Top Drawer Drugs

Front 1

Atropine

Back 1

Anticholinergic/ Antimuscarinic
Use: Symptomatic Bradycardia
Dose: 0.2-1.0 mg IV Push
Onset: Immediate
Duration: 4 hours
Half-life:
Metabolism: Hepatic, 2.5 hrs
Elimination: Renal - Urine
More rapid than glycopyrolate
Antagonizes Ach receptors

Front 2

Ephedrine

Back 2

Indirect Sympathomimetric
Alpha and Beta
Use: Increase BP
Dose: 5-10 mg increments
Vials: 50 mg/1mL diluted in 5-10 mL of NS.
Dilute in 5 mL: 10 mg/mL. Dilute in 10mL: 5 mg/mL
Onset: Instant
Duration: 1 hour
Half-life: 3-6 hours
Metabolism: Hepatic
Elimination: Renal- Urine
Indirectly causes release of endogenous catecholamines
Can increase HR with multi dosing due to depletion of catecholamine stores

Front 3

Lidocaine

Back 3

Local Anesthetic, Antidysrhythmic
1.Reduces pain on injection; 2. Blunts SNS response with intubation (so, decreases hr &BP )
Doses: (IV) 1.0 mg/kg (induction)
(IV Infusion) 1-4 mg/min. (arrythmia)
(Topical): up to 4 mg/kg via LTA kit-spray
Onset: (IV) Immediate, (Topical):
Duration: (IV) 10-20 min, (Topical):
Half-life: 1.5-2 hrs
Metabolism: Hepatic: 10 min, then 1.5- 3 hour
Elimination: Urine

Front 4

Succinylcholine
Anectine

Back 4

Depolarizing NMB/ Muscle Relaxant - Made two acetylcholine molecules bound together
Use: Facillitates Intubation
Dose: (IV) 1.0-1.5 mg/kg. Max dose: 150mg IV
Onset: 1 min - fastest of all NMB's
Duration: 2-3 min. - Fastest of all NMB's. (Be ready to give 2nd dose or a diff NMB w/n 3 mins)
Half Life:
Metabolism: Degraded by butyrylcholinesterase
Plasma cholinesterase
Terminates action of Ach
AE: Elevates serum K+, Triggers Malig. Hyperthermia, Profound Bradycardia w/ 2nd or 3rd dose., Causes muscle fasiculations followed by brief flaccidity., Will potentiate the effects of the other NMB's,

Front 5

Neosynephrine

Back 5

Alpha 1 Agonist - vasoconstictor (no beta)
Stimulates smooth muscle.
Dose: (IV) 40-100 mcg. (Infusion) 50-180 mcg/min
To admin: Draw up 10mL syringes of 80 mcg/mL. Give 0.5-1mL increm. doses to effect
Can also titrate to effect w/ microdrip
Cautions: Heart failure (inc. in SVR), - can cause ischemia.
Constricts blood flow to organs: Only use until you can restore volume.
Reflex bradycardia

Front 6

Nitroglycerine

Back 6

Dliates veins.
Uses: Angina, Control HTN
Admin: Draw up syringes of 100 mcg/mL
Dose: (IV)50-100 mcg incremental boluses. (Infusion) 1-3 mcg/kg/min or 50-200 mcg/min
Mild cerebral steal
Decreases myocardial O2 consumption
Metabolized in liver excreted in urine

Front 7

Propofol

Back 7

Sedative/ Hypnotic: GABA receptor selective
Dose:
Induction: (IV) 1.5-2.5 mg/kg bolus
Infusion for sedation) 20-100 mcg/kg/min
-->(Infusion for anesthesia) 100-300 mcg/kg/min
Onset: Rapid - 30 secs
Duration - Rapid (drug is not lipid soluble)
AE: Pain on injection., Allergic rxns with peanut allergy, Hypotension:
Use caution w. cardiac pts: CHF, CAD (give etomidate instead ), Resp. Suppression with lactic acidosis.
Use within 6 hrs

Front 8

Etomidate

Back 8

Induction/Intubation Agent
GABA receptor
Depresses brain stem activity
Agonist/Selective
Dose:
--> Intubation: (IV) 0.2-0.6 mg/kg
Onset: SHORT
Duration:
Elimination Halftime: 2-5 hours
AE: Pain on injection, Myoclonus, transiently depressed adrenocortial function
Awake after7-14 min
minimal cardio resp depression
Post op N/V

Front 9

Thiopental

Back 9

Barbituate: Thiobarbiturate/ Induction Agent
GABA Selective, Agonist
Dose: (IV) 3-5 mg/kg
Onset: Rapid - max brain uptake in 30s
Duration: Short
Distribution Halftime: 8.5 min
Metabolism: Highly lipid soluble - distributes to muscles and fat quickly
Elimination: Depends on metabolism: obese take longer.
AE: Decreases BP and CO, EKG changes (Use caution with cardiac pts..use etomidate instead), Immunosuppression with long-term doses.
Histamine release
Porphyria

Front 10

Glycopyrrolate

Back 10

Anticholinergic/ Antisialagogue
Dries up secretions, Prevents Bradycardia
Dose: Secretions: (IV) 0.004mg/kg.
Prevent Brady: (IV) 0.1-0.4 mg
less dramatic effect on HR than atropine
Does not cross BBB

Front 11

Scopolomine

Back 11

Anticholinergic
Use: to cause Amnesia
Dose: (IM,IV) 0.2-0.4 mg
Interactions: Opiods intensify effects
AE: CNS excitability in an awake pt
Full affect 4-24 hrs
Metabolized by liver ,excreted in urine
Acts in CNS blocking cholinergic to vomit center

Front 12

Epinephrine

Back 12

Sympathomimetric: Alpha and Beta Agonist
Uses: To increase HR, Contractility, Anaphylaxis
Doses:
-->Anaphylaxis: (subQ) 1 mL of a 1:1000 preparation
-->Hypotension: (IV) 2-8 mcg incremental doses
-->Codes: ACLS dose: 1 mg IV
-->Infusion: 0.1-0.5 mcg/kg.min
**(Used on local anesthetics to prolong the effects)
Alpha and Beta are dose related

Front 13

Propranolol

Back 13

Beta Adenergic Antagonist (Sympatholytic)
Beta 1 Beta 2 antagonist
Dose: 1-5 mg
Onset 15 mins
Duration: VERY LONG (reduces the ability to reverse with sympathomimetrics)
AE: Lack of selectivity: cause bronchoconstriction/ bronchospasm - blocks Alpha 2 receptors
Metabolized in liver, excreted urine

Front 14

Labetalol

Back 14

Sympatholytic: Adrenergic Antagonist
Alpha 1 and
non selective Beta Blocker
Use: Hypertension
Dose: (IV) 0.25 mg/kg (5-10mg increments)
-->Comes in 20mL Vials
AE: Postural HTN due to the alpha 1 blockade ...be cautious in outpatient sx.

Front 15

Metoprolol

Back 15

Sympatholytic: Beta1 Adrenergic Antagonist
Use: Antidysrhythmic, Antihypertensive
Dose: (IV) 2-5 mg IV (incremental doses)
Max 15 mg

Front 16

Hydralazine

Back 16

Direct Vasodilator
Dose: (IV) 2.5-20 mg incremental boluses
-->Avaliable in 20 mg/mL 1 mL vials
Onset: Slow 2-20 mins
AE: May cause reflex tachycardia. Follow with a beta blocker if necessary to control heart rate.
Directly dilates peripheral vessels

Front 17

Terbutaline

Back 17

Smooth Muscle Dilator
Uses: Bronchodilation, Arrest of pre-term labor
Dose: (SQ) 0.25 mg

Front 18

Vecuronium
Norcuron

Back 18

Non-depolarizing NMB Agent
Dose:
-->(IV Bolus) 0.05- 0.1 mg/kg
100mcg/kg
-->(After Sux) 0.04-0.06 mg/kg IV
-->(Maintenance) 0.01-0.15 mg/kg
Onset:3 mins
Duration: (T90): 20 min
AE: Repeated doses can cause accumulation and overmedication

Front 19

Rocuronium
Zemuron

Back 19

Non-Depolarizing NMB Agent
Dose:
-->(IV Bolus) 0.4-0.6 mg/kg
-->(Maintenance) 0.1-0.2 mg/kg
Onset: Most rapid of all NMB's
Duration: LONG 30-90mins
AE: Cummulation issues with repeated doses. Long duration can be a problem b/c can't can't reverse quickly/ easily.
Metabolized in liver excreted bile and urine

Front 20

Tracrium
Atracurium

Back 20

Non-Depolarizing NMB Agent
Dose:
-->(IV Bolus) 0.3-0.6 mg/kg
-->(After Sux) 0.2-0.4 mg/kg
-->(Maintenance) 0.08-0.1 mg/kg
Onset: 1-2 mins
Duration: 20 min
**Must be kept refrigerated.**
AE: Can cause histamine release if large doses are given IV rapidly - this can cause hypotension.
Hoffman elimination metabolized in plasma excreted urine and bile

Front 21

Cistracurium
Nimbex

Back 21

Non-Depolarizing NMB Agent (An isomer of atrocurium)
Dose:
-->(IV Bolus) 0.15-0.2 mg/kg
-->(Maintenance) 0.03 mg/kg
Onset:
Duration: 40 + min
AE: Does NOT cause histamine release.
Hoffman elimination in plasma

Front 22

Doxacurium

Back 22

Non-Depolarizing NMB Agent (derivative of atrocurium)
Dose:
-->(IV Bolus) 0.05-0.08 mg/kg
-->(After Sux) 0.025 mg/kg
-->(Maintenance) 0.005-0.01 mg/kg
Onset:
Duration: LONG - 100+ min

Front 23

Neostigmine

Back 23

Reversal Agent for NMB's/ An Anticholinesterase
Most commonly used - More effective in reversal
Dose:
--> (IV) 0.07 mg/kg
0.5-2mg IV
Max 5mg slow push
Onset: Peak Effect in 7-10 min
AE: Profound vagal stimulation - can stop the heart, Bradycardia (prevented by concomitant administration of glycopyrrolate 0.4-0.6 mg IV)
**(give 0.1 mg of Glycopyrrolate per mg of Neostigmine)
Vagal stimulation
Elimination kidneys and plasma esterase

Front 24

Edrophonium

Back 24

Reversal Agent for NMB's/ An Anticholinesterase
Dose: 1 mg/kg IV
Dose 10 mg max 40 mg
Onset: FAST
give 10 mins before end of surgery
Duration:
AE: Intense bradycardia: (Give 0.1 mg of Atropine per 10mg of Edrophonium to compensate.)
**Neostigmine is more effective at reversal than Edrophonium.**
Unknown metabolism
excreted kidneys

Front 25

Flumazenil

Back 25

Benzodiazepine Reversal Agent
Dose: (IV) 0.1-0.2 mg at 1-2 min intervals up to 3 mg
AE: Seizure in high risk patients. Withdrawal syndrome can occur in benzo-dependent patients.

Front 26

Naloxone (Narcan)

Back 26

Opoid Reversal Agent
Dose: (IV) 40-100 mcg increments
Duration: 1-4 hours
AE: too much too fast: CV stimulation &/or pulmonary edema. Withdrawal issues in opiod dependent pts.
Caution: DO NOT use to correct over-sedation, especially in pts with high pain levels. Long duration will keep them from being medicated for pain for up to 4 hrs.

Front 27

Doxapram
Dopram

Back 27

"The Magic Potion"
-->Respiratory and CNS Stimulant - effective in arousing patients after anesthesia
Dose: (IV)0.5-1.0 mg/kg (Tab gives about 20 mg.)
Duration: SHORT 12 mins
Onset 2 mins
Contraindications: Not for pt on narcotics. Do not give to pt with epilepsy, cerebral edema, or CVA.
increase in HR and BP

Front 28

Ondansetron (Zofran)

Back 28

5-HT3 Receptor Antagonist/ Antiemetic. (Only give prophylacticaly.)
Dose: (IV) 4-8 mg 15-30 min before end of surgery
Lasts 8 hours
metabolized liver excreted urine
blocks receptors on vagal nerve terminals peripherally & in area postrema of brain reducing traffic to vomiting center

Front 29

Dolasetron (Anzemet)

Back 29

5-HT3 Receptor Antagonist/ Antiemetic. (Only give prophylacticaly.)
Dose: (IV) 12.5 mg 15-30 min before end of surgery
metabolized in liver excreted urine and feces

Front 30

Granisetron (Kytril)

Back 30

5-HT3 Receptor Antagonist/ Antiemetic. (Only give prophylacticaly.)
Dose: (IV) 1.0 mg 15-30 min before end of surgery
metabolized liver excreted urine

Front 31

Promethazine (Phenergan)

Back 31

Antihistame, Sedative, Antiemetic
Dose: (IV) 12.5-25 mg
Duration 4-6hrs
Onset fast
metabolized liver excreted urine

Front 32

Dexamethazone (Decadron)

Back 32

Glucocorticoid - enhances the effects of 5-HT3 Antagonists
Dose: (IV) 4-10 mg
AE: Can delay wound healing. Can increase blood sugar.

Front 33

Methylprenisolone (SoluMedrol)

Back 33

Glucocorticoid
Uses: anti-inflammatory, Allergic Rxns, Steroid replacement therapy
Dose: (IV) 10-40 mg

Front 34

Diphenhydramine (Benedryl)

Back 34

Antihistamine, Sedative
Dose: (IV) 25-50 mg
Uses: MILD allergic rxns due to histamine release. Use in elderly for sedation.

Front 35

Reglan

Back 35

dopamine antagonist unkown mechanism of action
Increases gastric emptying
dose 10 mg IV
Duration 1-2 hrs
metabolized by liver excreted in urine

Front 36

Ketamine

Back 36

NMDA receptor antagonist blocking pain perception to th thalmus and cortex
dose 2-4 mg IV
peak 5 mins
Cardiac stimulant, increase BP, HR,CO, CVP
slight resp depression
metabolism liver excreted urine

Front 37

Zantac

Back 37

H2 receptor blocker
Dose 50 mg
onset fast
Duration 6-8 hrs
decreases acid production
metabolized liver excreted urine

Front 38

Inapsine

Back 38

Alpha adrenergic antagonist
dopamine receptor antagonist
Dose 2.5 mg IV slow push (QT prolonged)
Duration 2-4 hrs
sedative, crosses placenta
metabolized liver excreted urine