Drug Tray

Front 1

Reglan (metoclopramide)
Class: dopamine antagonist (centrally)
Cholinomimetic ( peripherally)

Back 1

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

Front 2

S/E of reglan

Back 2

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.)

Front 3

Reglan Delivery

Back 3

IVP over 1-2mins
15-30mins before induction
Antimuscarinic drugs may offset stimulant effects. (atropine & Robinul)

Front 4

Reglan indications

Back 4

Obese
Hiatal hernia/GERD
pregnancy
Diabetic
trauma/full stomach

Front 5

Reglan Contraindications

Back 5

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.

Front 6

Neostigmine
Class: Anticholinesterase
Quaternary ammonium with carbamyl group

Back 6

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

Front 7

Neostigmine action

Back 7

Reverses NDMB: inhibits the breakdown of ACH> more at NMJ
also use for treatment of myasthenia gravis.
onset 7-11mins

Front 8

S/E of neostigmine

Back 8

Bradycardia
inc. secretions
miosis
hyperperistalsis
bronchoconstruction
N/V (limit dose with hist. of N/V)
prolonged inhibition of plasma cholinesterase activity.

Front 9

Robinul (glycopyrrolate)
class: Anticholinergic
Quaternary ammonium(lack CNS or fetal HR activity)

Back 9

Dose: 0.01mg/kg
conc. 0.2mg/cc
given before anticholinesterase in reversal sequence
0.1-0.2mg increments to treat/prevent bradycardia

Front 10

Robinul action/ indications

Back 10

Competitively antagonizes ACH at cholinergic postganglionic.
Indications: Buffer S/E of anticholinesterase (neostigmine)
inc. HR
antisialagogue (resp. and salivary)

Front 11

S/E of Robinul

Back 11

anti secretion
inc. HR
relaxes smooth muscle (bronchodilator)

Front 12

Xylocaine (Lidocaine) gel
Class: Local anesthetic

Back 12

conc. 2% (20mg/cc)
used as topical anesthetic.
e.g. ETT placement, NGT, nasal airway

Front 13

Lidocaine (xylocaine)
class: Amide
local anesthetic/ antiarrhythmic

Back 13

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

Front 14

Lidocaine actions and indications

Back 14

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)

Front 15

S/E of Lidocaine

Back 15

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)

Front 16

Allergic reaction of Lidocaine

Back 16

<1%
Depression of hypoxic drive (ventilatory response to low PaO2)
Contraindications:
WPW, heart blocks
allergy to amides

Front 17

Toradol (Ketorolac)
class: NSAID

Back 17

conc. 30mg/cc
dose: 15-30mg IVP (peaks in 40-60mins)
last 6-8hrs
0.5-1mg/kg in peds.

Front 18

Action and indications of Toradol

Back 18

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.

Front 19

S/E of Toradol

Back 19

pts with (nasal polyps, asthma, and aspirin sensitivity)= life threatening bronchospasm
GI irritation
nausea
sedation
peripheral edema
spinal anesthesia= inc. bleeding time

Front 20

Contraindications of Toradol

Back 20

Aspirin Triad (asthma, Aspirin allergy, rhinitis +/- nasal polyps)
renal failure
high risk of postop bleeding

Front 21

Zofran (ondansteron)
Class: 5-HT3 receptor antagonist

Back 21

conc. 4mg/2cc
dose: 0.15mg/kg up to 40kg. >40kg, 4mg slow IVP
for PONV give befor induction of GA

Front 22

Action and use of Zofran

Back 22

Antagonizes serotonin receptor.
prevent PONV

Front 23

S/E of Zofran

Back 23

headache
diarrhea
transient inc. in liver transaminase enzymes
reported cardiac dysrhythmias after IV zofran and Reglan
prolonged QT syndrome.

Front 24

Bacteriostatic H2O

Back 24

used to dilute meds
30cc x 1 bottle

Front 25

Decadron (dexamethasone)
class: corticosteroid with glucocorticoid activity)

Back 25

conc. 10mg/cc
dose: adults: 4-10mg IVP
peds. 0.1-0.5mg/kg
half life: 36-72hrs

Front 26

action and indications of Decadron

Back 26

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

Front 27

S/E of Decadron

Back 27

HTN, Hyperglycemia, delayed wound healing, peptic ulcers
osteoporosis
cataracts
aseptic necrosis of femoral head
skeletal muscle myopathy
physical characteristics of cushing's syndrome

Front 28

Atropine

Back 28

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

Front 29

S/E atropine

Back 29

inc HR
anti secretion
relaxes smooth muscle
dry mouth
CNS effects (minimal)
dilation of cutaneous blood vessels

Front 30

Benadryl (diphenhydramine)
class: antihistamine
H1 receptor antagonist, anticholinergic, antiemetic

Back 30

conc. 50mg/cc
dose: 15-50mg IVP q4-6hrs PRN

Front 31

Indications/uses of benadryl

Back 31

allergic reactions
itching due to intrathecal narcotic
PONV prophylaxis
cough suppression
tx. of dyskinesias

Front 32

S/E of Benadryl

Back 32

somnolence
dry mouth
blurred vision
tachycardia, prolonged QT seg., heart block, hypotension

Front 33

Ephedrine
Class: Indirect and direct acting sympathomimetic (stimulates (agonist) alpha, beta 1, and beta 2 receptors)

Back 33

conc. 50mg/cc: diluted in 9cc NS = 5mg/cc
dose: 5-50mg IVP titrated to effect

Front 34

Indication and action of Ephedrine

Back 34

For hypotension
Action: Indirectly stimulates endogenous release of norepi. from sympathetic nerve endings, directly stimulates adrenergic receptors

Front 35

S/E of Ephedrine

Back 35

inc. HR and CO (SVR altered minimally bicos of the vasoconstriction (A1)/vasodilation(B2)
inc. BP (SBP &DBP)
mydriasis (pupil dilation)
mild bronchodilation

Front 36

Epinephrine/ ephedrine

Back 36

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

Front 37

Labetalol
Class: Beta:alpha blocking potency=7:1

Back 37

conc. 100mg/20cc= 5mg/cc
dose: 0-.1-1mg/kg titrate to effect Q10mins (2.5-10mg increment) MAX. 300mg/day

Front 38

Action and Indications of Labetolol

Back 38

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

Front 39

S/E of Labetolol

Back 39

orthostatic hypotension
bronchospasm/constriction (in asthma pts)
CHF, bradycardia, heart block

Front 40

contraindications of labetolol

Back 40

asthma(if not well controlled)
heart blocks > 1st degree
uncompensated heart failure
severe low BP

Front 41

Narcan(naloxone)
Class: Opiod antagonist
displaces opiod from mu receptor

Back 41

conc. 0.4mg/cc diluted in 10cc =40mcg/cc
dose: 0.5-1mcg/kg titrated Q2-3mins

Front 42

Narcan indications and action

Back 42

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)

Front 43

S/E of narcan

Back 43

Reversal of analgesia
N/V
inc. SNS activity DT reversal of opiods and perception of pain (inc HR, HTN, pulm edema, dysrhythmias)

Front 44

Neosynephrine (phenylephrine)
class:Direct acting alpha 1 adrenergic receptor agonist

Back 44

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

Front 45

Indication and action of Neo.

Back 45

hypotension effect last 5-20mins.
Action: vasoconstriction> arterial constriction(mimics effects of norepi. but less potent and longer lasting)

Front 46

S/E of Neo

Back 46

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

Front 47

Zemuron (rocuronium)
Class: intermediate acting NDMB

Back 47

conc: 10mg/cc
dose 0.6-1.2mg/kg IVP larger dose for RSI
onset: 1-2mins
duration: 20-35mins

Front 48

Indications for Zemuron

Back 48

the only NDMR that can be used as an alternate to sux when contraindicated.

Front 49

S/E of Zemuron

Back 49

no CV effects
30% of dose renally excreted CRF pts may have longer duration.
usually need to be reversed.

Front 50

Diprivan (propofol)
Class: Sedative-hypnotic

Back 50

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

Front 51

Action / indications for Diprivan

Back 51

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

Front 52

Diprivan effects on organ system

Back 52

dec. BP, dec. HR, dec. CO dec. preload and dec. SVR
apnea
cerebrovascular depressant
dec. CBF, ICP CPP
memory impairment

Front 53

S/E of Diprivan

Back 53

burning on injection
allergic reaction (pts allergic to eggs)
hallucinations, amorous behavior,
antioxidant props.
no analgesic props.

Front 54

succinylcholine (anectine, Quelicin)
Class: DEpolarizing NMB

Back 54

conc: 20mg/cc
dose; 0-5-1.5mg/kg IVP
onset: 30-60secs
duration: 3-5mins
ED95: .25mg/kg

Front 55

Action of Sux.

Back 55

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.

Front 56

indications for sux.

Back 56

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)

Front 57

S/E of sux.

Back 57

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.

Front 58

Epinephrine (Adrenalin)
Class: Sympathomimetic (alpha and beta adrenergic agonist)

Back 58

conc. 1:1000 (1mg/cc)
dose: 0-1-1mg IVP or 1mg via ETT q 5mins PRN for adults, .01mg/kg IVP for children

Front 59

Indications for Epi.

Back 59

severe HoTN
cardiac arrest/failure
bronchospasm
anaphylaxis
prolonged LA blockade DT local vasoconstriction.

Front 60

S/E of Epi.

Back 60

inc. SBP
inc. CO,
inc.HR
arrhythmias
bronchodilation
hypoglycemia
mydriasis
blood coag acceleration

Front 61

Albuterol (ventolin, proventil)
Class: Beta 2 adrenergic agonist

Back 61

Given mainly down ETT, drug amt dec. by 50-70% in presence of an ETT
Indication: bronchospasm/wheezing

Front 62

S/E of albuterol

Back 62

Tremors
bronchodilation
tachycadia
hyperglycemia
hypokalemia
hypomagnesemia

Front 63

Ofirmev (IV acetaminophen)
class: other analgesic

Back 63

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

Front 64

S/E and contraindications of ofirmev

Back 64

N/V
Headache
insomia
rash
contraindications:
severe liver impairment

Front 65

Versed(midazolam)
class: Benzodiazepine

Back 65

conc: 1mg/cc
very lipid solube

Front 66

Uses of versed

Back 66

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)

Front 67

Action of Versed

Back 67

activation of GABA leading to hyperpolariztion of neurons and reduced excitability

Front 68

Desired effects of Versed

Back 68

anterograde amnesia
anxiolysis

Front 69

S/E of versed

Back 69

CNS: dec. CMRO2
Dec. CBF
CV: dec. BP esp. if hypovolemic
Resp: minimal depression when given alone. more sever with opiods (synergism)

Front 70

Fentanyl (sublimaze)
Class: synthetic opiod agonist

Back 70

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

Front 71

S/E of fentanyl

Back 71

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

Front 72

S/E of fentanyl contd.

Back 72

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