TOTCD 6 (6)

Question 1

PROMETHAZINE HYDROCHLORIDE (PHENERGAN) dose

Answer 1

12.5-50mg Q4-6hr

Question 2

PROMETHAZINE HYDROCHLORIDE (PHENERGAN) MOA, indications

Answer 2

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

Question 3

PROMETHAZINE HYDROCHLORIDE (PHENERGAN) concern/complications

Answer 3

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

Question 4

DEXAMETHASONE (DECADRON) dose

Answer 4

4-8mg IV

Question 5

DEXAMETHASONE (DECADRON) MOA, indications

Answer 5

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

Question 6

DEXAMETHASONE (DECADRON) concern/complication

Answer 6

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

Question 7

SUGGAMADEX (ORGANON) dose

Answer 7

2-4mg/kg IV

Question 8

SUGGAMADEX (ORGANON) MOA, indications

Answer 8

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

Question 9

SUGGAMADEX (ORGANON) concern/complication

Answer 9

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)

Question 10

EPINEPHRINE dose

Answer 10

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

Question 11

EPINEPHRINE MOA, indications

Answer 11

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

Question 12

EPINEPHRINE concern/complication

Answer 12

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

Question 13

METOCLOPRAMIDE (REGLAN) Dose

Answer 13

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

May repeat X 1 (up to 20 mg)

Question 14

METOCLOPRAMIDE (REGLAN)

MOA, indications

Answer 14

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

Question 15

METOCLOPRAMIDE (REGLAN)

concern/complication

Answer 15

Contraindications

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

Question 16

SCOPOLAMINE Dose

Answer 16

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

Question 17

SCOPOLAMINE MOA, indications

Answer 17

Muscarinic cholinergic receptors antagonist

gastric acid secretion, gastrointestinal motility, and LES tone

Question 18

SCOPOLAMINE concern/complication

Answer 18

Crosses BBB

Side effects

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