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SIM > TOP OF THE CART DRUGS (ALL) > Flashcards

TOP OF THE CART DRUGS (ALL) Flashcards

1
Q

SUBLIMAZE (FENTANYL) Dosages: Induction, Intraop, Pediatric, Epidural, Infusion, Post-op pain

A 
Induction: 2-5mcg/kg
Intraop: 2-20mch/g
Pediatric: 1mcg/kg
Epidural: 50-100mcg
Infusion: 25-50mcg/hr
Post-op pain: 0.5-1.5mcg/kg
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2
Q

SUBLIMAZE (FENTANYL) indication, mechanism of action

A

PAIN, Stimulates μ receptors, Activation of μ receptors opens potassium channels inhibiting action potentials from firing in pain pathways throughout the CNS

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3
Q

SUBLIMAZE (FENTANYL) concern/complication

A

Greatest risk for respiratory depression is during peak action. High doses = chest wall rigidity. Highly lipid soluble. 75% first pass pulmonary uptake

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4
Q

MIDAZOLAM (VERSED) Dosages: Premed, Sedation, Induction

A

Premed: 0.07-0.15 mg/kg
Sedation: 0.01-0.1 mg/kg
Induction 0.1-0.4 mg/kg

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5
Q

MIDAZOLAM (VERSED) Mechanism of action, indication

A

BENZODIAZEPINE, Binds to the alpha subunits on the GABA-A receptor and leaves chloride channels open which hyperpolarizes the postsynaptic cell within the cerebral cortex, cerebellar cortex, and thalamus.

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6
Q

MIDAZOLAM (VERSED) Concern/complication

A

pH dependent ring opening phenomenon in which the ring remains open at pH values <4 thus maintaining water solubility and closes at pH values >4 making it highly lipid soluble. Cleft palate in neonates.

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7
Q

LIDOCAINE correct dose

A

1-1.5 mg/kg
4mg/kg (300mg)
7mg/kg (500mg)

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8
Q

LIDOCAINE mechanism of action, indication

A

LOCAL ANESTHETIC Blocks Na channels from inside he cell membrane. Occlusion of open Na channels inhibits the Na permeability thus slowing the rate of depolarization. Interruption of pain signal transmission.

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9
Q

LIDOCAINE concern/complication

A

Infiltration 0.5-1%, IVRA 0.25-5%, Epidural: 1.5-2%, Spinal: 1.5-5%

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10
Q

DIPRIVAN (PROPFOL) induction and maintenance dose

A

1.5-2.0 mg/kg

100-300mcg/kg/min

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11
Q

DIPRIVAN (PROPFOL) MOA, indication

A

Induces GA by facilitating inhibitory neurotransmission by GABA-A receptors—binds to the beta subunit on the GABA-A receptors. Results in sedative/hypnotic effects. GABA-A receptors activated, transmembrane chloride conductance increased=hyperpolarized postsynaptic cell membrane and functional inhibition of postsynaptic neuron.

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12
Q

DIPRIVAN (PROPFOL) concern/complication

A

High lipid solubility. Discard 6 hours after opening. Pain with injection. Caution in the elderly and hypovolemic patients. Decreases ICP, CMRO2, and CBP.

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13
Q

SUCCINYLCHOLINE (ANECTINE) standard and spasm dose

A

1.0-1.5 mg/kg

Spasm: 0.25-1mg/kg

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14
Q

SUCCINYLCHOLINE (ANECTINE) mechanism of action, indication

A

Neuromuscular Blocking Agent, Depolarizing NMB attaches to one or both alpha subunits of the nAchRs and mimics action of Ach (partial agonist). Causes depolarization of the postjunctional membrane.

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15
Q

SUCCINYLCHOLINE (ANECTINE) concern/complication

A

Do not give if trauma is > 24 hours, Caution in renal failure due to increased K

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16
Q

ROCURONIUM (ZEMURON) standard, bolus, priming 10% ID dosages

A

0.6-1.2 mg/kg
Bolus 0.06-0.6 mg/kg
Priming 10% ID 0.5mg, give 3-5 min before intubation

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17
Q

ROCURONIUM (ZEMURON) mechanism of action, indication

A

NDMR quaternary amniosteroid, competes for cholinergic receptors at the motor end plate.

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18
Q

ROCURONIUM (ZEMURON) concern/complication

A

Onset time is decreased and DOA prolonged with increasing doses
CV stable, good for infusions (mix 200mg in 100mLD5W for 2mg/ml)

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19
Q

VECURONIUM (NORCURON) standard, bolus, gtt and priming 10% ID dosages

A

0.08-0.1mg/kg
Bolus 0.01-0.05mg/kg
Gtt 1-2mcg/kg/min
Priming 10% ID 0.5-1.0mg

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20
Q

VECURONIUM (NORCURON) mechanism of action, indication

A

Intermediate NDMR that competes with cholinergic receptors at the motor end plate. 1/3 as potent as pancuronium. Vagotonic effects can occur when combined with opioids.

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21
Q

VECURONIUM (NORCURON) concern/complication

A

Reconstitute with sterile water
Gtt 20 mg/100mL D5W for 0.2mg/mL

10mg of powder reconstituted with 10mL of saline

concentration: 1mg/mL

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22
Q

CISATRACURIUM (NIMBEX) standard, bolus, gtt, and priming dose

A

0.15-0.2mg/kg
Bolus 0.02-0.1mg/kg
Gtt 1-5mcg/kg/min
Priming 1-2mg

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23
Q

CISATRACURIUM (NIMBEX) mechanism of action, indication

A

Isomer of atracurium, competes for cholinergic receptors at the motor end plate.

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24
Q

CISATRACURIUM (NIMBEX) concern/complication

A

Laudenosine is a metabolite of metabolism that can cause seizures.
Histamine release can cause tachycardia, hypotension, bronch- and laryngospasm.

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25
Q

NEOSTIGMINE Reversal, max, w/atropine, w/ glycopyrrolate, MG Tx dose

A 
Reversal 0.05mg/kg
MAX DOSE 5mg
With Atropine 0.015mg/kg
With Glycopyrrolate 0.01mg/kg
MG Tx 15-375mg PO QD
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26
Q

NEOSTIGMINE mechanism of action, indication

A

Reversal of NDMRs, treatment of MG, postoperative ileus, and urinary retention. Inhibits hydrolysis of acetylcholine by inhibiting achetylcholinesterase at the esteric site.

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27
Q

NEOSTIGMINE concern/complication

A

Cholinergic effects SLUDBBM
Cholinergic Crisis –> S/S: N/V, sweating, brady- or tachycardia, excessive salivation, sweating, bronchospasm, weakness, and paralysis. Treat with 10mcg/kg Atropine Q 3-10 min

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28
Q

GLYCOPYRROLATE (ROBINUL) dose with neostigmine or pyridostigmine

A

0.2mg for each 1mg of Neostigmine or 5mg of pyridostigmine

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29
Q

GLYCOPYRROLATE (ROBINUL) mechanism of action, indication

A

Quaternary ammonium anticholinergic. B/c of its polar nature it does not cross the BBB. It antagonizes muscarinic symptoms induced by cholinergic drugs. It produces less tachycardia than atropine.

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30
Q

GLYCOPYRROLATE (ROBINUL) concern/complication

A

Reduces LES tone, spincters in the GI tract are relaxed by nitric oxide that is released by the parasympathetic NANC fibers.
Can increase IOP—caution in pts with glaucoma. Use with caution in pts with BPH, MG, paralytic ileus, or ulcerative colitis. SEs orthostatic hypotension, dry mouth, and urine retention.

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31
Q

ATROPINE correct dose

A
  1. 01-0.02mg/kg
    vial: 0.4mg/mL
  2. 014 mg per mg of edtophonium
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32
Q

ATROPINE mechanism of action

A

Tertiary amine antimuscarinic It antagonizes muscarinic symptoms induced by cholinergic drugs. Tachycardia.

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33
Q

ATROPINE concern/complication

A

Crosses the blood/brain barrier; in large doses produces excitation/delirium. Can increase IOP—caution in pts with glaucoma. Use with caution in patients with BPH, MG, paralytic ileus, or ulcerative colitis

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34
Q

HYDROMORPHONE (DILAUDID) analgesic IV and PO, Spinal, Epidural infusion/bolus, and intrathecal dose

A 
Analgesia 0.01-0.04mg/kg
(0.5-2.0mg) Q4-6hr
2-4mg PO q4-6hr
Spinal 0.1-0.2mg (2-4mcg.kg)
Epidural Infusion 0.15-0.3mg/hr
Epidural Bolus 1-2mg
Intrathecal 0.1mg

concentration: 2mg/mL

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35
Q

HYDROMORPHONE (DILAUDID) mechanism of action, indication

A

Opiate agonists that is a hydrogenated ketone of morphine. 7x more potent than morphine. Effects on CNS and organs containing smooth muscle.

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36
Q

HYDROMORPHONE (DILAUDID) concern/complication

A

Can causes drowsiness, euphoria, resp depression, interference with adrenocortical response to stress at high doses. Releases histamine.
Prolonged analgesia by alpha agonists such as clonidine.
Reduce the dose in the elderly,
hypovolemic, or patients on other sedatives. Biliary smooth muscle spasm.

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37
Q

REMIFENTANYL (ULTIVA) Induction, Gtt, Bolus, MAC, MAC gtt dose

A 
Induction 1mcg/kg over 30-60sec
Gtt 0.5-4mcg/kg/min
Bolus 1mcg/kg
MAC 0.5-1mcg/kg over 30-60 sec
MAC gtt 0.025-0.1mcg/kg/min
*not recommended as sole agent*
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38
Q

REMIFENTANYL (ULTIVA) mechanism of action, indication

A

μ-opioid agonist with rapid onset and peak effect. Short DOA due to its metabolism by nonspecific plasma and tissue esterases. Recovery within 5-10 minutes and no residual analgesia.

39
Q

REMIFENTANYL (ULTIVA) concern/complication

A

Decrease initial dose in elderly by 50%
Can increase does upward 25-100% and downward 25-50% every 2-5min due to its rapid onset and short DOA
CBF, ICP and CMRO2 decreased
Not used for spinal, epidural, or intrathecal—contains glycine

40
Q

MORPHINE (DURAMORPH) premedication, intraop pain, postop pain, epidural and epidural infusion dose

A 
Premedication 0.05-0.2mg/kg
Pain intraop 0.1-1mg/kg
Postop pain 0.03-0.15mg/kg
Epidural 2-5mg
Epidural infusion 0.3-0.9mg/hr
41
Q

MORPHINE (DURAMORPH) mechanism of action, indication

A

Prototypical opioid agonist. Alkaloid of opium that exerts its effects on CNS and organs containing smooth muscle. N/V secondary to CTZ stimulation. Histamine release can cause pruritis.

42
Q

MORPHINE (DURAMORPH) concern/complication

A

75-85% metabolized to morphine 3 glucuronide (inactive) but 5-10% metabolized to morphine-6-glucuronide (has analgesic and respiratory depression effects). Caution in ARF/CRF secondary to accumulation of metabolites and increased respiratory depression.

43
Q

SUFENTANIL CITRATE (SUFENTA) Analgesia, induction, Gtt, epidural infusion, epidural gtt and spinal dose

A 
Analgesia 0.2-0.3mcg/kg
Induction 2.-10mcg/kg
Gtt 0.1-0.5mcg/kg/min
Epidural infusion 0.2-0.7mcg/kg
Epidural Gtt 0.1-0.6mcg/kg/min
Spinal 0.02-0.2mcg/kg
44
Q

SUFENTANIL CITRATE (SUFENTA) mechanism of action, indication

A

Thienyl analogue of fentanyl with 5-7x the analgesic potency. Attenuates the hemodynamic response to DVL and surgical manipulation.

45
Q

SUFENTANIL CITRATE (SUFENTA) concern/complication

A

Can cause dose dependent bradycardia. Highly lipophilic, crosses the placenta causing resp depression in fetus. Rapid redistribution terminates effects of small doses, but accumulates with larger doses

46
Q

MEPERIDINE (DEMEROL) Analgesia, post-op shivering doses

A

Analgesia: 25-100mg

Post-op Shivering: 12.5-25mg

47
Q

MEPERIDINE (DEMEROL) MOA, indication

A

Premedication, analgesia, and treatment of post-op shivering. Synthetic opioid agonist 1/10th as potent as morphine. Direct myocardial depressant at high doses

48
Q

MEPERIDINE (DEMEROL) concern/complications

A

DO NOT GIVE WITH MAOI’S. Active metabolite NORMEPERIDINE can cause seizures

49
Q

KETOROLAC (TORADOL) dose

A

15-30mg QID

50
Q

KETOROLAC (TORADOL) MOA, indication

A

Analgesia. NSAID that has analgesia, anti-inflammatory, and antipyretic effects. 30mg is equivalent to 9mg morphine. Inhibits the synthesis of prostaglandins, no sedative effects. Peripheral analgesia

51
Q

KETOROLAC (TORADOL) concern/complications

A

Caution in renal/hepatic insufficiency. Can cause HTN due to loss of prostaglandin synthesis. Do not use in pregnancy b/c it inhibits uterine contractions, affects fetal circulation (promotes closure of PDA), and is excreted in breat milk. Do not use with other NSAID’s of pt. with hx of GI bleed

52
Q

ETOMIDATE (AMDIATE) induction, gtt doses

A

Induction: 0.1-0.4mg/kg
Gtt: 0.25-1mg/min

53
Q

ETOMIDATE (AMDIATE) MOA, indication

A

Induction and supplementation of anesthesia. Nonbarbituate hypnotic. No analgesic effects. Can elicit alternation in SSEP’s. Minimal effects on BP make it a good choice to maintain CPP

54
Q

ETOMIDATE (AMDIATE) concern/complication

A

Can cause adrenocortical suppression that can last 4-6 hours and is due to etomidate induced inhibition of 11-beta hydroxylase. 30-60% of myoclonus

55
Q

KETAMINE (KETALAR) sedation/analgesia, induction, gtt, epidural dose

A

Sedation/analgesia: 0.5-1mg/kg
Induction: 1-2.5mg/kg
Gtt: 15-80mcg/kg/min
Epidural: 0.5mg/kg

56
Q

KETAMINE (KETALAR) MOA, indication

A

Dissociative anesthetic, induction and maintenance of anesthesia. Useful in hypovolemic or high risk patients. Ideal for short procedures. A phencyclidine derivative that produces rapid acting dissociative anesthesia characterized by normal or enhanced skeletal tone, resp stimulation, and minimal resp depression. Antagonist effect on NMDA - long term excitatory effects of nociceptive transmission

57
Q

KETAMINE (KETALAR) concern/complications

A

CBF, CRMO2, and ICP are increased. Increased EEG activity. Increased salivary and tracheobronchial secretions. Emergence delirium. Disconjugate eyes, and SNS effects from indirect NE release - HTN. Decreases VA’s

58
Q

ESMOLOL (BREVIBLOC) loading, bolus, Gtt, HTN, HTN Gtt doses

A 
Loading: 0.5mg/kg
Bolus: 0.2-0.5mg/kg (5-10mg)
Gtt: 50-200mcg/kg/min
HTN: 0.5-2mg/kg (repeat Q5min)
HTN Gtt: 50-300mcg/kg/min
59
Q

ESMOLOL (BREVIBLOC) MOA, indication

A

Treatment of SVT and HTN. Cardioselective beta blocker with rapid onset and short DOA. At high doses can effect beta-2 receptors

60
Q

ESMOLOL (BREVIBLOC) concerns/complications

A

hypotension, bradycardia

61
Q

LABETALOL (NORMODYNE, TRANDATE) dose, Gtt, max cumulative dose

A

Single Dose: 2.5-20mg (over 2min)
Gtt: 0.5-2mg/min
Cumulative Dose: 1-4mg/kg

62
Q

LABETALOL (NORMODYNE, TRANDATE) MOA, indications

A

Nonselective adrenergic receptor blocking agent with mild alpha, and predominant beta activity (Alpha:Beta = 1:7 (IV), 1:3 (PO)). Decreased BP with minimal risk of reflex tachycardia. Risk of bronchospasm

63
Q

LABETALOL (NORMODYNE, TRANDATE)

A

Crosses placenta

64
Q

PHENYLEPHRINE dose

A

0.5-1mcg/kg

50-100mcg bolus

65
Q

PHENYLEPHRINE MOA, indication

A

Direct alpha-1 agonist, produces intense peripheral vasoconstriction, increased SBP & DBP, reflex bradycardia can result in decreased CO. Increased SVR can aid in reducing R-L shunt in Fallot

66
Q

PHENYLEPHRINE concern/complications

A

Tachyphylaxis may occur

67
Q

EPHEDRINE dose, max dose

A

2.5-10mg

150mg/24 hours

68
Q

EPHEDRINE MOA, indications

A

Vasopressor, bronchodilator. Noncatecholamine sympathomimetic with mixed direct and indirect actions. Resistant to MAO and COMT resulting in longer DOA. Increases CO, BP and HR by alpha and adrenergic stimulation. Increases coronary and skeletal blood flow, bronchodilation by beta-2 receptor stimulation. Restores uterine blood flow when used to treat epidural/spinal hypotension.

69
Q

EPHEDRINE concern/complications

A

Tachyphylaxis may occur once catecholamine stores are depleted

70
Q

ONDANSETRON (ZOFRAN) dose

A

4mg Q4-8hr

71
Q

ONDANSETRON (ZOFRAN) MOA, indication

A

Selective serotonin 5HT3 antagonist, receptors are found peripherally on vagal nerve terminals and centrally in the CTZ. Prevention and treatment of chemo induced and post-op N/V

72
Q

ONDANSETRON (ZOFRAN) concerns/complications

A

Expensive

73
Q

DEXMEDETOMIDINE loading, Gtt dose

A

Loading: 1mcg/kg over 10min
Gtt: 0.2-0.7mcg/kg/hr

74
Q

DEXMEDETOMIDINE MOA, indications

A

Selective alpha-2 adrenergic agonist. Binding in the locus ceruleus produces sedation and binding in the spinal cord produces analgesia

75
Q

DEXMEDETOMIDINE concern/complications

A

Does not decrease resp drive or CRMO2: may decrease cerebral arterial responsiveness to CO2 changes.; bradycardia and hypotension are common side effects; HTN may be seen with rapid admin of large dose due to spillover of alpha-1 adrenergic receptors.

76
Q

PROMETHAZINE HYDROCHLORIDE (PHENERGAN) dose

A

12.5-50mg Q4-6hr

77
Q

PROMETHAZINE HYDROCHLORIDE (PHENERGAN) MOA, indications

A

Phenothiazine derivative, does not possess neuroleptic or antipsychotic activity. H1 receptor antagonist with sedative, antiemetic, and anti-motion sickness effects

78
Q

PROMETHAZINE HYDROCHLORIDE (PHENERGAN) concern/complications

A

EPS symptoms may occur. DO NOT USE WITH EPI TO TREAT HYPOTENSION, PHENOTHIAXINES CAUSE A REVERSAL OF EPI’S VASOPRESSOR EFFECTS AND CAUSE FURTHER DECREASES IN BP. USE NE OR NEO

79
Q

DEXAMETHASONE (DECADRON) dose

A

4-8mg IV

80
Q

DEXAMETHASONE (DECADRON) MOA, indications

A

Corticosteroid- potential anti-inflammatory agent. Treatment of inflammatory diseases, cerebral edema, raised ICP, airway edema, aspiration pneumonitis, bronchial asthma, myofascial pain, allergic rxn, prevention of rejection of organ transplant, replacement therapy for adrenocortical insufficiency

81
Q

DEXAMETHASONE (DECADRON) concern/complication

A

Does not cause Na/H2O retention, caution in DM. HPA axis suppression

82
Q

SUGGAMADEX (ORGANON) dose

A

2-4mg/kg IV

83
Q

SUGGAMADEX (ORGANON) MOA, indications

A

SRBA’s (selective relaxant binding agents)
•Binds steroidal MR (Roc>Vec»Panc)
•Forming water soluble complex in plasma
•Markedly enhances conc. gradient b/t plasma & synapse

Terminates NMB rapidly by enhanced diffusion of drug away from NMJ

84
Q

SUGGAMADEX (ORGANON) concern/complication

A

Women who use OCPs must be advised to used alternative BC method (condoms, abstinence, etc) for 7 days after suggamadex •Approximately 0.004% of patients may suffer anaphylaxis (genetically moderated, with highest rate to rocuronium
•May prolong coagulation at highest doses (16 mg/kg), but clinical significance of this effect remains unclear •Will antagonize subsequent aminosteriod blockade until excreted renally (give succinylcholine or cisatracurium)

85
Q

EPINEPHRINE dose

A

Infusion: 16mg/500ml =32ug/ml
Start at 2ug/min
2 times 60 =120ug/hr
120ug divided by 32ug/ml =3.75ml/hr

86
Q

EPINEPHRINE MOA, indications

A 
Low dose (2-10 mcg/min) stimulate adrenergic beta 1 and beta 2 receptors
Increases HR, CO, contractility, conduction     bronchodilaton
High doses ( >10 mcg/min) stimulate adrenergic alpha receptors
Vasoconstriction of skin, mucosa, and renal vascular beds
87
Q

EPINEPHRINE concern/complication

A

Complications: Cerebral hemorrhage (from increased BP), CNS disturbances, pulmonary edema, coronary ischemia, ventricular dysrhythmias (potentiated by halothane)

Hyperglycemia
Hypokalemia - drives K+ into skeletal muscle cells (usually mild).
increases Factor V, accelerating coagulation

88
Q

METOCLOPRAMIDE (REGLAN) Dose

A

Dosing ( comes as 10mg/ml )
10 mg IV over 1-2 mins in adults

May repeat X 1 (up to 20 mg)

89
Q

METOCLOPRAMIDE (REGLAN)

MOA, indications

A

D2 receptor antagonist and Cholinergic receptor agonist

Physiologic effects
Gastric motility in upper GI tract
LES tone by 10-20 cm

Uses
- Prokinetic
- Aspiration prophylaxis
Not an effective antiemetic

90
Q

METOCLOPRAMIDE (REGLAN)

concern/complication

A

Contraindications

  • Pediatric population
  • Pheochromocytoma
  • Bowel obstruction
  • Parkinson’s disease
  • Avoid w/ MOAs
91
Q

SCOPOLAMINE Dose

A

0.2-0.65 mg IV/IM/SC
Children 0.006 mg/kg
Patch 1.5 mg applied 1-4 hrs pre-op

Remove between 24 to 72 hrs after surgery

92
Q

SCOPOLAMINE MOA, indications

A

Muscarinic cholinergic receptors antagonist

gastric acid secretion, gastrointestinal motility, and LES tone

93
Q

SCOPOLAMINE concern/complication

A

Crosses BBB

Side effects

  • Sedation
  • Dry mouth
  • Urinary retention
  • Blurred vision
  • Confusion/anxiety
  • Central anticholinergic syndrome

SIM (8 decks)

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