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•Stimulation of GABA, highly lipid soluble •Indications: TIVA, induction, antiemetic qualities, outpatient surgery, endoscopy •Contraindications: soybean oil, glycerol and egg lecithin Pain on injection, can support bacteria. Decreases HR and B/P Propofol
Induction agent: causes dose dependent respiratory depression. Decrease in CBF and ICP. Protein binding 97-99%. Dosing 1.5-2 mg/kg IV induction; 50-200mcq/kg/min sedation. Onset < 1min; duration < 10min. Hepatic metabolism, urinary excretion Propofol
Noncompetitive NMDA receptor antagonist that blocks glutamate. Stimulates SNS: inhibits the reuptake of NE, dissociative anesthetic. Indications: induction, sedation, CV collapse, sedation for mentally challenged. Ketamine (Ketalar)
Induction agent: Effects: Profound analgesia. Increased HR, BP, CO, PAP, CVP, CI. Minimal respiratory depression, maintains upper airway reflexes, increased oral secretions, bronchodilator. Emergence delirium: low lights, quiet room, versed Ketamine (Ketalar)
Cerebral dilator >> Increased ICP. Phencyclidine derivative (1/10 the potentcy). Norketamine is an active metabolite (1/3 to 1/5 as potent as drug). Ketamine (Ketalar)
iInduction 1-2 mg/kg IV, 4-10mg/kg IM. Sedation analgesia 0.2-0.75 mg/kg IV; 2-4mg/kg IM. Onset IV in 30 seconds. Hepatic metabolism via hydroxylation and N methlyation Ketamine (Ketalar)
•Short acting barbiturate, activates GABA, depresses RAS •Uses: Sedative, hypnotic, anticonvulsant, treatment of ICP,  induction of anesthesia •Effects: •Hypotension •Decrease in CBP and ICP •May increase N/V •Some histamine release Thiopental (Pentathol)
Contraindicated in: Acute Intermettent Porphyria or Variegate Porphyria, Status Asthmaticus. •Avoid extravasation>>necrosis •Induction: 3-5 mg/kg IV in adults, 5-6 mg/kg kids •Onset: 30-60 sec •Duration: 5-30 min •Hepatic metabolism Thiopental
What is the Protein binding of Thiopental 72-86%
•Ultrashort-acting nonbarbiturate hypnotic •Uses: induction, procedural sedation •Effects: •Minimal CV effects, decrease in CMR, CBF, ICP •Respiratory depression •N/V and  pain on injection •Myoclonic movements •Adrenocorticol suppression Etomidate (Amidate)
•Protein Binding:  76% •Dosing: •Induction: 0.2-0.6 mg/kg •Infusion: 5-20 mcg/kg/min •Procedural sedation:  0.1-.02 mg/kg •Pharmacodynamics •Onset: 30-60 seconds •Duration: 3-5 min •Hepatic and plasma esterase metabolism Etomidate (Amidate)
•Highly selective, potent Alpha2 agonist. Inhibitsof NE release •Uses: sedation, awake fiberoptic intubation, postop sedation, pediatrics •Effects: Bradycardia and hypotension •Dose dependent analgesia, anxiolysis and sedation: mild resp depression Dexmedetomidine (Precedex)
•Protein Binding: >90% •Dosing: •ICU: 1 mcg/kg over 10 min >>0.2-0.7 mcg/kg/hr •Procedural sedation:.05- 1 mcg/kg over 10 min: infusion .02-1 mcg/kg/hour •Fiberoptic intubation: 1 mcg/kg: infusion 0.7 mcg/kg/hour Hepatic metabolism, urinary excretion Dexmedetomidine (Precedex)
Which induction agent also has analgesic properties Ketamine (Ketalar)
What type of non- depolarizing NMB are: •Rocuronium (Zemuron) •Vecuronium (Norcuron) •Pancuronium (Pavulon) Aminosteroids
What type of non-depolarizing NMB are: •Atracurium (Tracrium) •Cisatracurium (Nimbex) Benzylisoquinolines
•Binds to 2 alpha subunits of nicotinic cholinergic receptors, allows Na and Ca influx, K efflux, >> depolarization of muscle •Mimics action of AcH •Uses:  rapid muscle relaxation, routine intubation, OB, RSI, Laryngospasm Succinylcholine
•Can cause Hyperkalemia •Triggering Agent for Malignant Hyperthermia •Minimal Histamine release •Decrease HR due to muscarinic stimulation •Increases IOP, Intragastric pressure and ICP Succinylcholine
Weak active metabolite of Succinylcholine Succinylmonochline
NMB: •Dosing: •1-1.5 mg/kg IV for rapid sequence, 2 mg/kg IV in smaller children,  3-4 mg/kg IM, 20 mg IV for laryngospasm •Onset: 30-60 sec IV, 2-5 min IM •Duration: 4-6 min IV, 10-30 min IM Succinylcholine
•Compete with/block  Ach at the nicotinic receptor alpha subunits on motor endplate inhibiting depolarization •Uses:  Muscle Relaxation for surgery, intubation non-depolarizing NMB
Group of non- depolaring NMB that are primarily metabolized in the liver, kidney excretion, minimal histamine release, highly ionized at physiologic pH, small volume of distribution, limited lipid solubility Aminosteroids
•Intermediate action, rare histamine release, no effect of PB or HR, can be used to defasiculate with SUX •Dose: •0.6-1.2 mg/kg (routine-RSI) •5 mg for defasiculating dose w/ SUX •Maint/Repeat dose of 0.1-0.2 mg/kg prn Rocuronium (Zemuron)
•Intermediate NMB, no histamine release, cardiac stable, might precipitate with Thiopental •Dose: •Induction: 0.08-0.1 mg/kg •Pretreatment/priming with 10% of intubation dose given 3-5 min before intubation dose •Maint for surgical relaxation: 0.01 mg Vecuronium (Norcuron)
What is the onset of Vecuronium 2-3 mins
NMB: •Long acting, no histamine release, ^ HR d/t antimuscarinic stimulation, ^ BP. •Dose: •Initial: .06-0.1 mg/kg •Maint: 0.01 mg/kg •Onset: 2-3 min •Duration:  60-100 min •Hepatic metabolism •Urinary excretion Pancuronium (Pavulon)
•Hofmann Elimination, ester hydrolysis, plasma cholinesterase metabolism •Histamine release, some changes to BP and HR Benzylisoquinolines
•Intermediate acting, Hofmann Elimination and nonspecific ester hydrolysis, small histamine release, minimal change in BP •metabolite, Laudanosine, can produce rare seizure activity •Dose: 0.3-0.6 mg/kg •Onset:  2-3 minutes Atracurium (Tracrium
Gastrointestinal prokinetic, enhances response to AcH in upper GI tract to enhance gastric motility and accelerate gastric emptying. Antiemetic action due to D2 antagonist in CTZ (centrally). Can cause sedation, restlessness, and EPS. Reglan (Metoclopramide)
Antiemetic: Contraindicated in Bowel obstruction and Parkinsons. Dose 10-20mg IV. Duration 1-2hours, onset 1-3 minutes. Potential for Neuroleptic Malignant Syndrome Reglan (Metoclopramide)
H2 receptor antagonist, inhibits gastric acide secretion and raises gastric pH. Given in pre-op to decrease risk of aspiration pneumonia, w/ GERD and PUD Pepcid (Famotidine)
Antiemetic. H2 receptor antagonist. Dose 20mg IV. Onset 30min-1hr. DOA up to 10 hours Pepcid (Famotidine)
Selective 5 HT3 receptor antagonist in GI tract and CTZ. Preventative and rescue treatment for N/V used in chemotherapy Zofran (Ondansetron)
Antiemetic. Side effects H/A constipation. Dose 4mg IV. DOA 4-6 hours. Metabolism: extensive hepatic. Careful use in patients with prolonged QT>>>torsades. Zofran (Ondansetron)
Phenothiazine. H1 receptor antagonist (antihistamine). Anticholinergic action (motion sickness), and D2 antagonist in CTZ. Used for N/V and anxiety Phenergan (Promethazine)
Antiemetic. Causes sedation, potentiates sedative effects of benzos and opiods (C-section), hypotension, EPS (Akathisia). Dose 12.5-25mg IV. onset 3-5mins. DOA 4-6 hours. Dilute and give slowly Phenergan (Promethazine)
Corticosteroid, used in combination with other antiemetics. Lowers surgical inflammation and cost. S.E. genital itching/burning and hyperglycemia. Dose 4-10mg. DOA 24hrs Decadron (Dexamethasone)
Blocks Ach in the vestibular apparatus, blocks H1 reptors in the solitary tract. Antihistamine. Uses: N/V, pruritis, antianxiety. S.E. Sedation, pain on injecton. Dose 25mg mixed w/ Ephedrine 25mg IM 20min before end of surgery. Careful in HTN pt's Vistaril (Hydroxyzine)
Which antiemetic is an H2 receptor antagonist Pepcid
Which antiemetics are D2 antagonist in CTZ Phenergan, and Reglan
Which antiemetic is a selective 5 HT3 receptor antagonist Zofran
Which antiemetics are H1 receptor antagonists Vistaril and Phergan
Which antiemetic is both a H1 receptor antagonist and D2 antagonist in the CTZ Phenergan
Uses: induction of labor and control postpartum uterine bleeding, after suction D&C. Indirectly ^ intracelluar Ca, directly stimulates the oxytocin receptor on the myometrium, some antidiuretic and pressor effects. Pitocin (Oxytocin)
OB medication: Contraindicated in fetal distress, unfavorable fetal positions, previous uterine rupture. S.E. flushing, bradycardia/tachycardia, HTN, hypotension. Dose: 10-40 U in 1L of LR (normally 20u/1L). Onset: immediate. DOA: w/in 1hr. Pitocin (Oxytocin)
Semi synthetic ergot alkaloid, increases motor activity of uterus by acting directly on smooth muscle to ^ tone, rate , and amplitude of Cx. Aterial vasoconstriction by alpha stimulation, inhibition of endothelial derived relaxation & factor release Methergine (Methylergonovine)
OB med: contraindicated in severe HTN, PIH, and cardiac disease. Dose: 0.2mg IM Q 2-4hrs (max 5 doses). Onset 2-5min. DOA about 3hrs Methergine (Methylergonovine)
Synthetic analogue of prostoglandin F2 that stimulates uterine Cx, increase of myometrial Ca, stimulates smooth muscle of GI tract to cause diarrhea. ^ in temp r/t effect on hypothalamic thermoregulation (can ^ 2 degrees) Hemabate (Carboprost)
OB medication: Causes airway constriction and wheezing, increasing CO, BP and PVR (constriction of vascular smooth muscle). Dose 250mcq IM repeated every 15-45 mins, max 8 doses. Onset immediate. DOA 2hrs. Hemabate (Carboprost)
Non-narcotic pain medicine, alternative to Toradol o Careful use in patients with hepatic impairment /disease, alcoholism, chronic malnutrition, severe hypovolemia, or severe renal impairment.   Ofirmev (IV Acetaminophen)
Non-narcotic pain medication. o Dose: > 50kg dose is 1000 mg IV over 15 min, repeated every 6 hours or 650 mg every 4 hours (Max 4 grams in 24 hour period); < 50 kg adult is 15 mg/kg every 6 hours.   Ofirmev (IV Acetaminophen)
Non-selective Cox 1 and Cox 2 inhibitor o NSAID, inhibits cyclooxygenase, preventing thromboxane synthesis= inhibits platelet aggregation. o Uses: decrease pain and cramping, OB postpartum C-sections, after cerclages, given procedures, ortho, laparoscop Toradol (Ketorlac)
combined alpha and beta antagonist, rapid onset, few neonatal complications (bradycardia) Labetalol
potent vasodilator, decrease afterload, decrease peripheral resistance (especially when used with volume repletion), decrease maternal BP and uterine vascular resistance to increase uterine blood flow Hyrdalazine
for acute hypertensive crises, potent arteriolar dilator, rapid onset and short duration, maternal/fetal cyanide toxicity is a concern, but at low doses 5-10 mcg/kg/min is unlikely. Nipride
venodilator to decrease cardiac filling pressures by acting on capacitance vessels, may get reflex tachycardia. Nitroglycerin
Mixed acting sympathomimetic; Directly stimulates alpha 1, Beta 1, and some beta-2;  INDIRECTLY stimulates release of NE • Uses:  increase BP/HR, CO and contractility, PONV, bronchodilator effect. • Used in OB: can cause fetal tachycardia and acidosis. Ephedrine
Used for hypotension in Obstetrics • Contraindicated with MAO inhibitors (increases norepi/epi), Pheochromocytoma (tumor of adrenal gland that cause oversecretion of norepi/epi). • Careful in patients with CAD: • Dose: 5-10 mg at at time to increase BP Ephedrine
_____ 25 mg/Vistaril 25 mg IM for antiemetic effect 20 minutes before end of surgery (don’t give before surgery b.c patient will get hypertensive and tachycardic) • Onset: <1 min • Duration: 3-10 min, half-life 3-6 hours Ephedrine
• Directly stimulates alpha-1 receptors, minimal stimulation of alpha-2 or beta-1 at high doses. • Uses: hypotension, decrease in CO in patients with ischemic heart disease.   • Vasopressor of choice in OB Phenylephrine (Neosynephrine)
• Vasopressor of choice in OB • Causes vasoconstriction to increase BP, reflex decrease in HR, increase in coronary blood flow. • Dose: 50-100 mcg titration to effect • If lip bleeds during intubation put it on a 4x4 and put it on cut Phenylephrine (Neosynephrine)
Non-selective beta-1 and beta-2, with selective alpha -1 adrenergic antagonist, primarily considered a Beta- blocker. Blood pressure reduction causes decreased CO and PVR, can depress cardiac contractility, minimally affects CBP or ICP Labetalol (Trandate)
Uses: HTN in pregnant pts, treat ^^ in BP and HR from stimulation • Contraindications: Bronchospastic disease, impaired cardiac conduction or underlying resting bradycardia.   • Dose: 5-20 mg boluses IV; onset: 2-3 mins; duration of action: 2-6 hrs Labetalol (trandate)
Beta-blocker. • Contraindicated: bradycardia, heart block, cardiogenic shock, and heart failure. • Metabolized: esterases in the cytosol of RBC’s (very fast on and off) • NOT TREATMENT FOR HIGH BP, just HR!! Esmolol (Brevibloc)
• Non-selective beta-1 and beta-2 antagonist= decreases BP due to decrease in myocardial contractility, HR, CO therefore decrease in myocardial oxygen demand. • Uses: HTN, angina, acute MI, pheochromocytoma, treat anxiety and panic attacks. Propranolol (Inderal)
 Non-selective beta-1 and beta-2 antagonist= decreases BP due to decrease in myocardial contractility, HR, CO therefore decrease in myopcardial oxygen demand .• Dose: 0.5 mg every 3-5 min, titrated to effect; onset: <2 min; duration: <10 minutes. Propranolol(Inderal)
Selective B1 receptor antagonist • Uses: rapid heart rate and contractility control, CO and therefore decrease BP, tx for MI. • Dose: 1-5 mg IV up to 15 mg Metoprolol (Lopressor)
  • Peripheral vasodilator causing relaxation of arterial smooth muscle; blocks calcium release from sarcoplasmic reticulum; decreases BP with an increase in HR, SV, and CO.   Hydralazine (Apresoline)
Uses: HTN, heart failure, Eclampsia (OB when labetalol does not work or when you cannot control HTN) • Contraindications:  CAD; and people with high ICP • Dose: 2.5-5 mg IV titrated every 20-30 minutes; Onset: 15-30 min; DOA: 4-6 hours.   Hydralazine (Apresoline)
Used with atropine due to the rapid onset.  Inhibits the destruction of Ach by AchE. Enlon Plus is a mixture of edrophonium and atropine together in the same vial. • Dose: 0.25-1 mg/kg mixed with atropine. 0.14 mg/ 1 mg of edrophonium Edrophonium (Enlon)
Used for reversal, myasthenia gravis, pretreatment for soman nerve gas exposure; Quaternary amine. Dose: 0.1-0.25 mg/kg with glycopylorate; 0.05 mg per 1 mg pyridostimine.  Pharmacodynamics: Onset: 2-5 minutes DOA: 2-3 hours. Pyridostigmine (Regonol)
  Used to treat central anticholinergic syndrome. Tertiary Amine: Crosses BBB. Dose: 0.01-0.03 mg/kg IV, Max dose of 2 mg.  Pharmacodynamics: Onset: about 5 minutes Duration: 1-2 hours.   Physostigmine (Antilirium)
Inhibits hydrolysis of Ach by AChE; used with glycopyrolate. Quaternary ammonium compound therefore does not penetrate the blood brain barrier very well.   Neostigmine (PROSTIGMIN)
AcHEI : Dose: 0.04- 0.08 mg/kg (max 5 mg); For every 1 mg of neostigmine mix with 0.2 mg Glyco. ​Pharmacodynamics: • Onset: 1-20 minutes; DOA: 1-2 hours; Hepatic metabolism, urinary excretion. Neostigmine
Used for reversal of zemuron/vecuronium; No side effects; Only approved in Europe.   Selective relaxant binding agent that encapsulates rocuronium or vecuronium preventing its action: can reverse profound NMB.. reversal action in 3 minutes.   Sugammadex
Symptoms include Muscarinic (SLUDGE), nicotinic (muscle cramping, weakness, increase BP/HR), CNS (restless, anxiety, confused, seizures, coma). Treatment: Atropine, benzos (versed/valium), pralidoxime, obidoxime.   Cholinergic Syndrome (Crises)
Competitive AcH antagonist. antimuscarinic, natural alkaloid.  Tertiary comp; Uses: reversal, decrease secretions, brady arrhythmias/ vagal stimulation. Avoid in narrow angle glaucoma.  Dose 0.14 mg/1 mg edrophonium.  Onset: <1 min; Duration: 15-30 min IV Atropine
Overdose of atropine, scopolamine (tertiary amine), phenothiazinesà D1 antagonist Signs: anxiety, disoriented, hyperactive, sedation, seizure, mydriasis. Treat: Physostigmine: crosses the BBB/tertiary amine:   Dose: 15-60 mcq/kg Central Anticholinergic Syndrome
Dose for Scopolamine DOSE: 0.2-0.6 mg IV/IM before surgery
Synthetic antimuscarinic, competitive Ach antagonist. Uses: in combination with neostigmine for reversal, antisialogue, increase HR (not as extreme as atropine). Quaternary ammonium; Dose: 0.2 mg per1 mg Neostigmine; Onset: about 1 minute IV; 15-30 min GLYCOPYROLATE (ROBINUL)  
Created by: Bvaleris