Pharmacology Flashcards
1
Q
Etomidate
(induction dose)
A
- 2 - 0.6 mg/kg
* for ages > 10 y.o.
2
Q
Ketamine
(induction dose)
A
1 - 2 mg/kg
- given IM or PR
3
Q
Methohexital
(induction dose)
A
1 - 2 mg/kg
4
Q
Midazolam
(induction dose)
A
0.15 - 0.35 mg/kg
5
Q
Propofol
(induction dose)
A
2 - 2.5 mg/kg
6
Q
Propofol
(Induction dose - Pediatric)
A
2.5 - 3.5 mg/kg
7
Q
Propofol
(infusion dose)
A
100 - 200 mcg/kg/min
8
Q
Fentanyl
(Induction dose)
A
5 - 40 mcg/kg
9
Q
Fentanyl
(infusion dose)
A
0.1 - 1 mcg/kg/min
10
Q
Succinylcholine
(Intubating dose)
A
0.6 mg/kg
11
Q
Succinylcholine
(Intbuating dose - Pediatric)
A
1 - 2 mg/kg
12
Q
Succinylcholine
(RSI dose)
A
1 - 1.5 mg/kg
13
Q
Succinylcholine
(Laryngospasm dose)
A
20 mg
14
Q
Succinylcholine
(Laryngospasm dose - Pediatric)
A
0.1 - 0.2 mg/kg
15
Q
Atracurium
(Intubating dose)
A
0.5 mg/kg
16
Q
Rocuronium
(intubating dose)
A
0.6 mg/kg
17
Q
Vecuronium
(intubating dose)
A
0.1 mg/kg
18
Q
Rocuronium
(RSI dose)
A
0.6 - 1.2 mg/kg
19
Q
Vecuronium
(RSI dose)
A
0.3 - 0.4 mg/kg
20
Q
Atropine and Edrophonium
(reversal dose)
A
0.015 - 0.03 mg/kg Atropine
and
0.5 - 1 mg/kg Edrophonium
21
Q
Glycopyrrolate and Neostigmine
(reversal dose)
A
0.01 - 0.02 mg/kg
and
0.04 - 0.08 mg/kg
22
Q
Acetaminophen
(IV dose)
A
650 - 1000 mg
(15 mg/kg)
23
Q
Acetaminophen
(PO dose)
A
5 - 15 mg/kg
24
Q
Ketorolac
(IV dose)
A
30 mg
(0.5 mg/kg)
25
**Dexamethasone**
| (antiemetic dose)
8 mg
| (0.25 mg/kg)
26
**Droperidol**
| (IV dose)
0.625 - 2.5 mg
| (10 - 20 mcg/kg)
27
**Metoclopromide**
| (IV/IM/PO dose)
5 - 20 mg
| (0.1 mg/kg)
28
**Ondansetron**
| (IV dose)
4 mg
| (0.1 mg/kg for child \< 40kg)
29
**Flumazenil**
| (IV dose)
0.2 mg
| (every 15 minutes)
30
Naloxone
| (IM/IV dose)
0.1 - 0.4 mg
31
**Desflurane**
| (MAC - adult)
6.0
32
**Desflurane**
| (MAC - infant)
10
33
**Desflurane**
| (vapor pressure)
660
34
**Desflurane**
| (blood:gas)
0.42
35
Rank Inhalational Agents according to their Brain:blood coefficients
(greatest to least)
Halothane
Sevoflurane
Isoflurane
Desflurane
Nitrous Oxide
36
Rank Inhalational Agents according to their Fat:Blood Coefficients
(greatest to least)
Halothane
Sevoflurane
Isoflurane
Desflurane
Nitrous Oxide
37
**Halothane**
| (MAC - adult)
0.77
38
**Halothane**
| (MAC - infant)
1.2
39
**Isoflurane**
| (MAC - adult)
1.15
40
**Isoflurane**
| (MAC - infant)
1.87
41
Nitrous Oxide
| (MAC - adult)
104
42
**Sevoflurane**
| (MAC - adult)
2.4
43
**Sevoflurane**
| (MAC - infant)
3
44
**Halothane**
| (vapor pressure)
240
45
**Isoflurane**
| (vapor pressure)
238
46
**Nitrous Oxide**
| (vapor pressure)
39,000
47
**Sevoflurane**
| (vapor pressure)
160
48
For no movement to noxious stimuli, use _____ MAC
1.25 - 1.3
49
For blocking adrenergic response use _____ MAC
(MAC-BAR)
1.5
50
**Phenylephrine**
| (IV push dose)
50 - 200 mcg
51
**Phenylephrine**
| (IV infusion dose)
0.15 - 0.75 mcg/kg/min
52
**Norepinephrine**
| (IV infusion dose)
0.05 - 0.5 mcg/kg/min
53
**Epinephrine**
| (IV push dose)
2 - 10 mcg
54
**Epinephrine**
| (IV Beta Infusion dose)
0.01 - 0.03 mcg/kg/min
55
**Epinephrine**
| (IV B \> a infusion dose)
0.03 - 0.15 mcg/kg/min
56
**Epinephrine**
| (IV a + B infusion dose)
0.15 - 0.5 mcg/kg/min
57
**Ephedrine**
| (IV push dose)
5 - 10 mg
58
**Phenylephrine**
| (dilution)
20mg in 250mL bag
| (80 mcg/mL)
59
**Norepinephrine**
| (dilution)
8mg in 250mL bag
| (32 mcg/mL)
60
**Dopamine**
| (IV infusion - renal dose)
0.5 - 3 mcg/kg/min
61
**Dopamine**
| (IV infusion - Beta dose)
3 - 10 mcg/kg/min
62
**Isoproterenol**
| (IV push dose)
20 - 60 mcg
63
**Isoproterenol**
| (IV infusion dose)
0.01 - 0.5 mcg/kg/min
64
**Vasopressin**
| (IV infusion dose)
0.01 - 0.06 U/min
65
**Milrinone**
| (IV push dose)
50 mcg/kg
66
**Milrinone**
| (IV infusion dose)
0.375 - 0.75 mcg/kg/min
67
**Hydralazine**
| (IV push dose)
2.5 - 5 mg
68
**Nitroglycerine**
| (IV push dose)
25 - 50 mcg
69
**Nitroglycerine**
| (IV infusion dose)
0.1 - 7 mcg/kg/min
70
Niroglycerine
| (dilution)
50mg in 250mL
| (200 mcg/mL)
71
**Nitroprusside**
| (IV push dose)
0.5 - 1 mcg/kg
72
**Nitroprusside**
| (IV infusion dose)
0.1 - 10 mcg/kg/min
73
**Diltiazem**
| (IV push dose)
0.25 then 0.35 mg/kg
74
**Diltiazem**
| (IV infusion dose)
1 - 3 mcg/kg/min
75
**Nicardipine**
| (IV push dose)
0.5 - 2 mg
76
**Nicardipine**
| (IV infusion dose)
1 - 4 mcg/kg/min
77
**Nifedipine**
| (IV push dose)
10 - 20 mcg/kg
78
**Nifedipine**
| (IV infusion dose)
1 - 3 mcg/kg/min
79
**Verapamil**
| (IV push dose)
75 - 150 mcg/kg
80
**Verapamil**
| (IV infusion dose)
1 - 5 mcg/kg/min
81
**Esmolol**
| (IV push dose)
0.5 - 1 mg/kg
82
**Labetalol**
| (IV push dose)
0.1 - 0.25 mg/kg
83
**Metoprolol**
| (IV push dose)
2 - 15 mg
84
**Amiodarone**
| (antiarrhythmic dose)
150mg in 1st 10 minutes
360mg over next 6 hours
540mg over remaining 18 hours
85
**Diazepam**
| (PO/IM dose - pediatric)
0.3 - 0.4 mg/kg
86
**Midazolam**
| (PO dose - pediatric)
0.5 - 1 mg/kg
87
**Midazolam**
| (IM dose - pediatric)
0.1 - 0.2 mg/kg
88
**Morphine**
| (IM dose - pediatric)
0.1 - 0.2 mg/kg
89
**Clonidine**
| (IV dose - pediatric)
2.5 mcg/kg
90
**Ketamine**
| (IM dose - pediatric)
3 - 5 mg/kg
91
**Ketamine**
| (IV dose - pediatric)
0.25 - 0.75 mg/kg
92
Pediatric IM Cocktail
0.15 mg/kg Midazolam
3 - 3.5 mg/kg Ketamine
10 mcg/kg Glycopyrrolate
93
Lipid Rescue
1.5 mL/kg IV of 20% Lipid Emulsion
followed by 0.25mL/kg/min for 30-60 minutes
94
**2-Chloroprocaine**
| (toxic dose)
11 and 14 mg/kg
| (plain and with Epi)
95
**Procaine**
| (toxic dose)
8 and 14 mg/kg
| (plain and with Epi)
96
**Tetracaine**
| (toxic dose)
1 and 2.5 mg/kg
| (plain and with Epi)
97
**Bupivacaine**
| (toxic dose)
2.5 and 3 mg/kg
| (plain and with Epi)
98
**Lidocaine**
| (toxic dose)
4.5 and 7 mg/kg
| (plain and with Epi)
99
**Mepivacaine**
| (toxic dose)
4 and 7 mg/kg
| (plain and with Epi)
100
**Prilocaine**
| (toxic dose)
6 and 9 mg/kg
| (plain and with Epi)
101
**Ropivacaine**
| (toxic dose)
2.5 and 3 mg/kg
| (plain and with Epi)
102
**Diazepam**
| (IV dose - adult)
2 - 10 mg
103
**Midazolam**
| (IV dose - adult)
0.5 - 5 mg
104
**Morphine**
| (IV dose - adult)
5 - 15 mg
105
**Atropine**
| (IV/IM/SQ dose)
0.4 - 0.8 mg
106
**Glycopyrrolate**
| (IV/IM/SQ dose)
0.1 - 0.3 mg
107
**Scopolamine**
| (IV/IM dose)
0.3 - 0.6 mg
108
**Diphenhydramine**
| (IM/IV/PO dose)
25 - 50 mg
109
**Propofol**
| (overview)
[diprivan]
sedative and hypnotic
* can also be used as an anti-emetic, anti-pruritic, anti-convulsantt, and attenuates bronchoconstriction
110
**Propofol**
| (mechanism of action)
GABAA Agonist
* Propofol decreases the rate of dissociation between GABA and its receptor; thereby increasing the duration of GABA activated chloride channels and resulting in hyperpolarization of cell membranes
111
**Propofol**
| (metabolism and excretion)
metabolized mostly in the liver
(very fast clearance)
excreted through the kidneys
112
**Propofol**
| (side effects and warnings)
* avoid in egg or soy allergy
* prolonged administration (\>24 hours) may cause lactic acidosis
* supports growth of E. coli and Pseudomonas
113
**Propofol**
| (effects on central nervous system)
* decreases CMRO2, cerebral blood flow, and ICP
* occasional excitatory activity
* myoclonic movements and hiccupping
114
**Propofol**
| (effects on cardiovascular system)
* venous dilation, decreased PVR, and cardiac depression lead to **hypotension**
* negative inotropic effect
* does not alter SA or AV node function
115
**Propofol**
| (bradycardia-related death)
chance of profound bradycardia and asystole after propofol administration
* increases incidence of oculocardiac reflex in pediatric strabismus surgery
* decreased response to atropine
* treat with direct Beta agonist (isoproterenol)
116
**Propofol**
| (effects on respiratory system)
* decreased ventilatory response during hypoxia
* decreased rate and tidal volume
* depression of laryngeal reflexes
117
**Etomidate**
| (overview)
[amidate]
sedative and hypnotic
* no histamine release
118
**Etomidate**
| (mechanism of action)
GABAA agonist
119
**Etomidate**
| (side effects and warnings)
* myoclonic movement
* relatively high incidence of PONV
* adrenal suppression
120
**Etomidate**
| (metabolism and excretion)
metabolized in the liver and by plasma hydrolysis
excreted by kidney
121
**Etomidate**
| (effects on central nervous system)
* may increase EEG activity
* especially in those with epilepsy
* myoclonic movements
* reduces CMRO2, CBF, and ICP
122
**Etomidate**
| (effects on cardiovascular system)
* slight decrease in PV
* may decrease blood pressure
* no histamine release
123
**Etomidate**
| (effects on respiratory system)
* transient apnea
* small decrease in rate and tidal volumes
124
**Etomidate**
| (effects on adrenal system)
inhibits 11-B-hydoxylase in adrenal cortex
* reduces corticoid production and elevates ACTH
* avoid continuous infusion in critically ill patients
125
**Ketamine**
| (overview)
[ketalar]
induction of anesthesia
126
**Ketamine**
| (mechanism of action)
NMDA antagonist
* also acts on opioid and cholinergic receptors
* causes dissociation between limbic and thalamocorticol systems
127
**Ketamine**
| (side effects and warnings)
* emergence delirium
* increased oropharyngeal secretions
* myoclonic movements
* nystagmus
* IOP increase
128
**Ketamine**
| (metabolism and excretion)
metabolized by the liver and excreted through kidney
* production of norketamine by-product prlongs analgesic effects
129
**Ketamine**
| (effects on central nervous system)
* increase CMRO2, CBP, and ICP
* EEG may be more active in seizure patients
* myoclonic activity
130
**Ketamine**
| (effects on cardiovascular system)
* MAP, CO, and HR increase
* may depress myocardium if catecholamine depleted or autonomic blockade
131
**Ketamine**
| (effects on respiratory system)
* minimal depression
* bronchodilator
132
(6) GABA agonists
* propofol
* etomidate
* benzodiazepines
* non-benzodiazepine benzodiazepine
* barbiturates
* alcohol
133
**Diazepam**
| (overview)
[valium]
sedative and anxiolytic
* benzodiazepine
* more prolonged action than midazolam
134
**Diazepam**
| (mechanism of action)
GABA agonist
135
**Diazepam**
| (metabolism)
hepatic enzymes using oxidative pathway
* produces two metabolites
* desmethyldiazepam and oxazepam
136
**Diazepam**
| (onset and duration)
60 seconds
15-30 minutes
137
**Diazepam**
| (effects on central nervous system)
* slight increase in CMRO2, CBF, CPP, and ICP
* muscle relaxant effect
* anterograde amnesia
* potent anticonvulsant
138
**Diazepam**
| (side effects and warnings)
* prolonged residual sedation
* caution in pregnant patients
* possible teratogenic
139
**Midazolam**
| (overview)
[versed]
sedative and anxiolytic
* benzodiazepine
140
**Midazolam**
| (mechanism of action)
GABA agonist
141
**Midazolam**
| (metabolism)
rapid absorption from GI tract
* 10x clearance rate compated to Diazepam
142
**Midazolam**
| (effect on central nervous system)
* anxiolysis
* amnesia
* central muscle relaxant
* anticonvulsant
143
**Midazolam**
| (effects on respiratory system)
* respiratory depression
* especially in COPD patients
144
**Flumazenil**
| (overview)
Competitive antagonist of benzodiazepine site on GABA complex
145
Inhalation Agents
| (effects on respiratory system)
Decreased tidal volume
increased respiratory rate and PaCO2
146
Inhalational agents
| (effects on CBF and ICP)
increase
147
Inhalational agents
| (effects on the renal system)
decrease RBF, GFR, and urine output
148
inhalational agents
| (effects on the hepatic system)
decrease blood flow
149
**Isoflurane**
| (effects on the cardiovascular system)
* lowers arterial BP and SVR
* increases HR by 20%
* Coronary steal syndrome
150
**Desflurane**
| (effects on cardiovascular system)
* decreased BP and SVR
* increased HR, CVP, and PA pressure
* no coronary steal
151
Sevoflurane
| (effects on cardiovascular system)
* decrease CO, SVR, and MAP
* no change in HR
152
**Thiopental**
| (overview)
[sodium pntothal or thiopentone]
rapid-onset barbiturate
153
**Thiopental**
| (effects on central nervous system)
* increased slow-wave high-amplitude activity on EEG
* anticonvulsant
* decreased CMRO2, CBF, and ICP
154
**Thiopental**
| (effects on cardiovascular system)
* venous dilation with cardiac depression
* slight increase in HR
155
**Thiopental**
| (effects on respiratory system)
decreased rate and tidal volume
156
**Thiopental**
| (side effects and warnings)
* allergy - may increase histamine by 300%
* fixed cardiac output syndromes may lead to profound hypotension
* intra-arterial injection may cause spasm or thrombosis
* acute intermittent porphyria
157
**Nitrous Oxide**
[blood:gas]
0.46
158
**Sevoflurane**
[blood:gas]
0.69
159
**Isoflurane**
[blood:gas]
1.46
160
**Nitrous Oxide**
[adverse effects]
absorption of N2O in gas containing spaces
inactivates vitamin B12
PONV
161
best anesthetic gas for ECT
Enflurane
decreases seizure threshold
162
Elimination Half-Life
time for drug concentration to decrease 50%
163
How does elimination half-life related to Vd and clearance?
directly proportional to Vd
inversely proportional to clearance
164
Context Sensitive Half-Life
time to decrease 50% after discontinuing a continuous infusion
165
First Pass Hepatic Effect
drug gets absorbed in the blood and goes to the liver which is extracted before returning to systemic circulation
166
**Transmucosal administration**
[advantage]
rapid onset
bypasses liver and first pass hepatic effect
167
Difference between proximal and distal rectum administration
proximal rectum undergoes first-pass hepatic effect
168
**Volume of Distribution**
[equation]
[drug given] / [plasma drug]
169
What is the Vd influenced by?
lipid solubility
binding to plasma proteins
molecular size
170
Non-Ionized ddrugs
lipid soluble and diffuse across cell membranes
171
weak base with pH \> pKa environment
unionized form predominates
172
Diazepam, a weak base (pKa3.3), is given orally to a patient. If this patient’sstomach pH is 1.3 and the
plasma pH is 7.4, which compartment will the Diazepam become “trapped” in?
stomach
173
Where do bound drugs go in the body?
once bound they will stay in the intravascular space
174
Where do unbound and unionized drugs go in the body?
cross placenta and blood brain barrier
175
Coumadin is \_\_\_\_\_% protein bound
98
176
(3) Types of Phase I reactions
hydrolysis, oxidation, and reduction
177
**Creatinine Clearance**
[equation]
CLcr = (140-age) \* (weigh) / (72\*Scr)
178
(3) Phase II reactions
conjugation reactions
(sulfation, acetylation, and glucuronidation)
179
describe the Second Gas Effect with N2O
N2O has a high volume of uptake and diffuses quickly which increases the alveolar pressure of the second gas
180
Which (2) gases are most soluble?
halothane and isoflurane
181
How does solubility affect alveolar pressure?
solubility is inversely related to rate of increase of alveolar pressure
Example: Des
lower blood:gas → less soluble → higher pressure in alveoli → brain sees higher pressure → faster
182
How does cardiac output affect the speed of an inhalational induction?
If CO is increased, more rapid uptake of agent so alveolar pressure is lower and therefore a slower induction
_increased CO = slower induction_
183
Diffusion Hypoxia
reverses the partial pressure gradients so that N2O leaves the blood to enter alveoli
* occurs when inhalation is discontinued abruptly
* dilutes PAO2, PaO2, and PaCO2
184
**MAC**
[estimation equation]
150 / oil:gas
185
Factors that increase MAC
* hyperthermia
* red hair
* cyclosporin
* hypernatremia
186
Factors that decrease MAC
* hypothermia
* elderly
* pregnant
* lidocaine
* acute EToH
* narcotics
187
Henry's Law
the amount of gas which dissolves in a liquid is directly proportional to the partial pressure of the gas in equilibrium with the liquid
188
Dalton's Law
the sum of the partial pressures of each gas in a mixture equals the total pressure of the entire mixture
189
Blood:Gas Coefficient
[ideal]
lower coefficient indicates a greater control of anesthetic depth and recovery
* higher numbers are worse due to it wanting to stay in the blood
190
Pernicious Anemia
lack of vitamin B12 causing macrocytic RBCs
* treat with high doses of vitamin B12
191
**Nitrous Oxide**
[cardiovascular effects]
myocardial depressant
no change in BP or pulse
**increases pulmonary vascular resistance**
192
Concern with increasing pulmonary vascular resistance
increases work by the right heart, increases O2 consumption, may lead to heart failure
* avoid in Tet babies with any type of shunt defect
193
**Nitrous Oxide**
[CNS effects]
increases CMRO2, CBF, CBV, and ICP
194
What volatile agent can cause hepatotoxicity
halothane
195
Characteristics of Nephrotoxicity
polyuria
hypernatremia or hyperosmolarity
increased Cr
dilute urine
196
**Inhalational Agents**
[effect on the Uterus]
decrease uterine contractility and tocolytics
decrease blood flow to uterus (except N2O)
197
MAC BAR
the MAC at which Blocks Autonomic Response
(around 2 MAC)
198
At what MACs can volatile agents cause circulatory collapse?
Des 2.45 and Iso 3.0
199
volatile agents
[cerebral blood flow]
increases intially due to vasodilation
uncouples CBF and CMRO2
200
**Inhalational Agents**
[rank of increasing cerebral blood flow]
N2O \> Iso \> Des \> Sevo
201
**volatile agents**
[geriatric patients]
decreased MAC
5% decrease for every decade after 40yrs
202
which inhalational agent doesn't lower MAP
N2O
203
which agent maintains CO best
Desflurane
204
Which agents decrease stroke volume
Sevoflurane and Halothane
205
which agents decrease SVR
all but N2O
206
which agent increases PVR
N2O
207
which agent increases chance of arrhythmias
Halothane
sensitizes myocardium to catecholamines
208
GABA
[mechanism of action]
inhibitory neurotransmitter in the CNS
* allows chloride ions to enter the cell
* hyperpolarizes the post-synaptic neuron and reduces its excitability
209
**Barbiturates**
[mechanism of action]
increases duration of GABA
210
**Barbiturates**
[cardiovascular effects]
decrease BP and increase HR
211
cerebral perfusion pressure
[equation]
MAP - ICP (or CVP)
212
Barbiturate of choice in ECT
**Brevital**
(methohexital)
* induces seizure activity but decreases duration
* 1 mg/kg
* must be dissolved in normal saline because it precipitates with LR
213
Acute Intermittent Porphyria
deficiency of a heme enzyme
* "Dracula" disease
* barbiturates precipitate symptoms
* abdominal pain, urinary symptoms, and peripheral neuropathy
214
**Propofol**
[anti-emetic infusion dose]
500 mcg/kg/min
215
What effects of opioids can you _not_ develop tolerance for?
miosis and bowel motility
216
**Fentanyl**
[potency compared to morphine]
100x more potent than morphine
217
Opioids
[potency rank]
Sufentanyl \> Fentanyl and Remi \> Dilaudid \> morphiine \> tramadol
218
Benzodiazepines
[substances with synergistic effects]
alcohol, anesthetics, and alpha-2 agonsts
219
(2) types of sympathetic adrenergic receptors
alpha and beta
220
Alpha-1 Receptor
smooth muscle contraction and vasoconstriction
221
Alpha-2 Receptors
smooth muscle contraction and inhibition of NE release
222
Beta-1 Receptors
increase heart rate and contractility
223
Beta-2 Receptors
smooth muscle relaxation and bronchodilation
224
Synthesis of Norepinephrine
Tyrosine
L-DOPA
DOPA
Norepinephrine
225
How is Norepineprine terminated?
80% by reuptake and reused
diffusion from receptors
metabolism by MAOs and COMT
226
Where are nicotinic receptors found?
autonomic ganglia and skeletal muscle
227
Reflex Sympathetic Dystrophy
painful stimulation evokes sympathetic activity
* leads to acidosis and tissue ischemia
228
Pseudochoinesterase Deficiency
[causes]
* pregnancy
* insecticides
* liver disease
* echothiophate eye drops
* hypothermia
* organophophates
* magnesium
* ester local anesthetics
229
