Pharm review Flashcards
1
Q
MAC % Sevoflurane
A
1.8
2
Q
MAC % Desflurane
A
6.6
3
Q
MAC % Isoflurane
A
1.17
4
Q
MAC % Nitrous Oxide
A
104
5
Q
Blood: Gas Sevoflurane
A
0.69
6
Q
Blood: Gas Desflurane
A
0.42
7
Q
Blood: Gas Isoflurane
A
1.46
8
Q
Blood: Gas Nitrous Oxide
A
0.46
9
Q
Vapor Pressure Sevoflurane
A
157
10
Q
Vapor Pressure Desflurane
A
669
11
Q
Vapor Pressure Isoflurane
A
238
12
Q
5 things that increase anesthesia Gas requirements
A
Chronic ETOH
Infant (highest MAC at 6 mo.)
Red hair
Hypernatremia
Hyperthermia
13
Q
8 things that decrease anesthetic requirements
A
Acute ETOH
Elderly Patients
Hyponatremia
Hypothermia
Anemia (Hgb < 5 g/dL)
Hypercarbia
Hypoxia
Pregnancy
14
Q
This Gas can cause airway irritant and can increase HR
A
Desflurane
15
Q
These 2 gas can increase HR
A
iso (increase) and des (N/C or increase)
No change: N2O and sevo
decrease HR: halothane
16
Q
T/F: all gases decrease BP
A
F: Nitrous oxide doesn’t have an effect on BP
17
Q
What 2 gases do not have a decreasing effect on SVR?
A
N2O and Halothane: no change
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
19
Q
T/F: all VA decrease tidal volume
A
T
20
Q
T/F: all VA increase respiratory rate
A
T
21
Q
T/F: All VA decrease PaCO2 at rest and challenge
A
F: all increase
22
Q
T/F: all VA decrease cerebral blood flow
A
F: all increase CBF and ICP
23
Q
T/F: all VA increase cerebral metabolic rate
A
F: all VA except N2O decrease cerebral metabolic rate
Nitrous oxide increases cerebral metabolic rate
24
Q
T/F: all VA decrease risk of seizures
A
T
25
T/F: VA do not augment nondepolarizing blockade
F
26
T/F: all VA decrease renal blood flow, GFR and UO
True
27
Induction dose of Propofol (Diprivan)
1.5-2.5 mg/kg IV
* 2 mg/kg
28
Sedation maintenance rate for Propofol
25-100 mcg/kg/min
29
TIVA maintenance rate for Propofol
100-300 mcg/kg/min
30
This induction agent dose rarely needs to be changed with renal or liver disease. May decrease dose in elderly pts.
Propofol
31
onset of Propofol
30-60 secs
32
Duration of Propofol
1-8 mins
33
What induction agent causes bronchodilation and blunts SNS response to laryngoscopy
Propofol
34
MOA of Propofol
GABA
35
MOA of Etomidate
GABA modulator does not mimic has to have GABA present
36
This induction agents has a Carboxylated imidazole like versed
Etomidate
37
this induction agent is used when cardiovascular stability is necessary
Etomidate
38
this induction agent can induce seizures
etomidate
39
Induction Dose for Etomidate
0.3 mg/kg
40
onset of etomidate
1 min
41
This induction drug can cause adrenocortical suppression (cortisol) up to 4-8 hrs
etomidate
42
This induction drug has the highest % of PONV
Etomidate
43
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
Ketamine
44
onset of Ketamine IV and IM
1 min IV
5 mins IM
45
duration of ketamine
10-20 mins
46
maintenance dose of ketamine IV and IM
0.2-0.5 mg/kg IV
4-8 mg/kg IM
47
Induction dose of Ketamine
0.5-1.5* mg/kg
48
EPS symtoms caused by ketamine will last how long after?
1 hr
49
metabolism for ketamine
hepatic
clearance: renal
50
Contraindications for Ketamine
No MAOIS --> increases epi
51
This Induction agent maintains pharyngeal and laryngeal reflexes, but secretions can cause Coughing and Laryngospasm
dt dissociation airway is not considered protected
ketamine
52
this induction agent has an intense bronchodilator effect dt B2 stimulation and can treat status asthmaticus
ketamine
53
Induction dose for midazolam
0.1-0.2 mg/kg
* may proceed dose with fentanyl 50-100 mcg
54
This medication is used to tx increased salivary sections from ketamine use
Robinul (anti-salagog)
55
Induction agent is a Potent cerebral vasodilator; ↑ CBF by 60%
ketamine
56
This induction agent ↑SVR – PVR, ↑HR, ↑CO, ↑MVO2, ↑SNS outflow, ↑Epi,Norepi – inhibit
reuptake
ketamine
57
Loading dose of dexmedetomidine
1 mcg/kg over 10 mins, if given too fast then transient hypertension will occur initially
58
the infusion rate of precedex
0.2-0.7 mcg/kg/hr
59
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
dexmedetomidine
60
Morphine intraop dose
1-10 mg
61
Morphine post-op dose
5-20 mg
62
Onset of morphine IV
10-20 min
63
duration of morphine IV
4-5 hrs
64
this opioid has a prolonged half-life in elderly, liver failure, and renal failure pts
morphine
65
____ has a potential for delayed respiratory depression up to 24 hr after intrathecal administration
morphine
Dt it being hydrophilic, stays in CSF longer —> late respiratory depression
66
fentanyl intra-op dose
1-3 mcg/kg
67
onset of fentanyl
30-60 secs
68
duration of fentanyl
1-1.5 hrs
69
sufentanil intraop dose
0.3-1 mcg/kg
70
onset of sufentanil
30-60 secs
71
duration of sufentanil
1-1.5 hrs
72
infusion rate of sufentanil
0.5-1 mcg/kg/hr
73
remifentanil intraop dose
0.5-1 mcg/kg over a min
74
infusion rate of remifentanil
0.125-0.375 mcg/kg/min
75
onset of remifentanil
30-60 secs
76
duration of remifentanil
6-8 mins
77
Meperidine (Demerol) postop dose for shivering
12.5 mg
78
onset of meperidine
5-15 mins
79
duration of meperidine
2-4 hrs
80
hydromorphone intraop dose
1-4 mg
81
postop dose of Hydromorphone
1.5-4 mg
82
onset of Hydromorphone
5-15 mins
83
duration of hydromorphone
2-4 hrs
84
Naloxone (Narcan) dose
40-80 mcg
** supplied: 400 mcg/mL (must dilute)
85
onset of naloxone
1-5 mins
86
duration of naloxone
30 mins
87
this drug is 7x more potent than morphine and has less histamine release
hydromorphone
88
is fentanyl dosed on IBW or TBW
IBW
89
Infusion rate of fentanyl
* off 60 mins before breathing
3-6 mcg/kg/hr
90
another name for fentanyl
sublimaze
91
this drug has affinity for mu, kappa, and delta opioid receptors
Meperidine
92
this drug is structurally similar to atropine and LA
meperidine
93
this drugs active metabolite can cause CNS stimulation --> seizures
meperidine
94
This drug is contraindicated with MAOIs and blocks the reuptake of serotonin
Meperidine
95
This opioid is a highly selective mu-opioid receptor agonist
sufentanil
96
0.5-1mcg/kg/hour (<2hrs = 30 min before breathing;
>2hrs = 45 min before breathing)
sufentanil
97
This opioid is CV stable
sufentanil
98
another name for remifentanil
ultiva
99
remifentanil infusion should be turned off for how many mins before breathing
6 mins
100
this opioid has quick respiratory depression/bradycarida and decreases MAC requirements by 70%
Remifentanil
101
This opioid is commonly used for neuro, carotid endarterectomy, eye blocks, and TIVA
Remifentanil
102
Nalbuphine other name
*opioid agonist/antagonist
Nubaine
103
Nalbuphine (Nubaine) dose
10 mg
** 10 mg = 10 mg morphine
104
This opioid agonist/antagonist is great for cardiac catheterization
Nalbuphine (Nubaine): CV- no increase in BP, PA BP, HR, or atrial filling pressures
105
Other name for Buprenorphine
Buprenex
106
dose of Buprenorphine (Buprenex)
0.3 mg IM
0.3 mg = 10 mg morphine
107
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
Buprenorphine (Buprenex)
108
Another name for Butorphanol
Stadol
109
Dose for Butorphanol (Stadol)
2-3 mg IM = 10 mg Morphine
** causes respiratory depression & increases BP, PA BP, & C0
110
this drug you can see cardiac stimulation r/t abrupt reversal of analgesia and has a potential for flash pulmonary edema
Naloxone (Narcan)
111
Dose for Diazepam (Valium) IV and PO
0.1 mg/kg IV
0.2 mg/kg PO
112
Onset for Diazepam
1-5 min
113
duration for diazepam
2-6 hrs
114
Dose for Lorazepam (ativan)
0.04 mg/kg
115
onset for Lorazepam
1-5 mins
116
duration of lorazepam
6-10 hrs
117
dose for midazolam (versed)
1-5 mg or (0.05 mg/kg)
118
onset for midazolam
1-5 mins
119
duration of versed
15-80 mins
120
Flumazenil other name
Romazicon
121
dose of Flumazenil (romazicon)
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
Onset of Flumazenil (romazicon)
1-5 mins
123
Duration of action: Flumazenil
30-60 mins
* shorter half-life than the drugs it reverses
124
Max of Flumazenil (Romazicon)
3 mg
125
Rank these benzos from most to least potent: Diazepam, Lorazepam, Midazolam
Lorazepam > Midazolam > Diazepam
Lorazepam is 5x more potent than Midazolam and Midazolam is 5x more potent that Diazepam
126
T/F: Benzos cause a significant drop in BP
F: benzos may cause a small drop in BP with sedation, but is minimal
127
What are the respiratory effects of benzos?
dose-dependent respiratory depression
with high doses ---> depresses airway reflexes and ability to swallow
128
Do benzos affect pt's hypoxic drive to breathe?
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
Can a small dose of midazolam cause apnea in a healthy person?
Yes, ANY DOSE, ANY PATIENT, CAN CAUSE APNEA IWTH MIDAZOLAM
130
T/F: Benzos blunt SNS response to intubation
F: benzos do not blunt the SNS response to intubation
131
T/F: PO diazepam and Lorazepam has almost no respiratory depression when used alone
True
132
Droperidol's dose
Reminder: Anti-dopaminergics (Butyrophenones)
< 0.625
** don't go any higher dt black box warning - torsades de pointes and sudden death at higher doses
133
onset of droperidol
1-5 mins
134
Duration of droperidol
2-3 hrs
135
Promethazine (Phenergan) dose
Reminder: Anti-dopaminergics (phenothiazines) - typically used as a rescue drug
6.25 - 25 mg
136
this drug has this black box warning
"Black box: tissue damage; respiratory arrest < 2 y/0"
also cause Sedation, hypotension, EPS
Phenergan
137
The onset of promethazine (Phenergan)
1-5 mins
138
Duration of promethazine (Phenergan)
4-6 hrs
139
Ondansetron (Zofran) dose
4 mg
140
Ondansetron (Zofran) onset
10 mins
141
Ondansetron (Zofran) duration
4-9 hrs
142
Dexamethasone (Decadron) dose
4 mg
143
Dexamethasone (Decadron) onset
10-30 mins
144
Dexamethasone (Decadron) duration
2-10 hrs
145
Metoclopramide (Reglan) dose
10-20 mg
146
Metoclopramide (Reglan) onset
10 mins
147
Metoclopramide (Reglan) duration
2hrs
148
SE of Metocolpramide
Restlessness, EPS
149
Scopolamine patch onset
2-4 hrs
150
scopolamine patch duration
72 hrs
151
this drug causes: forward motility, works on dopamine receptor, can cause anxiety, extrapyramidal side
effects. Got a bad rap because of flawed studies.
Metoclopramide (Reglan)
152
This drug is a H2 blocker, decreases acid, but can reduce N/V, FDA approved for morning sickness
Famotidine (Pepcid)
153
Famotidine (Pepcid) dose
20 mg
154
Famotidine (Pepcid) onset
< 30 mins
155
Famotidine (Pepcid) duration
10-12 hrs
156
Diphenhydramine (Benadryl) dose
H1 antagonist
25-50 mg
elderly 12.5 mg
157
Diphenhydramine (Benadryl) onset
< 30 mins
158
Diphenhydramine (Benadryl) duration
4-8 hrs
159
Propofol antiemetic dose
10-15 mg IV, followed by 10 mcg/kg/min
160
Emend (Aprepitant) dose
Reminder: Antagonize Substance P in the emetic center
give 2-3 hrs prior to induction
40mg or 125 mg
161
Succinylcholine (Anectine) dose
1-1.5 mg/kg
162
Succinylcholine (Anectine) onset
30-60 seconds
163
Succinylcholine (Anectine) duration
5-10 mins
164
Cisatricurium (Nimbex) dose
0.1 mg/kg
165
Cisatricurium (Nimbex) onset
2-3 mins
166
Cisatricurium (Nimbex) duration
40-75 mins
167
What intermediate-acting neuromuscular blocking agent is the safest to use in renal patients
Nimbex dt Hoffman elimination
168
What two NMBA drugs are intermediate acting
Roc and Vec
169
Vecuronium (Norcuron) dose
0.1 mg/kg
170
Vecuronium (Norcuron) onset
2-3 mins
171
Vecuronium (Norcuron) duration
45-90 mins
172
Rocuronium (Zemuron) dose
0.6 mg/kg or 1.2 mg/kg
173
Rocuronium (Zemuron) duration
35-75
174
Rocuronium (Zemuron) onset
2-3 mins (0.6 mg/kg)
1.5 mins (1.2 mg/kg)
175
Pancuronium (Pavulon) dose
0.1 mg/kg
176
Pancuronium (Pavulon) onset
2-3 mins
177
Pancuronium (Pavulon) duration
60-120
178
This paralytic is an isomer of atracurium and 4x more potent
nimbex
179
If you give sux firs to intubate the patient then switch to vecuronium. What is the dose for vec?
0.05 mg/kg
180
Can vecruonium (norcuron) accumulate in renal patients
yes
181
If you give sux to intubate then switch to rocuronim (zemuron), what dose would you use for Roc?
0.3 mg/kg
182
Is Rocuronium affected by renal failure and/or liver failure
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
This paralytic is slightly prolonged in the elderly and pregnant woman
Rocuronim dt a reduction in plasma cholinesterase activity.
184
Edrophonium (Tensilon) and Neostigmine (Prostigmin) are in this drug class
anticholinesterase inhibitors
185
Edrophonium (Tensilon) is also referred to as fast eddy
This drug is commonly used in what population and is frequently paired with what anticholinergic?
peds and paired with atropine
186
Edrophonium dose
max: 1 mg/kg range
will not work with deep block (0/4 twitches)
187
Edrophonium onset
1-2 mins
188
Edrophonium duration
5-15 mins
189
Neostigmine (Prostigmin®) dose
40-70 mcg/kg
or
0.04-0.07 mg/kg
190
Neostigmine (Prostigmin) onset
5-10 mins
191
Neostigmine (Prostigmin) duration
60 mins
192
Atropine dose (paired with Edrophonium)
7-10 mcg/kg
193
Glycopyrrolate dose when paired with Neostigmine
7 to 15 µg/kg (1 mg maximum)
** glycopyrrolate 0.2 mg per mg of Neostigmine
194
Sugammadex is contraindicated in what population
dialysis patients
**eliminated in urine
195
Sugammadex dose in a moderate block (2/4 twitches)
2mg/kg
196
Sugammadex dose in a deep block (reached 1-2 post-tetanic counts, no twitch responses to TOF)
4 mg/kg
197
Sugammadex dose in an extreme block (0/4 twitches with TOF and no PTS)
8-16* mg/kg
198
side effect of neostigmine
bradycardia
that is why it is paired with glycopyrrolate (Robinul)
199
Glycopyrrolate (Robinul) onset
2-3 mins
200
Glycopyrrolate (Robinul) duration
2 hrs
201
This Anticholinergic causes tachycardia, bronchodilation, and antisialagogue (but less tachycardia than atropine)
Robinul
* neostigmine can cause severe bradycardia --> asystole, which is why it is paired with Robinul to counteract each other
202
Dose sugammadex inhibit acetylcholinesterase?
No
MOA: MOA: intermolecular (van der Walls) forces, thermodynamic (hydrogen) bonds, and hydrophobic interactions* → very tight reversal by encapsulation
*Rocuronium > Vecuronium >> Pancuronium
**Binds to ‘free drug” in plasma
203
Dantrolene dose
2.5 mg/kg IV; repeat q5-10 mins
204
Dantrolene max
10 mg/kg
205
LAST intalipid 20% bolus dose
1.5 mL/kg over 1 min
206
how often can you repeat the lipid bolus for LAST
q 3-5 mins up to 3 ml/kg until circulation is restored
207
Once circulation is restored after intralipid bolus, what infuse rate do you start intralipids at?
0.25 ml/kg/min
208
If a patient goes into laryngospasm and it doesn't break with PPV and Larson's maneuver. What dose of succinylcholine can you give?
10-20 mg IV
209
dose of ephedrine
5 mg
on hand: 50mg/mL (add 9 cc Ns)
210
Neosynephrine works on what receptor
alpha
211
dose of neosynephrine
100 mcg
on hand: 10 mg/mL
