Pharmacology Flashcards
Midazolam (Versed)
Benzodiazepine Uses: Anxiolysis, Sedation, amnesia Supplied 1 mg/mL Dose Sedation: 1-2.5 mg IV Dose PO: 0.5 mg/kg
Morphine
Supplied: 10mg/mLOnset: 15-30 minutes
Duration: 3-6 hours
Dose Intraoperative: 0.1-1mg/kg (IV)
Dose Postoperative: 0.03-0.15 mg/kg (IV)
Fentanyl
Supplied: 50 mcg/mL Peak Effect: 3-5 minutes Duration: 30-60 minutes Dose Low: 1-2 mcg/kg Dose Moderate: 2-20 mcg/kg Infusion: 1-2mcg/kg/hr
Hydromorphone (Dilaudid)
Use: Analgesia Supplied: 2mg ampule Dose: 0.5-2mg Onset: 5 minutes Duration: 3-6 hours
Naloxone (narcan)
Use: overdose, respiratory depression
Supplied: 0.4 mg vial
Dose: 1-4 mcg/kg
Meperidine (Demerol)
Use: analgesia, Post-op shivering
Supplied: 2.5%, 5%, 7.5%, 10%
Dose: periop analgesia: 75-100mg IV
Post-op Shivering 12.5-25 mg IV
Propofol (Diprivan)
Class: Diisopropylphenol Use: Induction, Sedation, MAC Supplied: 10mg/mL (1%) Dose Induction: 1.0-2.5 mg/kg Dose Infusion: 25-200 mcg/kg/min Cautions: Use within 6 hours, soy or egg allergy, HYPOTENSION
Etomidate (Amidate)
Use: Induction/hypnosis Supplied: 2mg/mL (35% propylene glycol) Dose: 0.2 - 0.3 mg/kg CARDIOVASCULAR STABILITY Caution: Pain on injection, myoclonus, PONV
Lidocaine
Class: Amide
Use: Local anesthesia, cough, inhalation, cardiac arrythmias
Supplied: 0.5-5%
Dose: IV Induction (0.5-1mg/kg)
Ketamine (Ketalar)
Class: Phencyclidine (PCP Derivative) Use: Induction, analgesia, amnesia Supplied: 10, 50, 100 mg/mL Dose Analgesia 0.2-0.5 mg/kg Dose Induction 1-2mg/kg IV Dose Induction 4-8mg/kg IM Emergence Delirium
Succinylcholine (Anectine)
Class: Depolarizing NMBD Use: Intubation, Paralysis, Laryngospasm Supplied: 20 mg/mL Onset: 30 seconds Dose: Intubation: 1-2mg/Kg Laryngospasm: 0.1 mg /kg IV Duration: 3-5 minutes Fasciculations (5-10 mg of Roc prevent) Malignant Hyperthermia
Rocuronium (Zemuron)
Class: Aminosteroid, non-depolarizing Use: Paralysis, RSI Supplied: 10mg/mL Onset: 1-2 minutes (as short as 30 sec at high conc) Duration: 20-35 minutes Metabolism: Liver and Kidneys Dose Intubation: 0.6 - 1.2 mg/kg Maintenance: 0.1 mg/kg Infusion: 5-12 mcg/kg/min
Vecuronium (Norcuron)
Class: Aminosteroid, non-depolarizing Use: Paralysis Supplied:10mg powder reconstituted to 1 mg/ml Onset: 3-5 minutes Duration: 20-35 minutes Metabolism: Liver and Kidneys Dose Intubation: 0.08-0.12mg/kg Infusion: 1-2mcg/kg/min Maintenance 0.01 mg/kg
Cisatracurium (Nimbex)
Class: Benzyl isoquinolinium,non-depolarizing Use: Paralysis Supplied: 20 mg vial ( 2 mg/mL) Dose: Intubation 0.1-0.15 mg/kg Infusion 1-2 mcg/kg/min GOOD FOR RENAL/HEPATIC DYSFUNCTION Onset 3-5 minutes Duration 20-35 minutes
Neostigmine
Class: Anticholinesterase Use: NMB reversal Supplied: 1mg/mL (0.5 mg/mL) Dose: 0.04-0.07 mg/Kg Caution: BLUDS
Atropine
Class: Anticholinergic Use: Bradycardia, NMB reversal Supplied: 0.4, 0.5, 1 mg/mL Dose: IM 0.01-0.02 mg/Kg (up to 0.4-0.6 mg) Bradycardia: 0.4-0.6 mg (up to 3 mg)
Isoflurane
Highly Potent A/W Irritant Min Metabolism- 0.2% CV Changes- minimal at 1 MAC MAC = 1.1% Vapor Pressure: 238
Sevoflurane
Least A/W Irritant Inhalational induction Metabolized 2-5% Compound A Renal Tubular Injury Prompt Recovery MAC = 2.0% Vapor Pressure: 157
Desflurane
Pungent A/W irritant Decreased Potency Prompt Recovery CO formation MAC = 6.0% Vapor Pressure: 669
Glycopyrrolate (Robinul)
Class: Anticholinergic Use: Antisialigogue, NMB reversal Supplied: 0.2 mg/mL Dose: Pre-med: 0.2 mg IM Reversal: 0.2 mg per 1 mg Neostigmine Used with neostigmine because of similar onset and duration times
Epinephrine
Class: Catecholamine Use: Increase HR/BP, Anaphylaxis, bronchospasm Supplied: 16 µg/mL syringe; 4 µg/mL (1 mg in 250mL) Dose: Bolus (8-16mcg) Small Doses (1-2 µg/min) – β2 Medium Doses(4 µg/min)- β1 Large Doses (10-20 µg/min)- α and β
Phenylephrine
Class: Synthetic non-catecholamine Action: Direct Stimulates alpha receptors Use: Increase Blood pressure, nasal decongestant Supplied: **100mcg/mL (1mg vial)** Dose: Bolus: **50-100 mcg** Infusion: 0.25-1 mcg/kg/min Caution: Increased Afterload Reflex bradycardia
Ephedrine
Class: Synthetic non-catecholamine Action: Direct and Indirect Stimulated the release of norepinephrine to act on alpha receptors Use: increase heart rate and blood pressure Acts on the heart Supplied **5mg/mL (25 or 50mg in 1 mL)** Dose: **5-20mg** Caution: Tachyphylaxis Depletion of Norepinephrine
Esmolol (Brevibloc)
Class- Cardioselective Beta blocker Use: Decrease heart rate Supplied: **100 mg (10 mg/mL in 10 mL)** Dose: 0.2-0.5 mg/kg Normal initial dose is 10mg Decrease HR, Contractility, BP Onset: 5 minutes Duration 10-30minutes Metabolism: Plasma cholinesterases
Metoprolol (Lopressor)
Class: Beta-blocker Long acting….selective for beta-1 (heart) Use: Decrease HR Supplied: 5 mg (1 mg/mL) Dose: 1-2 mg Duration can be in hours not minutes
Labetalol (normodyne)
Class: Mixed antagonist α1, β1, β2
(Beta: Alpha = 7:1)
Use: Control HR and BP
Supplied: 5mg/mL (20 mL vial)
Dose: 0.1-0.25 mg/kg (5mg initial)
Can decrease BP through beta effects on the heart but also through vascular dilation by alpha receptors
Ashtma—B2 antagonist can cause broncho CONSTRICTION
Nitroglycerin
Class: Hypotensive agent Use: Angina, HTN Supplied: 100 µg/mL Dose: Bolus: 50-100 µg Infusion: 0.5-10 µg/kg/min Caution Principally Venous Dilator Decreases Ventricular Wall Tension
Hydralazine
Class: Hypotensive agent Use: HTN Supplied: 20 mg in 1 mL Dose: 5-20 mg Onset: 20 minutes Duration: 6-8 hours Principal Arterial Dilator
Droperidol (inapsine)
Class: Antidopaminergic Use: Antiemetic Supplied: 0.3125 mg/mL Dose: 0.625 mg Caution: Parkinsons Prolonged QT interval Abnormal EKG
Odansetron (zofran)
Class: Serotonin receptor antagonist Use: Antiemetic Decreased PONV in susceptible patients Supplied: 4 mg/2mL Dose: 4 mg
Cefazolin (Ancef)
Antibiotic (Cephalosporin)
Derivative of Penicillin
Dose: 1-2g IV
Given within 60 minutes of incision
Cefoxitin
Antibiotic (Cephalosporin)
More gram negative coverage specific to GI flora
2g IV within 60 minutes
Ampicillin
Antibiotic Penicillin cross reactive
Subacute bacterial endocarditis prophylaxis (SBE)
Mechanical Heart Valves, Congenital Heart Disease
Gentamicin
Antibiotic Often used with ampicillin for SBE Common in Urology Cases Given slowly Ototoxicity Can cause deafness (ideally transient)
Levaguin
Antibiotic
Often used for additional gram negative coverage
Abdominal Cases, ENT involving the mouth
Nafcillin
Antibiotic Penicillin Cross reactive
Often Used for Neuro Cases
Vancomycin
90kg 1.5g IV given over one hour
Increases risk of VRE (vancomycin resistant enterococci)
Used as broad spectrum treatment against over hospital acquired infections due to drug resistant bacteria
Given slowly over one hour to prevent Redman Syndrome where too much histamine is released causing hypotension and flushing of the torso
Clindamycin
Dose: 600 or 900mg IV
Usually first choice for somebody with PCN allergy
Redose every 6 hours (q6h)
Pancuronium
Non-Depolarizing Neuromuscular Blocker Can cause Tachycardia Initial Dose: 0.06-0.1mg/kg pH is 4 ish Provided 1-2mg/mL Duration: 60-90 minutes
Pancuronium
Non-Depolarizing Neuromuscular Blocker Can cause Tachycardia Initial Dose: 0.06-0.1mg/kg pH is 4 ish Provided 2mg/mL Duration: 60-90 minutes
