TOTCD 5 (3)

Question 1

ATROPINE correct dose

Answer 1

Dose is 0.5mg IV

When mixing with edrophonium 7ug/kg

Question 2

ATROPINE mechanism of action

Answer 2

Tertiary amine antimuscarinic It antagonizes muscarinic symptoms induced by cholinergic drugs. It produces more tachycardia than atropine.

Question 3

ATROPINE concern/complication

Answer 3

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

Question 4

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

Answer 4

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

Question 5

HYDROMORPHONE (DILAUDID) mechanism of action, indication

Answer 5

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

Question 6

HYDROMORPHONE (DILAUDID) concern/complication

Answer 6

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.

Question 7

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

Answer 7

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*

Question 8

REMIFENTANYL (ULTIVA) mechanism of action, indication

Answer 8

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.

Question 9

REMIFENTANYL (ULTIVA) concern/complication

Answer 9

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

Question 10

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

Answer 10

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

Question 11

MORPHINE (DURAMORPH) mechanism of action, indication

Answer 11

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.

Question 12

MORPHINE (DURAMORPH) concern/complication

Answer 12

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.

Question 13

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

Answer 13

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

Question 14

SUFENTANIL CITRATE (SUFENTA) mechanism of action, indication

Answer 14

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

Question 15

SUFENTANIL CITRATE (SUFENTA) concern/complication

Answer 15

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