Dosages, receptor sites, MOA, Duration........
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
shamus22
Popular Pharmacology sets