaine with or without opioids ranged from _________.

A
  • 8.8 mg to 15 mg.
29
Q

What are ways to prevent shivering from neuraxial anesthesia?

A
  • Ondansetron 4-8 mg
30
Q

__mL of epidural anesthetic should be given as an incremental dose to avoid high spinals, sympathectomy, etc.

A

5

31
Q

1mEq for every 10mL of anesthetic of this drug can be given to speed up onset of action of said anesthetic.

A

Na⁺HCO₃⁻

Sodium Bicarbonate

Clinical Meds (5 decks)

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