Things I cant remember for Pharm Test 2 Flashcards
Opioid Withdrawal
Meperidine:
Onset-
Peak intensity
-DOA
Onset: 2-6 hrs
Peak intensity: 6-12 hrs
DOA: 4-5 days
Fentanyl Opioid withdraw
Onset:
Peak intensity:
Duration
Onset: 2-6hrs
Peak: 6-12 hrs
DOA: 4-5 days
Morphine Opioid withdrawal
Onset:
Peak:
DOA:
Onset: 6-18 hrs
Peak: 36-72 hrs
DOA: 7-10 days
Heroin Opioid Withdraw
Onset:
Peak:
DOA:
Onset: 6-18 hrs
Peak: 36-72 hrs
DOA: 7-10 days
Methadone Opioid Withdraw
Onset:
Peak:
DOA:
Onset: 24-48 hrs
Peak: 3-21 days
DOA: 6-7 weeks
Morphine:
Intraop dose:
Post-op dose:
Onset:
DOA:
Bioavailability:
Intra: 1-10 mg
Post-op: 5-20 mg
Onset: 10-20 mins
DOA: 4-5 hrs
PO 1st pass - 25% is metabolized, so bioavailability = 75%.
Rapid accumulation in kidneys, liver, skel muscles.
Fentanyl:
Intra op:
Onset:
DOA:
Equilibrium at: ____
Increase ICP by:
Fent ___ mcg/kg before 25-50 mins to decrease MAC iso/des by ___%.
1 mg PO fent = ___ mg IV morphine
Intra op: 1.5-3mcg/kg
Onset: 30-60 seconds
DOA: 1-1.5 hrs
Equlibrium: 6.4 mins
Increase ICP by 6-9 mmHg
3mcg/kg to decrease MAC iso/des by 50%
1 mg PO= 5 mg IV morphine
LARGEST VD
Sufentanil
Intra-op dose:
Analgesia dose:
Induction dose:
Onset:
DOA:
S/E: (2)
Brady, chest rigidity
Intra-op: 0.3-1mcg/kg
Analgesia: 0.1-0.4 mcg/kg
Induction: 18.9 mcg/kg
Onset: 30-60 seconds
DOA: 1-1.5hrs
Alfentanil
Induction Laryngoscopy:
Induction (alone):
Maintainence:
Onset:
Highest protein binding?
Lowest clearance?
Larygosocopy: 15-30 mcg/kg
Induction alone: 150-300 mcg/kg IV
Maintenance: 25-150 mcg/kg/hr (with inhaled anesthestics)
Onset: 1.4 mins
Meperidine
Dose:
Onset:
DOA:
E1/2:
Toxicity/S/e:
Similar to: (2)
Dose: 12.5mg
Onset: 5-12 mins
DOA: 2-4 hrs
E1/2: 3-5 hrs
Tox: delirum, halluciate, myoclonus, seizure
S/e:
Tachycardia, (-) inotrope, serotonin syndrome, impaired vent
Similar to: atropine, lidocaine
Hydropmorphone (dilaudid)
Intra-op dose:
Post op dose:
Onset:
DOA
Intra-op dose: 1-4mg
Post-op dose: 1.5-4 mg
Onset: 5-15 mins
DOA: 2-4 hrs
Remifentanil:
Induction:
Maintain:
Infusion: ???!!!
Onset:
DOA:
E1/2:
No hepatic metabolism
S/E:
<3, neuro…, pain
Induction: 0.5-1 mcg/kg over 1 min
Maintain:
0.25-1mg/kg IV
Infusion: 0.125-0.375 mcg/kg/min
Onset: 30-60 seconds (FAST PEAK!)
DOA: 6-8 mins
E1/2: 6.3 mins
-Depressed cardiac + seizure like activity
-hyperanalgesia
Naloxone
Intra-op
Post-op
Dose:
Cont infusion:
Shock:
Epidural:
Onset: ????
DOA:
E 1/2:
Metabolism:??? how much left???
S/E:
Intraop: 40-80 mcg
Postop: 40-80 mcg
Dose: 1-4 mcg/kg
Cont infusion: 5 mcg/kg
Shock: >1 mcg/kt
Epidural: 0.25 mcg/kg
S/E: Reverse anesthesia/ N/V
Onset: 1-5 mins
DOA: 30-45 mins
E1/2: 60-90 mins
Metab: Glucuronic Acid -> 1/5 PO dose left :(
Nalmefene:
- Dose 1 and 2
E1/2:
USES:
Naltrexone:
Methylnatrexone
Alvimopan
Nalmefene:
-Dose=
15-25 mcg q2-5 mins :D
then 1mg/kg
E1/2: 10.8hrs
Naltrexone: Alcoholism (24 hrs)
Methylnatrexone: N/V, post op gastric emptying
Alvimopan: Post-op ileus… but long term= CV issues
Nalmefene:
- Dose/ E1/2:
USES:
Naltrexone:
Methylnatrexone
Alvimopan
Nalmefene:
-Dose=
15-25 mcg q2-5 mins :D
then 1mg/kg
E1/2: 10.8hrs
Naltrexone: Alcoholism (24 hrs)
Methylnatrexone: N/V, post op gastric emptying
Alvimopan: Post-op ileus… but long term= CV issues
Suboxone:
Embeda:
OxyNal:
Suboxone:
= Buprenorphine+ Naloxone
Embeda:
= ER morphine + Naltrexone
OxyNal:
=Oxycodone +Naltrexone
Drugs decrease MAC by: ___
Sufentanil:
Alfentanil:
Remifentanyl:
MAC % for Volitiles:
Isoflurane:
Sevoflurane:
Desflurane:
Fentanyl 3mcg/kg IV by 30 mins before incision = decrease MAC of ISO/DESO by ____%
Sufentanil:
- with enflurance by 70-90%
Alfentanil: up to 70%
Remifentanyl: 50-91%
MAC % for Volitiles:
Isoflurane: 1.2%
Sevoflurane: 2%
Desflurane: 6%
Fent 3mcg = decrease MAC iso/des by 50%
PCA Doses:
Morphine:
Dilaudid:
Fentanyl:
Morphine: 1-2 mg
Dilaudid: 0.2-0.4
Fent: 20-50 mcg
Neuraxial Opioid
Give ___x more epidural dose
Lipophilic/lipophoic? + Peak times?
Fentanyl
Sufentanil
Morphine
Lipophilic/lipophoic?
-Fentanyl - lipophilic
-Sufentanil - lipophilic
-Morphine- more hydrophilic
Fent 800x> Morphine
Peak: 20 mins
Sufentanil 1600x> Morphine
Peak: 6 mins
Neuraxial Opioid S/E;
Resp:
Urine:
CNS:
Pruritius tx:
OK TO BREAST FEED :D
Resp: depressed ventilation LOC + hypercapnia –> Give naloxone 0.25 mcg/kg
Urine Retention: more males
Pruritus: cephalic migration to trigeminal nucleus
–>Give Naloxone, anti-histamine, gabapentin, 10mg/1ml Prop?
CNS:
-Sedation
-CNS excite: Tonic skeletal muscle rigidity
Herpes reactivation 2-5 days
TEAM MODEL DRUGS
Pre-op
-Tylenol:
-Gabapentin:
Intra-op
-Magnesium:
-Lidocaine:
-Ketorolac:
-Decadron:
-Zofran:
-Ibuprofen IV:
Post Op 1 week
-IV Tylenol
-SUPER- MAG:
-Gabapentin:
-Celebrex/Advil:
Note:
Magnesium:
-Pre-op/ LOADING: 30-50mg/kg IV
-Intra-op continue:8-10mg/kg/hr
Pre-op
-Tylenol: 1000mg PO/IV
-Gabapentin: 300-1200mg
Intra-op
-Magnesium: 8mg/kg
–> 30-60 mg/kg (max 6g?) over 1 hr
-Lidocaine: 1mg/kg
-Ketorolac: 15-30 (max 60-120)
-Decadron:8-10mg
-Zofran: 4-8mg
-Ibuprofen IV: 200-800 IV over 30 mins (3200 max)
Post Op 1 week
-IV Tylenol: 1000mg TID
-SUPER- MAG: 400 mg BID
-Gabapentin: 300 mg TID
-Celebrex/Advil: (if permitted)
Fentanyl
Sufentanil
Morphine
CSF peak:
Plasma Peak:
Cervical level:
Fent:
-CSF: 20 mins
-Plasma: 5-10 mins
-Cervical: minimal
Sufentanil:
-CSF: 6 mins
-Plasma Peak: <5 mins
-Cervical: Minimal
Morphine:
-CSF: 1-4 hrs
-Plasma: 10-15 mins
-Cervical: 1-5 hrs
Pentazocine:
Recepter:
IV:
IM:
PO:
E1/2:
Metabolism: ____, % left?
Naloxone work?:
L> S/E: <3,*** (2 drugs that do this effect)
neuro
Recepter: delta, kappa
IV: 10-20mg
IM: 20-30 mg (eq: 10 mor)
PO: 60 mg (eq: 60 codeine)
E1/2: 2-3 hrs
Metab: Glucoronide conjugation
Extensive hepatic 1st pass= 20% avail after PO
Yes Naloxone
L> ^ Heart stuff
-Dysphoria, diaphoresis, sedate, dizzy
Butorphanol
Recepters:
Dose:—- compare to morphine
ROUTE: ????
E1/2: ??
Metab: where excreted the most?
L> S/E: <3, resp
Recepter: mu, delta, kappa*
Dose: 2-3mg IM =10 mor
E1/2: 2.5-3.5hrs
Metab: Bile>urine
L> ^BP,^CO
-**Depressed vent
-Dysphoria
Nalbuphine
Recepter:
Dose:—– compare to morphine
Strength:??
E1/2: (pretty long)
Best used for: ????
Mu
Dose: 10 mg= 10 mor
1/4 Nalorphine strength
E1/2: 3-6 hrs
Cardiac Cath pt! Cardiac STABLE
Buprenorphine
Recepter:
Strength:
Dose:??
Potency:…………. to morphine
Onset: ???
DOA:——–work shift? LONG
Fast/slow??
Does Naloxone work?
S/E: D:< RESP??
Mu
50x affinity> morphine
Analgesic potency: 0.3 mg IM= 10mg Mor
Onset: 30 mins
DOA: 8 hrs
Prolong resistence to naloxone
S/E: **decrease vent, Pul edema,
drowsy, N/V
Potency compared to morphine
Nalorphine
Bremazocine:
Doses compared to morphine
Dezocine: **
Meptazinol:
Nalorphine:
Bremazocine:
2x potent> morphine. NO naloxone effective
Dezocine:
0.15mg/kg= morphine
10-15 mg IM RAPID ABSORPTION
Meptazinol:
100 mg= 8 mg morphine
(Low protein binding 25%)
Thiopental
IV:
% non-ionized
Methohexital
IV:
Rectal:
%non-ionized:
E1/2?
BARBS:
Protein binding %:
S/E:
Cardiac, neuro, resp
Thiopental:
IV: 4mg/kg
% non-ionized: 61%
longer E/12
Methohexital: Seizures
IV: 1.5mg/kg
Rectal: 20-30mg/kg
% non-ionized: 76%
Faster metab/recovery
BARBS:
Protein binding 70-85%
S/E:
-Histamine
-Lack barceptor response:
-^HR, decrease BP
-* intra-arterial: lido/papa
-Cerebral vasoconstricter 55%
-*Depression of vent (dose)
Barb Drug interactions:
Enzyme induction after ____ days:
Accelerated metab of :
(7)
2-7 days
(INCREASE DOSE)
Anti-coagulant
Vitamin K
Phenytoin
TCAs
Corticosteroids
Bilesalts
Lidocaine
Type LA:
-Dose initial bolus:
-Drip Dose:
Stop at ___ hrs
Plasma levels:
1-5=
5-10=
10-15= XX
15-25=
>25=
Amide LA
Initial does: 1-2 mg/kg IV over 2-4 mins
Drip dose (post-op): 1-2 mg/kg/hr
Stop 12-72 hrs!
Plasma levels:
1-5= Analegsia
5-10= Muscle twitch, tinnitus, oral numb, hypo <3
10-15= Seizure/unconsious
15-25= Apnea/Coma
>25= Cardiovascular depression
Ketamine:
Pre-incision:
Intra-op:
Stop 1 hr prior end surgery
Post-op:
Pre-incision: 0.25-0.5 mg/kg
Intra op: 0.25-0.5 mg/kg
Post-op:
0.12 mg/kg/hr for 24 hrs
OR
5 mg Bolus between 0.3-0.5 mg/kg/hr
