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Clinicals > Pharm review > Flashcards

Pharm review Flashcards

1
Q

MAC % Sevoflurane

A

1.8

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2
Q

MAC % Desflurane

A

6.6

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3
Q

MAC % Isoflurane

A

1.17

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4
Q

MAC % Nitrous Oxide

A

104

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5
Q

Blood: Gas Sevoflurane

A

0.69

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6
Q

Blood: Gas Desflurane

A

0.42

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7
Q

Blood: Gas Isoflurane

A

1.46

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8
Q

Blood: Gas Nitrous Oxide

A

0.46

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9
Q

Vapor Pressure Sevoflurane

A

157

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10
Q

Vapor Pressure Desflurane

A

669

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11
Q

Vapor Pressure Isoflurane

A

238

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12
Q

5 things that increase anesthesia Gas requirements

A

Chronic ETOH
Infant (highest MAC at 6 mo.)
Red hair
Hypernatremia
Hyperthermia

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13
Q

8 things that decrease anesthetic requirements

A

Acute ETOH
Elderly Patients
Hyponatremia
Hypothermia
Anemia (Hgb < 5 g/dL)
Hypercarbia
Hypoxia
Pregnancy

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14
Q

This Gas can cause airway irritant and can increase HR

A

Desflurane

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15
Q

These 2 gas can increase HR

A

iso and des (N/C or increase)

No change: N2O and sevo

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16
Q

T/F: all gases decrease BP

A

F: Nitrous oxide doesn’t have an effect on BP

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17
Q

What 2 gases do not have a decreasing effect on SVR?

A

N2O and Halothane: no change

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18
Q

What 2 gases do not affect cardiac output?

A

No change: nitrous oxide and isoflurane

If HR goes up with Des then there is N/C with CO, but if HR isn’t effected then CO goes down

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19
Q

T/F: all VA decrease tidal volume

A

T

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20
Q

T/F: all VA increase respiratory rate

A

T

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21
Q

T/F: All VA decrease PaCO2 at rest and challenge

A

F: all increase

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22
Q

T/F: all VA decrease cerebral blood flow

A

F: all increase CBF and ICP

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23
Q

T/F: all VA increase cerebral metabolic rate

A

F: all VA except N2O decrease cerebral metabolic rate

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24
Q

T/F: all VA decrease risk of seizures

A

T

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25
Q

T/F: VA do not augment nondepolarizing blockade

A

F

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26
Q

T/F: all VA decrease renal blood flow, GFR and UO

A

True

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27
Q

Induction dose of Propofol (Diprivan)

A

1.5-2.5 mg/kg IV
* 2 mg/kg

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28
Q

Sedation maintenance rate for Propofol

A

25-100 mcg/kg/min

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29
Q

TIVA maintenance rate for Propofol

A

100-300 mcg/kg/min

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30
Q

This induction agent dose rarely needs to be changed with renal or liver disease. May decrease dose in elderly pts.

A

Propofol

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31
Q

onset of Propofol

A

30-60 secs

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32
Q

Duration of Propofol

A

1-8 mins

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33
Q

What induction agent causes bronchodilation and blunts SNS response to laryngoscopy

A

Propofol

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34
Q

MOA of Propofol

A

GABA

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35
Q

MOA of Etomidate

A

GABA modulator does not mimic has to have GABA present

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36
Q

This induction agents has a Carboxylated imidazole like versed

A

Etomidate

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37
Q

this induction agent is used when cardiovascular stability is necessary

A

Etomidate

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38
Q

this induction agent can induce seizures

A

etomidate

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39
Q

Induction Dose for Etomidate

A

0.3 mg/kg

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40
Q

onset of etomidate

A

1 min

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41
Q

This induction drug can cause adrenocortical suppression (cortisol) up to 4-8 hrs

A

etomidate

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42
Q

This induction drug has the highest % of PONV

A

Etomidate

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43
Q

This induction agent is not a hypnotic but causes dissociative anesthesia by depressing the neuronal function of the cortex and the thalamus, but stimulates the limbic system

It also activates opioid receptors and subcortical neurons in the spinal tract –> analgesic effects

Inhibits activation of NMDA receptors by glutamate and decreases the presynaptic release of glutamate

A

Ketamine

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44
Q

onset of Ketamine IV and IM

A

1 min IV

5 mins IM

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45
Q

duration of ketamine

A

10-20 mins

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46
Q

maintenance dose of ketamine IV and IM

A

0.2-0.5 mg/kg IV

4-8 mg/kg IM

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47
Q

Induction dose of Ketamine

A

0.5-1.5* mg/kg

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48
Q

EPS symtoms caused by ketamine will last how long after?

A

1 hr

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49
Q

metabolism for ketamine

A

hepatic

clearance: renal

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50
Q

Contraindications for Ketamine

A

No MAOIS –> increases epi

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51
Q

This Induction agent maintains pharyngeal and laryngeal reflexes​, but secretions can cause Coughing and Laryngospasm

dt dissociation airway is not considered protected

A

ketamine

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52
Q

this induction agent has an intense bronchodilator effect dt B2 stimulation and can treat status asthmaticus

A

ketamine

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53
Q

Induction dose for midazolam

A

0.1-0.2 mg/kg

  • may proceed dose with fentanyl 50-100 mcg
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54
Q

This medication is used to tx increased salivary sections from ketamine use

A

Robinul (anti-salagog)

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55
Q

Induction agent is a Potent cerebral vasodilator​; ↑ CBF by 60%

A

ketamine

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56
Q

This induction agent ↑SVR – PVR, ↑HR, ↑CO, ↑MVO2, ↑SNS outflow, ↑Epi,Norepi – inhibit
reuptake

A

ketamine

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57
Q

Loading dose of dexmedetomidine

A

1 mcg/kg over 10 mins, if given too fast then transient hypertension will occur initially

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58
Q

the infusion rate of precedex

A

0.2-0.7 mcg/kg/hr

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59
Q

Minimal respiratory depressant effects (respiratory sparing) the least of all the induction drugs.

Sleep like depression.

Anti-salagog (Dries them up).

Watch for obstruction (sleep apnea) still not protected airway – especially in obese.

ABG normal, no big change in TV, RR

A

dexmedetomidine

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60
Q

Morphine intraop dose

A

1-10 mg

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61
Q

Morphine post-op dose

A

5-20 mg

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62
Q

Onset of morphine IV

A

10-20 min

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63
Q

duration of morphine IV

A

4-5 hrs

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64
Q

this opioid has a prolonged half-life in elderly, liver failure, and renal failure pts

A

morphine

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65
Q

____ has a potential for delayed respiratory depression up to 24 hr after intrathecal administration

A

morphine

Dt it being hydrophilic, stays in CSF longer —> late respiratory depression

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66
Q

fentanyl intra-op dose

A

1-3 mcg/kg

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67
Q

onset of fentanyl

A

30-60 secs

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68
Q

duration of fentanyl

A

1-1.5 hrs

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69
Q

sufentanil intraop dose

A

0.3-1 mcg/kg

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70
Q

onset of sufentanil

A

30-60 secs

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71
Q

duration of sufentanil

A

1-1.5 hrs

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72
Q

infusion rate of sufentanil

A

0.5-1 mcg/kg/hr

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73
Q

remifentanil intraop dose

A

0.5-1 mcg/kg over a min

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74
Q

infusion rate of remifentanil

A

0.125-0.375 mcg/kg/min

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75
Q

onset of remifentanil

A

30-60 secs

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76
Q

duration of remifentanil

A

6-8 mins

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77
Q

Meperidine (Demerol) postop dose for shivering

A

12.5 mg

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78
Q

onset of meperidine

A

5-15 mins

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79
Q

duration of meperidine

A

2-4 hrs

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80
Q

hydromorphone intraop dose

A

1-4 mg

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81
Q

postop dose of Hydromorphone

A

1.5-4 mg

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82
Q

onset of Hydromorphone

A

5-10 mins

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83
Q

duration of hydromorphone

A

2-4 hrs

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84
Q

Naloxone (Narcan) dose

A

40-80 mcg

** supplied: 400 mcg/mL (must dilute)

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85
Q

onset of naloxone

A

1-5 mins

86
Q

duration of naloxone

A

30 mins

87
Q

this drug is 7x more potent than morphine and has less histamine release

A

hydromorphone

88
Q

is fentanyl dosed on IBW or TBW

A

IBW

89
Q

Infusion rate of fentanyl

  • off 60 mins before breathing
A

3-6 mcg/kg/hr

90
Q

another name for fentanyl

A

sublimaze

91
Q

this drug has affinity for mu, kappa, and delta opioid receptors

A

Meperidine

92
Q

this drug has is structurally similar to atropine and LA

A

meperidine

93
Q

this drugs active metabolite can cause CNS stimulation –> seizures

A

meperidine

94
Q

This drug is contraindicated with MAOIs and blocks the reuptake of serotonin

A

Meperidine

95
Q

This opioid is a highly selective mu-opioid receptor agonist

A

sufentanil

96
Q

0.5-1mcg/kg/hour (<2hrs = 30 min before breathing;
>2hrs = 45 min before breathing)

A

sufentanil

97
Q

This opioid is CV stable

A

sufentanil

98
Q

another name for remifentanil

A

ultiva

99
Q

remifentanil infusion should be turned off for how many mins before breathing

A

6 mins

100
Q

this opioid has quick respiratory depression/bradycarida and decreases MAC requirements by 70%

A

Remifentanil

101
Q

This opioid is commonly used for neuro, carotid endarterectomy, eye blocks, and TIVA

A

Remifentanil

102
Q

Nalbuphine other name

*opioid agonist/antagonist

A

Nubaine

103
Q

Nalbuphine (Nubaine) dose

A

10 mg

** 10 mg = 10 mg morphine

104
Q

This opioid agonist/antagonist is great for cardiac catheterization

A

Nalbuphine (Nubaine): CV- no increase in BP, PA BP, HR, or atrial filling pressures

105
Q

Other name for Buprenorphine

A

Buprenex

106
Q

dose of Buprenorphine (Buprenex)

A

0.3 mg IM

0.3 mg = 10 mg morphine

107
Q

This agonist-antagonist is commonly used to tx opioid use disorder, chronic pain, and cx pain

used more frequently than methadone dt less respiratory depression, constipation, immune suppression, and no accumulation in renal patients

A

Buprenorphine (Buprenex)

108
Q

Another name for Butorphanol

A

Stadol

109
Q

Dose for Butorphanol (Stadol)

A

2-3 mg IM = 10 mg Morphine

** causes respiratory depression & increases BP, PA BP, & C0

110
Q

this drug you can see cardiac stimulation r/t abrupt reversal of analgesia and has a potential for flash pulmonary edema

A

Naloxone (Narcan)

111
Q

Dose for Diazepam (Valium) IV and PO

A

0.1 mg/kg IV

0.2 mg/kg PO

112
Q

Onset for Diazepam

A

1-5 min

113
Q

duration for diazepam

A

2-6 hrs

114
Q

Dose for Lorazepam (ativan)

A

0.04 mg/kg

115
Q

onset for Lorazepam

A

1-5 mins

116
Q

duration of lorazepam

A

6-10 hrs

117
Q

dose for midazolam (versed)

A

1-5 mg or (0.05 mg/kg)

118
Q

onset for midazolam

A

1-5 mins

119
Q

duration of versed

A

15-80 mins

120
Q

Flumazenil other name

A

Romazicon

121
Q

dose of Flumazenil (romazicon)

A

0.2 mg (repeat 0.1 q1 min)

May repeat with 0.1 mg iv every 1 minute to a total of 1 mg in the first hour and 3 mg maximum dose.

122
Q

Onset of Flumazenil (romazicon)

A

1-5 mins

123
Q

Duration of action: Flumazenil

A

30-60 mins

  • shorter half-life than the drugs it reverses
124
Q

Max of Flumazenil (Romazicon)

A

3 mg

125
Q

Rank these benzos from most to least potent: Diazepam, Lorazepam, Midazolam

A

Lorazepam > Midazolam > Diazepam

Lorazepam is 5x more potent than Midazolam and Midazolam is 5x more potent that Diazepam

126
Q

T/F: Benzos cause a significant drop in BP

A

F: benzos may cause a small drop in BP with sedation, but is minimal

127
Q

What are the respiratory effects of benzos?

A

dose-dependent respiratory depression

with high doses —> depresses airway reflexes and ability to swallow

128
Q

Do benzos affect pt’s hypoxic drive to breathe?

A

Yes

Normally breathing is driven of CO2, however, some patients now use Oxygen/hypoxia to trigger breathing.
Ex.
1. Chronic COPD
2. Sleep Apnea
3. Morbid Obesity.

This drug will depress their drive to breathe.

129
Q

Can a small dose of midazolam cause apnea in a healthy person?

A

Yes, ANY DOSE, ANY PATIENT, CAN CAUSE APNEA IWTH MIDAZOLAM

130
Q

T/F: Benzos blunt SNS response to intubation

A

F: benzos do not blunt the SNS response to intubation

131
Q

T/F: PO diazepam and Lorazepam has almost no respiratory depression when used alone

A

True

132
Q

Droperidol’s dose

Reminder: Anti-dopaminergics (Butyrophenones)

A

< 0.625

** don’t go any higher dt black box warning - torsades de pointes and sudden death at higher doses​

133
Q

onset of droperidol

A

1-5 mins

134
Q

Duration of droperidol

A

2-3 hrs

135
Q

Promethazine (Phenergan) dose

Reminder: Anti-dopaminergics (phenothiazines) - typically used as a rescue drug

A

6.25 - 25 mg

136
Q

this drug has this black box warning

“Black box: tissue damage; respiratory arrest < 2 y/0”

also cause Sedation, hypotension, EPS

A

Phenergan

137
Q

The onset of promethazine (Phenergan)

A

1-5 mins

138
Q

Duration of promethazine (Phenergan)

A

4-6 hrs

139
Q

Ondansetron (Zofran) dose

A

4 mg

140
Q

Ondansetron (Zofran) onset

A

10 mins

141
Q

Ondansetron (Zofran) duration

A

4-9 hrs

142
Q

Dexamethasone (Decadron) dose

A

4 mg

143
Q

Dexamethasone (Decadron) onset

A

10-30 mins

144
Q

Dexamethasone (Decadron) duration

A

2-10 hrs

145
Q

Metoclopramide (Reglan) dose

A

10-20 mg

146
Q

Metoclopramide (Reglan) onset

A

10 mins

147
Q

Metoclopramide (Reglan) duration

A

2hrs

148
Q

SE of Metocolpramide

A

Restlessness, EPS

149
Q

Scopolamine patch onset

A

2-4 hrs

150
Q

scopolamine patch duration

A

72 hrs

151
Q

this drug causes: forward motility, works on dopamine receptor, can cause anxiety, extrapyramidal side
effects. Got a bad rap because of flawed studies.

A

Metoclopramide (Reglan)

152
Q

This drug is a H2 blocker, decreases acid, but can reduce N/V, FDA approved for morning sickness

A

Famotidine (Pepcid)

153
Q

Famotidine (Pepcid) dose

A

20 mg

154
Q

Famotidine (Pepcid) onset

A

< 30 mins

155
Q

Famotidine (Pepcid) duration

A

10-12 hrs

156
Q

Diphenhydramine (Benadryl) dose

H1 antagonist

A

25-50 mg

elderly 12.5 mg

157
Q

Diphenhydramine (Benadryl) onset

A

< 30 mins

158
Q

Diphenhydramine (Benadryl) duration

A

4-8 hrs

159
Q

Propofol antiemetic dose

A

10-15 mg IV, followed by 10 mcg/kg/min

160
Q

Emend (Aprepitant) dose

Reminder: Antagonize Substance P in the emetic center

give 2-3 hrs prior to induction

A

40mg or 125 mg

161
Q

Succinylcholine (Anectine) dose

A

1-1.5 mg/kg

162
Q

Succinylcholine (Anectine) onset

A

30-60 seconds

163
Q

Succinylcholine (Anectine) duration

A

5-10 mins

164
Q

Cisatricurium (Nimbex) dose

A

0.1 mg/kg

165
Q

Cisatricurium (Nimbex) onset

A

2-3 mins

166
Q

Cisatricurium (Nimbex) duration

A

40-75 mins

167
Q

What intermediate-acting neuromuscular blocking agent is the safest to use in renal patients

A

Nimbex dt Hoffman elimination

168
Q

What two NMBA drugs are intermediate acting

A

Roc and Vec

169
Q

Vecuronium (Norcuron) dose

A

0.1 mg/kg

170
Q

Vecuronium (Norcuron) onset

A

2-3 mins

171
Q

Vecuronium (Norcuron) duration

A

45-90 mins

172
Q

Rocuronium (Zemuron) dose

A

0.6 mg/kg or 1.2 mg/kg

173
Q

Rocuronium (Zemuron) duration

A

35-75

174
Q

Rocuronium (Zemuron) onset

A

2-3 mins (0.6 mg/kg)

1.5 mins (1.2 mg/kg)

175
Q

Pancuronium (Pavulon) dose

A

0.1 mg/kg

176
Q

Pancuronium (Pavulon) onset

A

2-3 mins

177
Q

Pancuronium (Pavulon) duration

A

60-120

178
Q

This paralytic is an isomer of atracurium and 4x more potent

A

nimbex

179
Q

If you give sux firs to intubate the patient then switch to vecuronium. What is the dose for vec?

A

0.05 mg/kg

180
Q

Can vecruonium (norcuron) accumulate in renal patients

A

yes

181
Q

If you give sux to intubate then switch to rocuronim (zemuron), what dose would you use for Roc?

A

0.3 mg/kg

182
Q

Is Rocuronium affected by renal failure and/or liver failure

A

Not affected by renal failure, but moderate prolongation in liver failure

** no active metabolites, excreted unchanged by the kidneys and excreted unchanged in bile

183
Q

This paralytic is slightly prolonged in the elderly and pregnant woman

A

Rocuronim dt a reduction in plasma cholinesterase activity.

184
Q

Edrophonium (Tensilon) and Neostigmine (Prostigmin) are the drug class

A

anticholinesterase inhibitors

185
Q

Edrophonium (Tensilon) is also referred to as fast eddy

This drug is commonly used in what population and is frequently paired with what anticholinergic?

A

peds and paired with atropine

186
Q

Edrophonium dose

A

max: 1 mg/kg range

will not work with deep block (0/4 twitches)

187
Q

Edrophonium onset

A

1-2 mins

188
Q

Edrophonium duration

A

5-15 mins

189
Q

Neostigmine (Prostigmin®) dose

A

40-70 mcg/kg

or

0.04-0.07 mg/kg

190
Q

Neostigmine (Prostigmin) onset

A

5-10 mins

191
Q

Neostigmine (Prostigmin) duration

A

60 mins

192
Q

Atropine dose (paired with Edrophonium)

A

7-10 mcg/kg

193
Q

Glycopyrrolate dose when paired with Neostigmine

A

7 to 15 µg/kg (1 mg maximum)

** glycopyrrolate 0.2 mg per mg of Neostigmine

194
Q

Sugammadex is contraindicated in what population

A

dialysis patients

**eliminated in urine

195
Q

Sugammadex dose in a moderate block (2/4 twitches)

A

2mg/kg

196
Q

Sugammadex dose in a deep block (reached 1-2 post-tetanic counts, no twitch responses to TOF)

A

4 mg/kg

197
Q

Sugammadex dose in an extreme block (0/4 twitches with TOF and no PTS)

A

8-16* mg/kg

198
Q

side effect of neostigmine

A

bradycardia

that is why it is paired with glycopyrrolate (Robinul)

199
Q

Glycopyrrolate (Robinul) onset

A

2-3 mins

200
Q

Glycopyrrolate (Robinul) duration

A

2 hrs

201
Q

This Anticholinergic causes tachycardia, bronchodilation, and antisialagogue (but less tachycardia than atropine)

A

Robinul

  • neostigmine can cause severe bradycardia –> asystole, which is why it is paired with Robinul to counteract each other
202
Q

Dose sugammadex inhibit acetylcholinesterase?

A

No

MOA: MOA: intermolecular (van der Walls) forces, thermodynamic (hydrogen) bonds, and hydrophobic interactions* → very tight reversal by encapsulation

*Rocuronium > Vecuronium&raquo_space; Pancuronium

**Binds to ‘free drug” in plasma

203
Q

Dantrolene dose

A

2.5 mg/kg IV; repeat q5-10 mins

204
Q

Dantrolene max

A

10 mg/kg

205
Q

LAST intalipid 20% bolus dose

A

1.5 mL/kg over 1 min

206
Q

how often can you repeat the lipid bolus for LAST

A

q 3-5 mins up to 3 ml/kg until circulation is restored

207
Q

Once circulation is restored after intralipid bolus, what infuse rate do you start intralipids at?

A

0.25 ml/kg/min

208
Q

If a patient goes into laryngospasm and it doesn’t break with PPV and Larson’s maneuver. What dose of succinylcholine can you give?

A

10-20 mg IV

209
Q

dose of ephedrine

A

5 mg

on hand: 50mg/mL (add 9 cc Ns)

210
Q

Neoynephrine works on what receptor

A

alpha

211
Q

dose of neosynephrine

A

100 mcg

on hand: 10 mg/mL

(add 9 cc of NS)

Clinicals (7 decks)

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