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TXWES Reference Guide 2024 > Pharmacology > Flashcards

Pharmacology Flashcards

TXWES REFERENCE GUIDE

1
Q

BENZOS

Dose (IV, PO), Onset, Duration:
Diazepam

A

0.1mg/kg IV
Onset 1-5mins ⏐Duration 2-6h

0.2mg/kg PO

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2
Q

BENZOS

Dose, Onset, Duration:
Lorazepam

A

0.04mg/kg ⏐ Onset 1-5mins ⏐6-10h

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3
Q

BENZOS

Dose, Onset, Duration:
Midazolam

Versed

A

1-5mg or 0.01-0.05mg/kg ⏐Onset 1-5mins ⏐15-80min

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4
Q

BENZOS

Dose, Onset, Duration:
Flumazenil

Romazicon

A

0.2mg ⏐ Onset 1-5mins ⏐30mins!!!

Repeat 0.1 q 1min –> MAX 3mg

BENZO REVERSAL

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5
Q

OPIOIDS

Dose (intraOp, postop), Onset, Duration:
Morphine

A

1-10mg IntraOp
5-20mg PostOp
Onset 10-20mins ⏐ Duration 4-5h

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6
Q

OPIOIDS

Dose, Onset, Duration:
Fentanyl

A

1-3mcg/kg
Onset 30-60sec ⏐ Duration 1-1.5h

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7
Q

OPIOIDS

Dose, Onset, Duration:
Sufentanil

A

0.3-1mcg/kg
Onset 30-60sec ⏐ 1-1.5hr

Infusion: 0.5-1mcg/kg/hr (close to intraop dose)

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8
Q

OPIOIDS

Dose, Onset, Duration:
Remifentanil

A

0.5 - 1mcg/kg OVER 1 MIN!!!
Onset 30-60sec ⏐ 6-8min

gtt: 0.125-0.375 mcg/kg/MIN

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9
Q

OPIOIDS

Dose, Onset, Duration:
Meperidine

Demerol

A

12.5mg (Shivering)
Onset 5-15min ⏐ Duration 2-4h

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10
Q

OPIOIDS

Dose (intra, postop), Onset, Duration:
Hydromorphone

Diluadid

A

1 - 4mg IntraOp
1.5 - 4mg PostOp (basically the same)
Onset 5-15min ⏐ Duration 2-4hr

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11
Q

OPIOIDS

Dose, Onset, Duration:
Naloxone

Narcan

A

40-80mcg ⏐ Onset 1-5 min⏐ Duration 30min

Opioid REVERSAL

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12
Q

INDUCTION MEDS

Dose (induction, sedation gtt, TIVA gtt), Onset, Duration:
Propofol

A

1.5-2.5mg/kg Induction
25-100 mcg/kg/min Sedation
100-300 mcg/kg/min TIVA
Onset 30-60sec ⏐ 1-8mins

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13
Q

Induction

Dose, Onset:
Etomidate

A

0.3mg/kg ⏐ Onset 1 min

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14
Q

Induction

Dose (induction, IV analgesia), Onset, Duration:
Ketamine

A

0.5-1.5mg/kg Induction
0.2-0.5 mg/kg IV Analgesia
Onset 1 min⏐ 10-20min

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15
Q

Induction Dose

Dose, Onset, Duration:
Midazolam

Versed

A

0.1-0.2mg/kg
Onset 30-60sec ⏐ Duration 5-10min

*may precede dose w/ Fentanyl 50-100mcg

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16
Q

Dose:
Dexmedetomidine

Precedex

A

Bolus 0.5-1mcg/kg over 10mins

Usually on-hand 200mcg/2ml > mix with 48cc NS > 4mcg/ml

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17
Q

Inhalation

MAC, VP, Blood:Gas Co.:
Sevoflurane (Ultane)

A

MAC 1.8
VP 157
Blood Coefficient 0.69

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18
Q

Inhalation

MAC, VP, Blood:Gas Co.:
Desflurane (Suprane)

A

MAC 6.6
VP 669
Blood Coefficient 0.42

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19
Q

Inhalation

MAC, VP, Blood:Gas Co.:
Isoflurane (Forane)

A

MAC 1.17
VP 238
Blood Coefficient 1.46

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20
Q

Inhalation

MAC, VP, Blood:Gas Co.:
Nitrous Oxide

A

MAC 104
VP 🚀 38,770 gas
Blood Coefficient 0.46

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21
Q

Muscle Relaxants

Dose, Onset, Duration:
Succinylcholine

Anectine

A

1-1.5 mg/kg
Onset 30-60sec ⏐Durations 5-10min

(20mg/mL)

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22
Q

Muscle Relaxants

Dose, Onset, Duration:
Cisatricurium

Nimbex

A

0.1 mg/kg
Onset 2-3min ⏐ Duration 40-75min

(2mg/mL)

Hoffman Elimination

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23
Q

Muscle Relaxants

Dose, Onset, Duration:
Vecuronium

Norcuron

A

0.1 mg/kg
Onset 2-3min⏐ 45-90min

(1mg/mL)

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24
Q

Muscle Relaxants

Dose (1st & 2nd), Onset, Duration:
Rocuronium

Zemuron

A

0.6 mg/kg Onset 2-3mins
1.2 mg/kg Onset 1.5 mins
Duration 35-75mins

(10mg/mL)

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25
# Muscle Relaxants Dose, Onset, Duration: **Pancuronium** | Pavulon
0.1 mg/kg Onset 2-3min ⏐Duration 60-120min (2mg/mL)
26
# 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**
27
# 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** 🙃
28
# REGIONAL MEDS Amide/Ester? MAX dose (mg/kg) w/ & w/o EPI? **Lidocaine**
Amide 5, 7
29
# REGIONAL MEDS Amide/Ester? MAX dose (mg/kg) w/ & w/o EPI? **Prilocaine**
Amide. 6, 8.5
30
# REGIONAL MEDS Amide/Ester? MAX dose (mg/kg) w/ & w/o EPI? **Mepivicaine**
Amide. 5, 7
31
# REGIONAL MEDS Amide/Ester? MAX dose (mg/kg) w/ & w/o EPI? **Bupivicaine**
Amide. 2.5, 2.5 | EPI DONT MAKE NO DIFFERENCE! 😅
32
# REGIONAL MEDS Amide/Ester? MAX dose (mg/kg) w/ & w/o EPI? **Ropivicaine**
Amide. 3, 4
33
# REGIONAL MEDS Amide/Ester? MAX dose (mg/kg) w/ & w/o EPI? **Procaine**
Ester. 7, 8.5
34
# REGIONAL MEDS Amide/Ester? MAX dose (mg/kg) w/ & w/o EPI? **Chloroprocaine**
Ester. 6, 14!
35
# REGIONAL MEDS Amide/Ester? MAX dose (mg/kg) w/ & w/o EPI? **Tetracaine**
Ester. 3, 3 | EPI MAKES NO DIFFERENCE 😅
36
# CSE LABOR ANALGESIA Epidural (%) & Spinal (mg) doses? **Bupivicaine**
0.0625-0.125% 1.25 - 2.5 ml
37
# CSE LABOR ANALGESIA Epidural (%) & Spinal (mL) doses? **Ropivicaine**
0.08 - 0.2% 2.5-4.5 mL
38
# CSE LABOR ANALGESIA Epidural (%) & Spinal (mL) doses? **Lidocaine + Epi**
2% in 5cc bolus N/A | No spinal dose.
39
# CSE LABOR ANALGESIA Epidural & Spinal doses? (mcg) **Fentanyl**
50-100 mcg 10-25 mcg
40
# CSE LABOR ANALGESIA Epidural & Spinal doses? (mcg) **Sufentanil**
5-10 mcg 1.5 - 5 mcg
41
# CSE LABOR ANALGESIA Epidural (%) & Spinal (mg) doses? **Morphine**
NO epidural dose. Spinal: 0.1 - 0.2 mg
42
# ANTIEMETICS Dose, Onset, Duration: **Droperidol** | Inapsine
0.625mg, 1-5min, 2-3hrs
43
# ANTIEMETICS Dose, Onset, Duration: **Promethazine** | Phenergran
6.25 -12.5 mg, 1-5mins, 4-6hrs
44
# ANTIEMETICS Dose, Onset, Duration: **Ondansetron** | Zofran
4mg, 10mins, 4-9hrs
45
# ANTIEMETICS Dose, Onset, Duration: **Dexamethasone** | Decadron
4mg, 10-30mins, 2-10hrs
46
# ANTIEMETICS Dose, Onset, Duration: **Metoclopramide** | Reglan
10-20mg, 10mins, 2hrs
47
# ANTIEMETICS Dose, Onset, Duration: **Scopolamine**
Patch, 2-4hrs, 72hrs! Non-hairy area - dont touch eyes after handling --> can cause mydriasis.
48
# ANTIEMETICS Dose, Onset, Duration: **Propofol** | Diprivan
10-15mg IV followed by 10**mcg**/kg/**min**
49
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
50
If I have 0 PONV risk factors, what is the chance I will have PONV?
10% | This requires NO pre-treament drugs.
51
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??
52
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
53
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 :)
54
# NON OPIOID ANALGESICS 1x Dose & daily MAX dose. **Acetaminophen** | Ofirmev
1000mg q 4-6hr MAX: 3-4g qd
55
# NON OPIOID ANALGESICS 1x Dose & daily MAX dose. **Ketorlac** | Toradol
15-30mg q6h 60-120mg qd
56
# NON OPIOID ANALGESICS 1x Dose & daily MAX dose. **Ibuprofen** | Caldor
200-800mg q6h 3200mg qd
57
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.
58
Explain the lipid rescue for LAST.
In addition to CPR - 1. bolus 20% intralipids 1.5 ml/kg/min over 1 min 2. circulate lipids w/ CPR 3. repeat bolus q3-5 mins UP TO 3ml/kg total dose until ROSC. 4. Initial infusion rate of 0.25ml/kg/min. ⬆ infusion to 0.5ml/kg/min if BP declines - continue infusion until hemodynamically stable. *MAX DOSE: 8ml/kg ## Footnote If you dont have 20% lipids immediately handy - give what you have until you obtain the 20%.
59
List the formula for Farenheit from Celcius.
°F = [(9/5) x °C) + 32]
60
If my patient's temp is 96.8°F, what is it in °C? 94°F?
36°C 34.5°C
61
What is the formula for Celcius from Farenheit?
°C = [(5/9) x (°F - 32)]
62
If my patients temp is 38°C, what is it in °F? 40°C?
100 °F 104 °F
63
A nice pattern to help do quick temp conversions.
1. If you start at 95°F - celcius is 35. 2. As you increase in 0.9°F, each °C goes up by 0.5° :)
64
# AIRWAY CLASSIFICATION Describe a Mallampati 1.
Soft palate, fauces, uvula, anterior & posterior tonsilar pillars
65
# AIRWAY CLASSIFICATION Describe a Mallampati 2.
Soft palate, fauces, & uvula only.
66
# AIRWAY CLASSIFICATION Describe a Mallampati 3.
Soft palate & base of uvula.
67
# AIRWAY CLASSIFICATION Describe a Mallampati 4.
Soft palate only.
68
# AIRWAY CLASSIFICATION Describe a Mallampati 5.
Lolz, gotcha.
69
# AIRWAY CLASSIFICATION List the Cormack-Lehane view grade: Full view of entire glottic opening.
Grade 1
70
# AIRWAY CLASSIFICATION List the Cormack-Lehane view grade: Neither glottis nor epiglottis seen.
Grade 4.
71
# AIRWAY CLASSIFICATION List the Cormack-Lehane view grade: Only epiglottis seen.
Grade 3.
72
# AIRWAY CLASSIFICATION List the Cormack-Lehane view grade: Only posterior portion of glottic opening.
Grade 2.
73
List the normal blood gas values: pH PaO2 PaCO2
pH: 7.35-7.45 PaO2: 90-100 PaCO2: 35-45
74
List the normal blood gas values: HCO3- BE SaO2
HCO3-: 22-26 BE: -2 to 2 SaO2: 95-98%
75
Formula for VO2
10 x kg(3/4) = VO2
76
Formula for VCO2
8 x kg(3/4) = VCO2
77
What does this formula describe? [FiO2 x (Pb - PH2O)] - PaCO2 / 0.8
Alveoar Gas/Air Equation ## Footnote https://youtu.be/vrjK4gxa-48
78
Formula for *arterial* O2 content/dL
(hgb x 1.34 x SaO2) + (PaO2 x 0.003)
79
PBW (predicted body weight) equation for a male.
50 + 0.91(cm height - 152.4)kg = male PBW ## Footnote PBW is used to determine your tidal volume (5 - 8cc/kg).
80
PBW (predicted body weight) equation for a female
45.5 + 0.91 (cm height -152.4)kg = female PBW. ## Footnote PBW is used to determine your tidal volume (5 - 8cc/kg).
81
Formula for MAP. What is the normal adult range?
[SBP + (2xDBP) / 3] Normal range: 70-105mmHg
82
Normal CO
4-8 L/min
83
Formula for CI Normal range for CI?
(CO / BSA) 2.5 - 4 L/min
84
Normal CVP range?
2-6 mmHg
85
Normal PCWP? What does PCWP measure?
8-12 mmHg Helps measures LA pressure, along with L heart function (mitral valves & LV filling pressure).
86
Normal PVR? (pulmonary vascular resistance)
50 - 350 dynes/cm/sec^-5
87
Normal SVR?
700 - 1400 dynes/cm/sec^-5
88
Normal EF?
55-70%
89
Normal mPAP? sPAP? dPAP?
mPAP: ~15mmHg sPAP: 15-30 mmHg dPAP: 5-15 mmHg
90
Formula for Shock Index
(HR / SBP) ## Footnote >1 = increased M&M & chance of Mass Transfusion protocol (MTP)
91
EBV of preemie
95ml/kg
92
EBV of term infant
85ml/kg
93
EBV of infant - 12mo
80kg/ml
94
EBV of male adult/child
75ml/kg
95
EBV of female adult/child
65ml/kg
96
EBV of morbid obese (BMI >40)
60ml/kg
97
Allowable blood loss (ABL) formula
[(initial Hct - final Hct) x EBV / initial Hct]
98
# Fluid Replacement Equivalent Crystalloids
3ml / 1ml EBL
99
# Fluid Replacement Equivalent Colloids
1ml / 1ml EBL
100
# Fluid Replacement Equivalent Whole Blood
1ml / 1ml EBL ## Footnote *same as colloids
101
# Fluid Replacement Equivalent PRBC
0.5ml / 1ml EBL ## Footnote PRBC Hct = 70%
102
# Fluid Replacement Equivalent How much EBL is in a fully soaked 4x4 guaze?
10 ml
103
# Fluid Replacement Equivalent How much EBL is in a fully soaked 'lap' pad?
100-150cc
104
What is the 4-2-1 rule for maintenance fluids?
1st 10kg = 4cc/kg/hr 2nd 10kg = 2cc/kg/hr Every kg >20 = 1cc/kg/hr
105
How do you accomodate for an NPO deficit with maintenance fluids?
(maintenance rate x #hrs NPO)
106
What are the estimated evaporated losses? (minimal, moderate, severe)
Minimal = 0.2 mL/kg/hr Moderate = 2 - 4 mL/kg/hr Severe = 4 - 8 mL/kg/hr
107
BMI formula(s)
## Footnote 1in = 0.025meters
108
Healthy BMI range
18.5 - 25
109
Overweight BMI
>25
110
Obese BMI
>30
111
Morbidly obese BMI
>35-40
112
Super morbidly obese
>55
113
List the IBW formulas. (male, female)
Male: (cm Ht - 100)=kg Female (cm Ht - 105)=kg ## Footnote 1in = 2.5cm
114
Dose of ephedrine for HoTN? Main receptor(s)?
5mg ⍺ & β
115
Dose of Neosynephrine for HoTN? Main receptor(s)?
100mcg ⍺
116
Labetalol dose for HTN? Main receptor?
5mg β
117
Esmolol dose for HTN? Main receptor?
10mg β1
118
Hydralazine dose? Main receptor?
5mg Directly vasodilates on the smooth muscle of the arterioles.
119
# LABS Hct (male, female)
male: 42-52 g/dL female: 37-47 g/dL
120
# LABS Hgb (male, female)
male: 14-18 g/dL female: 15-16 g/dL (seems high...I use 13-16 lolz)
121
# LABS WBCs
4k-11k microL
122
# LABS Plts
150k-450k microL
123
# LABS K+
3.5-5 mEq/L
124
# LABS Mg
1.5-2.5 mEq/L
125
# LABS Ca++
8.5-10.5 mg/dL
126
# LABS iCa++
**4.8 - 5.3 mg/dL** (easy to remember bc it's 1/2 of normal Ca++ level) or **1.1 - 1.3 mmol/L** (used often)
127
# LABS Phos
1.8 - 2.6 mEq/L
128
# LABS Cl-
100-108 mEq/L
129
# LABS BUN & Creatinine
BUN: 10-20 mg/dL Creatinine: 0.6-1.3 mg/dL
130
# LABS Albumin
3.5-5.5 g/dL
131
# LABS PT
11-14 sec ## Footnote WEPT (warfarin, extrinsic, PT level)
132
# LABS INR
1 sec ## Footnote Normal INR on Warfarin: 2-3secs
133
# LABS PTT
21-34 sec ## Footnote On heparin = varies (~60-100 secs) depending on your coag goals!
134
# LABS ACT | Activating Clotting Time
80-120 secs > 160-180sec for ECMO | > 400sec for CPB ## Footnote Used for large heparin doses.
135
# LABS FSP | Fibrin Split Products
<10 µ/dL | Fragments from dissolved clots. Used often for DIC
136
# LABS Fibrinogen
160-450 mg/dL | (the netting that covers the clot)
137
# LABS Plasminogen
62-130% | Plasminogen makes Plasmin. Plasmin degrades fibrin (or clots)
138
# LABS FDP | Fibrin Degredation Products
<10 µ/mL | basically FSP but resulted in different units.
139
# LABS D-Dimer
<250 ng/dL | Only detectable if you are currently breaking down lots of clots.
140
# LABS TSH T3 T4
TSH: 0.4 µ units/mL T3: 90 -230 ng/dL T4: 13 - 15 µ/dL | Control metabolism, temp, mood, weight, neuro fxn, & muscle strength. ## Footnote T3 = MORE active, 7%, majority made in cells. T4 = main circulating thyroid hormone, 93%, can be converted to T3 using iodinase.
141
# LABS AST ALT
<35 IU/L ## Footnote Liver function - ALT more specfic to liver, AST involves other organs including the liver.
142
# LABS Fill in the blanks:
143
# LABS Fill in the blanks:
144
# LABS Fill in the blanks:
145
List triggers for MH.
Volatile Anesthetics & SCh
146
List signs of MH crisis
1. tachycardia 2. **rapidly increasing ETCO2** 3. skin mottling 4. tachypnea 5. increase in temp
147
List the treatment regimen for MH.
1. STOP THE TRIGGER 2. 100% O2 hyperventilation 3. Dantrolene 2.5mg/kg IV (repeat 5-10mins; MAX 10mg/kg) 4. Actively cool pt 5. correct hyperkalmia and metabolic acidosis 6. Monitor labs and maintain UO >2cc/kg/hr (hydration, mannitol, lasix) *watch for rhabdo*
148
What is the dose of Dantrolene for MH?
2.5mg/kg IV (repeat q5-10mins prn) ## Footnote MAX 10mg/kg
149
# PEDI ETT How can you determine the ETT length?
(Tube size x 3)
150
# PEDI ETT List the ETT sizes: Preemies (≤ 1kg) Preemies (1-2.5kg) Term Neonate
2.5 3 3-3.5
151
# PEDI ETT List the ETT sizes: 6mo-1yr 1-2yr
3.5-4 4-4.5
152
# ETT SIZING How do you determine ETT for >2yrs?
[(age + 16) / 4]
153
# PEDI LMA SIZES List the size & max cuff air volume: 0-5kg 5-10kg 10-20kg 20-30kg >30kg Adult
1 (4cc) 1.5 (7cc) 2 (10cc) 2.5 (14cc) 3 (20cc) 4 (30cc)

TXWES Reference Guide 2024 (1 decks)

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