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528 Cards in this Set

  • Front
  • Back
What is the Brand name of Atropine?
Atro-Pen
How is Atropine typically supplied (concentration)?
0.4 mg/ml OR 1 mg/ml
The usual dose of Atropine is?
0.01 - 0.02 mg/kg OR 0.5-1 mg
What is the time to onset of Atropine?
1 minute
What is the time to peak of Atropine?
2 minutes
What is the duration of Atropine?
1-4 hrs
How is Atropine metabolized?
50-75% liver
What receptors does Atropine act on?
Muscarinic blocker
What drug class is Atropine in?
Anticholinergic
What is the mechanism of action of Atropine?
competitively blocks binding of acetylcholine and prevents receptor activation
What patients would you not give Atropine to?
caution in narrow angle glaucoma, prostatic hypertrophy, bladder neck onstruction
Does Atropine cross the blood brain barrier?
Yes, it is a tertiary ammonium
What is the Brand name of Scopalomine?
Hyoscine
How is Scopalomine typically supplied (concentration)?
0.3mg/ml, 0.4mg/ml, 1mg/ml
The usual dose of Scopalomine is?
0.3-0.6mg IV
What is the time to onset of Scopalomine?
10 minutes
What is the time to peak of Scopalomine?
50-80 minutes
What is the duration of Scopalomine?
2 hours
How is Scopalomine metabolized?
hepatic metabolism, renal elimination
What receptors does Scopalomine act on?
muscarinic
What drug class is Scopalomine in?
anticholinergic, antiemetic
What is the mechanism of action of Scopalomine?
peripheral and central cholinergic (muscarinic) antagonist, antisialagogue, histamine and serotonin antagonist
What patients would you not give Scopalomine to?
obstetrics- crosses placenta- tertiary amine
What patients might you give Scopolamine to?
Unstable trauma patients that are too sick for GA
What is the Brand name of Glycopyrrolate?
Robinul
How is Glycopyrrolate typically supplied (concentration)?
0.2 mg/ml for injection
The usual dose of Glycopyrrolate is?
Premedication 0.1-0.2mg / Reversal 0.2mg per 1mg Neostigmine (1ml/1ml)
What is the time to onset of Glycopyrrolate?
<1 min
What is the time to peak of Glycopyrrolate?
5 minutes
What is the duration of Glycopyrrolate?
2-3 hours
How is Glycopyrrolate metabolized?
hepatic
What receptors does Glycopyrrolate act on?
muscarinic cholinergic receptors
What drug class is Glycopyrrolate in?
anticholinergic
What is the mechanism of action of Glycopyrrolate?
reversibly blocks muscarinic cholinergic receptors causing increase HR decreased secreations
What patients would you not give Glycopyrrolate to?
Tachycardia, narrow angle glaucoma, prostate hypertrophy, bladder neck obstruction
What is the Brand name of Esmolol?
Brevibloc
How is Esmolol typically supplied (concentration)?
10mg/ml
The usual dose of Esmolol is?
0.2-0.5mg/kg
What is the time to onset of Esmolol?
1-2 mins
What is the time to peak of Esmolol?
5 minutes
What is the duration of Esmolol?
10-20 mins
How is Esmolol metabolized?
In the plasma by Ester hydrolysis
What receptors does Esmolol act on?
Beta 1 adrenergic receptor
What drug class is Esmolol in?
Beta blocker
What is the mechanism of action of Esmolol?
Cardio selective beta 1 antagonist
What patients would you not give Esmolol to?
Bradycardia, 2nd or 3rd degree AV block
What is the Brand name of Hydralazine?
Apresoline
How is Hydralazine typically supplied (concentration)?
20mg/ml
The usual dose of Hydralazine is?
2.5-40mg (0.1-0.2 mg/kg)
What is the time to onset of Hydralazine?
IV 5- 20 Mins
What is the time to peak of Hydralazine?
IV 10-80mins
What is the duration of Hydralazine?
2-4 hours ( so be cautious with dosing)
How is Hydralazine metabolized?
Hepatic
What receptors does Hydralazine act on?
unknown ( Nagelhout)
What drug class is Hydralazine in?
Peripheral Vasodilator
What is the mechanism of action of Hydralazine?
Direct relaxant effect on arteriolar smooth muscle (interference with Ca Ion transport)
What patients would you not give Hydralazine to?
Tachycardiac pt's 2t reflexive tachycardia,
What is the Brand name of Labetalol?
Trandate; Normodyne
How is Labetalol typically supplied (concentration)?
5 mg/mL (comes in 20 mg Carpuject, 100 mg and 200 mg multi-dose vials)
The usual dose of Labetalol is?
20 mg over 2 min. Then 20-80 mg q 10 min until desired BP is achieved. Max 300 mg. Peds:0.4-1 mg/kg/hr IV infusion for HTN crisis
What is the time to onset of Labetalol?
2-5 min
What is the time to peak of Labetalol?
5-15 min
What is the duration of Labetalol?
2-4 hours
How is Labetalol metabolized?
Hepatic
What receptors does Labetalol act on?
selective alpha-1 and non-selective beta-1 and 2 antagonist
What drug class is Labetalol in?
Beta-blocker (mixed alpha/beta adrenergic antagonist)
What is the mechanism of action of Labetalol?
Selectively antagonizes alpha-1 adrenergic receptors. Antagonizes beta-1 and 2 receptors
What patients would you not give Labetalol to?
Asthma, CHF, any degree of heart block, bradycardia, cardiogenic shock
What are some clinical uses for Labetalol?
Pregnancy induced hypertension, hypertensive crisis, and controlled hypotension during anesthesia
What is the Brand name of Droperidol?
Inapsine
How is Droperidol typically supplied (concentration)?
2.5mg/mL
The usual dose of Droperidol is?
PONV: 0.625-2.5 mg
What is the time to onset of Droperidol?
1-2 min
What is the time to peak of Droperidol?
30 min
What is the duration of Droperidol?
2-4 hrs
How is Droperidol metabolized?
Hepatic, renal
What receptors does Droperidol act on?
Primarily dopamine receptors in CNS
What drug class is Droperidol in?
antiemetic, neuroleptic
What is the mechanism of action of Droperidol?
Sedation produced by effects on dopamine, GABA and serotonin receptors in CNS; antiemetic effects produced by blockade in the CTZ
What patients would you not give Droperidol to?
DON'T give to: parkinson's pts; also potentiates other CNS depressants
What is the Brand name of Ranitidine?
Zantac
How is Ranitidine typically supplied (concentration)?
25 mg/mL
The usual dose of Ranitidine is?
50mg IV (dilute in 20mL)
What is the time to onset of Ranitidine?
<15 min
What is the time to peak of Ranitidine?
1-2 hrs
What is the duration of Ranitidine?
6-8 hrs
How is Ranitidine metabolized?
Hepatic; 70% renal unchnged
What receptors does Ranitidine act on?
H2 receptor
What drug class is Ranitidine in?
H2 receptor antagonist
What is the mechanism of action of Ranitidine?
competitively antagonizes H2 receptors, inhibiting secretion of hydrogen ions by gastric parietal cells
What patients would you not give Ranitidine to?
Dose should be reduced by 50% with renal failure
What is the Brand name of Ondansetron?
Zofran
How is Ondansetron typically supplied (concentration)?
2mg/ml
The usual dose of Ondansetron is?
4mg; peds 0.15mg/kg
What is the time to onset of Ondansetron?
< 30 sec
What is the time to peak of Ondansetron?
Variable
What is the duration of Ondansetron?
12-24 hrs
How is Ondansetron metabolized?
Hepatic
What receptors does Ondansetron act on?
Serotonin 5-HT3 receptors
What drug class is Ondansetron in?
Antiemetic
What is the mechanism of action of Ondansetron?
Antagonizes serotonin (5-HT3) receptor on vagal nerve terminals and central chemoreceptor trigger zone
Is Ondansetron for the treatment or prevention of N/V?
Prevention (per package insert... written by McD... pimp question?!?!)
What is the Brand name of Dexamethasone?
Decadron
How is Dexamethasone typically supplied (concentration)?
4mg/ml
The usual dose of Dexamethasone is?
5-20mg
What is the time to onset of Dexamethasone?
<1 min
What is the time to peak of Dexamethasone?
12-24 hours
What is the duration of Dexamethasone?
~24-48 hrs
How is Dexamethasone metabolized?
Hepatic
What receptors does Dexamethasone act on?
Glucocorticoid receptors
What drug class is Dexamethasone in?
Glucocorticoid
What is the mechanism of action of Dexamethasone?
for antiemesis: not completely understood
What patients would you not give Dexamethasone to?
possibly diabetics, immunocompromised
Is dexamethasone generally used alone for PONV?
No, more commonly used with other antiemetics
What is the Brand name of Metoclopramide?
Reglan
How is Metoclopramide typically supplied (concentration)?
5 mg/mL, 10 mg/mL
The usual dose of Metoclopramide is?
10 mg IV
What is the time to onset of Metoclopramide?
1-3 min
What is the time to peak of Metoclopramide?
< 1 hr
What is the duration of Metoclopramide?
1-2 hr
How is Metoclopramide metabolized?
Minimally metabolized, excreted in urine and feces
What receptors does Metoclopramide act on?
Dopamine receptors in the stomach and intestine as well as in the brain
What drug class is Metoclopramide in?
antiemetic and gastroprokinetic agent
What is the mechanism of action of Metoclopramide?
Exact mechanism is unknown
What patients would you not give Metoclopramide to?
pheochromocytoma, sizure disorders, GI bleeding/perforation/obstruction
What might Metoclopramide cause?
Tardive dyskinesia
What patients would you not give Ondansetron to?
Caution in hepatic impairment and abdominal surgery
What is the Brand name of Omeprazole?
Prilosec
How is Omeprazole typically supplied (concentration)?
Delayed-release capsules 10mg, 20 mg, & 40 mg. Delayed-release oral suspension 2.5 mg & 10 mg.
The usual dose of Omeprazole is?
Delayed-release capsule 20 mg po once daily
What is the time to onset of Omeprazole?
within 1 hour
What is the time to peak of Omeprazole?
within 2 hours
What is the duration of Omeprazole?
upto 72 hours
How is Omeprazole metabolized?
Liver
What receptors does Omeprazole act on?
Inhibits the proton pump
What drug class is Omeprazole in?
Proton Pump Inhibitor
What is the mechanism of action of Omeprazole?
Binds to an enzyme on gastric parietal cells in the presense of acidic gastric pH, preventing the final transportof hydrogen ions into the gastric lumen
What patients would you not give Omeprazole to?
use with caution in pts with liver disease, avoid in pregnancy and lactation
What are the side effects of Omeprazole?
Abdominal pain, nausea, vomiting, diarrhea, rah, dizziness, drowsiness
What is the Brand name of Citric Acid/Sodium Citrate?
Bicitra
How is Citrate Acid/Sodium Citrate typically supplied (concentration)?
500mg/5ml
The usual dose of Citrate Acid/Sodium Citrate is?
Adult Dose: 15ml's diluted in 15ml's of water as a single dose Children: 5-15ml's diluted in 5-15ml's of water as a single dose
What is the time to onset of Citrate Acid/Sodium Citrate?
2 - 10 minutes
What is the time to peak of Citrate Acid/Sodium Citrate?
Few Minutes
What is the duration of Citrate Acid/Sodium Citrate?
1-2 hours
How is Citrate Acid/Sodium Citrate metabolized?
metabolized to sodium bicarbonate. Clearance: oxidation; 5% excreted in urine (unchanged)
What receptors does Citrate Acid/Sodium Citrate act on?
antacids neutralize the acidity of gastric fluid by providing a base that reacts with hydrogen ions to form water
What drug class is Citrate Acid/Sodium Citrate in?
Nonparticulate neutralizing buffer
What is the mechanism of action of Citrate Acid/Sodium Citrate?
Neutralization of gastric acid
What patients would you not give Citrate Acid/Sodium Citrate to?
contraindicated in patients with sodium restriction or severe renal impairment. Do not use with aluminum based antacids. Addison's disease
What is the Brand name of Sufentanil?
Sufenta
How is Sufentanil typically supplied (concentration)?
50mcg/ml
The usual dose of Sufentanil is?
Infusion 0.005 - 0.05 mcg/kg/min Start with a 0.25 - 1 mcg/kg bolus Intraop dose 0.25-30mcg/kg
What is the time to onset of Sufentanil?
1-3min
What is the time to peak of Sufentanil?
3-5 minutes
What is the duration of Sufentanil?
25-45min
How is Sufentanil metabolized?
hepatic
What receptors does Sufentanil act on?
Mu
What drug class is Sufentanil in?
opioid
What is the mechanism of action of Sufentanil?
doses up to 8mcg/kg produces analgesia; doses >8mcg/kg produce hypnosis and anesthesia; doses of 25mcg/kg attenuate the sympathetic nervous system response to surgical stress; doses 25-30mcg/kg attenuate catecholamine response
What patients would you not give Sufentanil to?
known hypersensitivity; avoid using high doses when using nitrous oxide or vice versa (cardiovascular depression); pts on CCB and BB may experience more bradycardia and hypotension; head injuries-may obscure clinical course; use with caution in pulmonary disease; use with caution in kidney/liver dysfunction
What is the Brand name of Hydromorphone?
Dilaudid
How is Hydromorphone typically supplied (concentration)?
1 mg/ml, 2mg/ml
The usual dose of Hydromorphone is?
Analgesic dosing 0.4 - 2mg IV
What is the time to onset of Hydromorphone?
15 - 30 minutes
What is the time to peak of Hydromorphone?
30 - 90 minutes
What is the duration of Hydromorphone?
2 - 4 hours (IV), 4- 6 hours (IM, PO, subQ)
How is Hydromorphone metabolized?
Liver, urine and bile excretion
What receptors does Hydromorphone act on?
Mu receptor agonist
What drug class is Hydromorphone in?
Semisynthetic Opioids/Opiates, Morphine derivative
What is the mechanism of action of Hydromorphone?
Binds to opiate receptors in the CNS
What patients would you not give Hydromorphone to?
Lack of known active metabolites, recommended for patients with renal failure.
What is the potency of Hydromorphone compared to Morphine?
5x (2mg Dilaudid = 10mg Morphine
What is the Brand name of Fentanyl?
Sublimaze
How is Fentanyl typically supplied (concentration)?
50 mcg/ml
The usual dose of Fentanyl is?
Sedation: 1-2 mcg/kg IV General: 5-15+mcg/kg IV Cardiac Surgery: 50-150 mcg/kg IV
What is the time to onset of Fentanyl?
Immediate onset
What is the time to peak of Fentanyl?
3-5 minutes
What is the duration of Fentanyl?
0.5-2 hours
How is Fentanyl metabolized?
Liver (CYP 3A4)
What receptors does Fentanyl act on?
Mu opioid receptor
What drug class is Fentanyl in?
Opioid agonist (narcotic analgesic)
What is the mechanism of action of Fentanyl?
Agonist reaction with mu receptors in brain, spinal cord, and other tissues. Highly lipophilic, crosses BBB
What patients would you not give Fentanyl to?
Pts with known sensitivity, head injury (increased (ICP), caution in elderly, liver impairment, renal impairment, resp impairment, seizure disorder
How potent is Fentanyl compared to Morphine?
75 to 125x more potent than morphine as an analgesic
How does Fentanyl effect midazolam and propofol?
Analgesic concentrations greatly potentiate the effects of midazolam and decrease the dose requirements of propofol
Does Fentanyl cause a release of histamine?
No histamine release
Does Fentanyl have cardiac effects?
Minimal cardiac depressant effects
What benefits does IV administration have over other routes?
Intravenous administration permits increased concentrations in highly perfused tissues such as the kidneys, lungs, spleen, heart, and brain.
What is the Brand name of Meperidine?
Demerol
How is Meperidine typically supplied (concentration)?
10 mg/ml
The usual dose of Meperidine is?
25-100mg (0.5-2 mg/kg)
What is the time to onset of Meperidine?
<1 minute
What is the time to peak of Meperidine?
5-20 minutes
What is the duration of Meperidine?
2-4 hours
How is Meperidine metabolized?
In the liver by hydrolysis to meperidinic acid followed by partial conjugation with glucuronic acid; urinary excretion
What receptors does Meperidine act on?
Kappa receptors (opiate receptors)
What drug class is Meperidine in?
Synthetic opioid agonist
What is the mechanism of action of Meperidine?
Activation of kappa receptors inhibits presynaptic release and postsynaptic response to excitatory neurotransmitters (ACh, Substance P) from nociceptive neurons.
What patients would you not give Meperidine to?
MAOI use w/in 14 days
How potent is Meperidine compared to morphine
1/10th potency of morphine
Does Meperidine cross the placenta?
Yes, Meperidine crosses the placenta and appears in breast milk
What is the Brand name of Morphine?
Morphine, MS Contin, Duramorph etc
How is Morphine typically supplied (concentration)?
1-2-4-10 mg/ml IV
The usual dose of Morphine is?
Typical dose is 2-10mg bolus.
What is the time to onset of Morphine?
Typically 15-30 minutes due to Morphine's relatively low lipid solubility
What is the time to peak of Morphine?
30-45 minutes IV
What is the duration of Morphine?
2-4 hours depending on dose IV
How is Morphine metabolized?
Hepatic via glucuronidation by phase II metabolism enzyme UDP-glucuronosyl transferase-2B7
What receptors does Morphine act on?
The mu receptors - appears most important in terms of analgesia and respiratory depression and opioid effects.
What drug class is Morphine in?
Opiod
What is the mechanism of action of Morphine?
Morphine's main effect is binding to and activating the μ-opioid receptors in the central nervous system.
What patients would you not give Morphine to?
Hypovolemic, Opiod naive, acute resp depression, increased ICP, renal failure
What is the Brand name of Ketorolac?
Toradol
How is Ketorolac typically supplied (concentration)?
15 mg/ml or 30 mg/ ml
The usual dose of Ketorolac is?
IM/IV: 30-60mg followed by 15-30mg q6-8h; PO: 10mg q4-6h
What is the time to onset of Ketorolac?
30 mins
What is the time to peak of Ketorolac?
60-120 minutes
What is the duration of Ketorolac?
4 - 6 hours
How is Ketorolac metabolized?
<50% hepatic, renal metabolism; 91% renal elimination
What receptors does Ketorolac act on?
COX receptor inhibition
What drug class is Ketorolac in?
NSAID
What is the mechanism of action of Ketorolac?
limits prostaglandin synthesis by COX inhibition
What patients would you not give Ketorolac to?
Adverse effects are similar to other NSAIDs: peptic ulceration, bleeding decreased renal blood flow, do not exceed 5d, caution with hypovolemia/impaired renal function; consider reactive airway disease in patients with perennial vasomotor rhinitis and nasal polyps
What is the Brand name of Alfentanil?
Alfental
How is Alfentanil typically supplied (concentration)?
500 mcg/ml
The usual dose of Alfentanil is?
50-300 mcg/kg
What is the time to onset of Alfentanil?
1-2 mins
What is the time to peak of Alfentanil?
1-2 mins
What is the duration of Alfentanil?
10-15 mins
How is Alfentanil metabolized?
Hepatic metabolize; Renal elimination
What receptors does Alfentanil act on?
Mu opioid receptor
What drug class is Alfentanil in?
Opioid agonist (narcotic analgesic)
What is the mechanism of action of Alfentanil?
Agonist reaction with mu receptors in brain, spinal cord, and other tissues. Highly lipophilic, crosses BBB
What patients would you not give Alfentanil to?
Pts with known sensitivity, Caution in head injury (increased (ICP), caution in elderly, liver impairment, renal impairment, resp impairment, seizure disorder
How potent is Alfentanil compared to Morphine?
10x more potent than morphine
What is the Brand name of Mivacurium?
Mivacron
How is Mivacurium typically supplied (concentration)?
2 mg/ml
The usual dose of Mivacurium is?
Intubating dose 0.15-0.25 mg/kg
What is the time to onset of Mivacurium?
Time to intubation 1.5-2 minutes
What is the time to peak of Mivacurium?
1-3 minutes
What is the duration of Mivacurium?
12-20 minutes
How is Mivacurium metabolized?
plasma cholinesterase
What receptors does Mivacurium act on?
Binds to postsynaptic nicotinic Acetylcholine receptors and competitvely inhibits action of acetylcholine
What drug class is Mivacurium in?
non-depolarizing muscle relaxant
What is the mechanism of action of Mivacurium?
Binds to postsynaptic nicotinic Acetylcholine receptors and competitvely inhibits action of acetylcholine
What patients would you not give Mivacurium to?
Plasma cholinesterase deficient; reactive airway disease (b/c of histamine) Stoelting and Hiller; burn injury (burns decrease plasma cholinesterase activity - Stoelting and Hiller)
Maintenace dose of Mivacurium?
0.01-0.1 mg/kg
Histamine release with Mivacurium?
Yes (slight)
What is the Brand name of Atracurium?
Tracrium
How is Atracurium typically supplied (concentration)?
No longer available in US
The usual dose of Atracurium is?
0.5 mg/kg over 30-60 sec
What is the time to onset of Atracurium?
2-3 min
What is the time to peak of Atracurium?
3-5 min
What is the duration of Atracurium?
30-45 min
How is Atracurium metabolized?
Ester Hydrolysis, Hoffman Elimination
What receptors does Atracurium act on?
Binds to postsynaptic nicotinic Acetylcholine receptors and competitvely inhibits action of acetylcholine
What drug class is Atracurium in?
non-depolarizing muscle relaxant
What is the mechanism of action of Atracurium?
Binds to postsynaptic nicotinic Acetylcholine receptors and competitvely inhibits action of acetylcholine
What is the Brand name of Cisatracurium?
Nimbex
How is Cisatracurium typically supplied (concentration)?
2mg/ml
The usual dose of Cisatracurium is?
0.15-0.2mg/kg (ED95=0.05mg/kg)
What is the time to onset of Cisatracurium?
2-3 min
What is the time to peak of Cisatracurium?
2-3 min
What is the duration of Cisatracurium?
40-75 min
How is Cisatracurium metabolized?
Hoffman elimination (and possibly ester hydrolysis, Evers)
What receptors does Cisatracurium act on?
Binds to postsynaptic nicotinic Acetylcholine receptors and competitvely inhibits action of acetylcholine
What drug class is Cisatracurium in?
Intermediate acting non-depolarizing muscle blockers
What is the mechanism of action of Cisatracurium?
Binds to postsynaptic nicotinic Acetylcholine receptors and competitvely inhibits action of acetylcholine
What patients would you not give Cisatracurium to?
No significant contraindications but hypothermia and acidosis will prolong Cisatracurium's action
What are the storage considerations for Cisatracurium?
Must be refrigerated and used within 21 days after removal from refrigeration
Drug-drug interactions for Cisatracurium?
Will precipitate if introduced into same line as alkaline drugs (eg: thiopental)
What is the Brand name of Succinylcholline?
Anectine
How is Succinylcholline typically supplied (concentration)?
20 mg/mL
The usual dose of Succinylcholline is?
0.7 - 1.0 mg/kg intubation, 20mg for laryngospasm
What is the time to onset of Succinylcholline?
30-60 sec
What is the time to peak of Succinylcholline?
1 minute
What is the duration of Succinylcholline?
5 minutes
How is Succinylcholline metabolized?
plasma pseudocholinesterase
What receptors does Succinylcholline act on?
nicotinic cholinergic receptors
What drug class is Succinylcholline in?
Depolarizing neuromuscular relaxant
What is the mechanism of action of Succinylcholline?
Binds to both alpha subunits of cholinergic receptors, producing depolarization resulting in flaccid paralysis.
What patients would you not give Succinylcholline to?
High K+, Hx of MH, 48 -72 hrs after Spinal cord injury
The dose of Succinylcholline for laryngospasm?
0.15-0.3 mg/kg (10-20 mg)
What is the Brand name of Vecuronium?
Norcuron
How is Vecuronium typically supplied (concentration)?
1-2mg/mL
The usual dose of Vecuronium is?
0.08-0.1 mg/kg
What is the time to onset of Vecuronium?
2-3 min
What is the time to peak of Vecuronium?
3-5 min
What is the duration of Vecuronium?
30-45 min
How is Vecuronium metabolized?
Hepatic
What receptors does Vecuronium act on?
nicotinic cholinergic receptors
What drug class is Vecuronium in?
Non-depolarizing neuromuscular relaxant
What is the mechanism of action of Vecuronium?
Competitively binds to Alpha subunit(s) of cholinergic receptor at motor end plate. Preventing Na+ and Ca++ from entering and K+ from exiting
What patients would you not give Vecuronium to?
those with hepatic dysfunction or extrahepatic biliary obstruction due to prolonged duration
What is the Brand name of Pancuronium?
Pavulon
How is Pancuronium typically supplied (concentration)?
1mg/mL, 2mg/mL
The usual dose of Pancuronium is?
Intubating- 0.04 - 0.1 mg/kg, 0.01-0.05 mg/kg maintainece
What is the time to onset of Pancuronium?
1-3 min
What is the time to peak of Pancuronium?
3-5 minutes
What is the duration of Pancuronium?
60-90 minutes
How is Pancuronium metabolized?
Hepatic (deacetylated), Excretion is 40% renal, 10% bile
What receptors does Pancuronium act on?
It is Bisquaternary, acts on nicotinic choliergic receptor
What drug class is Pancuronium in?
Nondepolarizing muscle relaxants
What is the mechanism of action of Pancuronium?
Competitively binds to Alpha subunit(s) of cholinergic receptor at motor end plate. Preventing Na+ and Ca++ from entering and K+ from exiting
What patients would you not give Pancuronium to?
Pt in whom an increased heart rate would be particularly detrimental (coronary artery disease, IHSS); Renal patients may have prolonged neuromuscular blockade
What is the Brand name of Pipecuronium?
Arduan
How is Pipecuronium typically supplied (concentration)?
10mg powder
The usual dose of Pipecuronium is?
0.07-0.085 mg/kg
What is the time to onset of Pipecuronium?
2 min
What is the time to peak of Pipecuronium?
3-5 minutes
What is the duration of Pipecuronium?
45-120 min
How is Pipecuronium metabolized?
Renal
What receptors does Pipecuronium act on?
cholinergic receptors at the motor end plate
What drug class is Pipecuronium in?
long acting nondepolarizing neuromuscular blocking agent
What is the mechanism of action of Pipecuronium?
competitive antagonist at the cholinergic receptors of the motor end plate
What patients would you not give Pipecuronium to?
enhanced neuromuscular blockade in pts with myasthenia gravis or inadequate adrenocortical function
Does Pipecuronium release histamine?
No
What is the Brand name of Rocuronium?
Zemuron
How is Rocuronium typically supplied (concentration)?
10mg/ml
The usual dose for intubation with Rocuronium is?
0.6-1.2mg/mg
What is the time to onset of Rocuronium?
60-90 sec
What is the time to peak of Rocuronium?
1-3 min
What is the duration of Rocuronium?
30-60 (150) min
How is Rocuronium metabolized?
Hepatic; It is excreted 30% Renal, 70% Biliary
What receptors does Rocuronium act on?
nicotinic cholinergic receptor
What drug class is Rocuronium in?
Non-depolarizing neuromuscular relaxant
What is the mechanism of action of Rocuronium?
Competitively binds to Alpha subunit(s) of cholinergic receptor at motor end plate. Preventing Na+ and Ca++ from entering and K+ from exiting
What is the Brand name of Doxacurium?
Nuromax
How is Doxacurium typically supplied (concentration)?
1 mg/ml
The usual dose of Doxacurium is?
0.05-.08mg/kg
What is the time to onset of Doxacurium?
2 mins
What is the time to peak of Doxacurium?
3-9 mins
What is the duration of Doxacurium?
30-60 mins
How is Doxacurium metabolized?
Minimal metabolism Excreted Renally
What receptors does Doxacurium act on?
acetylcholine receptors of the nicotinic type
What drug class is Doxacurium in?
non-depolarizing muscle relaxant
What is the mechanism of action of Doxacurium?
Binds to postsynaptic nicotinic Acetylcholine receptors and competitvely inhibits action of acetylcholine
What is the maintenance dose of Rocuronium?
0.15 mg/kg
What is the Brand name of Ephedrine?
Generic only, no brands available
How is Ephedrine typically supplied (concentration)?
50mg/1ml
The usual induction dose of Ephedrine is?
5-25mg bolus dose only, avg for a 70kg adult
What is the time to onset of Ephedrine?
<1 minute
What is the time to peak of Ephedrine?
2-5 minutes
What is the duration of Ephedrine?
10-60 minutes
How is Ephedrine metabolized?
minimal hepatic, mostly renal elimination (unchanged)
What receptors does Ephedrine act on?
alpha 1, beta1 & beta2
What drug class is Ephedrine in?
Indirect Acting Sympathomimetic (Synthetic Noncatecholemine)
What is the mechanism of action of Ephedrine?
alpha and beta adrenergic stimulation; norepinephrine release at sympathetic nerve endings
What patients would you not give Ephedrine to?
Avoid in patients taking MAO inhibitors
What is the Brand name of Phenylephrine?
Neo-Synephrine
How is Phenylephrine typically supplied (concentration)?
10mg/ml ampule, 100mcg/ml pre-made sticks
The usual dose of Phenylephrine is?
50-100mcg
What is the time to onset of Phenylephrine?
<1 min
What is the time to peak of Phenylephrine?
1 min
What is the duration of Phenylephrine?
15-20 mins
How is Phenylephrine metabolized?
Hepatic, renal elimination
What receptors does Phenylephrine act on?
direct alpha 1 (high dose alpha 2 & beta)
What drug class is Phenylephrine in?
adrenergic agoinst
What is the mechanism of action of Phenylephrine?
stimulates the post-synaptic alpha receptors, increased systemic vascular resistence, decreased cardiac output, increased stroke volume and bradycardia.
What patients would you not give Phenylephrine to?
Bradycardia, Ventricular tachycardia, Severe arteriosclerosis
Is Phenylephrine a pure alpha agoist?
No, in high doses it can have alpha 2 and beta activation
What is the Brand name of Epinephrine?
Epinephrine hydrochloride (generic), Adrenaline/Epinephrine (brand)
How is Epinephrine typically supplied (concentration)?
1mg/ml (1:1,000), 0.5mg/ml (1:2,000), 0.1mg (1:10,000), 0.01mg/ml (1:100,000)
What is the dose of Epinephrine for treatment of cardiac arrest
1mg or 0.02mg/kg
What is the Brand name of Epinephrine?
Epinephrine hydrochloride (generic), Adrenaline/Epinephrine (brand)
How is Epinephrine typically supplied (concentration)?
1mg/ml (1:1,000), 0.5mg/ml (1:2,000), 0.1mg (1:10,000), 0.01mg/ml (1:100,000)
What is the dose of Epinephrine for treatment of cardiac arrest
1mg or 0.02mg/kg
What is the time to onset of Epinephrine?
IV: 30-60sec, SC: 6-15min, intratracheal: 5-15sec, inhalation: 3-5min
What is the time to peak of Epinephrine?
IV peak effect is within 3 minutes
What is the duration of Epinephrine?
IV: 5-10min, intratracheal: 15-25min, inhalation/SC: 1-3hrs
How is Epinephrine metabolized?
Enzymatic degradation (hepatic, renal, GI tract)
What receptors does Epinephrine act on?
activates both alpha and beta receptors
What drug class is Epinephrine in?
sympathomimetic
What is the mechanism of action of Epinephrine?
Direct stimulation of apha 1, beta 1, and beta 2 receptors
What patients would you not give Epinephrine to?
Closed angle glaucoma, hypersensitivity, obstetric patients...but if the patient arrests, we're gonna give it to them anyways!
What effect does Epinephrine have when mixed with local anesthetics?
It decreases systemic absorption and prolongs duration of action
What is the Brand name of Dopamine?
Intropin
How is Dopamine typically supplied (concentration)?
200-400mg/5mL amp -- diluted 400 mg in 250 mL D5W
The usual induction dose of Dopamine is?
2-20 mcg/kg/min infusion
What is the time to onset of Dopamine?
2-4 min
What is the time to peak of Dopamine?
2-10 min
What is the duration of Dopamine?
10-20 min
How is Dopamine metabolized?
Hepatic elimination
What receptors does Dopamine act on?
alpha, beta 1, and dopaminergic receptors; also indirectly by releasing norepi
What drug class is Dopamine in?
Inotrope, vasoconstrictor
What is the mechanism of action of Dopamine?
Low dose - increase RBF; Med dose - stimulates beta 1 increasing SV and CO; Large dose - stimulates alpha increasing PVR, decreasing RBF
What patients would you not give Dopamine to?
DON'T give to Pt's with: pheochromocytoma, tachyarrhythmias, v-fib, occlusive vascular disease such as Raynaud's
What is the Brand name of Dobutamine?
Dobutrex
How is Dobutamine typically supplied (concentration)?
250mg in a 20 ml vial
The usual dose of Dobutamine is?
an infusion of 2 to 20mcg/kg/min Method: 250 mg should be placed in 500 ml of d5w, which gives a concentration of 0.5 mg/ml.
What is the time to onset of Dobutamine?
1 to 2 min
What is the time to peak of Dobutamine?
10 min
What is the duration of Dobutamine?
brief under goes rapid metabolism
How is Dobutamine metabolized?
the liver and other tissues
What receptors does Dobutamine act on?
selective beta 1 agonist
What drug class is Dobutamine in?
sympathomimetic
What is the mechanism of action of Dobutamine?
increases myocardial contractility which increases cardiac output, and decreases atrial filling pressures
What patients would you not give Dobutamine to?
Be sure pt has an adequate HR before giving. Use with caution in people following an MI, with ventricular irritability, & know alkaline solutions can deactivate it
What is an indication for the use of Dobutamine?
short term management of CHF
What are some effects of Dobutamine?
increased HR, HTN, PVC SYNERGESTIC effects with Nipride
What is the Brand name of Flumazenil?
Romazicon
How is Flumazenil typically supplied (concentration)?
0.1mg/ml in 5ml Vial
The usual dose of Flumazenil is?
0.2-1.0mg IV at 0.2mg/min (wait at least 1min. b/w doses & repeat at least q 20 min. to avoid resedation, with max dosing 3mg/hr
What is the time to onset of Flumazenil?
1-3 min.
What is the time to peak of Flumazenil?
2-10 min.
What is the duration of Flumazenil?
60 min.
How is Flumazenil metabolized?
hepatic
What receptors does Flumazenil act on?
Competitive antagonism of GABA receptor, antagonizing benzodiazepine effect
What drug class is Flumazenil in?
Benzodiazepine antagonist
What is the mechanism of action of Flumazenil?
Benzodiazepine antagonist
What patients would you not give Flumazenil to?
Do not use in unknown drug overdose, suspected tricyclic antidepressant overdose, or seizure-prone patients
What are possible effects of this drug?
CNS excitation including seizures, acute withdrawal, nausea, dizziness, agitation, HTN, arrhythmias.
What is the Brand name of Edrophonium?
Tensilon
How is Edrophonium typically supplied (concentration)?
2.5mg/ml
The usual dose of Edrophonium is?
0.5-1 mg/kg IV Max dose 40mg
What is the time to onset of Edrophonium?
.5-1 min
What is the time to peak of Edrophonium?
1 min
What is the duration of Edrophonium?
45-60 mins
How is Edrophonium metabolized?
Renal 70%, Hepatic 30%
What receptors does Edrophonium act on?
all receptors
What drug class is Edrophonium in?
Cholinesterase Inhibitor/ Anticholinesterase
What is the mechanism of action of Edrophonium?
Inhibits junctional acetylcholinesterase at NMJ and also plasma cholinesterase
What patients would you not give Edrophonium to?
Possibly renal failure (prolonged clearance time)
What anticholinergic drug would you add to Edrophonium to counteract bradycardia?
Most rapid onset & shortest duration of any CIs matches it better with atropine than glycopyrrolate
What is the Brand name of Physostigimine?
Antilirium
How is Physostigimine typically supplied (concentration)?
1mg/ml
The usual dose of Physostigimine is?
0.01 - 0.03mg/kg
What is the time to onset of Physostigimine?
4 min
What is the time to peak of Physostigimine?
7 minutes
What is the duration of Physostigimine?
30 min to 5 hours
How is Physostigimine metabolized?
plasma esterases
What receptors does Physostigimine act on?
nicotinic and muscarinic receptors
What drug class is Physostigimine in?
antidote/ cholinergic agent
What is the mechanism of action of Physostigimine?
increases amount of acetylcholine at site of NMJ.
What patients would you not give Physostigimine to?
asthma, diabetes, or mechanical obstruction of the intestine or urogenital tract
What is the Brand name of Neostigmine?
Prostigmine
How is Neostigmine typically supplied (concentration)?
1mg/ml
The usual dose of Neostigmine is?
0.03-0.06mg/kg MAX 5mg
What is the time to onset of Neostigmine?
<3 mins
What is the time to peak of Neostigmine?
~7 mins
What is the duration of Neostigmine?
40-60 mins
How is Neostigmine metabolized?
hepatic
What receptors does Neostigmine act on?
acetylcholinesterase in the NMBJ
What drug class is Neostigmine in?
Cholinesterase inhibitor
What is the mechanism of action of Neostigmine?
competitive binds to acetylcholinesterase, allowing the build up of acetylcholine
What patients would you not give Neostigmine to?
A patient with GI or GU obstruction
What is the Brand name of Naloxone?
Narcan
How is Naloxone typically supplied (concentration)?
0.4 mg/ml
The usual dose of Naloxone is?
0.4-2 mg (post-op 1-2mg)
What is the time to onset of Naloxone?
1-2 min
What is the time to peak of Naloxone?
5-15 minutes
What is the duration of Naloxone?
1-2 hours
How is Naloxone metabolized?
Hepatic
What receptors does Naloxone act on?
mu receptor
What drug class is Naloxone in?
opioid antagonists
What is the mechanism of action of Naloxone?
Unknown exactly; believed to antagonizes the opioid effects by competing for the same receptor sites
What patients would you not give Naloxone to?
Caution with ESRD, ESHD, opoid addiction
What is the brand name for Etomidate?
Amidate
How is Etomidate supplied?
2 mg/ml
What is the induction dose for Etomidate?
0.1-0.4 mg/kg
(70 kg patient = 7 - 28 mg)
(100 kg patient = 10 - 40 mg) Typical dose 20-40 mg
What is the Onset of Etomidate?
30 to 60 seconds
What is the Duration of Etomidate?
3 to 10 minutes
How is Etomidate metabolized?
Primary through ester hydrolysis secondary through hepatic
Is Etomidate highly protein bond?
Yes 77% bond to albumin
What receptor does Etomidate effect?
Potentiation of GABA (A) -mediated chloride channels
What effects does Etomidate have on the CNS?
Potent cerebral vasoconstrictor
Decreases CBF & ICP Myoclonus
What effects does Etomidate have on CV?
Minimal changes in BP & HR
(Drop in BP maybe exaggerated by hypovolemia)
What effect does Etomidate have on respiratory?
Minimal depression, but if given rapidly IV may cause apnea.
Exaggerated depression with inhaled anesthetics or opioid
What effect does Etomidate have on endocrine?
Adrenal suppression
Who (patient population) would you choose Etomidate over propofol or barbiturates?
In patients with compromised myocardial contractility
Does infusion of Etomidate hurt?
Yes
Is recovery from Etomidate fast?
Yes 3 - 10 minutes
Does Etomidate produce analgesia?
No, it produces hypnotic effects
What is the half life of Etomidate?
75 minutes
What is the pregnancy category of Etomidate?
Category C
What is the brand name for Ketamine?
Ketalar
How is Ketamine supplied?
10 mg/ml
What is the Induction dose for Ketamine?
0.5 - 2 mg/kg
(70 kg patient 35 -140 mg)
(100 kg patient 50 -200 mg)
Typical dose ????
What is the Onset of Ketamine?
30 seconds
What is the Duration of Ketamine?
5 to 15 minutes
Does Ketamine produce analgesia?
Yes significant analgesia
The cataleptic state aka "dissociative anesthesia" is associated with which anesthetic?
Ketamine
What is the cataleptic state aka "dissociative anesthesia"?
After the admin of Ketamine the patient's eyes remain open with a slow nystagmic gaze.
What is the major psychological issue with Ketamine?
Unpleasant hallucinations
How is Ketamine metabolized?
Hepatic CYP450 system
Is Ketamine bond to protein?
It has a low protein binding (12%)
What receptor does Ketamine work on?
Inhibition of the N-methyl-D-aspartate receptor complex
Is amnesia complete with solo admin of Ketamine?
Amnesia is not complete, however when benzos are coadmin then amnesia is complete
What effects does Ketamine have on CNS?
Cerebral vasodilator, increases CBF & CMRO2 (metabolic rate)
What effects does Ketamine have on CV?
Significant, but transient increase in BP, HR, & CO
What effects does Ketamine have on respiratory?
Minor depression Hypercapnia response preserved
After rapid IV may cause apnea
Increase salivation which is a risk for laryngospasm (especially in peds)
Relaxes bronchial smooth muscles
What is the pregnancy category for Ketamine?
Ketamine is contraindicated in pregnancy, there is no FDA assignment however the manufacture has assigned Category B
What is the Brand name for Methohexital?
Brevital
How is Methohexital supplied?
10 mg/ml
What is the Induction dose for Methohexital?
1 - 1.5 mg/kg
(70kg patient 70 - 105 mg)
(100kg patient 100 - 150 mg)
Typical dose 70 mg
What is the Onset of Methohexital?
45 seconds - 1 minute
What is the Duration of Methohexital?
4 to 7 minutes
How is Methohexital metabolized?
Hepatic metabolism by oxidation
Chronic use of barbiturates does what to liver enzymes?
Induces oxidative mircosomal enzymes
What receptors does Methohexital work on?
GABA (A) and unknown inhibition of excitatory receptors
What effect does Methohexital have on CNS?
Potent cerebral vasoconstrictor
Decreases CBF, ICP, & cerebral blood volume
Decreases CMRO2 Neuroprotection from focal cerebral ishemia
Does Methohexital have analgesic effects?
No, in fact evidence suggest that it lowers the pain threshold and increases pain
Does Methohexital decrease activity on EEG?
No it is an exception among barbiturates.
Which barbiturate activates epileptic foci?
Methohexital
What effects does Methohexital have on CV?
Decrease in BP 2/2 vasodilation
Increase HR
What effects does Methohexital have on respiratory?
Marked depression with decreased TV and RR, apnea
Decreased hypercapnia and hypoxia response
Requires neuromuscular blocking drugs for instrumentation of airway
What Pregnancy category is Methohexital?
Category B
What is the brand name for Propofol?
Diprvan
How is Propofol supplied?
10 mg/ml
What is the induction dose of Propofol?
1.5 - 2.5 mg/kg
(70 kg patient 105 - 175 mg)
(100 kg patient 150 - 250 mg)
Typical dose around 175 - 200 mg
What is the Onset of Propofol?
45 seconds to a minute
What is the Duration of Propofol?
5 to 10 minutes
How is Propofol stored?
In a lipid emulsion.
Can you give Propofol to a patient with an egg allergy?
Yes, Maybe, No, depends because the major component of the lipid emulsion is egg yolk lecithin... clear as mud?
How long should a Propofol bottle be used for after it has been opened and why?
6 hours because of the lipid emulsion can support bacterial growth
How is Propofol metabolized?
Hepatic metabolism, however their maybe up to 30% metabolism in the lungs
Is Propofol highly protein bond?
Yes 97% bond
Describe the context-sensitive half-time of Propofol.
The context-sensitive half-time of Propofol is brief, even after prolonged infusion allowing for rapid recovery
What receptors does Propofol work on?
Potentiation of chloride current mediated channels at the GABA (A) receptor complex
What are the effects of Propofol on CNS?
Hypnotic effect without analgesic effects
Decreased CBF, CMRO2, ICP
Has neuroprotective properties
Anticonvulsant effects
What are the effects of Propofol on CV?
Most pronounced decrease in BP
Vasodilates Arterial and Venous - reduced preload and afterload Inhibits baroreflex (very small increase in HR)
What are the effects of Propofol on Respiratory?
Potent respiratory depressant
Apnea after induction dose
Response to hypoxia and hypercapnia is reduced
Relaxes reflexes for instrumentation of the airway
Decrease wheezing
Would you use Propofol in a patient you are concerned about post-op N/V?
Yes Propofol has antiemetic activity
Does Propofol potentiate neuromuscular blockage drugs?
NO
What should you do if you unexpectedly get tachycardia during Propofol induction?
Evaluate for metabolic acidosis (ABG)
Known as propofol infusion syndrome
Does Propofol hurt on injection?
Yes
Do children require more or less Propofol for induction?
More 2.5 - 3.5 mg/kg