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75 Cards in this Set
- Front
- Back
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how does atropine work?
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interrupts normal cholinergic, muscarinic transmission at the various end organs
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Symptoms of Atropine overdose
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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- |
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A muscarinic agonists that competes with atropine and reverses its effect
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pilocarpine
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These two compounds combine to make acetylcholine
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acetyl-Coenzyme A + choline
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where are nicotinic receptors found?
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neuromuscular junction of skeletal muscle
within ganglia and the CNS |
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where are muscarinic receptors found?
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within both peripheral and central nervous systems
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After ACH is hydrolyzed what re-enters the motor nerve endings to again participate in the synthesis of new acetylcholine
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Choline
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this prevents sustained depolarization
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Rapid hydrolysis of ACH
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what can cause up-regulation of Nicotinic Acetylcholine Receptors (nAChR)
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Spinal Cord Injury, CVA, Prolonged exposure to NMB drugs, Guillain-Barre syndrome
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what can cause down-regulation of Nicotinic Acetylcholine Receptors
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Down-regulation
Myasthenia Gravis Organophosphate Poisonings |
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the only NMB drug that affects depolarization
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SCh
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At what dose is SCh ED 90-95
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ED 90-95 @ 0.3 (mg/kg)
never go higher than this dose |
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What is SCh used for?
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Induction of neuromuscular blockade
During surgery as an adjunct to general anesthesia and to facilitate tracheal intubation or mechanical ventilation |
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Dosing of SCh for short procedures
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0.6 mg/kg IV (range 0.3-1.1 mg/kg) over 10-30 seconds
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Dosing of SCh for long procedures
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Initial loading dose of 0.3-1.1 mg/kg IV
followed by 0.04-0.07 mg/kg at appropriate intervals |
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what is rapid sequence intubation
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2 or 3 consecutive doses
maximum dose 1.5 mg/kg IV |
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Dosing of SCh for intubation
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0.6 mg/kg IV (range 0.3-1.1 mg/kg) over 10-30 seconds
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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
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Mivacurium
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Short-acting non-depolarizing
use with glaucoma pts OR setting <100/<60 hypotension |
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Mivacurium ED 90-95 dose
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0.07 (mg/kg)
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Rhabdomyolysis is an adverse effect seen in children from this drug
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SCh
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initial dose of Mivacurium for intubation
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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)
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when is Mivacurium used
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used for glaucoma patients or in the OR setting
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maintenance of Mivacurium
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4 mcg/kg/min continuous IV infusion if initiated simultaneously with administration of initial dose
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Adverse Effects of Mivacurium
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Flushing, Bradyarrhythmia, Cardiac dysrhythmia, Hypotension(<100/<60), Tachyarrhythmia, Prolonged neuromuscular block
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Rocuronium
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Intermediate-Acting non-depolarizing
onset 2-3 min last 20-30 min |
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What is Rocuronium used for
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used for intubation of cerebral bleeds, hemorrhagic stroke pts
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initial dosing of Rocuronium for induction of neuromuscular blockade
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0.6 mg/kg IV
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maintenance of Rocuronium for induction of neuromuscular blockade
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0.1-0.2 mg/kg IV repeated as needed
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Intubation initial dose for Rocuronium
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initial, 0.6 mg/kg IV 2) maintenance, 0.1-0.2 mg/kg IV repeated as needed
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Rapid sequence intubation dose for Rocuronium
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0.6 to 1.2 mg/kg IV
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Rocuronium is also used for
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for anesthetic procedure
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Adverse Effects of Rocuronium
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Injection site pain, Cardiac dysrhythmia (rare), Hypertension, Hypotension, Tachyarrhythmia (rare), Anaphylaxis (rare)
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what is the onset and how long does Rocuronium last?
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Onset 1 -2 minutes, last 25-30 minutes
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Premedication for anesthetic procedure
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0.05 to 0.06 mg/kg IV 1.5-3 min prior to succinylcholine administration
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the prototypic blocker of the muscarinic receptor
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atropine
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some anti-choligernic agents
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Atropine
Mushrooms (recreational drug) Benadryl tricyclic anti-depressants |
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this drug is used for intubation in pts with cerebral bleeds
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Rocuronium
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Intubation drug choice if pt has arrythmias
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Rocuronium because dysrythmias are rare
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Safest intubation drug with liver and renal disease
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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 |
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don't use this drug with renal pts, CHF, cardiac problems
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Atracurium because it causes edema, cardiac and many others adverse effects
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Initial dose of Vecuronium
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Initial: O.O8-0.1 mg/kg IV bolus
Maintenance: 0.010-0.015 25-40 min after initial dose |
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drugs of choice for difficult intubation
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Cisatracurium
Vecuronium |
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Long-Acting Nondepolarizing NMBs
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Pancuronium
Doxacurium 60-90 min |
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This drug is not used for intubation
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Pancuronium because it has a 3-5 min onset
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Pancuronium facts
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3-5 onset
DOA=60-90 min Do not use in hepatic failure or renal failur > risk of cardiac dysrhythmias |
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Drug that gives you hyper salivation
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Pancuronium
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Intermediate acting drugs
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Rocuronium
Atracurium Cistracurium Vecuronium 20-30 min |
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Initial dose for Doxacurium
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0.05 mg/kg IV
if used in combo with SCh, initial dose is half(0.025) |
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what can prolong the paralytic effects of NMBs
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Aminoglycosides(gentomycin,tobromycin)
antibiotics anaesthetic gases magnesium Digoxin(antiarythmic) |
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what decreases the NMB effects
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Hypercalcemia
Hyperkalemia phenytoin anticholinesterases carbamazepin |
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short acting drugs
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SCh
Mivacurium onset less than 1 minute |
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When do you use NMBs
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To allow intubation
Dangerous movements of pt Poor oxygenation despite adequate sedation |
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what do you do before starting a paralytic
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adequate sedation and analgesia
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What is the train-of-four
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a machine that test muscular twitches to monitor sedation; they should be at 1-2 twitches
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Drugs that treat thromboembolism
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Heparin
Lovenox Arixtra Coumadin |
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Drug used to treat acute MI, ischemic stroke, and Heparin induced Thombocytopenia (TCP)
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Argotraban
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duration of heparin and lovenox
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6-12 hrs, so when you send pt home, send them on coumadin to keep them anticouagulated
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warfarin (coumading)
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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 |
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Antiplatelets
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ASA-inhibits COX 1
Plavix-inhibits ADP Persantine Aggrenox |
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Cox 2 inhibitor
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Celebrex
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Cox 1 inhibitors
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NSAIDs
ASA |
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what part of the coagulation cascade does plavix work on?
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inhibits ADP
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ASA and Aggrenox work on what
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inhibits thromboxine
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how long do platelets live
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about a week
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if you're going to have surgery, when should you stop taking ASA and Plavix
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1 week
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loading dose for plavix in acute MI
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300 mg
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alternative med for aspirin, if pt is allergic
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Plavix
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Drug of choice for post-MI, ACS
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Aspirin, can also be used in combo with plavix
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what drug is used to treat malignant hyperthermia
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dantrolline, given IV
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example of an immediate release drug
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Cardizam
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macromolecular drug carriers
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albumin
dextran DNA glucoproteins |
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Epi binds to these receptors
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a1 and B-adrenergic receptors of liver cells
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the negative consequence of Epi
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cardiac irritability, can lead to complications after ressucitation
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effect of Epi on vessels of bronchioles
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vasodilation
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