Pharmacology

Question 0

What are contraindications to zofran?

What are some warnings?

Answer 0

Hypersensitivity
Apomorphine- taken together causes severe HypoTN and loss of consciousness
Don’t give in congenital long QT syndrome. It incr QT - this is dose dependent
( ecg monitoring recommended in pts with electrolyte abN, CHF, bradyarrythmias or when taking in conjunction with other meds causing long QT

Question 1

What ages is odansetron approved for?

Answer 1

6 months or older

Question 2

What is the MOA of odansetron ?

What are its official indications?

Answer 2

5HT3 antagonist selective. Blocks serotonin peripherally on vagal n. Terminals and in the chemoreceptor trigger zone (located in medulla oblongata).

It is Not a dopamine receptor antagonist.
Post op N/V, and with chemorx

Question 3

What pregnancy category is zofran?

Answer 3

Category B. No evidence that it causes harm to fetus but not first line. It also passes into breast milk.

Question 4

What dosage consideration for zofran do to have to think about in pts with severe liver dz? Renal insuff?

Answer 4

Liver dz: don’t exceed 8 mg/ day. Is metabolized by cytochrome P 450
Renal: doesn’t matter.

Question 5

What are the side effects of steroids?

Answer 5

1. OP
2. Mood swings
3. Psychosis
4. Weight gain
5. Metabolic syndrome/DM
6. Cervical dorsal fat pad (Buffalo hump), moon facies
7. AVN
8. Delayed healing
9. Immunocompromised.

Question 6

Which benzodiazepines are not metabolized in the liver?

they are water soluble, excreted by the kidney

Answer 6

LOT
Lorazepam
Oxazepam
Temazepam

Question 7

What are the 3 most common Benzodiazepines that we use? What are the usual dose for each and 1/2 life?

Answer 7

Midazolam (Versed)

• 0.025-0.1 mg/kg (in 70 kg male 7mg)
• Oral peak: 1-2 h
• Half life 1.5-3 hours

Lorazepam (Ativan)

• usual dose: 0.5-2mg
• Oral peak: 2-4 h
• Half life: 10-20h

Diazepam (valium)

• usual dose: 2-10 mg
• oral peak 0.5-1 h
• Half life: 20-50 hr

Question 8

What is Diclectin?

Answer 8

A combination of pyridoxine (vitamin B6) and doxylamine prescribed for the management of nausea and vomiting of pregnancy or morning sickness.

Question 9

What are the 2 types of CCB?

Answer 9

Dihydropyridines - block vasculature L-type calcium channels
- potent vasodilators, little negative effect on contractility or conduction

Non-dihydropyridines - block L-type calcium channels in myocardium (verapamil, diltiazem)
- weak vasodilator but depressive effects on cardiac conduction and contractility

Question 10

How does digoxin work?

Answer 10

1) Blocks Na/K ATPase
- This increases intra-cellular Na
- The Na/Ca anti-porter then is not as active and more calcium accumulates in the cell
- This leads to incr inotropy and contractility

2) increases vagal tone which results in decr conduction thru SA and AV nodes

Question 11

For procedural sedation analgesia what is the typical dose for Fentanyl?

Answer 11

1 mcg/kg IV

Question 12

For procedural sedation what is the typical dose for Ketamine?

Answer 12

1-2 mg/kg IV

4-5 mg/kg IM

Question 13

For procedural sedation analgesia what is the typical dose for Morphine?

Answer 13

0.1 mg/kg IV

Question 14

For procedural sedation what is the typical dose for Midazolam?

Answer 14

0.05mg/kg IV

Question 15

For procedural sedation what is the typical dose for Propofol?

Answer 15

0.5 mg/kg IV Bolus (0.25 in elderly) followed by 0.25-0.5 mg /kg every 3-5 minutes (~1-2 cc every few minutes in 70kg pt)

‘Titrate dont calculate’

Question 16

What does it mean if I say ketamine has a threshold response?

Answer 16

Titrating the medication doesnt result in an additive effect on sedation. The threshold dose of ketamine for achieving a dissociative state is 1-1.5mg/kg IV in adult and 2-2.5 mg/kg IV in peds.
- Higher doses dont enhance sedation.

Question 17

Drug trivia: How does etomidate cause adrenal suppression?

Answer 17

It inhibits 11-B- hydroxylase activity

Question 18

What is the MOA for metoclopramide?

Answer 18

1. Blocks dopamine receptors
2. (when given in higher doses) blocks serotonin receptors in chemoreceptor trigger zone of the CNS;
3. Enhances the response to acetylcholine of tissue in upper GI tract causing enhanced motility and accelerated gastric emptying without stimulating gastric, biliary, or pancreatic secretions; increases lower esophageal sphincter tone