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Barry Top 40

Dosages, receptor sites, MOA, Duration........

QuestionAnswer
What is the Mechanism of Action for propofol? It stimulates GABA (inhibiting neurotransmitter)
What are several indications for propofol?(4) induction, sedation, outpatient anesthesia, antiemetic qualities
What are the contrainications for using propofol? contains soybean oil, glycerol and egg lecithin, should not be given to anyone with egg allergy
What can you give prior to Propofol to help with buring on injection? 2cc lidocaine. Use a Large bore IV.
What is the IV induction dose for propofol? 1.5-2mg/kg IV induction
What is the Onset for propofol? < 1 min.
What is the IV infusion dose of propofol for sedation? 50-200mcq/kg/min infusion for sedation.
What is the duration of propofol? duration: 4-10 minutes
What are the cardiovascular effects of propofol? decrease heart rate and BP due to decrease in SVR and CO
What are the CNS effects of Propofol. decrease in CBF and ICP.
Are there any respiratory effects with propofol? yes, dose dependent respiratory depression
How is propofol metabolized? Hepatic/renal
What is the "other" name for Propofol? Diprivan
What is the mechanism of action for Ketamine? (5 receptors) interacts with NMDA receptors, opiod receptors, monoaminergic receptors, muscarinic and voltage-sensitive calcium receptor
What are the CNS effects of Ketamine? causes direct stimulation of the CNS to inhibit norepinephrine re-uptake into post ganglionic nerve endings to stimulate the SNS; dissociative anesthetic
What are the indications for use of Ketamine? (4) general anesthesia, OB for patchy blocks, CV collapse, sedation for mentally challenged
What is ketamine a derivative of? related potency? phencyclidine derivative(PCP), 1/10th as potent
What does Ketamine need to be accompanied with and why? causes hallucinogenic effects therefore must be given with a Benzo(Versed)
Does Ketamine cause Analgesia? yes, profound analgesia
What is the "other" name for Ketamine? Ketalar
Does Ketamine have profound effects on respiratory rate? No real depression, maintains upper airway reflexes and is a bronchodilator
What are some cases where you can use Ketamine when other anesthetics are not appropriate Cardio vascular collapse, Trauma.
What needs to be considered regarding the metabolism of Ketamine? ketamine is a metabolite that is 1/3-1/5th as potent as Ketamine
What are the Cardiovascular effects of Ketamine? increase in BP, HR, CO, PAP, CVP, CI
Who do you NOT give Ketamine to? Head patients and patients with eye problems.
What is the IV dosing for Ketamine? 1-2mg/kg IV
What is the duration of Ketamine? duration: 10-15 minutes
What is the IM dose of Ketamine? 5-10mg/kg IM
What is the onset time for IV Ketamine? onset: 1-2min IV
What is the Rectal dose for Ketamine? 8mg/kg rectally
What is the onset time for IM ketamine? less than 5 min IM
Describe the metabolism of Ketamine? Hepatic
What is a side effect of ketamine that can be treated and with what? Increased salivation. Can treat with antimuscurinic
What is the "other" name for Thiopental? PENTOTHAL
What is the mechanism of action for TPL? activates GABA, depresses RAS
What drug class is TPL? barbiturate
What are the cardiac effects of TPL? decrease BP and increase in HR
What are the CNS effects of TPL? decrease CBF and ICP
What are the indications for TPL use? induction, especially in OB
What pt. populations is TPL contraindicated in? ACUTE INTERMITTENT PORPHYRIA and STATUS ASTHMATICUS
Is TPL good for Nausea and vomiting? NO, higher incidence of N/V
What happens if a pt with acute intermittent porphyria gets TPL? Episodes of acute intermittent porphyria may be induced by barbiturates because of their effect in increasing aminolevulinic acid synthetase, which is the enzyme that catalyzes the rate-determining step in the porphyrin biosynthetic pathway.
What is Acute intermittent porphyria? metabolic disorder affecting the production of heme, the oxygen-binding prosthetic group of hemoglobin. It is characterized by a deficiency of the enzyme porphobilinogen deaminase.
Why do you not give TPL to asthmatics? It has some histamine release.
What is the dose of TPL? 3-5mg/kg
What is the duration of action for TPL? duration: 15-20 minutes
Describe the metabolism of TPL Hepatic/Renal
What is the onset of TPL? onset: <30 seconds
True or false, TPL is highly protein bound. True
What is the "Other" name for Etomidate? Amidate
What is the Mechanism of action for Etomidate? mimics the inhibitory effects of GABA, depresses RAS
What is a physilogical benefit to Etomidate? It is Cardiac stable. So can be used on volume depleted or Cardiac instable pts.
What are the side effect of Etomidate? (4) nausea/vomiting, adrenocorticol suppression after long term use, and is dissolved in propylene glycol which causes pain on injection, myoclonus.
How can the myoclonic movements caused by Etomidate be attenuated? Use opioids or benzos prior to etomidate.
What are the CNS effects of Etomidate? CMR, CBF, ICP
What is the dose of Etomidate? 0.2-0.3mg/kg IV
What is the onset of Etomidate? onset: 1 min
What is the metabolism of Etomidate? plasma esterase/hepatic mircosomal enzymes cause rapid breakdown to inactive metabolites with renal excretion
What is the duration of Etomidate? duration: 5-15 min
Does Etomidate cause histamine release? No
What is the mechanism of action for Precedex? VERY POTENTENT alpha 2
What is the "other" name for Precedex? Dexmedetomidine
What can precedex be used for? Awake intubations
What are the cardiac effects of precedex? bradycardia and hypotension and decreased SVR
What is a major benefit of precedex? Does not supress respiratory drive
What are the AMINOSTEROID nondepolarizing muscle relaxants? (3) Rocuronium, Vecuronium, Pancuronium
What are the Benzylisoquinoline nondepolarizing muscle relaxants Mivacurium, Atracurium, Cisatracurium
What is the mechanism of action for nondepolarizing muscle relaxants? competes with Acetylcholine(Ach) for binding to nicotinic receptor alpha subunits to cause muscle relaxation, competitive antagonist of Ach
What is the "Other" name for Rocuronium? Zemuron
What is the dose of Rocuronium? What is the RSI dose? 0.6-1 mg/kg IV, 1-2mg/kg RSI
How is Rocuronium metabolized? Hepatic/Renal
Is ROC considered short, long or intermediate acting. Intermediate
What is the duration of action for ROC? duration: 30-45 minute
How can ROC be used with Sux and what is the dose. It is used as a defasiculator. Dose 5 mg.
What is the onset time for ROC? onset: 1-2 min
Does ROC have any cardiac effects? no effect on BP or HR
Does ROC cause histamine release? NO.
What type of Surgeries is VEC frequently used for? Robot
What is the "other" name for Vecuronium. Norcuron
What is the dose of VEC? dose: .08-.2mg/kg IV
Is VEC considered long, short or intermediate acting. Intermediate
What is the duration of VEC? duration: 40-60 minutes
Does VEC have any cardiac effects? yes, no effect on BP, HR, Cardiac stability,
What can VEC not be mixed with and why? TPL, it will precipitate.
What is the "other" name for Pancuronium? Pavulon
What is the dose for Pancuronium? dose: .08-.12mg/kg
Are there any cardiac effects with Pancuronium? modest tachycardia due to antimuscarinic stimulation, increase BP
Is Pancuronium considered long, short or intermediate acting? Long
Does Pancuronium cause histamine release? NO
What is the onset time for Pancuronium? onset: 1-2 min
Who do you NOT give Pancuronium to and why? IHSS,because of increase HR
What is the duration of Pancuronium? duration: 60-90 min
If you are going to give Pancuronium to heart patients what else do you need to give. Fentanyl and Versed
When is the peak of Pancuronium? peak in 2-4min
What is the big thing to remember with BENZYLISOQUINOLINES? HISTAMINE RELEASE
what is the "other" name for MIVACURIUM Mivacron
What is the dose for Mivacurium? dose: .15-.25mg/kg
How is Mivacurium metabolized? short acting, metabolized by plasma cholinesterase(similar to Sux),
Does Mivacurium release histamine? YES!!!(doses are divided to reduce histamine release.
What is the onset time for Mivacurium? onset: 2 minutes
Is Mivacurium long, short or intermediate acting? Short, simmilar to Sux
What is the duration of Mivacurium? duration: 20-30 min
Who do you NOT give Mivacurium to? Asthmatics!!! causes massive histamine release and bronchoconstriction
What are some signs and symptoms of histamine release? tachycardia, hypotension and red flushing.
What is the "other" name for Atracurium? Tracrium
What is the dose of Atracurium? dose: .3-.6mg/kg IV
Is Atracurium short, long or intermediate acting? intermediate acting
Does Atracurium cause histamine release? Only a small amount
What is the onset of Atracurium? onset: 2-3 min;
How is Atracurium metabolized? Hofmann elimination/ester hydrolysis
What is the duration of Atracurium? duration: 35-50 min
What is the metabolite of Atracurium? primary metabolite is Laudanosine, which can produce rare seizure activity
What are the cardiac effects of Atracurium? minimal BP changes or reflex tachycardia
What pt population should you be concerned about regarding Atracurium? Epileptics: Laudanosine(the metabolite),can produce rare seizure activity
Are there any medications that should not be mixed with Atracurium and why? TPL due to precipitate.
What is the "other" name for Cisatracurium Nimbex
What is the dose of Cisatracurium? dose: .15-.2mg/kg IV
Does Cisatracurium cause histamine release? NO HISTAMINE RELEASE
What is the duration of action of Cisatracurium? duration: 40-70 min
Is Cisatracurium long, short or intermediate acting? intermediate acting/longer acting
How is Cisatracurium metabolized? Hofman elimination (that is why no histamine release)
Are there any cardiac effects from Cisatracurium? NO changes in BP/HR
What is the onset time of Cisatracurium? onset: 2-3 min
What surgeries and pt populations is Cisatracurium good for? good for longer cases(renal and heart patients)
How does a depolarizing muscle relaxant work? binds to the alpha subunits of nicotinic cholinergic receptors, resulting in depolarization of the muscle, mimics the action of (AcH), remains depolarized until Sux diffuses away from the receptor
What are teh uses for Sux? Rapid Muscle RelaxationVery short casesOBRapid Sequence IntubationsLaryngospasm, full stomachs, bad airways
What is the adult IV dose for Sux? 1-1.5 mg/kg IV(adults)
What is the duration of Sux? Less than 10 minutes
What is the pediatric dose of Sux? 2-3 mg/kg(children)
Who do you not give Sux to and why? Malignant hyperthermia patients, strokes, burns, bedridden. (MH trigger and the others have upregulation so they get a very high release of K+)
What is the onset time for Sux IV? ONSET: 30-60 seconds IV,
How is Sux metabolized? Plasma cholinesterase,"aka"Psuedocholinesterase &butyrocholinesterase
What is the problem with Low levels of pseudocholinesterase It can prolong the block
What is the other name for Succinylmonocholine Anectine
After SCH diffused away from the NMJ what happens? hydrolyzed in the plasma and liver by plasma cholinesterase
What is the dose of Sux for for laryngospasm? 20mg IV
Does Sux cause histamine release? Minimal
What is the IM dose for SUX? 4-5 mg/kg IM,
What physical sign might you question MH after giving SUX? Masseter muscle rigidity, difficulty opening mouth from incomplete relaxation of the jaws
What is used in conjunction with Sux and why? Pretreat with nondepolarizer( 5mg Rocuronium)
Are there any cardiac effects associated with SUX? Decrease in HR due to muscarinic stimulation
What is the onset for SUX when given IM? 3-5 min IM
What are reversal agents also called? Also called CHOLINESTERASE INHIBITORS, Anticholinesterase or Acetylcholinesterse Inhibitors
What is the mechanism of Action for reversal agents? Indirectly increase the amount of Ach to compete for the receptor sites (nicotinic).
What do you give in conjunction with reversal agents and why? increased levels of Ach also lead to unwanted muscarinic stimulation, therefore an antimuscarinic must be given concurrently to prevent side effects caused by the cholinesterase inhibitor
What is the main goal of Cholinesterase inhibitors? MAXIMIZE NICOTINIC TRANSMISSION AND MINIMIZE MUSCARINIC SIDE EFFECTS
What are some other uses for Cholinesterase inhibitors? myasthenia gravis (diagnosis/treatment)treatment of central anticholinergic syndrome
How do you get Anitcholinergic syndrome? give too much atropine, scoplamine, glyco
What is the biggest problem you will see with Cholinesterase inhibitors? Bradycardia
Other than Bradycardia what else will you see with cholinesterase inhibitors? (2) SLUD, increased bronchial secretions bronchospasm/constriction,
What causes the bradycardia associated with Cholinesterase inhibitors? slow conduction velocity of the cardiac impulse through the AV node
What can excessive doses of cholinesterase inhibitors do? potentiate NMB
How do you minimize the muscarinic effects of cholinesterase inhibitors? give atropine/glycopyrolate
What is the "other" name for Neostigmine? PROSTIMINE
What is the dose of neostigmine? dose: .04-.08 mg/kg(max 5 mg)
What is the MOA for Neostigmine? INHIBITS hydrolysis of Ach by acetylcholinesterase
What is the time of onset for Neostigmine? onset: 5-10 min
What is the biggest side effect seen with Neostigmine? Tachycardia
What is the peak onset for Neostigmine? (peak 10 min)
What is the anticholinergic you give with Neostigmine and what is the dose? mix glycopyrolate .2 mg per 1 mg of Neostigmine in the same syringe**you can give 1 less CC of glyco than neo to prevent tachycardia.
How is neostigmine metabolized? Hepatic
What is the MOST Neostigmine you will give 5mg(5cc)
What is the duration of Neostigmine? duration: 45-60 min
What else can Neostigmine be used to treat? can be used to treat Myasthesnia Gravis
What is the "other" name for EDROPHONIUM? TENSILON,ENLON
What is the dosage for Edrophonium? dose: .5-1 mg/kg IV
What is the MOA for Edrophonium? decreases Acetylcholinesterase at sites of cholinergic transmission
What anticholinergic do you use with Edrophonium give dosage and why? with atropine .01 mg/kg; use with atropine due to rapid onset, used to reverse short acting NMB
What is Enlon plus? mixture of edrophonium and atropine together in the same vial
What is the onset time for Edrophonium? onset: 1-2 min;
What is the duration of Endrophonium? 5-20 minutes
What is the "other" name for PYRIDOSTIGMINE? REGONOL
What is Pyridostigmine normally used for? Myasthenia Gravis**It is rarely used for NMB reversal
What is the dose of Pyridostigmine? dose: 10-20 mg
What do you give with Pyridostigmine and what is the dose? atropine .6-1.2 mg IV
What is the MOA for Pyridostigmine? Inhibits the breakdown of acetylcholine by acetylcholinesterase
What is the "other" name for PHYSOSTIGMINE? ANTILIRIUM
What is Physostigmine normally used for? used to treat CENTRAL ANTICHOLINERGIC SYNDROME (Atropine toxicity)~crosses BBB*rarely used for NMB reversal
What is the dose of physostigmine? dose: .01-.03 mg/kg IV
Who do you use caution in with Physostigmine? exacerbates parkinsonian sym.(easliy crosses the blood brain barrier)
What is the onset time for Physostigmine? onset: 3-5 min;
What is the duration of Physostigmine? duration; 30min-5hrs
% of the post junctional receptors that can still be occupied with TOF 4/4? 70%
Which are more resistant to block the facial muscles (orbicularis oculi) or the ulnar nerve (adductor pollicis muscle) facial muscles (orbicularis oculi)
FACTORS THAT CAN DELAY OR INHIBIT ANTAGONISM OF BLOCKADE(6) hypothermiaprofound blockrespiratory acidosiscertain antibioticshypokalemia & hypomagnesium
What does an anticholinergic drug do? competitive acetylcholine antagonist at central and peripheral muscarinic receptors
What are anticholinergics used for? reversal, decrease secretions, brady arrhythmias
What is the dose of Atropine, and in combo with what drug? dose: .01 mg/kg in combo with edrophonium;
How is atropine metabolized? Hepatic/Renal
What is the onset time for atropine? onset: less than 1 min;
Who is atropine contraindicated in? contraindicated in narrow-angle glaucoma, decreases intestinal motility, mydriasis ~because it crosses the BBB
What is the duration of atropine? 2-4 hours
What is the "other" name for GLYCOPYRROLATE Robinul
What is the dose of glycopyrrolate and what is is used with? dose: 0.2 mg per 1 mg Neostigmine;
Does Glycopyrrolate cross the BBB? NO, therefore,it is unlikely to cause CNS toxicity.
What is the onset time for Glycopyrrolate? onset: 1-2 min
What is the MOA for glycopyrrolate? competitive acetylcholine antagonist at peripheral muscarinic receptors, synthetic antimuscarinic
What is the duration of glycopyrrolate? duration: 3-7 min
What are some clinical uses for Glycopyrrolate? used in combo with neostigmine for reversal, decrease secretions, increase heart rate (vagal stimulation, peritoneal traction)~
Are patients ever given Glycopyrrolate in preop? yes, so you must consider this if your pt is tachy in the OR. Did they get glyco and that is why the rate is increased...?
What is the "other" name for SCOPOLAMINE? Scopace, Transderm-Scop, Maldemar
What is the dose for Scopolamine? dose: 0.2-0.6 mg IM/IV before surgery; (can also be in patch form)
What is the MOA of Scopolamine? competitive antagonist of acetylcholine at muscarinic receptors, antagonizes histamine and serotonin(the last 2 help with N/V)
What are some uses for scopolamine?(4) decreases secretions, antiemetic, motion sickness/vertigoOften given in trauma to cause anmesia.
What does scopolamine do to pupils? Dilates them.(Mydriasis)
What is the MOA of Ephedrine? DIRECT stimulation of alpha-1, beta-1 and some beta-2INDIRECT endogenous release of norepinephrine adrenergic agonist, sympathomimetic amine
What happens if you stimulate Beta1 You get an increase in HR and BP
How does Ephedrine come prepared? How much do you give at a time? 10cc of 5 mg per cc. You give a 1-2 cc at a time.
What are the cardiac effects of Ephedrine? increase BP, HR, CO and contractility
Does Ephedrine have an effect on uterine blood flow? Very LITTLE effect therefore making it the pressor of choice in OB.
What are some other uses of Ephedrine? (2) antiemetic effect, bronchodilator
Who is Ephedrine contraindicated in? (4) contraindicated in MAO inhibitors, IHSS, pheochromocytoma, closed angle glaucoma
What patients to you use CAUTION in with Ephedrine? careful use in CAD
What can occur with Ephedrine that you might notice with repeated dosing? tachyphylaxis
How would you make your "own" Ephedrine if it was not prepackaged? mix 1 vial (50 mg) in 9 cc of NS to make a 5 mg/cc concentration,
What is the onset of Ephedrine? onset: almost immediate;
How is Ephedrine Metabolized? metabolized in the liver with renal excretion
What is the Duration of Ephedrine? duration: 3-10 min
Why would you not want to give Ephedrine/Vistaril at the beginning of the case? Because it can mask other "issues" it makes the pt. hypertensive and tacycardic.
What is Ephedrine/Vistaril combo used for and what is the dosage? Used for N/V 25mg Ephedrine and 25mg vistaril mixed given IM in the deltoid 20 min before the end of sx.
What is the "other" name for PHENYLEPHRINE? NEOSYNEPHRINE
What is the MOA of Phenylephrine? directly stimulates the alpha-1 receptors, minimal stimulation of beta-1 and alpha-2 at high doses
What is the dose of Phenylephrine? Dose: 50-100 mcg titration,
What effects do you see with Phenylephrine? vasoconstriction, increase BP, reflex decrease in HR, increase coronary blood flow
How would you make your"own" Phenylephrine if it wasn't prepackaged? mix .1 cc(10 mg/cc vial) in 10 cc NS***USE a TB syringe to draw it up then put into the NS****
What are some indications for using Phenylephrine? treat hypotension, decrease CO in patients with ischemic heart disease, treat symptoms in tetralogy Fallot
How do you decide to give your pt. Phenylephrine or Ephedrine? You look at the heart rate.Brady= EphedrineTachy- Phenylephrine
Is ephedrine ever used in the while putting in spinals? A lot of people give 2cc of ephedrine right when spinal goes in to keep pt normotensivebecause as block advances, HR will go down
What is the "Other" name for HYDRALAZINE? APRESOLINE
What is the dose of Hydralazine? dose:2.5-5 mg boluses every 15 min
What is the MOA for Hydralazine direct vasodilation of vascular smooth muscle, decrease precapillary arteriolar resistance, VASODILATOR
What is the MAX dose of Hydralazine? (max 20-40 mg)
What are the effects of Hydralazine? decrease SVR by relaxing arterioles, decrease PVR and BP, increase HR and CO,
What is the duration of action for hydralazine? duration: 2-6 hours
How is Hydralazine eliminated? Hepatic/renal elimination
What does Hydralazine do to uterine blood flow? It increases it.
What is the time of onset for hydralazine? 10-15 min;
When is Hydralazine used in PIH to decrease blood pressure? after using labetalol.
What can patients who use hydralazine long term(>6months) develope? Lupus like symptoms
Can Hydralazine be used with MH patients? Yes!
Do you want to have a "heavy" hand when pushing hydralazine? No, Give and wait then give more because it adds up and it lasts forever.
What is the "Other" name for ESMOLOL? BREVIBLOC
What is the MOA of Esmolol? Beta-1 selective antagonist, decrease the force and rate of contraction(Will afftect HR not really BP because it is Beta1 selective)
What is the dose of Esmolol? Dose: 10 mg boluses, for a (0.5-1 mg/kg bolus) then infusion if needed.
What is the infusion dose for Esmolol? 10-300 mcg/kg/min infusion to get a hypotensive technique
What are the indications for giving Esmolol?(4) treatment of perioperative tachycardia, HTN, acute MI; good for decreasing HR during intubation/extubation
What is the duration of Esmolol? Very short duration: duration; 30 min
Who is Esmolol contraindicated in? (3) contraindicated in brady, heart block, cardiogenic shock and heart failure
What is the onset of Esmolol? RAPID
What effects do you see from Esmolol? decrease HR, CO and some decrease in BP, no rebound effects,
How is Esmolol metabolized? metabolized rapidly by esterases in the cytosol of RBC, rapid redistribution, urinary excretion
What is the "Other" name for PROPRANOLOL INDERAL
What is the dose of Propranolol? dose: 0.5 mg every 3-5 min
What is the MOA of Propranolol? Beta-1 and Beta-2 antagonist
What is the onset of Propranolol? onset: < 2 min; duration
What is Propranolol indicated for?(5) HTN, angina, IHSS, pheochromocytoma, acute MI
What effects do you see as a result of Propranolol?(8) decrease BP due to decrease in myocardial contractility, HR, CO therefore a decrease in myocardial oxygen demand; bronchospasm, AV block and bradycardia, withdrawal syndrome.
What is the duration of action of propranolol? duration: < 10 min
What will you see if the pt has withdrawal syndrome of Propranolol? (3) withdrawal syndrome (can get upregulation of Beta receptors, increase in BP, HR and chest pain
What is the MAX dose of Propranolol? max .15 mg/kg;
How is Propranolol metabolized? Hepatic/renal
What is the "other" name for Labetalol? TRANDATE
What is the dose for Labetalol? 5-10 mg titrated boluses IV
What is the MOA for Labetalol? nonselective Beta-1 and Beta-2 with alpha-1 antagonist, primarily considered a BETA BLOCKER
What is the MAX Dose for Labetalol? to max of 300 mg
What is Labetalol indicated for?(2) acute and chronic HTN in pregnant patients, treat increases in BP and HR from stimulation (intubation)
What is the onset for Labetalol? onset: 1-2 min (FASTER ONSET THAN HYDRALAZINE)
What effects will you see with Labetalol?(5) BP reduction causes decreased CO and PVR, reduces plasma renin activity, no rebound HTN,
What is the duration of Labetalol? duration: 2-3 hours
What illness associated with pregnancy is Labetalol often used for? PIH
What dose might you give to cardiac pts or difficult intubations to attenuate stimulation effects of intubation? 5 mg IV
What is the "other" name for Reglan? METOCLOPRAMIDE
What is the dose of Reglan? dose: 10-20 mg IV in preop
What is the MOA of Reglan? gastrointestinal prokinetic, benzamide, D2 dopamine antagonist in CTZ (centrally), blocks dopamine in the GI tract (peripherally)
Why do we give reglan? Mostly for gastric emptying but it does have an antiemetic effect.
What mechanism gives reglan an antiemetic effect? antiemetic effect: blocks dopamine receptors and also blocks serotonin receptors in the CTZ of the CNS (in higher doses)
What is the onset of Reglan? onset: 1-3 min;
2 ways Reglan enhances gastric motility. enhances the response to Ach of tissue in upper GI tract causing enhanced motility and accelerated gastric emptyingincrease in lower esophageal sphincter tone, speeds gastric
Who is reglan contraindicated in? (4) contraindicated in bowel obstructions, parkinsons, elderly, epilepsy, pheochromocytoma
What is the duration of Reglan? 1-2 hours
What are some problems seen with Reglan?(4) causes sedation, restlessness and extrapyramidal symptoms from dopamine antagonism, hypotension
When do we give Reglan and WHY? usually given in preop for aspiration prophalaxis (GERD or Diabetic), antiemetic effect (blocks dopamine receptors)
What is the "Other" name for Pepcid? FAMOTIDINE
What is the dose for Pepcid? dose: 20 mg IV;
What is the MOA of Pepcid? H2 receptor antagonist, competitive inhibition of histamine at H2 receptors of the gastric parietal cells, which inhibits gastric acid secretion and raises gastric pH
What is the onset of Pepcid? 1-2 hours, effects gastric acid produced after the pepcid is given
What does pepcid cause? decrease stomach acid volume, increase pH
What is the duration of Pepcid? 10-12 hours
What is the metabolism of Pepcid? Renal
What are the indications for using pepcid? given in preop to decrease risk of aspiration pneumonia, Pts with GERD, Peptic Ulcer Disease
Problems associated with Pepcid? can cause dizziness and headaches
What is the 'Other' name for Zofran? ONDANSETRON
What is the dose of Zofran? dose: 4 mg IV in preop, intraop or postop;
What is the MOA of Zofran? selective 5-HT3 receptor antagonist, blocks the N/V specific 5-HT3 serotonin receptors in the CTZ
What is the onset of Zofran? onset: 30 min
What is Zofran indicated for? preventive and rescue treatment for N/V, used in chemo
What is the duration of Zofran? duration: 4-6 hours
What are some problems seen with Zofran?(3) can cause headaches, constipation, increase in liver enzymes
Does Zofran cause sedation, respiratory depression or EPS? No, Has NO effect on dopaminergic, cholinergic or histaminergic receptors.
What is the "other" name for Anzemet? DOLASETRON
What is the dose for Anzemet? dose: 12.5 mg preop or intraop
What is the MOA of Anzemet? 5-HT3 receptor antagonist, blocks the N/V specific receptors in the CTZ
What is the duration of Anzemet? duration: 4-6 hours
What is the indication for using ANZEMET? used to pretreat for N/V
What are some problems associated with using Anzemet? (2) headaches are possible, can cause prolonged QT interval and should be used carefully in patients on antiarrhythmics or prolonged QT (due to a breakdown product of Anzemet)
What is the onset of Anzemet? onset: 20-30 min
What is the "Other" name for Phenergan? PROMETHAZINE
What is the dose of phenergan? dose: 12.5-25 mg IV
What must be done to phenergan before administration? should be diluted in at least 10 cc of LR and given in top port slowly
What is the duration of Phenergan? duration: 4-6 hours
What is Phenergan indicated for?(2) indicated for N/V, usually used as a rescue drug or for anxiety
What is the onset time of Phenergan? onset: 3-5 min
What are some problems associated with Phenergan?(4) causes sedation, will increase the sedative effects of benzos and opiods (Csections), hypotension, extrapyramidal symptoms such as AKATHISIA (restlessness)
What is the "Other" name for Decadron? DEXAMETHASONE
What is the dose of Decadron? dose: 4-8 mg IV on induction
What is the MOA of Decadron? (4) corticosteroid, mode of action in regards to N/V enhance the effects of other antiemetics, inhibition of prostaglandin synthesis, release endorphins, positive psycho. effects, antiinflammatory
What is the duration of Decadron? duration about 24 hours
What population must you use caution when giving decadron? Diabetics
What are some adverse effects seen with Decadron?(5) genital itching (hot feeling), hyperglycemia, adrenal suppression, lightheadedness, increase in liver enzymes
What is the "other" name for Vistaril? HYDROXYZINE
What is the dose of the Vistaril/ephedrine combo? dose: 25 mg mixed with ephedrine 25 mg IM 20 minutes before end of surgery
What pts should you be cautious when using the vistaril combo? Careful using this mixture in Hypertensives
What are the indication for vistaril?(3) indicated for N/V, pruritus, antianxiety
What is the "Other" name for pitocin? OXYTOCIN
What is the dose of pitocin? dose: 20mg in 1000cc LR;
What is the MOA of Pitocin? binds to the oxy receptor in muscle lining of uterus causing increase in intracellular Ca+ activating myosin lightchain kinasesel. stimulates the smooth muscle of the uterus enhancing sodium permeability to myofibrils membranes
What is the onset of Pitocin? onset: immediate
What must you do when preparing the pitocin. Mix the bag well!
What does "double" PIT mean. Double pitocin is either 20mg in 500cc or 40mg in 1000cc LR
What is the duration of Pitocin? duration: 20 min-1 hour
How is pitocin metabolized? rapid hepatic/renal excretion, plasma by oxytocinase
What are some effects seen with Pitocin? will see decrease in BP due to relaxation of vascular smooth muscle, increase heart rate, flushing
Why do we give Pitocin? selectively stimulates the smooth muscle of the uterus by enhancing sodium permeability to the myofibrils membranes. Causes uterus to contract.
Why would you want to stimulate the uterus to contract? Give in labor to stimulate contractionIn sx to stimulate contraction and decrease blood lossSuction d/c because she has been preg. You want to stimulate the uterus to contract.
Again, what Mechanism of pitocin stimulates the uterus to contract? INCREASES INTRACELLULAR CALCIUM AND ACTIVATES MYOSIN LIGHT CHAIN KINASE
Theoretically, at what point do your pitocin receptors become active? 14-16 weeks really become active. Some MD’s use pit at 6 some used at 14…..depends.
Why would you double pitocin and can you keep doubling it? if pt has been on pitocin for a long time, multiple c-sections, multigravita, placenta previa) More is not better once doubled you are DONE!
What is the "Other" name for METHERGINE? METHYLERGONOVINE
What is the dose of Methergine? dose: 0.2 mg IM every 2-4 hours
What is the MOA of Methergine? semisynthetic ergot alkaloid that increases motor activity in the uterus, acts directly on smooth muscle of the uterus to increase tone, rate, and amplitude of contraction
What is the duration of Methergine? duration: 3 hours
What do we use methergine for? produces arterial vasocontriction by stimulation of alpha adrenergic and serotonin receptor, inhibition of endothelial derived relaxation factor release (used in bleeding)
What is the onset of Methergine? onset: 2-5 min
Who is Methergine contraindicated in?(3) careful in PIH, HTN and cardiac disease****If the pt is hypertensive, they do NOT get methergine.
What are some adverse effects of Methergine?(5) causes hypertension, severe HTN can cause stroke, seizures; coronary artery vasospasm (myocardial infarction reported)
What is the max dose of Methergine? Max 2 mg)
Where is the ONLY place you give Methergine? .2mg IM ONLY GIVEN IM in deltoid!
What is the "other" name for Hemabate? CARBOPROST
What is the dose for Hemabate? dose: 250 mcg IM, may repeat every 15-90 minutes
What is the MOA for Hemabate? PGF2 alpha(smooth muscle contraction and vasoconstriction), 15-methyl prostaglandin Fa2
What is the duration of action for Hemabate? duration: 2 hours
What is the ONLY way you give hemabate? IM!!!!!
Why do we give Hemabate? For Uterine atony and abortions . stimulates uterine contraction by increasing myometrial calcium, stimulates smooth muscle of GI tract to cause vomiting and diarrhea
What is the onset time for Hemabate? Immediate
Who is Hemabate contraindicated in? Be very careful in Asthma, HTN and Diabetics (stimulates the production of steroids)
What is the MAX dose of Hemabate? max 8 doses
What are some adverse effects associated with Hemabate? increase in body temperature,can increase temp 2 degrees,airway constriction and wheezing, increase in inflammation and vasoconstriction, increase CO, PVR and BPMakes them POOP,POOP,POOP!
Should Hemabate be given to hypertensive patients? yes, IF PT IS HYPERTENSIVE AND YOU NEED SOMETHING YOU GIVE HEMABATE.
What is the "other" name for MISOPROSTOL? Cytotec
What is the dose for Misoprostol? dose: 1-2 tablets buccal (200 mcg each)
What is the MOA of Misoprostol? synthetic prostaglandin E1group PG1
Can you give Misoprostol to Asthmatics? yes, SAFELY USED IN ASTHMA BECAUSE IT IS A PG1
What is the duration of Misoprostol? duration: half life= 20-40 min
Other than buccal, how can Misoprostol be given? Rectally or vaginally
Who do you NOT give Misoprostol to? bucally on INTUBATED pts.
What is the onset of Misoprostol Rapid, once absorbed. It can take a while for it to dissolve.
How is Misoprostol metabolized? hepatic metabolism
How many doses do you give of Misoprostol? Usually give 2 doses then move on to hemabate or Methergine.
What is the abbreviation for MAGNESIUM SULFATE? MgSO4
Does Anesthesia order Magnesium sulfate? NO, but it will affect our anesthesia.
What is the indication for giving Misoprostol? Indicated for uterine atony, abortions, cervical ripening, peptic ulcer disease
What is the "bolus" dose and infusion rate for Magnesium Sulfate? dose: 4 grams over 20 min, 2-3 grams/hour infusion;
Why do we give Magnesium Sulfate? treatment of choice to prevent eclampsia, control and prevent seizures, tocolytic therapyAlso used for preterm labor and shut off before C-section.
What is the duration of Magnesium Sulfate? duration: 20-30 min with good renal perfusion
What are some effects associated with Magnesium sulfate administration? POTENTIATES nondepolarizers and depolarizers, competes with calcium and causes a decrease in amount of Ach released at myoneural junctioncan cause pulmonary edema
What do you need to monitor when giving Magnesium Sulfate? must monitor magnesium levels,
What is the treatment for Magnesium toxicity? Calcium gluconate 1 gram over 2 min, fluids, diuresis
What is a normal Magnesium level? 1.5-2 mg/dl
Does Magnesium cross the placenta? If so, what effect will it have on the baby? Yes, the baby will come out floppy with too much magnesium.
What is a theraputic magnesium level for treatment with magnesium sulfate? 4-8 mg/dl
What do you do if your patient becomes "floopy"? Stop the magnesium drip and get a Mag. level.
What type of EKG changes will you see with a Mg level between 5-10 mg/dl? ECG changes, prolonged PR, widened QRS
What Mg level will you see a decrease in deep tendon reflexes? 10 mg/dl
At what Mg levels will you see respiratory and cardiac arrest? 15mg/dl(respiratory arrest)25mg/dl (cardiac arrest)
When is Nipride used in O.B.? for acute hypertensive crisis,
What is the dosing of Nipride? 5-10 mcg/kg/min its (low doses decrease the risk of maternal/fetal cyanide toxicity
The onset for Nipride is? Rapid
Is the duration of Nipride long or short? Short
What does your pateint need with a Nipride infusion? An A-line
What is the MOA of Nitroglycerine? venodilator to decrease cardiac filling pressures by acting on capacitance vessels,
What might be seen with Nitroglycerine infusion? may get reflex tachycardia
What is VOLUME REPLETION and what is is used for? for severe pre-eclampsia, intravascular repletion can improve the low CO, when right and left cardiac filling pressures normalize, CI improves, maternal HR and SVR decrease, improves fetal perfusion, urine output and tissue perfusion
What is the "other" name for Toradol? KETOROLAC
What is the dose of Toradol? dose: 30 mg IV or IM every 6 hours
What is the MOA of Toradol? anti-inflammatory, non-steroidal drug that inhibits synthesis of prostaglandins and may be considered a peripherally acting analgesic, inhibits platelet aggregation and prolongs bleeding times
What is the duration of Toradol? duration; 6 hours
Why do we give Toradol? INDICATIONS: decrease pain and cramping, OB postpartum CSections, after cerclages, given in preop 30 min before Essures, given in GYN/OB all the time
What is the Onset of Toradol? onset: <10 min
Who do you NOT give Toradol to? careful with elderly, bleeding issues, renal impairment, ASA or NSAID allergy, asthma
What are some adverse effects seen with Toradol? Not much, minimal CNS effects, no respiratory depression, sedation or N/V
Created by: shamus22 on 2010-05-21



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