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Barry Top 40
Dosages, receptor sites, MOA, Duration........
| Question | Answer |
|---|---|
| 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 |
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