Drugs And Doses

Question 1

Spinal for ortho

Answer 1

3cc of 0.5% isobaric PF bupivacaine with 1:100,000 epi for long acting spinal

2.6cc of 0.5% isobaric PF bupivacaine for shorter acting spinal (same day discharge)

Check level before positioning and sedation

Question 2

Digoxin toxicity

Answer 2

Normal level 0.5-2.0 ng/mL

Above this, can have ST depression, arrhythmias, fatigue, hypersalivation, confusion, N/V, visual changes.

Potentiated by hypokalemia, hypomagnesemia, hypercalcemia.

Question 3

Meds to be cautious with in ESRD

Answer 3

Sevoflurane (theoretical nephrotoxicity)
Morphine (active metabolite renally cleared) - respiratory depression
Meperidine (active metabolite renally cleared) - neurotoxic
Midazolam - infusion can accumulate
Rocuronium, Vecuronium - renal clearance

Question 4

Mannitol dosing and side effects

Answer 4

Up to 2g/kg

Causes rapid fluid shifts (draws water into intravascular compartment) and can worsen heart failure, electrolyte abnormalities (dilutes lytes). In impaired blood-brain barrier, can worsen cerebral edema since it leaks into the brain parenchyma and draws water INTO the brain.

Used in CPB (non-FDA approved indication) to protect renal function by promoting renal blood flow and preventing swelling of renal cells. Also theoretic benefit of free radial scavenging. Neither have been provided.

Question 5

Dantrolene dosing for MH

Answer 5

2.5 mg/kg IV

Repeat q5min until symptoms resolve
May need >10 mg/kg