Pharmacology Lecture Flashcards
0
Q
What is versed most frequently used for?
A
Anxiolytic and as an amnestic
1
Q
In what kinds of cases can versed be used as an induction agent?
A
Longer cases, its duration of action limits its use to longer OR cases.
2
Q
What is versed’s duration of action?
A
2 to 6 hours
3
Q
What drug class is versed a member of?
A
Benzodiazepine
4
Q
What are two important things to remember about versed before giving it?
A
- It can be painful
2. Dose may have to be adjusted due to tolerance issues of the patient
5
Q
What drug can be used to reverse versed?
A
Fluemazenil/Romazicon
6
Q
What is the induction dose of versed?
A
.1-.25 mg/kg for induction
7
Q
Why is versed given in preop?
A
For anxious folks and for it amnestic qualities…it is given at smaller doses for these. Less than the induction doses
8
Q
What is versed’s onset?
A
1 to 5 minutes
9
Q
What is versed’s peak?
A
5 to 30 minutes
10
Q
What is the duration of action of versed?
A
2 to 6 hours
11
Q
What is the non-induction preop dose of versed?
A
1 to 5 mg
12
Q
When given to patients with existing pulmonary disease and when given with other sedatives what can happen?
A
Respiratory depression
13
Q
What is the other name for versed?
A
Midazolam
14
Q
What is the dose of propofol?
A
1 to 2.5 mg/kg
15
Q
What is another name for vecuronium?
A
Norcuron
16
Q
What is the primary advantage of using propofol?
A
Its short duration of action. No “HANGOVER AFFECT”
17
Q
What is the onset time of propofol?
A
15 to 30 seconds
18
Q
What is the duration of action time for propofol?
A
5 to 10 minutes
19
Q
In what type of allergy should propofol not be used in?
A
Egg allergy
20
Q
What is a frequent complaint of propofol administration?
A
Pain
21
Q
What are three ways the pain of propofol infusion can be averted?
A
- bigger vein
- bigger IV
- give lidocaine?
22
Q
Besides being allergic to eggs, what other type of patient should propofol not be used in?
A
It is a cardiac suppressant, so it should not be used in a very sick patient as it tends to drop the BP…i.e. ASA 3 or 4 patients
23
Q
Besides it induction properties, what is another characteristic of propofol?
A
antiemetic
24
Besides induction, what other case is propofol used for and why?
Its used as a sedative in MAC(minimal anesthesia care) cases, in these cases there is suppose to be no loss of lid reflex, so not general anesthesia
25
What drug should be used to induce sick patients that might not tolerate the cardiac suppressant affects of propofol?
Ketamine
26
What can be a reason not to use etomidate to induce a patient?
Nausea and Vomiting
27
What is two of the hallmark properties of using etomidate?
1. Its cardiovascular stability
| 2. Its fast onset
28
What type of patient would be the ideal patient for etomidate?
The critical ill, ASA class 3 or 4 patient with no history of N and V with anesthesia
29
What is something to remember about the administration of etomidate?
Its painful due to being mixed in a propylene glycol solution
30
Why might you pretreat with fentanyl before giving etomidate?
To decrease the incidence of myoclonia/twitching movements...they go away when the patient is fully induced
31
What is the concentration of etomidate?
2 mg/ml
32
What is etomidate's onset?
15 to 30 seconds
33
What is the duration of etomidate?
3 to 10 minutes
34
What is the dose of etomidate?
0.2-0.4 mg/kg
35
When would you decrease the dose of etomidate?
When it is given in conjuction with sedatives, opioids and hypnotics
36
What is a complication of Brevital?
Seizures...does not lower the sz thresh hold like propofol does
37
What is the drug class of Brevital?
Barbiturate
38
Brevital shares a similar effect as Etomidate....what is it?
Excitatory movements
39
In what type of patient should you avoid Brevital?
Epileptic
40
What is the concentration of Brevital?
10 mg/ml
41
What is the dose of Brevital?
1.5 to 2.5 mg/kg
42
What is the onset of Brevital?
20 - 40 seconds
43
What is the duration of action of Brevital?
5 to 10 minutes
44
What kind of depressant is Brevital?
Respiratory
45
Ketamine is a derivative of what?
PCP
46
What is a disturbing emergency reaction of Ketamine?
"Bad Trips"
47
What is the only induction agent that also has analgesia properties?
Ketamine
48
How does ketamine affect the HR and BP?
Ketamine is excellent for many critically ill patients as it increases both HR and BP. May be contraindicated in patients who cannot tolerate high heart rates or blood pressure. i.e. aortic stenois and patients with high ICP
49
Besides causing nightmares and "bad trips", what other negative side affect does Ketamine have?
Increased secretions
50
What drug can help control the negative affects of Ketamine?
Robinol
51
What type of agent is Ketamine?
Opioid induction agent
52
What receptors are stimulated by Ketamine?
Kappa and Sigma
53
What is the 3 different types of concentration of Ketamine?
50 mg/ml
10 mg/ml
100 mg/ml
54
What is the typical IV induction dose of Ketamine?
1-2 mg/kg
55
What is the IM induction dose of Ketamine?
4 - 8 mg/kg
56
What is the onset of Ketamine?
30 - 60 seconds
57
How do you know when Ketamine has started to work?
The patient will have nystagmous
58
How long does Ketamine's hypnotic affect last?
15 minutes, analgesia affect last much longer
59
What is the standard concentration of Fentanyl?
50 mcg/ml
60
At what dose does Fentanyl start having anagesia effects?
0.5 mcg/kg
61
At what dose is Fentanyl given when it is the primary anesthetic?
100 mcg/kg
62
What is the onset time for Fentanyl?
Typically about 30 seconds or 1 to 2 circulation.
63
What is the duration of action for an analgesic dose of Fentanyl?
30-60 minutes
64
When the dose of Fentanyl is greater than analgesic dosages, what happens to its duration of action?
It increases
65
What is the primary adverse effect of Fentanyl?
Respiratory depression
66
What medication will reverse the effects of Fentanyl?
Naloxone
67
On which receptors does Fentanyl work?
Fentanyl works on the opioid receptors, primarily the mu opioid receptors
68
What does the Mu receptors mediate?
They mediate the effects of analgesia, respiratory depression and addiction
69
What is the analgesic dose of Sufentanil aka Sufenta?
0.1 mcg/kg
Much more potent than Fentanyl
70
At what dose might someone receive Sufentanil aka Sufenta if they are having a complex or extremely painful surgery?
20 mcg/kg
71
What is the onset of Sufentanil?
15-30 seconds
72
What is the duration of action for Sufentanil aka Sufenta?
20-45 minutes in analgesic doses. Duration of action increases as doses increased
73
Sufenta aka Sufentanil use is limited to what and why?
Its use is limited to long and extremely stimulating surgical procedures due to being very expensive
74
What is the #1 adverse reaction of Sufentanil?
Profound respiratory depression
75
What receptors are stimulated by Sufentanil?
The Mu opioid receptors. They are primarily responsible for the clinical effects of sufenta
76
What routes is Sufentanil available?
Although Fentanyl is available in many forms, Sufentanil aka Sufenta is only available in IV form.
77
What is the other name for Demerol?
Meperidine
78
What receptors do Demerol stimulate?
Opioid Mu receptors.
It is not a narcotic...is does not cause narcosis!
79
In what way is Demerol similar to Atropine?
Due to a similar structure, it can cause an increased HR like atropine. It's use should be avoided in patients who will not tolerate a higher HR.
80
Demerol was the first what?
It was the first synthetic opioid
81
What is the primary reason Meperidine is used in anesthesia?
Demerol is primarily used in the PACU for shivering
82
What is the concentration of Demerol?
50 mg/ml is the most common, but may be supplied in either 25 mg/ml or 100 mg/ml
83
What is the analgesic dose of Demerol?
0.5-2 mg/kg, smaller doses needed to stop shivering
84
What is the onset of Demerol?
30-60 seconds
85
What is the duration of action of Demerol?
2-4 hours
86
What receptors does Demerol act upon?
It works on the Mu receptors as well as other ones
87
What are some adverse effects of Demerol?
tachycardia, respiratory depression, hallucinations
88
If a patient is taking what kind of home meds should Demerol be avoided in?
MAOIs
89
What is Morphine known for?
It was the original opioid, the prototype opioid agonist. It was derived from the opium poppy.
90
What is the primary use of Morphine in anesthesia?
Post op pain relief.
91
What is the concentration of Morphine?
1-15 mg/ml
92
What is the typical analgesic dose of Morphine?
0.1 mg/kg
93
What is the onset of Morphine?
30-60 seconds, peak analgesic effects much longer
The less potent an opioid is the longer its peak effect due to crossing the blood brain barrier
94
What is the duration of action for Morphine?
3-4 hours
95
What are some side effects of Morphine?
Pruitis, nausea and vomiting, hallucinations, respiratory depression, hypotension, constipation
96
What receptors does Morphine stimulate?
Morphine works primarily on the Mu opioid receptors but also the Kappa receptors
97
Hydromorphone is what time of opioid?
Dilaudid is a semi-synthetic opioid, it is a derivative of morphine with approx 5 times greater potency of morphine
98
What is the concentration of Dilaudid?
It is 1 mg/ml or 2mg/ml
99
What is the typical dose of Hydromorphone?
0.25 - 2 mg for adults
100
What is the onset of Dilaudid?
30-60 seconds
101
What is the duration of action of Hydromorphone?
2-3 hours
102
What is the primary use of Dilaudid by anesthesia?
It is useful for post op pain relief in the PACU, also given towards the end of the case after spontaneous ventilation is restored to ensure comfortable wake up.
103
What are the side effects of Dilaudid?
Respiratory depression and nausea and vomiting
104
What receptors does Hydromorphone work?
Opioid
105
What is the concentration of Remifentanil?
It comes as a powder for reconstitution in 1 or 2 mg vials
106
What is the dose for Remifentanil?
0.05-2 mcg/kg/min
107
What is the onset of action of Remifentanil?
Onset is EXTREMELY rapid at 15 seconds
108
What is the duration of action of Remifentanil?
Its duration of action is only 5-10 minutes as its rapidly metabolized
109
In what type of surgical procedures is Remifentanil particularly useful?
It is very expensive, but it is particularly useful in surgical procedures requiring intensive but brief periods of analgesia. Often part of T.I.V.A.~total intravenous anesthetic(given with propofol and a skeletal muscle relaxant)
110
What class of muscle relaxant is Succinylcholine aka sux?
Depolarizing agent
111
What is Sux claim to fame?
It is the only muscle relaxant for true RSI! Its the drug of choice when securing the AW as rapidly as possible is the goal.
112
What is the onset of Sux?
30-60 seconds
113
What is the concentration of Anectine?
20 mg/ml
114
What is the dose of Anectine?
1 - 1.5 mg/kg
115
What is the duration of action of Sux?
3-5 minutes
116
What are two very serious possible side effects of Succinylcholonine?
It may trigger malignant hyperthermia as well as it may transiently raise K+ levels so it is contraindicated with disease states that may exhibit hyperkalemia.
117
What should be check before giving a non-depolarizer after the patient has received Anectine which is a depolarizer agent?
Twitches....this verifys that the effects of succinycholine has worn off
118
What precedes muscle relaxation?
Fasciculations
119
What type of muscle relaxant is Cisatracurium?
Non-depolarizer
120
What is the concentration of Nimbex?
2 mg/ml
121
What is the dose of Nimbex?
0.1-0.2 mg/kg
122
What is the onset of Cisatracurium?
3-5 minutes
123
What is the duration of action of Nimbex?
20-35 minutes
Requires no renal function for metabolism!!!!!
124
When giving Nimbex What is the pre-treatment dose for succinylcholine administration?
1-2 mg
125
Cisatracurium aka Nimbex is the muscle relaxant of choice for what patient population?
Those in renal failure!
It is not metabolized by the kidneys.
126
What is important about the storage of Cisatracurium?
It must be refrigerated for storage
127
Why is Nimbex safe for infusion?
There are not cumulative effects
128
What is the concentration of Vecuronium?
1 mg/ml
129
What is the dose of Norcuron?
0.1 to 0.12 mg/kg
130
What is the onset of action of Vecuronium?
1-3 minutes
131
What is the duration of action of Norcuron?
20-35 minutes
132
What are side effects of Vecuronium both good and bad not related to its muscle relaxation?
It has no cardiovascular or histamine releasing effects
It is less popular as an infusion as it has cumulative effects...requires hepatic function for metabolism.
133
What is the concentration of Rocuronium?
10 mg/ml
134
What is the classification of Zemuron?
Non-depolarizing skeletal muscle relaxant
135
What is the intubating dose of Roc?
0.6 - 1.2 mg/kg
136
What is Roc aka Zemuron's claim to fame as a skeletal muscle relaxant?
It has a quicker onset than cis or vec, so this make it the second best drug after Sux for rapid intubationi
137
What is the onset of action of Zemuron?
1-2 minutes dependent on the dose!
138
What is the duration of action of Zemuron?
20-35 minutes with normal intubating dose, duration lengthens as doses increase
139
How does Roc affect the cardiovascular/histamine systems?
It has minimal CV effects and no noticeable histamine release
140
What is the most common reason Atropine is given by anesthesia?
it is given with acetylcholinesterase inhibiting drugs like neostigmine to prevent excessive drooling, bradycardia
141
What is the concentration of Atropine?
0.4 mg/ml or 0.4 mg/0.5 ml
142
What is the dose of Atropine when given with Neostigmine?
15-70 mcg/kg
143
What is the onset of Atropine?
15- 30 seconds...works quicker than robinol
144
What is the duration of action of Atropine?
1-2 hours
145
Why is Atropine used less than Robinol?
Atropine crosses the blood brain barrier and may lead to confusion as it has loco weed in it
146
What is the drug classification of Atropine?
it is a Tertiary Amine Anticholinergic
147
Why is Glycopyrrolate used by anesthesia?
Anti-muscarinic given with acetylcholinesterase inhibiting drugs to block the adverse effects of drooling and bradycardia
148
What is the concentration of Robinal?
0.2 mg/ml
149
What is the dose of Glycopyrrolate aka Robinal?
0.01-0.02 mg/kg or 10-20 mcg/kg
150
How is Robinol administered in peds?
Glycopyrrolate administered in equal volume with neostigmine
151
What is the onset of action of Glycopyrrolate?
1 minute or less
152
What is the duration of action of Robinal?
2-4 hours
153
What is the drug classification of Robinal?
Quaternary Ammonium Anticholinergic
154
How does Robinal compare to Atropine?
It does not cross the blood brain barrier so it does not contribute to post op delirium
155
What is Neostigmine/Prostigmine known for?
It is the gold standard of anticholinesterase drugs, it blocks the active site of acetylcholinesterase so the enzyme can no longer break down the acetylcholine molecules before they reach the postsynaptic receptors. This allows for the threshold be reached so new impulses can be triggered in the next neuron.
156
What concomitant drug is required for Neostigmine's use?
Atropine or Robinal?
157
What is the concentration of Neostigmine?
1 mg/ml
158
What is the dose of Neostigmine?
0.45 to 0.07 mg/kg
159
What is the onset of action of Neostigmine?
1-3 minutes
160
What is the duration of action of Neostigmine?
40-60 minutes
161
What's important to know about Neostigmine on its limitations?
You can't reverse a completely paralyzed patient, it must work in combination with spontaneous recovery from pharmaceutical muscle relaxers`
