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Pharmacology 1 > Reversal Associated Dosages > Flashcards

Reversal Associated Dosages Flashcards

1
Q

Narcan (alternate name):

A

Naloxone

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2
Q

Narcan structure:

A

Derivative of Oxymorphone

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3
Q

Narcan MOA:

A

Competitive agonist of all opioid receptors
Greatest for Mu

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4
Q

Narcan Onset:

A

2 min

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5
Q

Narcan Duration of action:

A

20-60 min

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6
Q

Narcan PB:

A

60%

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7
Q

Narcan Metabolism:

A

Rapidly metabolized by the liver, has very high clearance

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8
Q

Narcan IV adult Dose:

A

IV Adult: 0.4 - 2 mg
(repeat as needed)

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9
Q

Narcan IV peds Dose:

A

IV peds: 0.1 mg/kg (max 2mg)
(repeat as needed)

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10
Q

Narcan Side effects:

A
  1. Reversal of opioids
  2. increased resp drive
  3. increased BP
  4. N/V
  5. Arrythmias
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11
Q

Narcan Contraindications / cautions:

A
  1. Pulmonary edema
  2. Sudden death
  3. May need to re-dose
  4. Do not give fast
    5.
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12
Q

Sugammadex (alternate name):

A

Bridion

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13
Q

Sugammadex Structure:

A

Gamma cyclodextrin (selective relaxant-binding agent)

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14
Q

Sugammadex MOA:

A
  1. Hydrophobic cavity
  2. Encapsulates the steroid NMB (specifically roc)
  3. Forms a complex that cannot have an effect on receptors or acetylcholinesterase
  4. Highly water soluble
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15
Q

Sugammadex Onset:

A

1-2 min

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16
Q

Sugammadex duration of action:

A

2-16 hr

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17
Q

Sugammadex PB:

A

0%

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18
Q

Sugammadex Metabolism:

A

Really excreted unchanged (80%)

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19
Q

Sugammadex IV dose:

A

IV: 2 mg/kg (TOF 2-4)
IV: 4 mg/kg (TOF 0-1)
IV: 16 mg/kg (1.2 mg/kg RSI reversal)

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20
Q

Sugammadex side effects:

A
  1. Bradycardia
  2. Nausea
  3. Headache
  4. Hepatic stable
  5. Potential asystole
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21
Q

Sugammadex Contraindications / cautions

A
  1. Birth control pills ineffective for 1 week
  2. Caution in renal disease
  3. Known hypersensitivity
  4. If need to reintubate, use a different NMB
  5. Ensure adequate reversal before extubation: head lift 5 secs, spontaneous ventilation, eye opening, hand grip, cough/gag reflex, leg raise
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22
Q

Glycopyrrolate (alternate name):

A

Robinul

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23
Q

Glycopyrrolate structure:

A

Anticholinergic
Quaternary ammonium

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24
Q

Glycopyrrolate MOA:

A
  1. Block muscarinic receptors
  2. Not nicotinic so that NMB can be antagonized while muscarinic effects are minimized
  3. blocks parasympathetic effects
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25
Q

Glycopyrrolate Onset:

A

2 min

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26
Q

Glycopyrrolate duration of action:

A

2-6 hr

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27
Q

Glycopyrrolate PB:

A

40%

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28
Q

Glycopyrrolate metabolism:

A

Small amount metabolized by liver and kidneys

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29
Q

Glycopyrrolate IV dose:

A

0.6-1 mg (equal volume to anticholinesterase)

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30
Q

Glycopyrrolate side effects (same as other anticholinergics):

A
  1. Bronchodilation
  2. Decrease PONV
  3. Dry mouth
  4. Pupil dilation
  5. Increase HR
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31
Q

Glycopyrrolate Contraindications / cautions:

A
  1. Give prior to anticholinesterase
  2. Adjust dose if already tachycardic
  3. Mix with equal volume of anticholinesterase
  4. Tachycardia may be seen when administered with pyridostigmine b/c of its slow onset
  5. Does not cross BBB
  6. Overdose: mad as a hatter (confusion), blind as a bat (mydriasis), hot as a hare (no sweating), dry as a bone (dry mouth), red as a beet (flushing), full as a flask (urinary retention) (can’t see, pee, spit, or shit)
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32
Q

Atropine (alternate name):

A

Atropen

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33
Q

Atropine structure:

A

Anticholinergic
Tertiary amine

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34
Q

Atropine MOA:

A
  1. Competitively bind to the Ach receptor
  2. prevents cGMP or cAMP mediated effects
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35
Q

Atropine Onset:

A

1 min

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36
Q

Atropine duration of action:

A

1-2 hr

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37
Q

Atropine PB:

A

40%

38
Q

Atropine Metabolism:

A

Liver and kidneys

39
Q

Atropine IV dose:

A

IV: 15 mcg/kg (with equal volume anticholineasterase) or
IV: 1-2 mg (with equal volume anti cholinesterase)

40
Q

Atropine side effects (same as other anticholinergics):

A
  1. Bronchodilation
  2. Decrease PONV
  3. Dry mouth
  4. Pupil dilation
  5. Increase HR
41
Q

Atropine Contraindications / cautions:

A
  1. Crosses BBB
  2. Decreased baroreceptor sensitivity
  3. High variability in HR
  4. Does not increase HR in Heart transplant patients
  5. Overdose: mad as a hatter (confusion), blind as a bat (mydriasis), hot as a hare (no sweating), dry as a bone (dry mouth), red as a beet (flushing), full as a flask (urinary retention) (can’t see, pee, spit, or shit)
42
Q

Scopolamine (alternate name):

A

Hyoscine

43
Q

Scopolamine structure:

A

Anticholinergic
Tertiary amine
Aromatic ester

44
Q

Scopolamine MOA:

A

Competitive antagonist of peripheral and central muscarinic receptors

45
Q

Scopolamine Onset:

A

4 hr

46
Q

Scopolamine duration of action:

A

3 days

47
Q

Scopolamine PB:

A

30%

48
Q

Scopolamine Metabolism:

A

CYP3A4, then conjugated and excreted by the kidneys

49
Q

Scopolamine transdermal dose:

A

1.5 mg patch
Releases 0.5 mg/day
Stays on for 3 days

50
Q

Scopolamine side effects (same as other anticholinergics):

A
  1. Bronchodilation
  2. Decreases PONV
  3. Dry mouth
  4. Pupil dilation
  5. Increases HR
51
Q

Scopolamine Contraindications / cautions:

A
  1. Delirium
  2. Sedation
  3. Constipation
  4. Blurred vision
  5. Dizziness
  6. Crosses BBB
  7. Avoid in narrow-angle glaucoma (increases eye pressure)
  8. Overdose: mad as a hatter (confusion), blind as a bat (mydriasis), hot as a hare (no sweating), dry as a bone (dry mouth), red as a beet (flushing), full as a flask (urinary retention) (can’t see, pee, spit, or shit)
52
Q

Neostigmine (alternate name):

A

Bloxiverz

53
Q

Neostigmine structure:

A

Anticholinesterase
Quaternary Ammonia

54
Q

Neostigmine MOA:

A
  1. Inhibits acetylcholinesterase at NMJ
  2. Increase Ach at the NMJ
  3. Ach competes with NMB
  4. reversal of nondepolarizing NMB
55
Q

Neostigmine Onset:

A

5-15 min

56
Q

Neostigmine duration of action:

A

30-90 min

57
Q

Neostigmine PB

A

25%

58
Q

Neostigmine Metabolism:

A

Cholinesterase in NMJ and liver, excreted by kidneys

59
Q

Neostigmine IV dose:

A

IV: 0.05-0.07 mg/kg
MAX DOSE: 5 mg
Ceiling effect at 0.07 mg/kg

60
Q

Neostigmine side effects:

A
  1. Cholinergic Crisis (DUMBELLS)
  2. Diarrhea
  3. Urination
  4. Miosis
  5. Bradycardia
  6. Emesis
  7. Lacrimation (tears)
  8. Lethargy
  9. Salivation
61
Q

Neostigmine Cautions / contraindications

A
  1. Always mix with anticholinergic
  2. Must have 1-2 twitches on TOF
  3. Previous allergic rxn
  4. Use caution in pt with asthma
  5. Does not cross the BBB
62
Q

Physostigmine (alternate name):

A

antilirium

63
Q

Physostigmine structure

A

Anticholinesterase
Tertiary amine

64
Q

Physostigmine MOA:

A

Inhibits acetylcholinesterase, thus allowing acetylcholine to increase at the NMJ

65
Q

Physostigmine Onset:

A

5-10 min

66
Q

Physostigmine duration of action:

A

30-60 min

67
Q

Physostigmine PB:

A

50%

68
Q

Physostigmine Metabolism:

A

Rapid hydrolysis and renal excretion

69
Q

Physostigmine IV dose:

A

IV: 15-60 mcg/kg

70
Q

Physostigmine side effects:

A
  1. Cholinergic Crisis (DUMBELLS)
  2. Diarrhea
  3. Urination
  4. Miosis
  5. Bradycardia
  6. Emesis
  7. Lacrimation (tears)
  8. Lethargy
  9. Salivation
71
Q

Physostigmine Contraindications / cautions:

A
  1. Used in central anticholinergic syndrome
  2. Used for reversal of confusion following atropine/ scopolamine
  3. Crosses BBB
  4. Allergic reaction
72
Q

Pyridostigmine (alternate name):

A

Mestinone

73
Q

Pyridostigmine structure:

A

Anticholinesterase
Quaternary ammonia

74
Q

Pyridostigmine MOA:

A
  1. Inhibit acetylcholinesterase at the NMJ
  2. Allows for increased Ach at the NMJ to compete with NMB
  3. results in the reversal of competitive nondepolarizing NMB
75
Q

Pyridostigmine Onset:

A

10-20 min

76
Q

Pyridostigmine duration of action:

A

60-120 min

77
Q

Pyridostigmine PB:

A

minimal

78
Q

Pyridostigmine Metabolism:

A

75% renal, 25% hepatic

79
Q

Pyridostigmine IV dose:

A

IV: 0.1 - 0.3 mg/kg

80
Q

Pyridostigmine side effects:

A
  1. Cholinergic Crisis (DUMBELLS)
  2. Diarrhea
  3. Urination
  4. Miosis
  5. Bradycardia
  6. Emesis
  7. Lacrimation (tears)
  8. Lethargy
  9. Salivation
81
Q

Pyridostigmine Contraindications / cautions:

A
  1. Always mix with anticholinergic
  2. Must have 1-2 twitches on TOF
  3. Previous allergic rxn
  4. Use caution in pt with asthma
  5. Does not cross the BBB
82
Q

Flumazenil alternate name:

A

Romazicon

83
Q

Flumazenil structure:

A

1, 4 imidazobenzodiazepine derivative

84
Q

Flumazenil MOA:

A

Competitive benzodiazepine antagonist with high receptor affinity

85
Q

Flumazenil Onset:

A

1-3 min

86
Q

Flumazenil Duration of action:

A

30-60 min

87
Q

Flumazenil PB:

A

50%

88
Q

Flumazenil Metabolism:

A

Hepatic to inactive metabolites

89
Q

Flumazenil IV dose:

A
  1. IV Initial dose: 0.2 mg
  2. IV Repeat dose: 0.3-0.5 mg Q 60 seconds (max 3 mg)
  3. > 5 mg w/o response = alternate reason for sedation
90
Q

Flumazenil side effects:

A
  1. Benzodiazepine reversal
  2. Seizure
  3. Nausea & Vomiting
  4. Tachycardia
  5. Hypertension
91
Q

Flumazenil Contraindications / Cautions

A
  1. Allergic Reaction
  2. Arrhythmias
  3. Withdrawal Symptoms
  4. Dizziness/Lightheadedness
  5. CAUTION: avoid with seizure patients on antiepileptics

Pharmacology 1 (12 decks)

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