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75 Cards in this Set

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how does atropine work?
interrupts normal cholinergic, muscarinic transmission at the various end organs
Symptoms of Atropine overdose
Mad as a hatter-delirium
Blind as a bat-mydriasis
Dry as a bone-dry mouth
Red as a beet-Flushing
Hot as a pistol- >body temp-
A muscarinic agonists that competes with atropine and reverses its effect
pilocarpine
These two compounds combine to make acetylcholine
acetyl-Coenzyme A + choline
where are nicotinic receptors found?
neuromuscular junction of skeletal muscle
within ganglia and the CNS
where are muscarinic receptors found?
within both peripheral and central nervous systems
After ACH is hydrolyzed what re-enters the motor nerve endings to again participate in the synthesis of new acetylcholine
Choline
this prevents sustained depolarization
Rapid hydrolysis of ACH
what can cause up-regulation of Nicotinic Acetylcholine Receptors (nAChR)
Spinal Cord Injury, CVA, Prolonged exposure to NMB drugs, Guillain-Barre syndrome
what can cause down-regulation of Nicotinic Acetylcholine Receptors
Down-regulation
Myasthenia Gravis Organophosphate Poisonings
the only NMB drug that affects depolarization
SCh
At what dose is SCh ED 90-95
ED 90-95 @ 0.3 (mg/kg)
never go higher than this dose
What is SCh used for?
Induction of neuromuscular blockade
During surgery as an adjunct to general anesthesia and to facilitate tracheal intubation or mechanical ventilation
Dosing of SCh for short procedures
0.6 mg/kg IV (range 0.3-1.1 mg/kg) over 10-30 seconds
Dosing of SCh for long procedures
Initial loading dose of 0.3-1.1 mg/kg IV
followed by 0.04-0.07 mg/kg at appropriate intervals
what is rapid sequence intubation
2 or 3 consecutive doses

maximum dose 1.5 mg/kg IV
Dosing of SCh for intubation
0.6 mg/kg IV (range 0.3-1.1 mg/kg) over 10-30 seconds
these are the adverse effects of what drug: Muscle rigidity, Prolonged Myalgia, Raised intraocular pressure,Bradyarrhythmia, Tachyarrhythmia (especially in children),Hyperkalemia, Malignant hyperthermia, Hypersensitivity reaction
Rhabdomyolysis with myoglobinemia in children, Prolonged neuromuscular block, Respiratory depression, Apnea
SCh
Mivacurium
Short-acting non-depolarizing
use with glaucoma pts
OR setting
<100/<60 hypotension
Mivacurium ED 90-95 dose
0.07 (mg/kg)
Rhabdomyolysis is an adverse effect seen in children from this drug
SCh
initial dose of Mivacurium for intubation
0.15 mg/kg IV bolus over 5-15 sec OR 0.2 mg/kg IV bolus over 30 sec OR 0.25 mg/kg IV bolus in divided doses (0.15 mg/kg followed in 30 sec by 0.1 mg/kg)
when is Mivacurium used
used for glaucoma patients or in the OR setting
maintenance of Mivacurium
4 mcg/kg/min continuous IV infusion if initiated simultaneously with administration of initial dose
Adverse Effects of Mivacurium
Flushing, Bradyarrhythmia, Cardiac dysrhythmia, Hypotension(<100/<60), Tachyarrhythmia, Prolonged neuromuscular block
Rocuronium
Intermediate-Acting non-depolarizing
onset 2-3 min
last 20-30 min
What is Rocuronium used for
used for intubation of cerebral bleeds, hemorrhagic stroke pts
initial dosing of Rocuronium for induction of neuromuscular blockade
0.6 mg/kg IV
maintenance of Rocuronium for induction of neuromuscular blockade
0.1-0.2 mg/kg IV repeated as needed
Intubation initial dose for Rocuronium
initial, 0.6 mg/kg IV 2)  maintenance, 0.1-0.2 mg/kg IV repeated as needed
Rapid sequence intubation dose for Rocuronium
0.6 to 1.2 mg/kg IV
Rocuronium is also used for
for anesthetic procedure
Adverse Effects of Rocuronium
Injection site pain, Cardiac dysrhythmia (rare), Hypertension, Hypotension, Tachyarrhythmia (rare), Anaphylaxis (rare)
what is the onset and how long does Rocuronium last?
Onset 1 -2 minutes, last 25-30 minutes
Premedication for anesthetic procedure
0.05 to 0.06 mg/kg IV 1.5-3 min prior to succinylcholine administration
the prototypic blocker of the muscarinic receptor
atropine
some anti-choligernic agents
Atropine
Mushrooms (recreational drug)
Benadryl
tricyclic anti-depressants
this drug is used for intubation in pts with cerebral bleeds
Rocuronium
Intubation drug choice if pt has arrythmias
Rocuronium because dysrythmias are rare
Safest intubation drug with liver and renal disease
Cisatracurium; it aslo has the least number of adverse effects;
metabolized by the bile and it doesn't accumulate
used with hard intubations:
HIV, Thrush, spinal surgeries, oral candidiasis, cancer
don't use this drug with renal pts, CHF, cardiac problems
Atracurium because it causes edema, cardiac and many others adverse effects
Initial dose of Vecuronium
Initial: O.O8-0.1 mg/kg IV bolus
Maintenance: 0.010-0.015 25-40 min after initial dose
drugs of choice for difficult intubation
Cisatracurium
Vecuronium
Long-Acting Nondepolarizing NMBs
Pancuronium
Doxacurium
60-90 min
This drug is not used for intubation
Pancuronium because it has a 3-5 min onset
Pancuronium facts
3-5 onset
DOA=60-90 min
Do not use in hepatic failure or renal failur
> risk of cardiac dysrhythmias
Drug that gives you hyper salivation
Pancuronium
Intermediate acting drugs
Rocuronium
Atracurium
Cistracurium
Vecuronium
20-30 min
Initial dose for Doxacurium
0.05 mg/kg IV
if used in combo with SCh, initial dose is half(0.025)
what can prolong the paralytic effects of NMBs
Aminoglycosides(gentomycin,tobromycin)
antibiotics
anaesthetic gases
magnesium
Digoxin(antiarythmic)
what decreases the NMB effects
Hypercalcemia
Hyperkalemia
phenytoin
anticholinesterases
carbamazepin
short acting drugs
SCh
Mivacurium

onset less than 1 minute
When do you use NMBs
To allow intubation
Dangerous movements of pt
Poor oxygenation despite adequate sedation
what do you do before starting a paralytic
adequate sedation and analgesia
What is the train-of-four
a machine that test muscular twitches to monitor sedation; they should be at 1-2 twitches
Drugs that treat thromboembolism
Heparin
Lovenox
Arixtra
Coumadin
Drug used to treat acute MI, ischemic stroke, and Heparin induced Thombocytopenia (TCP)
Argotraban
duration of heparin and lovenox
6-12 hrs, so when you send pt home, send them on coumadin to keep them anticouagulated
warfarin (coumading)
takes 3-5 days to work
start at 5 mg
too much will give you purple toe syndrom(depletion of protein C and S)
get INR/PT daily at first
goal 2-3 INR then DC heparin
Antiplatelets
ASA-inhibits COX 1
Plavix-inhibits ADP
Persantine
Aggrenox
Cox 2 inhibitor
Celebrex
Cox 1 inhibitors
NSAIDs
ASA
what part of the coagulation cascade does plavix work on?
inhibits ADP
ASA and Aggrenox work on what
inhibits thromboxine
how long do platelets live
about a week
if you're going to have surgery, when should you stop taking ASA and Plavix
1 week
loading dose for plavix in acute MI
300 mg
alternative med for aspirin, if pt is allergic
Plavix
Drug of choice for post-MI, ACS
Aspirin, can also be used in combo with plavix
what drug is used to treat malignant hyperthermia
dantrolline, given IV
example of an immediate release drug
Cardizam
macromolecular drug carriers
albumin
dextran
DNA
glucoproteins
Epi binds to these receptors
a1 and B-adrenergic receptors of liver cells
the negative consequence of Epi
cardiac irritability, can lead to complications after ressucitation
effect of Epi on vessels of bronchioles
vasodilation