TOTCD 5 (1)

Question 1

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

Answer 1

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

vial: 50mcg/ml

Question 2

SUBLIMAZE (FENTANYL) indication, mechanism of action

Answer 2

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

Question 3

SUBLIMAZE (FENTANYL) concern/complication

Answer 3

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

Question 4

MIDAZOLAM (VERSED) Dosages: Premed, Sedation, Induction

Answer 4

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

Vial: 1mg/mL
Common dose: 2mg

Question 5

MIDAZOLAM (VERSED) Mechanism of action, indication

Answer 5

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.

Question 6

MIDAZOLAM (VERSED) Concern/complication

Answer 6

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.

Question 7

LIDOCAINE correct dose

Answer 7

Induction: 1-1.5 mg/kg

vial: 1% and 2% concentrations

Question 8

LIDOCAINE mechanism of action, indication

Answer 8

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.

Question 9

LIDOCAINE concern/complication

Answer 9

Blunts adrenergic effects of intubation, block pain from propofol injection, pH vs pKa ionization concerns

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

Question 10

DIPRIVAN (PROPFOL) induction and maintenance dose

Answer 10

1.5-2.0 mg/kg
100-300mcg/kg/min

1% solution

Question 11

DIPRIVAN (PROPFOL) MOA, indication

Answer 11

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.

Question 12

DIPRIVAN (PROPFOL) concern/complication

Answer 12

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

Question 13

SUCCINYLCHOLINE (ANECTINE) standard and spasm dose

Answer 13

1.0-1.5 mg/kg
Spasm: 0.25-1mg/kg

vial: 20mg/ml

Question 14

SUCCINYLCHOLINE (ANECTINE) mechanism of action, indication

Answer 14

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.

Question 15

SUCCINYLCHOLINE (ANECTINE) concern/complication

Answer 15

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