TOTCD 5 (4)

Question 1

MEPERIDINE (DEMEROL) Analgesia, post-op shivering doses

Answer 1

Analgesia: 25-100mg

Post-op Shivering: 12.5-25mg

Question 2

MEPERIDINE (DEMEROL) MOA, indication

Answer 2

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

Question 3

MEPERIDINE (DEMEROL) concern/complications

Answer 3

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

Question 4

KETOROLAC (TORADOL) dose

Answer 4

15-30mg QID

Question 5

KETOROLAC (TORADOL) MOA, indication

Answer 5

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

Question 6

KETOROLAC (TORADOL) concern/complications

Answer 6

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

Question 7

ETOMIDATE (AMDIATE) induction, gtt doses

Answer 7

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

Question 8

ETOMIDATE (AMDIATE) MOA, indication

Answer 8

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

Question 9

ETOMIDATE (AMDIATE) concern/complication

Answer 9

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

Question 10

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

Answer 10

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

Question 11

KETAMINE (KETALAR) MOA, indication

Answer 11

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

Question 12

KETAMINE (KETALAR) concern/complications

Answer 12

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

Question 13

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

Answer 13

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

Question 14

ESMOLOL (BREVIBLOC) MOA, indication

Answer 14

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

Question 15

ESMOLOL (BREVIBLOC) concerns/complications

Answer 15

Hypotension, bradycardia