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72 Cards in this Set

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Reglan (metoclopramide)
Class: dopamine antagonist (centrally)
Cholinomimetic ( peripherally)
Conc. 10mg/2cc. Dose: 10mg IVP
Onset: 1-3mins duration: 1-2hrs
Action: stimulate motility of UGIT-< gastric emptying time. > LES tone by 10-20cm H2O and relaxes pyloric sphincter. No alteration in gastric pH
S/E of reglan
Dystonia, abd cramping if given fast. Cardiac dys in pts receiving ondansteron. Feeling of unease and restless. (ESP in young and elderly with renal dysfunction.
Inc. Plasma prolactin conc.
Inhibit effect of plasma cholinesterase ( may prolong response to sux.)
Reglan Delivery
IVP over 1-2mins
15-30mins before induction
Antimuscarinic drugs may offset stimulant effects. (atropine & Robinul)
Reglan indications
Obese
Hiatal hernia/GERD
pregnancy
Diabetic
trauma/full stomach
Reglan Contraindications
GI obstruction
MAOI( inc. risk of HTN and seizures)
TCAs (may exacerbate depression)
Parkinsons, seizure disorders
RLS
Haldol, Droperidol (inc. extrapyramidal symptoms)
pheochromocytoma (regalan causes the release of catecholamines which can trigger HTN crisis.
Neostigmine
Class: Anticholinesterase
Quaternary ammonium with carbamyl group
conc. 0.5mg/cc or 1mg/cc
dose: 0.04-0.08mg/kg with max dose 5mg. Given after anticholinergic
duration: last up to 1hr
Neostigmine action
Reverses NDMB: inhibits the breakdown of ACH> more at NMJ
also use for treatment of myasthenia gravis.
onset 7-11mins
S/E of neostigmine
Bradycardia
inc. secretions
miosis
hyperperistalsis
bronchoconstruction
N/V (limit dose with hist. of N/V)
prolonged inhibition of plasma cholinesterase activity.
Robinul (glycopyrrolate)
class: Anticholinergic
Quaternary ammonium(lack CNS or fetal HR activity)
Dose: 0.01mg/kg
conc. 0.2mg/cc
given before anticholinesterase in reversal sequence
0.1-0.2mg increments to treat/prevent bradycardia
Robinul action/ indications
Competitively antagonizes ACH at cholinergic postganglionic.
Indications: Buffer S/E of anticholinesterase (neostigmine)
inc. HR
antisialagogue (resp. and salivary)
S/E of Robinul
anti secretion
inc. HR
relaxes smooth muscle (bronchodilator)
Xylocaine (Lidocaine) gel
Class: Local anesthetic
conc. 2% (20mg/cc)
used as topical anesthetic.
e.g. ETT placement, NGT, nasal airway
Lidocaine (xylocaine)
class: Amide
local anesthetic/ antiarrhythmic
conc. 4% (40mg/cc) x 2 vials
dose: 1-1.5mg/kg on induction
MAX dose = 4.5mg/kg plain or 7mg/kg if combined with epi
Lidocaine actions and indications
Blocks Na+ channels, preventing AP propagation.
indications: Giving on induction of GA, it suppresses direct laryngoscopy stimulation and eases burning from diprivan.
use for freq. PVCs (phase 4 attenuation)
S/E of Lidocaine
Systemic toxicity (tongue nuwbness, CNS chages: restlessness, tinnitus, vertigo, skeletal muscle twitching, seizures)
myotoxicity/neurotoxicity
depression of myocardial automaticity with dec. refractory period (CV collapse)
Allergic reaction of Lidocaine
<1%
Depression of hypoxic drive (ventilatory response to low PaO2)
Contraindications:
WPW, heart blocks
allergy to amides
Toradol (Ketorolac)
class: NSAID
conc. 30mg/cc
dose: 15-30mg IVP (peaks in 40-60mins)
last 6-8hrs
0.5-1mg/kg in peds.
Action and indications of Toradol
Inhibits platelet production and aggregation by reversible inhibition of prostaglandin synthesis (prolong bleeding time)
For postop analgesia in conduction with opiods
30mg = 10mg MSO4 and 100mg of demerol
NO ventilatory or CV depression nor biliary tract spasm.
S/E of Toradol
pts with (nasal polyps, asthma, and aspirin sensitivity)= life threatening bronchospasm
GI irritation
nausea
sedation
peripheral edema
spinal anesthesia= inc. bleeding time
Contraindications of Toradol
Aspirin Triad (asthma, Aspirin allergy, rhinitis +/- nasal polyps)
renal failure
high risk of postop bleeding
Zofran (ondansteron)
Class: 5-HT3 receptor antagonist
conc. 4mg/2cc
dose: 0.15mg/kg up to 40kg. >40kg, 4mg slow IVP
for PONV give befor induction of GA
Action and use of Zofran
Antagonizes serotonin receptor.
prevent PONV
S/E of Zofran
headache
diarrhea
transient inc. in liver transaminase enzymes
reported cardiac dysrhythmias after IV zofran and Reglan
prolonged QT syndrome.
Bacteriostatic H2O
used to dilute meds
30cc x 1 bottle
Decadron (dexamethasone)
class: corticosteroid with glucocorticoid activity)
conc. 10mg/cc
dose: adults: 4-10mg IVP
peds. 0.1-0.5mg/kg
half life: 36-72hrs
action and indications of Decadron
Has anti-inflammatory, possible analgesic, and antiemetic actions.
Indications:
high risk PONV
tx. of aspiration pneumonitis
traumatic intubation
ENT-tonsils
Neuro-crani, cerebral edema, cord trauma,
organ transplants
asthma
ocular inflammation
S/E of Decadron
HTN, Hyperglycemia, delayed wound healing, peptic ulcers
osteoporosis
cataracts
aseptic necrosis of femoral head
skeletal muscle myopathy
physical characteristics of cushing's syndrome
Atropine
conc. 1mg/cc
dosage 0.5-1mg IVP
Action: prevents ACH from binding to and activating the muscarinic receptor
Indication: Bradycardia_ faster onset than Robinul
tx. for occulocardiac reflex
used for reversal with endrophonium
S/E atropine
inc HR
anti secretion
relaxes smooth muscle
dry mouth
CNS effects (minimal)
dilation of cutaneous blood vessels
Benadryl (diphenhydramine)
class: antihistamine
H1 receptor antagonist, anticholinergic, antiemetic
conc. 50mg/cc
dose: 15-50mg IVP q4-6hrs PRN
Indications/uses of benadryl
allergic reactions
itching due to intrathecal narcotic
PONV prophylaxis
cough suppression
tx. of dyskinesias
S/E of Benadryl
somnolence
dry mouth
blurred vision
tachycardia, prolonged QT seg., heart block, hypotension
Ephedrine
Class: Indirect and direct acting sympathomimetic (stimulates (agonist) alpha, beta 1, and beta 2 receptors)
conc. 50mg/cc: diluted in 9cc NS = 5mg/cc
dose: 5-50mg IVP titrated to effect
Indication and action of Ephedrine
For hypotension
Action: Indirectly stimulates endogenous release of norepi. from sympathetic nerve endings, directly stimulates adrenergic receptors
S/E of Ephedrine
inc. HR and CO (SVR altered minimally bicos of the vasoconstriction (A1)/vasodilation(B2)
inc. BP (SBP &DBP)
mydriasis (pupil dilation)
mild bronchodilation
Epinephrine/ ephedrine
Unlike epi, ephedrine does not produce marked hyperglycemia, lasts longer and much less potent.
does not greatly alter uterine blood flow when given to restore maternal BP
0.5mg/kg IM for antiemetic effect
in presence of beta blockade, the CV responses resemble that of alpha stimulation.
Tachyphylaxis= due to persistent adrenergic blockade or depletion of norepi. storage
Labetalol
Class: Beta:alpha blocking potency=7:1
conc. 100mg/20cc= 5mg/cc
dose: 0-.1-1mg/kg titrate to effect Q10mins (2.5-10mg increment) MAX. 300mg/day
Action and Indications of Labetolol
Lowers SBP by dec. SVR
Reflex tachycardia due to vasodilation prevented by beta blockade.
Indication: used to lower BP and HR
used for pheochromocytoma and rebound HTN after withdrawal of clonidine
S/E of Labetolol
orthostatic hypotension
bronchospasm/constriction (in asthma pts)
CHF, bradycardia, heart block
contraindications of labetolol
asthma(if not well controlled)
heart blocks > 1st degree
uncompensated heart failure
severe low BP
Narcan(naloxone)
Class: Opiod antagonist
displaces opiod from mu receptor
conc. 0.4mg/cc diluted in 10cc =40mcg/cc
dose: 0.5-1mcg/kg titrated Q2-3mins
Narcan indications and action
tx. opiod induced resps depression
facilitates tx. of opiods overdose.
Action: displaces opiod agonist , DT its high affinity at mu receptor
effect last 30-45 mins (may need to redose)
S/E of narcan
Reversal of analgesia
N/V
inc. SNS activity DT reversal of opiods and perception of pain (inc HR, HTN, pulm edema, dysrhythmias)
Neosynephrine (phenylephrine)
class:Direct acting alpha 1 adrenergic receptor agonist
conc: 1%-10mg/cc: diluted 10mg in 9cc=1mg/cc- dilute 1cc in 9cc=0.1mg/cc or 100mcg/cc
for gtt 10mg in 250cc NS=40mcg/cc
Dose: 50-100mcg IVP titrate to pressure
Indication and action of Neo.
hypotension effect last 5-20mins.
Action: vasoconstriction> arterial constriction(mimics effects of norepi. but less potent and longer lasting)
S/E of Neo
inc. SBP with dec. CO
dec. HR
inc. pulmonary artery pressure, and coronary blood flow
dec. renal and cutaneous blood flow
uterine vasoconstriction
Contraindication: pheochromocytoma
MAOIs
Zemuron (rocuronium)
Class: intermediate acting NDMB
conc: 10mg/cc
dose 0.6-1.2mg/kg IVP larger dose for RSI
onset: 1-2mins
duration: 20-35mins
Indications for Zemuron
the only NDMR that can be used as an alternate to sux when contraindicated.
S/E of Zemuron
no CV effects
30% of dose renally excreted CRF pts may have longer duration.
usually need to be reversed.
Diprivan (propofol)
Class: Sedative-hypnotic
conc: 1%-10mg/cc
dose: 0.5-2.5mg/kg IVP on induction.
25-75mcg/kg/min gtt for sedation and 100-300mcg/kg/min for GA
onset: 30secs
duration: 3-8mins
Action / indications for Diprivan
Interacts with GABA
Indications:
most common induction drug for GA.
sedation for MAC cases
antiemetic(10-20mg IVP or 100mcg/kg/min gtt)
amnesia
anticonvulsant
antipruritic
Diprivan effects on organ system
dec. BP, dec. HR, dec. CO dec. preload and dec. SVR
apnea
cerebrovascular depressant
dec. CBF, ICP CPP
memory impairment
S/E of Diprivan
burning on injection
allergic reaction (pts allergic to eggs)
hallucinations, amorous behavior,
antioxidant props.
no analgesic props.
succinylcholine (anectine, Quelicin)
Class: DEpolarizing NMB
conc: 20mg/cc
dose; 0-5-1.5mg/kg IVP
onset: 30-60secs
duration: 3-5mins
ED95: .25mg/kg
Action of Sux.
attaches to nicotinic cholinergic receptor and mimics action of ACH at the postjunctional membrane (phase 1 block)
Broken down by pseudocholinesterase (no need for reversal)
phase II block with larger dose.
indications for sux.
RSI
(known or suspected difficult airways, obese, GERD, hiatal hernia, pregnant, bowel obstruction, trauma/full stomach)
procedures, which NDMRs are not indicated.
short cases
Nervr intergrate monitors (thyroid surgery)
S/E of sux.
Myalgia (DT muscle fasiculations)
hyperkalemia (more in burns, trauma, head injury pts, or immobile pts)=5=10mEq/L inc.
myoglobinuria
inc. intragastric pressure
cardiac dysrhy (brady, junctional rhythms)
cardiac arrest
inc. BP and HR
inc. IOP
inc. ICP, MH, myopathies
open eye surgery
renal failure
plasma cholinesterase deficiencies.
Epinephrine (Adrenalin)
Class: Sympathomimetic (alpha and beta adrenergic agonist)
conc. 1:1000 (1mg/cc)
dose: 0-1-1mg IVP or 1mg via ETT q 5mins PRN for adults, .01mg/kg IVP for children
Indications for Epi.
severe HoTN
cardiac arrest/failure
bronchospasm
anaphylaxis
prolonged LA blockade DT local vasoconstriction.
S/E of Epi.
inc. SBP
inc. CO,
inc.HR
arrhythmias
bronchodilation
hypoglycemia
mydriasis
blood coag acceleration
Albuterol (ventolin, proventil)
Class: Beta 2 adrenergic agonist
Given mainly down ETT, drug amt dec. by 50-70% in presence of an ETT
Indication: bronchospasm/wheezing
S/E of albuterol
Tremors
bronchodilation
tachycadia
hyperglycemia
hypokalemia
hypomagnesemia
Ofirmev (IV acetaminophen)
class: other analgesic
conc: 10mg/cc=1000mg/100cc
Dose: <50kg-15mg/kg IV q6hrs prn
>50kg- 1gm IV q6hrs prn; max dose 1gm/dose or 4gm/24h
give over 15mins
Uses: pain control and antipyretic
S/E and contraindications of ofirmev
N/V
Headache
insomia
rash
contraindications:
severe liver impairment
Versed(midazolam)
class: Benzodiazepine
conc: 1mg/cc
very lipid solube
Uses of versed
preop (0.5-2+ mg)
peds. 0.5mg/kg orally
IV sedation (MAC, conscious sedation)
IV induction (0.1-0.3mg/kg)
suppression of seizure activity(0.1mg/kg)
Action of Versed
activation of GABA leading to hyperpolariztion of neurons and reduced excitability
Desired effects of Versed
anterograde amnesia
anxiolysis
S/E of versed
CNS: dec. CMRO2
Dec. CBF
CV: dec. BP esp. if hypovolemic
Resp: minimal depression when given alone. more sever with opiods (synergism)
Fentanyl (sublimaze)
Class: synthetic opiod agonist
conc: 50mcg/cc
75-125 times as potent as MSO4
Dose: 2-20mcg/kg IVP to blunt direct laryngoscopy
50-150mcg/kg for nitrous/narcotic tecnique
S/E of fentanyl
bradycardia
synergism action with other depressant
benzo+opiod= marked resp. depression
opiods+N2O or benzo= < BP
< responsiveness to CO2
Dec. RR with inc. TV
Stiff chest with large doses
dec. CBF and possibly ICP
accumulation of CO2= inc. ICP
Dec. MAC of inhaled anesthetics
S/E of fentanyl contd.
biliary smooth muscle spasm
dec. peristaltic activity with inc. pyloric sphincter tone=delayed GI tract emptying
difficulty urinating
N/V
tolerance and dependence
prolonged exposure= immunosuppression