Pharm 6-10 (Etomidate, Furosemide, Rocuronium, Succinylcholine, Vecuronium)

Question 1

Etomidate (Amidate): Class?

Answer 1

Class: Anesthetic, hypnotic

Question 2

Etomidate (Amidate): Action?

Answer 2

Action: Etomidate is a very potent drug that acts on the central nervous system to produce a short-acting anesthesia with amnesic properties. Etomidate has very little effect on respiratory drive which makes it ideal for certain procedures.

Question 3

Etomidate (Amidate): Indication?

Answer 3

Indications: Premedication prior to procedures such as endotracheal intubation, synchronized cardioversion, conscious sedation for bone dislocation relocation.

Question 4

Etomidate (Amidate): Contraindication?

Answer 4

Contraindications: 1. Hypersensitivity 2. Labor and delivery

Question 5

Etomidate (Amidate): Onset/Duration?

Answer 5

ONSET: < 1 min
DURATION: 5-10 min

Question 6

Etomidate (Amidate): Dose/Route?

Answer 6

ADULT: 0.3mg/kg IV over 30-60 sec, limited to one dose
PEDS: 0.3mg/kg IV over 30-60 sec with a max dose of 20 mg

Question 7

Etomidate (Amidate): Side effects?

Answer 7

1. Hypotension 2. Hypertension 3. Dysrhythmias 4. Hypoventilation 5. Nausea/vomiting 6. Cortisol suppression

Question 8

Etomidate (Amidate): Notes?

Answer 8

Primarily used for Rapid Sequence Intubation/induction (RSI) in the prehospital setting

Question 9

Furosemide (Lasix): Class?

Answer 9

Class: Loop diuretic

Question 10

Furosemide (Lasix): Action?

Answer 10

Action: Furosemide is a potent diuretic that inhibits the reabsorption of sodium and chloride in the proximal tubule and loop on Henle. IV doses can also reduce cardiac preload by increasing venous capacitance.

Question 11

Furosemide (Lasix): Indications?

Answer 11

Indications: Pulmonary edema (CHF) with SBP > 90, hypertensive emergencies, hyperkalemia

Question 12

Furosemide (Lasix): Contraindications?

Answer 12

Contraindications: Anuria, hypersensitivity, hypovolemia, hypokalemia

Question 13

Furosemide (Lasix): Onset/Duration?

Answer 13

ONSET: 15-20 min IV
DURATION: 2 hrs

Question 14

Furosemide (Lasix): Dose/Route?

Answer 14

ADULT: 20-40 mg IV over 1-2 min. If no response double dose up to 2 mg/kg over 1-2 min. Most services allow up to a max of 40-80 mg IV.
PEDS: 1 mg/kg/dose IV over 1-2 min with a total max of 6 mg/kg

Question 15

Furosemide (Lasix): Side effects?

Answer 15

Side effects: Tinnitus and hearing loss (if given too quickly), hypotension, hypokalemia, hyponatremia, hypocalcemia, hyperglycemia

Question 16

Furosemide (Lasix): Notes?

Answer 16

Note: Must give slowly or may cause permanent hearing problems.

Question 17

Rocuronium (Zemuron): Class?

Answer 17

Class: Nondepolarizing neuromuscular blocker

Question 18

Rocuronium (Zemuron): Action?

Answer 18

ACTION: Rocuronium competitively blocks acetylcholine at the neuromuscular junction, resulting in chemical paralysis. An increased initial dose of rocuronium causes a rapid onset of chemical paralysis, similar to succinylcholine (R has a longer duration of action than does S, but has fewer problematic side effects).

Question 19

Rocuronium (Zemuron): Indication?

Answer 19

INDICATIONS: 1. Chemical paralysis for airway placement 2. Ongoing chemical paralysis for mechanically ventilated patients

Question 20

Rocuronium (Zemuron): Contraindication?

Answer 20

CONTRAINDICATIONS: 1. Hypersensitivity 2. Consider risk versus benefit in patients with anticipated difficult/failed airways or chronic neuromuscular conditions.

Question 21

Rocuronium (Zemuron): Onset/Peak/Duration?

Answer 21

ONSET: 1 minute
PEAK: 4 minutes
DURATION: 26-40 minutes

Question 22

Rocuronium (Zemuron): Dose/Route?

Answer 22

ADULT: 0.6-1.2 mg/kg IV; often ordered as 1 mg/kg initially, then 0.5 mg/kg for subsequent doses.
PEDS: Considered off label for rapid-sequence induction despite numerous successful studies. 0.9-1.2 mg/kg; often ordered as 1 mg/kg (max 100 mg), then 0.5 mg/kg for subsequent doses.

Question 23

Rocuronium (Zemuron): Side Effects?

Answer 23

SIDE EFFECTS: Apnea, Tachycardia (Assess for inadequate sedation or analgesia), Hypertension (Assess for inadequate sedation or analgesia), Anaphylaxis, Dysrhythmias

Question 24

Rocuronium (Zemuron): Notes?

Answer 24

NOTE: Pregnancy safety- Category C

Question 25

Succinylcholine (Anectine): Class?

Answer 25

CLASS: Depolarizing neuromuscular blocker

Question 26

Succinylcholine (Anectine): Action?

Answer 26

ACTION: Succinylcholine is a short acting, depolarizing neuromuscular blocking agent that binds to acetylcholine receptor sites. This produces complete muscle paralysis but since it is a depolarizing agent it causes fasciculations and muscular contractions making it the drug of choice for rapid sequence intubation.

Question 27

Succinylcholine (Anectine): Indication?

Answer 27

INDICATIONS: To facilitate endotracheal intubation, terminate laryngospasm, muscle relaxation.

Question 28

Succinylcholine (Anectine): Contraindication?

Answer 28

CONTRAINDICATIONS: Hypersensitivity, burns or crush injuries > 72 old, skeletal muscle myopathies, inability to control the airway or support ventilations with O2 and positive pressure (BVM), family or personal history of malignant hyperthermia, rhabodomyolysis. Use with caution in pt’s that may have hyperkalemia (renal failure, trauma/burns, electrolyte disturbances, crush injury etc.)

Question 29

Succinylcholine (Anectine): Onset/Duration?

Answer 29

ONSET: less than 1 min
DURATION: 5-10 min

Question 30

Succinylcholine (Anectine): Dose/Route?

Answer 30

ADULT: 1-1.5 mg/kg IV/IO for RSI
PEDS: 1-1.5mg/kg IV/IO for RSI
INFANTS: 2 mg/kg IV/IO for RSI

Question 31

Succinylcholine (Anectine): Side effects?

Answer 31

SIDE EFFECTS: Fasciculations, bradycardia, hypotension, tachycardia, hypertension, dysrhythmias, malignant hyperthermia, hyperkalemia, respiratory depression, excessive salivation, hyperkalemia

Question 32

Succinylcholine (Anectine): Notes?

Answer 32

NOTE: Although after administering Succinylcholine it may appear that the patient is not conscious, it has NO effect on the central nervous system, so the patient will be completely aware of procedures unless appropriate sedation is also given.

Question 33

Vecuronium: Class?

Answer 33

CLASS: Nondepolarizing neuromuscular blocker

Question 34

Vecuronium: Action?

Answer 34

ACTION: Vecuronium competitively blocks acetylcholine at the neuromuscular junction, resulting in chemical paralysis. Providers may use vecuronium for ongoing chemical paralysis of mechanically ventilated patients during inter-facility transports.

Question 35

Vecuronium: Indications?

Answer 35

INDICATIONS: 1. Chemical paralysis for airway placement, particularly in controlled situations and settings. 2. Ongoing chemical paralysis for mechanically ventilated patients

Question 36

Vecuronium: Contraindications?

Answer 36

CONTRAINDICATIONS: 1. Hypersensitivity 2. Consider risk versus benefit in patients with anticipated difficult/failed airways or chronic neuromuscular conditions.

Question 37

Vecuronium: Onset/Peak/Duration?

Answer 37

ONSET: 2.5-3 minutes
PEAK: 3-5 minutes
DURATION: 30-40 minutes

Question 38

Vecuronium: Dose/Route

Answer 38

ADULT: .08 to .1 mg/kg IV
PEDS: Infants >7weeks, children, and adolescents: IV: .08-.1 mg/kg (Note: If intubation is performed using succinylcholine, the initial dose of vecuronium may be reduced to .04-.06 mg/kg

Question 39

Vecuronium: Side effects?

Answer 39

SIDE EFFECTS: Apnea, Tachycardia (Assess for inadequate sedation or analgesia), Hypertension (Assess for inadequate sedation or analgesia), Anaphylaxis, Dysrhythmias

Question 40

Vecuronium: Notes?

Answer 40

Pregnancy safety: Category C