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664 Cards in this Set
- Front
- Back
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What is the MAC of Halothane?
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0.75
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What is the Blood/Gas Coefficient of Halothane?
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2.4
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What is the Vapor Pressure in mmHG of Halothane?
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244
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How much is Halothane metabolized?
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20%
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What is the Fat/Blood Coefficient of Halothane?
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51
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What is the Boiling Point of Halothane?
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50.2 degrees C
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What is the chemical formula for Halothane?
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C2ClBrF3H
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What is the chemical structure of Halothane?
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F Br
F - C - C - H F Cl |
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What is the IUPAC name for Halothane?
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2-Bromo-2-Chloro-1,1,1Triflorethane
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Which inhalation agent contains thimol as a preservative?
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Halothane
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Does Halothane have high or low airway irritability?
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Low airway irritability
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Does Halothane have a rapid onset of induction?
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It can related to low MAC and high fraction inhaled. Basically you can dial Halothane concentration to 3-5 times* MAC
* I think |
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Is Halothane used more in adults or children?
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Used in children most often
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What inhalation agent potentates cardiac dysrhythmias?
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Halothane
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What inhalation agent does NOT decrease SVR but rather depresses myocardial contractility, decreaseing cardiac output?
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Halothane
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Halothane increases sensitivity to catecholamines (like epi)? True or False.
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True
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Is Halothane a poor bronchodilator or an excellent bronchodilator?
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Halothane is an excellent bronchodilator
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Is Halothane toxic and if so what organ?
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Halothane is hepatotoxic
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Is Halothane pungent?
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No Halothane is non-pungent
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What is the MAC of Isoflurane?
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1.15
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What is the Blood/Gas coefficient for Isoflurane?
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1.4
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What is the Blood/Fat coefficient for Isoflurane?
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45
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What is the vapor pressure in mmHG of Isoflurane?
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239
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How much is Isoflurane metabolized?
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0.2%
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What is the boiling point for Isoflurane?
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48.5 degrees C
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What inhalation agent might cause coronary steal syndrome?
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Isoflurane
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What is coronary steal syndrome?
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Phenomenon caused when there is narrowing of the coronary arteries and an arteriolar vasodilator is used - "stealing" blood away from those parts of the heart. This happens as a result of the narrowed coronary arteries being always maximally dilated to compensate for the decreased upstream blood supply. Dilating the other arterioles causes blood to be shunted away from the coronary vessels.
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How does Isoflurane effect the cardiovascular system?
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Isoflurane decreases SVR and MAP, increases HR and may slightly decrease CO
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What happens when Isoflurane is degraded in dry absorbent?
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It produces carbon monoxide (CO)
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What is the recovery time for Halothane?
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It has a slow recovery time
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What is the recovery time for Isoflurane?
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It has a moderate recovery time
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Does Isoflurane have a pungent odor?
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Yes
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Why do you avoid Isoflurane in CAD patients?
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Because of coronary steal syndrome
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For economical reasons which gas would you choose: Sevoflurane, Isoflurane, Desflurane?
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Isoflurane
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Is Isoflurane a respiratory irritant?
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Yes very irritating, second only to Desflurane.
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What happens at 2 MAC in the brain with Isoflurane?
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2 MAC = silent EEG
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Enflurane causes what neurologically?
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Seizures
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What is the chemical formula for Isoflurane?
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C3H2F5ClO
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What is the chemical structure of Isoflurane?
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F Cl F
F - C - C - O - C - H F H F |
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What is the chemical structure of Enflurane?
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Cl F F
H - C - C - O - C - H F F F |
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What is the chemical formula for Enflurane?
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C3H2F5ClO
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Enflurane and Isoflurane are what kind of isomer?
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Structural isomers
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What is the MAC of Desflurane?
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6
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What is the Blood/Gas Coefficient of Desflurane?
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0.42
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What is the Fat/Blood Coefficient of Desflurane?
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27
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What is the Vapor Pressure in mmHG for Desflurane
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669
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How much of Desflurane is metabolized ?
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0.02%
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What happens to Desflurane when it goes through dry absorbent?
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It is degraded and forms carbon monoxide (CO)
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Does Desflurane have a slow wash in slow wash out?
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No, Desflurane has a fast wash in fast wash out
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Is Desflurane an airway irritant?
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Yes it is the greatest irritant, but irritant can be minimized at concentrates below 6% (Eger)
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At what temperature does Desflurane boil?
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22.8 degrees C aka room temperature
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What anesthetic agent is in a special vaporizer?
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Desflurane
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Why does Desflurane have a rapid onset?
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Rapid onset is due to low blood/gas solubility
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Does Desflurane have a rapid or slow recovery?
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Rapid
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With what anesthetic gas might your patient have a seizure?
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With Enflurane when you have a low PaCO2
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Does Desflurane have a high potency or a low potency?
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low potency
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What are the special concerns Desflurane in peds patients?
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DELERIUM
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What are the cardiovascular effects of Desflurane?
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Increase HR, decrease SVR, decrease MAP, CO is unchanged, minimal coronary vasodilation.
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Does Desflurane stimulate or depress respiration?
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marked depression
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Neurologically what happens at 2 MAC of Desflurane?
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2 MAC of Desflurane = silent EEG
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What is the chemical formula for Desflurane?
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C3H2F6O
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What is the chemical structure of Desflurane?
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F F F
F - C - C - O - C - H F H F |
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What is the IUPAC name for Desflurane?
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2-(difluoromethoxy)-1,1,1,2-tetrafluoroethane
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What is the MAC of Sevoflurane?
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2.1
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What is the chemical formula of Sevoflurane?
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C4H3F7O
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What is the chemical structure of Sevoflurane?
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F
F - C - F F H - C ----- O - C - H F - C - F H F |
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What is the IUPAC name for Sevoflurane?
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1,1,1,3,3,3-hexafluoro-2-(fluoromethoxy)propane
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What is the Blood/Gas coefficient for Sevoflurane?
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about 0.70
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What is the Fat/Blood coefficient for Sevoflurane?
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48
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What is the Vapor Pressure in mmHg of Sevoflurane?
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170 mmHg
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How much is Sevoflurane metabolized?
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2-5%
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What is the boiling point of Sevoflurane?
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58.6 degrees C
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What is the major concern with Sevoflurane and absorbers?
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Compound A with low flows
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What is the flow rule for Sevoflurane?
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At least 1 L/min up to 2 MAC hours then increase flow to at least 2 L/min
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What is a MAC hour?
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The number of MAC multiplied by the time in hours. I.e 2 MAC for 1 hr is equal to 2 MAC hours
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What organ does Compound A effect?
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It's nephrotoxic
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Is Sevoflurane pungent?
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No it is not pungent
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What happens when you give Sevoflurane at >1.5 MAC
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Increase in HR
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Sevoflurane is good at reversing bronchospasms, True or False?
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True
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Does Sevoflurane have a low or high airway irritability?
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A low airway irritability
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Describe the onset of Sevoflurane.
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It has a rapid onset related to it's low blood/gas solubility and can be given in excess of 3-4 MAC
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Is the recovery from Sevoflurane fast or slow?
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It has a rapid recovery with shorter cases but a more pronounced delay in recovery with long cases. (Do to its higher Fat/blood coefficient)
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Does Sevoflurane have a high potency or a low potency?
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Low potency
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What is a major concern with Sevoflurane and peds patients?
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DELIRIUM
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Is Sevoflurane expensive?
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Yes
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What are the cardiovascular effects of Sevoflurane?
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Decreases SVR, decrease MAP, increase HR (at greater than 1.5 MAC) may prolong QT interval
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What is the MAC of Nitrous Oxide?
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104%
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What is the blood/gas coefficient of Nitrous Oxide?
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0.46
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What is the Fat/Blood coefficient of Nitrous Oxide?
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2.3
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What is the Vapor Pressure of Nitrous Oxide?
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39,000
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How much is Nitrous Oxide metabolized?
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0.04%-Trace
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What is the boiling point of Nitrous Oxide?
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-88.5 degrees C
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What is the chemical formula for Nitrous Oxide?
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N2O
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What is the structure of Nitrous Oxide?
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Trick question because it exists in 2 isomers N=N=O or N (triple bond) N - O
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Is Nitrous Oxide more soluble than Nitrogen?
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Yes by more than 35 times
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Which inhalation agent does not cause MH?
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Nitrous Oxide
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Which Inhalation agent has teratgenic effects?
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Nitrous Oxide
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Describe the induction of Nitrous Oxide.
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Rapid onset related to low blood/gas solubility and concentration effect (second gas effect)
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What is the second gas effect?
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Because Nitrous Oxide is so soluble it quickly leave the alveoli decreasing the volume of the alveoli thereby increasing the concentration of the anesthetic gas
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Does Nitrous Oxide have a rapid or slow recovery?
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Rapid recovery
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Which inhalation agent is inorganic?
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Nitrous Oxide
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Which inhalation agent has a higher risk for hypoxia?
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Nitrous Oxide
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What is the potency of Nitrous Oxide?
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Low potency
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Why would you not use Nitrous Oxide on a laparoscopic surgery?
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Because Nitrous Oxide will readily move into the abd and increase intra-abdominal pressure
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Nitrous Oxide requires large concentrations to have anesthesia effects True or False
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True
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What are the cardiovascular effects of Nitrous Oxide?
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Increase in CO, CVP, and PVR. No changes in HR or SVR
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What is diffusion hypoxia?
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An abrupt transient decrease in alveolar oxygen tension when room air is inhaled at the conclusion of a nitrous oxide anesthesia
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Does Nitrous Oxide depress hypoxic drive?
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Yes
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How does Nitrous Oxide effect ICP?
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There is a minor increase in ICP due to increase cerebral blood volume
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All Volatile Anesthetics do: Pulmonary
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All increase respiration rate and PCO2
All decrease Tidal Volume, & CO2 response, All decrease hypoxic response All broncholdilate, but impair HPV @ > 1 MAC |
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What is HPV?
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Hypoxic pulmonary vasoconstriction
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All Volatile Anesthetics do: Cerebral
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All cerebral vasodilate, (order Hal>Enf>Des>Iso>Sevo)
All increase cerebral blood flow (dose dependent) All decrease amplitude SSEP All increase latency of SSEP |
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What is SSEP?
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Somatic sensory evoked potential
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Do all Volatile Anesthetics have skeletal muscle relaxing effects?
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All Volatile Anesthetics do relax muscles, however not all inhalation agents relax muscles, i.e. N2O
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What effect does Volatile Anesthetics have on NDNMB drugs?
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Potentiation effect
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What are the four "reservoirs of the body"?
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Vessel Rich Group
Muscle Group Fat Group Vessel Poor Group |
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What is the CO of the Vessel Rich Group?
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75%
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What is the Body Mass of the Vessel Rich Group?
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10%
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What is the Body Mass of the Muscle Group?
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50%
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What is the CO to the Muscle Group?
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19%
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What is the CO to the Fat Group?
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6%
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What is the Body Mass of the Fat Group?
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20% (that's being nice)
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What is the Body Mass of the Vessel Poor Group?
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20%
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What is the CO of the Vessel Poor Group?
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<1%
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What is MAC?
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minimum alveolar concentration of a vapor in the lungs that is needed to prevent movement (motor response) in 50% of subjects in response to surgical (pain) stimulus.
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What is MAC Amnesia?
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minimum alveolar concentration of a vapor in the lungs that is needed to prevent memory in 50% of patients
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What is MAC Awake?
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minimum alveolar concentration of a vapor in the lungs that is needed to for 50% of patients to follow simple commands
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What is MAC BAR?
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minimum alveolar concentration of a vapor in the lungs that is needed to Block Autonomic Response in 50% of patients
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What is MAC Intubation?
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minimum alveolar concentration of a vapor in the lungs that is needed to intubate a patient without autonomic response in 50% of patients
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What is the value of MAC Amnesia?
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0.25-0.30 MAC
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What is the value of MAC Awake?
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0.33-0.5 MAC
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What is the value of MAC BAR?
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1.3 MAC
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What is the value of MAC Intubation?
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1.5 MAC
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All Volatile Anesthetics: Renal
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Decrease renal blood flow, GFR, UO. ADH and Renin remain unchanged.
If the concentration of [F] >50mmol/L = Nephrotoxic *I also found that des and sevo do not decrease renal blood flow |
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All Volatile Anesthetics: OB
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All cross the placenta, all are vasodilators of the uterine and all relax the uterus
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What is the target organ of Anesthetic gases?
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The spine and to a less extent the brain (Eger)
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What is the Brand name of Atropine?
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Atro-Pen
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How is Atropine typically supplied (concentration)?
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0.4 mg/ml OR 1 mg/ml
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The usual dose of Atropine is?
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0.01 - 0.02 mg/kg OR 0.5-1 mg
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What is the time to onset of Atropine?
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1 minute
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What is the time to peak of Atropine?
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2 minutes
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What is the duration of Atropine?
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1-4 hrs
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How is Atropine metabolized?
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50-75% liver
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What receptors does Atropine act on?
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Muscarinic blocker
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What drug class is Atropine in?
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Anticholinergic
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What is the mechanism of action of Atropine?
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competitively blocks binding of acetylcholine and prevents receptor activation
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What patients would you not give Atropine to?
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caution in narrow angle glaucoma, prostatic hypertrophy, bladder neck onstruction
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Does Atropine cross the blood brain barrier?
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Yes, it is a tertiary ammonium
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What is the Brand name of Scopalomine?
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Hyoscine
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How is Scopalomine typically supplied (concentration)?
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0.3mg/ml, 0.4mg/ml, 1mg/ml
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The usual dose of Scopalomine is?
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0.3-0.6mg IV
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What is the time to onset of Scopalomine?
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10 minutes
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What is the time to peak of Scopalomine?
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50-80 minutes
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What is the duration of Scopalomine?
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2 hours
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How is Scopalomine metabolized?
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hepatic metabolism, renal elimination
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What receptors does Scopalomine act on?
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muscarinic
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What drug class is Scopalomine in?
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anticholinergic, antiemetic
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What is the mechanism of action of Scopalomine?
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peripheral and central cholinergic (muscarinic) antagonist, antisialagogue, histamine and serotonin antagonist
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What patients would you not give Scopalomine to?
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obstetrics- crosses placenta- tertiary amine
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What patients might you give Scopolamine to?
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Unstable trauma patients that are too sick for GA
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What is the Brand name of Glycopyrrolate?
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Robinul
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How is Glycopyrrolate typically supplied (concentration)?
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0.2 mg/ml for injection
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The usual dose of Glycopyrrolate is?
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Premedication 0.1-0.2mg / Reversal 0.2mg per 1mg Neostigmine (1ml/1ml)
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What is the time to onset of Glycopyrrolate?
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<1 min
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What is the time to peak of Glycopyrrolate?
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5 minutes
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What is the duration of Glycopyrrolate?
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2-3 hours
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How is Glycopyrrolate metabolized?
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hepatic
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What receptors does Glycopyrrolate act on?
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muscarinic cholinergic receptors
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What drug class is Glycopyrrolate in?
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anticholinergic
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What is the mechanism of action of Glycopyrrolate?
|
reversibly blocks muscarinic cholinergic receptors causing increase HR decreased secreations
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What patients would you not give Glycopyrrolate to?
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Tachycardia, narrow angle glaucoma, prostate hypertrophy, bladder neck obstruction
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What is the Brand name of Esmolol?
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Brevibloc
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How is Esmolol typically supplied (concentration)?
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10mg/ml
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The usual dose of Esmolol is?
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0.2-0.5mg/kg
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What is the time to onset of Esmolol?
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1-2 mins
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What is the time to peak of Esmolol?
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5 minutes
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What is the duration of Esmolol?
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10-20 mins
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How is Esmolol metabolized?
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In the plasma by Ester hydrolysis
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What receptors does Esmolol act on?
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Beta 1 adrenergic receptor
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What drug class is Esmolol in?
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Beta blocker
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What is the mechanism of action of Esmolol?
|
Cardio selective beta 1 antagonist
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What patients would you not give Esmolol to?
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Bradycardia, 2nd or 3rd degree AV block
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What is the Brand name of Hydralazine?
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Apresoline
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How is Hydralazine typically supplied (concentration)?
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20mg/ml
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The usual dose of Hydralazine is?
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2.5-40mg (0.1-0.2 mg/kg)
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What is the time to onset of Hydralazine?
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IV 5- 20 Mins
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What is the time to peak of Hydralazine?
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IV 10-80mins
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What is the duration of Hydralazine?
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2-4 hours ( so be cautious with dosing)
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How is Hydralazine metabolized?
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Hepatic
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What receptors does Hydralazine act on?
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unknown ( Nagelhout)
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What drug class is Hydralazine in?
|
Peripheral Vasodilator
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What is the mechanism of action of Hydralazine?
|
Direct relaxant effect on arteriolar smooth muscle (interference with Ca Ion transport)
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What patients would you not give Hydralazine to?
|
Tachycardiac pt's 2t reflexive tachycardia,
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What is the Brand name of Labetalol?
|
Trandate; Normodyne
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How is Labetalol typically supplied (concentration)?
|
5 mg/mL (comes in 20 mg Carpuject, 100 mg and 200 mg multi-dose vials)
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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
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What is the time to onset of Labetalol?
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2-5 min
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What is the time to peak of Labetalol?
|
5-15 min
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What is the duration of Labetalol?
|
2-4 hours
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How is Labetalol metabolized?
|
Hepatic
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What receptors does Labetalol act on?
|
selective alpha-1 and non-selective beta-1 and 2 antagonist
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What drug class is Labetalol in?
|
Beta-blocker (mixed alpha/beta adrenergic antagonist)
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What is the mechanism of action of Labetalol?
|
Selectively antagonizes alpha-1 adrenergic receptors. Antagonizes beta-1 and 2 receptors
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What patients would you not give Labetalol to?
|
Asthma, CHF, any degree of heart block, bradycardia, cardiogenic shock
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What are some clinical uses for Labetalol?
|
Pregnancy induced hypertension, hypertensive crisis, and controlled hypotension during anesthesia
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What is the Brand name of Droperidol?
|
Inapsine
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How is Droperidol typically supplied (concentration)?
|
2.5mg/mL
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|
The usual dose of Droperidol is?
|
PONV: 0.625-2.5 mg
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What is the time to onset of Droperidol?
|
1-2 min
|
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What is the time to peak of Droperidol?
|
30 min
|
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What is the duration of Droperidol?
|
2-4 hrs
|
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How is Droperidol metabolized?
|
Hepatic, renal
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What receptors does Droperidol act on?
|
Primarily dopamine receptors in CNS
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What drug class is Droperidol in?
|
antiemetic, neuroleptic
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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
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What patients would you not give Droperidol to?
|
DON'T give to: parkinson's pts; also potentiates other CNS depressants
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What is the Brand name of Ranitidine?
|
Zantac
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How is Ranitidine typically supplied (concentration)?
|
25 mg/mL
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|
The usual dose of Ranitidine is?
|
50mg IV (dilute in 20mL)
|
|
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What is the time to onset of Ranitidine?
|
<15 min
|
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|
What is the time to peak of Ranitidine?
|
1-2 hrs
|
|
|
What is the duration of Ranitidine?
|
6-8 hrs
|
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How is Ranitidine metabolized?
|
Hepatic; 70% renal unchnged
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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 |
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Would you use Propofol in a patient you are concerned about post-op N/V?
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Yes Propofol has antiemetic activity
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Does Propofol potentiate neuromuscular blockage drugs?
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NO
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What should you do if you unexpectedly get tachycardia during Propofol induction?
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Evaluate for metabolic acidosis (ABG)
Known as propofol infusion syndrome |
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Does Propofol hurt on injection?
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Yes
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Do children require more or less Propofol for induction?
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More 2.5 - 3.5 mg/kg
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