rsi drugs

Question 1

ketamine ; ketalar

Answer 1

Classification: Anesthetic; analgesic agent

MOA: blocks afferent transmission of impulses associated with pain perception; causes short-acting amnesia without muscular relaxation

Pharmacokinetics: Well absorbed, onset 30 seconds, duration 10-15 minutes

Indications: sedation, pain control, induction agent for RSI

AR/SE: Apnea, Severe Respiratory depression, hallucinations, explicit dreams

Contraindications: known allergy, hypertensive patients or patients with increased ICP

Dosage: Adult- 1mg/kg over 1 min IV (2-4 mg/kg IM) Peds- 1-2 mg over 1 min IV (3-5 mg/kg IM)

Special considerations: (P Class C) prolonged recover time if used with other opioids or barbituates, monitor vital signs frequently.

Question 2

midazolam ; versed

Answer 2

Classification: benzodiazepine, antianxiety, sedative/hypnotic

MOA: Acts on CNS to produce generalized CNS depression via GABA

Pharmacokinetics: Onset IN 5 min, IM 15 min, IV 1.5-5 min, Duration IN ½-1 hr, IM/IV 2-6 hrs

Indications: seizure activity, anxiety, premedication before painful procedures, RSI induction and sedation

AR/SE: Apnea, laryngospasm, respiratory depression, cardiac arrest, phlebitis, hiccups

Contraindications: known allergy, preexisting CNS depression, uncontrolled severe pain or angle-closure glaucoma.

Dosage: 1-2.5mg IV, 5mg IN (for sedation/induction, initial dose of 2-4 mg IV/IO followed by 3-5 mg q 15 min to maintain sedation)

Special considerations: (P Class C) monitor vital signs continuously.

Question 3

etomidate ; amidate

Answer 3

Classification: Sedative/hypnotic

MOA: exact MOA is unknown; believed to enhance GABA neurotransmission.
GABA is an inhibitory neurotransmitter in the CNS.

Pharmacokinetics: Well absorbed IV, Onset 1 minute, Duration 4-15 minutes

Indications: induction of anesthesia; premedication before tracheal intubation or cardioversion

AR/SE: Apnea, N/V, involuntary muscle movement

Contraindications: Known allergy, pts in labor

Dosage: 0.3 mg/kg over 30-60seconds IV

Special considerations: (P Class C) increased risk of apnea if administered with verapamil; monitor vitals constantly

Question 4

propofol ; diprivan

Answer 4

Class: General Anesthetic

MOA: unknown but produces amnesia, has no analgesic properties

Pharmacokinetics: complete absorption; onset 45 sec; duration 3-5 min

Indications: sedation of intubated & ventilated patients

AR/SE: apnea, bradycardia, hypotension, burning, pain, stinging, long term use can lead to refractory bradycardia then asystole.

Contraindications: known allergy including to soybean oil, egg lecithin, and glycerol

Dosage: 40 mg every 10 seconds until induction achieved, then 100-200 mcg/kg/min for maintenance.

Special Considerations: (P class B)

Question 5

pancuronium ; pavulon

Answer 5

Class: Neuromuscular blocker

MOA: competes with acetylcholine for the receptor sites in the muscle cells, causing paralysis.

Pharmacokinetics: rapid absorption; onset 30-45 sec; duration 30-60 min

Indications: produce muscle relaxation and facilitate ET intubation

AR/SE: bronchospasm, apnea, tachycardia, hypotension

Contraindications: known allergy including to bromides

Dosage: 0.1 mg/kg IV

Special Considerations: (P class C) note that it does not effect consciousness!

Question 6

rocuronium ; zemuron

Answer 6

Class: Neuromuscular blocker

MOA: competes with acetylcholine for the receptor sites in the muscle cells, causing paralysis.

Pharmacokinetics: rapid absorption; onset 2-8 min; duration 30 min

Indications: produce muscle relaxation and facilitate RSI or routine ET intubation

AR/SE: bronchospasm, apnea, arrhythmias, N/V

Contraindications: known allergy including to bromides

Dosage: 0.6 mg/kg IV induction and maintenance (15-45 minutes after induction)

Special Considerations: (P class B) note that it does not effect consciousness!

Question 7

succinycholine ; anectine

Answer 7

Class: Depolarizing neuromuscular blocker

MOA: prevents muscle from contracting by prolonging time during which the receptors at the neuromuscular junction cannot respond to acetylcholine

Pharmacokinetics: rapid absorption; onset 30-60 sec; duration 2-3 min

Indications: facilitate ET intubation

AR/SE: bradycardia/asystole in pediatric patients, apnea, bradycardia, malignant hyperthermia, hyperkalemia

Contraindications: known allergy, malignant hyperthermia pts, acute narrow angle glaucoma or penetrating eye injury.

Dosage: 1.0 mg/kg IV/IO max dose 150 mg

Special Considerations: (P class C) fractures can occur from severe muscle spasms in pediatric pts.

Question 8

vecuronium ; norcuron

Answer 8

Class: Neuromuscular blocker

MOA: competes with acetylcholine for the receptor sites in the muscle cells, causing paralysis.

Pharmacokinetics: rapid absorption; onset <1 min; duration 30-40 min

Indications: produce muscle relaxation and facilitate RSI or routine ET intubation

AR/SE: bronchospasm, apnea, arrhythmias including cardiac arrest, bradycardia

Contraindications: known allergy including to bromides

Dosage: 0.1 mg/kg IV induction and maintenance (15-45 minutes after induction)

Special Considerations: (P class C) note that it does not effect consciousness!