Pharmacology Flashcards
TXWES REFERENCE GUIDE
BENZOS
Dose (IV, PO), Onset, Duration:
Diazepam
0.1mg/kg IV
Onset 1-5mins ⏐Duration 2-6h
0.2mg/kg PO
BENZOS
Dose, Onset, Duration:
Lorazepam
0.04mg/kg ⏐ Onset 1-5mins ⏐6-10h
BENZOS
Dose, Onset, Duration:
Midazolam
Versed
1-5mg or 0.01-0.05mg/kg ⏐Onset 1-5mins ⏐15-80min
BENZOS
Dose, Onset, Duration:
Flumazenil
Romazicon
0.2mg ⏐ Onset 1-5mins ⏐30mins!!!
Repeat 0.1 q 1min –> MAX 3mg
BENZO REVERSAL
OPIOIDS
Dose (intraOp, postop), Onset, Duration:
Morphine
1-10mg IntraOp
5-20mg PostOp
Onset 10-20mins ⏐ Duration 4-5h
OPIOIDS
Dose, Onset, Duration:
Fentanyl
1.5-3mcg/kg
Onset 30-60sec ⏐ Duration 1-1.5h
OPIOIDS
Dose, Onset, Duration:
Sufentanil
0.3-1mcg/kg
Onset 30-60sec ⏐ 1-1.5hr
Infusion: 0.5-1mcg/kg/hr (close to intraop dose)
OPIOIDS
Dose, Onset, Duration:
Remifentanil
0.5 - 1mcg/kg OVER 1 MIN!!!
Onset 30-60sec ⏐ 6-8min
gtt: 0.125-0.375 mcg/kg/MIN
OPIOIDS
Dose, Onset, Duration:
Meperidine
Demerol
12.5mg (Shivering)
Onset 5-15min ⏐ Duration 2-4h
OPIOIDS
Dose (intra, postop), Onset, Duration:
Hydromorphone
Diluadid
1 - 4mg IntraOp
1.5 - 4mg PostOp (basically the same)
Onset 5-15min ⏐ Duration 2-4hr
OPIOIDS
Dose, Onset, Duration:
Naloxone
Narcan
40-80mcg ⏐ Onset 1-5 min⏐ Duration 30min
Opioid REVERSAL
INDUCTION MEDS
Dose (induction, sedation gtt, TIVA gtt), Onset, Duration:
Propofol
1.5-2.5mg/kg Induction
25-100 mcg/kg/min Sedation
100-300 mcg/kg/min TIVA
Onset 30-60sec ⏐ 1-8mins
Induction
Dose, Onset:
Etomidate
0.3mg/kg ⏐ Onset 1 min
Induction
Dose (induction, IV analgesia), Onset, Duration:
Ketamine
0.5-1.5mg/kg Induction
0.2-0.5 mg/kg IV Analgesia
Onset 1 min⏐ 10-20min
Induction Dose
Dose, Onset, Duration:
Midazolam
Versed
0.1-0.2mg/kg
Onset 30-60sec ⏐ Duration 5-10min
*may precede dose w/ Fentanyl 50-100mcg
Dose:
Dexmedetomidine
Precedex
Bolus 0.5-1mcg/kg over 10mins
Usually on-hand 200mcg/2ml > mix with 48cc NS > 4mcg/ml
Inhalation
MAC, VP, Blood:Gas Co.:
Sevoflurane
MAC 1.8
VP 157
Blood Coefficient 0.69
Inhalation
MAC, VP, Blood:Gas Co.:
Desflurane
MAC 6.6
VP 669
Blood Coefficient 0.42
Inhalation
MAC, VP, Blood:Gas Co.:
Isoflurane
MAC 1.17
VP 238
Blood Coefficient 1.46
Inhalation
MAC, VP, Blood:Gas Co.:
Nitrous Oxide
MAC 104
VP 🚀 38,770 gas
Blood Coefficient 0.46
Muscle Relaxants
Dose, Onset, Duration:
Succinylcholine
Anectine
1-1.5 mg/kg
Onset 30-60sec ⏐Durations 5-10min
Muscle Relaxants
Dose, Onset, Duration:
Cisatricurium
Nimbex
0.1 mg/kg
Onset 2-3min ⏐ Duration 40-75min
Hoffman Elimination
Muscle Relaxants
Dose, Onset, Duration:
Vecuronium
Norcuron
0.1 mg/kg
Onset 2-3min⏐ 45-90min
Muscle Relaxants
Dose (1st & 2nd), Onset, Duration:
Rocuronium
Zemuron
0.6 mg/kg Onset 2-3mins
1.2 mg/kg Onset 1.5 mins
Duration 35-75mins
Muscle Relaxants
Dose, Onset, Duration:
Pancuronium
Pavulon
0.1 mg/kg
Onset 2-3min ⏐Duration 60-120min
Muscle Relaxants Reversals
Dose, Onset, Duration, Anticholinergic buddy:
Neostigmine
0.04-0.07 mg/kg
Onset 5-10min ⏐ Duration 60min
Glycopyrrolate 0.2mg/ml of Neo to avoid bradycardia
Muscle Relaxants Reversals
Dose, Onset, Duration, Anticholinergic buddy:
Sugammadex
2-16 mg/kg (depends on TOF & PTP)
Onset 1-4min ⏐ Duration 1.5-3hrs
NONE 🙃
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Lidocaine
Amide
5, 7
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Prilocaine
Amide.
6, 8.5
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Mepivicaine
Amide.
5, 7
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Bupivicaine
Amide.
2.5, 2.5
EPI DONT MAKE NO DIFFERENCE! 😅
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Ropivicaine
Amide.
3, 4
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Procaine
Ester.
7, 8.5
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Chloroprocaine
Ester.
6, 14!
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Tetracaine
Ester.
3, 3
EPI MAKES NO DIFFERENCE 😅
CSE LABOR ANALGESIA
Epidural (%) & Spinal (mg) doses?
Bupivicaine
0.0625-0.125%
1.25 - 2.5 ml
CSE LABOR ANALGESIA
Epidural (%) & Spinal (mL) doses?
Ropivicaine
0.08 - 0.2%
2.5-4.5 mL
CSE LABOR ANALGESIA
Epidural (%) & Spinal (mL) doses?
Lidocaine + Epi
2% in 5cc bolus
N/A
No spinal dose.
CSE LABOR ANALGESIA
Epidural & Spinal doses? (mcg)
Fentanyl
50-100 mcg
10-25 mcg
CSE LABOR ANALGESIA
Epidural & Spinal doses? (mcg)
Sufentanil
5-10 mcg
1.5 - 5 mcg
CSE LABOR ANALGESIA
Epidural (%) & Spinal (mg) doses?
Morphine
NO epidural dose.
Spinal: 0.1 - 0.2 mg
ANTIEMETICS
Dose, Onset, Duration:
Droperidol
Inapsine
0.625mg, 1-5min, 2-3hrs
ANTIEMETICS
Dose, Onset, Duration:
Promethazine
Phenergran
6.25 -12.5 mg, 1-5mins, 4-6hrs
ANTIEMETICS
Dose, Onset, Duration:
Ondansetron
Zofran
4mg, 10mins, 4-9hrs
ANTIEMETICS
Dose, Onset, Duration:
Dexamethasone
Decadron
4mg, 10-30mins, 2-10hrs
ANTIEMETICS
Dose, Onset, Duration:
Metoclopramide
Reglan
10-20mg, 10mins, 2hrs
ANTIEMETICS
Dose, Onset, Duration:
Scopolamine
Patch, 2-4hrs, 72hrs!
Non-hairy area - dont touch eyes after handling –> can cause mydriasis.
ANTIEMETICS
Dose, Onset, Duration:
Propofol
Diprivan
10-15mg IV followed by 10mcg/kg/min
List some PONV risk factors.
Female, <40yrs, Hx of PONV or Motion Sickness, vertigo, non-smokers
Surgeries: Laparotomy, Laparoscopy, Major Breast, Strabismus, Intraocular, Middle Ear, Tonsils, Adenoids, Neuro (intracranial), Gynecologic, Testicular, Scrotum, Kidney stones
If I have 0 PONV risk factors, what is the chance I will have PONV?
10%
This requires NO pre-treament drugs.
If I have 3 PONV risk factors, what is the chance I will have PONV?
What drugs will you pre-treat your patient with?
> 60% chance.
Give at least 3 pre-treament drugs: 5HT blocker, steroid, propofol + TIVA??
My patient requires 2 pre-treatment drugs for PONV; I gave zofran and decadron before her surgery.
How many risk factors do you think she has?
What are her chances of developing PONV based on this info?
2 risk factors = 40% chance of developing PONV
My chance of PONV is 20%.
How many risk factors do I have?
What drug(s) will you give me?
I have 1 risk factor and you should give me a 5HT-blocker like zofran :)
NON OPIOID ANALGESICS
1x Dose & daily MAX dose.
Acetaminophen
Ofirmev
1000mg q 4-6hr
MAX: 3-4g qd
NON OPIOID ANALGESICS
1x Dose & daily MAX dose.
Ketorlac
Toradol
15-30mg q6h
60-120mg qd
NON OPIOID ANALGESICS
1x Dose & daily MAX dose.
Ibuprofen
Caldor
200-800mg q6h
3200mg qd
List some symptoms of LAST.
Local Anesthetic Systemic Toxicity
Analgesia, lightheadedness, tinnitis, tongue/circumoral numbness, tingling of mouth, funny/metallic taste, SZ, LOC, respiratory arrest, cardiovascular arrest.
Explain the lipid rescue for LAST.
In addition to CPR -
1. bolus 20% intralipids 0.25ml/kg/min
2. circulate lipids w/ CPR
3. repeat bolus q3-5 mins UP TO 3ml/kg total dose until ROSC.
4. ⬆ infusion to 0.5ml/kg/min if BP declines - continue infusion until hemodynamically stable.
*MAX DOSE: 8ml/kg
If you dont have 20% lipids immediately handy - give what you have until you obtain the 20%.
List the formula for Farenheit from Celcius.
°F = [(9/5) x °C) + 32]
If my patient’s temp is 96.8°F, what is it in °C?
94°F?
36°C
34.5°C
What is the formula for Celcius from Farenheit?
°C = [(5/9) x (°F - 32)]