Pharmacology Flashcards
TXWES REFERENCE GUIDE
BENZOS
Dose (IV, PO), Onset, Duration:
Diazepam
Valium
Valium
0.1mg/kg IV
Onset 1-5mins ⏐Duration 2-6h
0.2mg/kg PO
BENZOS
Dose, Onset, Duration:
Lorazepam
Ativan
Ativan
0.04mg/kg ⏐ Onset 1-5mins ⏐Duration 6-10h
BENZOS
Dose, Onset, Duration:
Midazolam
Versed
Versed
1-5mg or 0.01-0.05mg/kg ⏐Onset 1-5mins ⏐Duration 15-80min
BENZOS
Dose, Onset, Duration:
Flumazenil
Romazicon
Romazicon
0.2mg ⏐ Onset 1-5mins ⏐Duration 30mins!!! (may need redose to outlast BZD)
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 ⏐ Duration 1-1.5hr
Infusion: 0.5-1mcg/kg/hr (close to intraop dose)
OPIOIDS
Dose, Onset, Duration:
Remifentanil
LOAD: 0.5 - 1mcg/kg OVER 1 MIN!
Onset 30-60sec ⏐ Duration 6-8min
gtt: 0.125-0.375 mcg/kg/min
OPIOIDS
Dose, Onset, Duration:
Meperidine
Demerol
Demerol
12.5mg (Shivering)
Onset 5-15min ⏐ Duration 2-4h
OPIOIDS
Dose (intra, postop), Onset, Duration:
Hydromorphone
Diluadid
Dilaudid
1 - 4mg IntraOp
1.5 - 4mg PostOp (basically the same)
Onset 5-15min ⏐ Duration 2-4hr
OPIOIDS
Dose, Onset, Duration:
Naloxone
Narcan
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
4 - 8 mg/kg IM
Induction Dose
Dose, Onset, Duration:
Midazolam
Versed
Versed
0.1-0.2mg/kg Induction
Onset 30-60sec ⏐ Duration 5-10min
*may precede dose w/ Fentanyl 50-100mcg
Dose (Bolus and Infusion):
Dexmedetomidine
Precedex
Precedex
Bolus 0.5-1mcg/kg over 10mins
Infusion 0.2 - 0.7 mcg/kg/hr
Usually on-hand 200mcg/2ml > mix with 48cc NS ⇒ 4mcg/ml
Inhalation
MAC, VP, Blood:Gas Co.:
Sevoflurane
Ultane
MAC 1.8
VP 157
Blood:gas Coefficient 0.69
Inhalation
MAC, VP, Blood:Gas Co.:
Desflurane
Suprane
MAC 6.6
VP 669
Blood:gas Coefficient 0.42
Inhalation
MAC, VP, Blood:Gas Co.:
Isoflurane
Forane
MAC 1.17
VP 238
Blood:gas 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
Anectine
1-1.5 mg/kg
Onset 30-60sec ⏐Durations 5-10min
Muscle Relaxants
Dose, Onset, Duration:
Cisatricurium
Nimbex
Nimbex
0.1 mg/kg
Onset 2-3min ⏐ Duration 40-75min
Hoffman Elimination
Muscle Relaxants
Dose, Onset, Duration:
Vecuronium
Norcuron
Norcuron
0.1 mg/kg
Onset 2-3min⏐ 45-90min
Muscle Relaxants
Dose (1st & 2nd), Onset, Duration:
Rocuronium
Zemuron
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
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:
Sugammadex
2-16 mg/kg (depends on TOF & PTP)
Onset 1 - 4min ⏐ Duration 1.5 - 3hrs
REGIONAL MEDS
Amide/Ester?
Regional MAX dose (mg/kg) w/ & w/o EPI?
Lidocaine
Amide
Max
w/o Epi: 5 mg/kg
w/ Epi: 7 mg/kg
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Prilocaine
Amide
Max
w/o Epi: 6 mg/kg
w/ Epi: 8.5 mg/kg
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Mepivicaine
Amide.
Max
w/o Epi: 5 mg/kg
w/ Epi: 7 mg/kg
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Bupivicaine
Amide.
Max
w/o Epi: 2.5 mg/kg
w/ Epi: 2.5 mg/kg
EPI DONT MAKE NO DIFFERENCE! 😅
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Ropivicaine
Amide.
Max
w/o Epi: 3 mg/kg
w/ Epi: 4 mg/kg
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Procaine
Ester.
Max
w/o Epi: 7 mg/kg
w/ Epi: 8.5 mg/kg
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Chloroprocaine
Ester.
Max
w/o Epi: 6 mg/kg
w/ Epi: 14 mg/kg
REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
Tetracaine
Ester.
Max
w/o Epi: 3 mg/kg
w/ Epi: 3 mg/kg
EPI MAKES NO DIFFERENCE 😅
CSE LABOR ANALGESIA
Epidural (%) & Spinal (mg) doses?
Bupivicaine
Epidural: 0.0625-0.125%
Spinal: 1.25 - 2.5 mg
CSE LABOR ANALGESIA
Epidural (%) & Spinal (mg) doses?
Ropivicaine
Epidural: 0.08 - 0.2%
Spinal: 2.5-4.5 mg
CSE LABOR ANALGESIA
Epidural (%) & Spinal (mL) doses?
Lidocaine + Epi
Epidural: 2% in 5cc bolus
Spinal: N/A
No spinal dose.
CSE LABOR ANALGESIA
Epidural & Spinal doses? (mcg)
Fentanyl
Epidural: 50-100 mcg
Spinal: 10-25 mcg
CSE LABOR ANALGESIA
Epidural & Spinal doses? (mcg)
Sufentanil
Epidural: 5 - 10 mcg
Spinal: 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⎪O: 1-5min⎪D: 2-3hrs
ANTIEMETICS
Dose, Onset, Duration:
Promethazine
Phenergan
6.25 - 25 mg⎪O: 1-5mins⎪D: 4-6hrs
ANTIEMETICS
Dose, Onset, Duration:
Ondansetron
Zofran
4mg⎪O: 10mins⎪D: 4-9hrs
ANTIEMETICS
Dose, Onset, Duration:
Dexamethasone
Decadron
4mg⎪O: 10-30mins⎪D: 2-10hrs
ANTIEMETICS
Dose, Onset, Duration:
Metoclopramide
Reglan
10-20mg⎪O: 10mins⎪D: 2hrs
ANTIEMETICS
Dose, Onset, Duration:
Scopolamine
Patch⎪O: 2-4hrs⎪D: 72hrs
Non-hairy area - dont touch eyes after handling –> can cause mydriasis.
ANTIEMETICS
Dose, Onset, Duration:
Propofol
Diprivan
Antiemetic Dose
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 prophylactic drugs.
If I have 3 PONV risk factors, what is the chance I will have PONV?
What drugs will you treat your patient with?
> 60% chance.
Give at least 3 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
Dose & daily MAX dose.
Acetaminophen
Ofirmev
1000mg q 4-6hr
MAX: 3-4g qd
NON OPIOID ANALGESICS
Dose & daily MAX dose.
Ketorlac
Toradol
15-30mg q6h
Max: 60-120mg qd
NON OPIOID ANALGESICS
1x Dose & daily MAX dose.
Ibuprofen
Caldor
200-800mg q6h
Max: 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 -
* BOLUS 20% intralipids 1.5mL/kg over 1min
* ⇒ Infusion 0.25mL/kg/min
* Circulate lipids w/ CPR
* Repeat bolus q3-5 mins UP TO 3ml/kg total dose until ROSC.
* ⬆ 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 Celcius ⇉ Farenheit
°F = [(9/5) x °C) + 32]
If my patient’s temp is 96.8°F, what is it in °C?
94°F?
96.8ºF ⇉ 36°C
94ºF ⇉ 34.5°C
What is the formula for Farenheit ⇉ Celcius?
°C = [(5/9) x (°F - 32)]
If my patients temp is 38°C, what is it in °F?
40°C?
38°C ⇉ 100 °F
40°C ⇉ 104 °F
A nice pattern to help do quick temp conversions.
- If you start at 95°F - celcius is 35.
- As you increase in 0.9°F, each °C goes up by 0.5°
:)