13 Drugs in the Drawer

Question 1

List all 3 emergency drugs?

Answer 1

1-Epinephrine
-Nonselective agonist for alpha-adrenergic and
beta-adrenergic receptors

2-Phenylephrine
-alpha1 agonist with very little beta effect
-Brings up BR and brings down HR (don’t use for HR < 70)

3-Ephedrine
-Agonist of alpha-1, beta-1 and beta-2-adrenergic
receptors
-Brings up both BR and HR up

Question 2

Epinephrine comes in different concentrations, Identify them?

Answer 2

1 mg/ml 1:1,000 ampule
(dilute before IV administration)

• 1:10,000 for cardiac arrest
  -1:100,000 for bronchospasm

Question 3

Phenylephrine, comes in different concentrations, Identify them?

Answer 3

AKA (Neosynephrine)
-100 mcg/ml (5 ml syringe)
-10 mg/ml vial - dilute in 100 ml NS bag for 100 mcg/ml concentration

Question 4

Indication of phenylephrine?

Answer 4

Reflex bradycardia- don’t give if HR is under 70

Question 5

Ephedrine , comes in different concentrations, Identify them?

Answer 5

• 5mg/ml ( 5 cc syringe)
• 50 mg/ml vial- dilute to 5 mg/ml concentration

Question 6

Indications of Ephedrine?

Answer 6

Tachyphylaxis- cant due infusion due to this

Question 7

Atropine, comes in different concentrations, Identify them?

Answer 7

0.4 mg/ml (1 ml vial)

Question 8

Indications of Atropine?

Answer 8

-Muscarinic agonist
-Tertiary amine
-Very strong reaction - Huge bump in HR
-Crosses the blood brain barrier and placental barrier
-Won’t work in heart transplant - Transplant heart isn’t connected to vagus nerve - De innervated heart
-Doesn’t last very long - Onset of IV atropine typically is rapid and duration of action generally short, ranging from 20–30 minutes

Question 9

List the two common Neuromuscular blocking agents?

Answer 9

1-Succinylcholine

2-Rocuronium

Question 10

What is the concentration of Succinylcholine ?

Answer 10

20mg/ ml (5 cc syringe)
-IV dose 1mg/kg
-IM dose 4 mg/kg

NOTE: K increase 0.5-1 mEq/L, pseudocholinesterase deficiency, MH

Question 11

What is the concentration of Rocuronium?

Answer 11

10 mg/ml (5 or 10 cc vial or syringe)
- 0.45- 0.6 mg/kg intubation
- 0.6- 1.2 mg/kg RSI

-Allergy risk
-The onset of action is dose-dependent from 45—120
seconds, with a duration of action 30—90 minutes

Question 12

Concentration of Sugammadex ?

Answer 12

100 mg/ml (2 ml and 5 ml vials)
16 mg/kg for fast reversal (~3 minutes after administration)
4 mg/kg for TOF = 0-1
2 mg/kg for TOF = 2

Side effects: Interferes with hormonal contraceptive, Bradycardia, Anaphylaxis
rapid onset - bite block before reversal

Question 13

Concentration of Neostigmine ?

Answer 13

Neostigmine
1 mg/ml (5 ml syringe or 10 ml vial)
0.03 – 0.07 mg/kg depending on TOF
(0.05 mg/kg @ NYU)
Not used in kids
Onset of action is within 1 min, peak effect occurs in 10 min and duration of action is 20–30 min
give after fascia is closed

Question 14

Concentration of Anticholinergics/ glycopyrrolate?

Answer 14

Glycopyrrolate (aka robinul)
0.2 mg/ml (1 ml or 5 ml vial)
Pair 0.2 mg with 1 mg neostigmine for reversal
0.1 – 0.2 mg dose for bradycardia, antisialagogue
Pediatric: 0.004 mg/kg not to exceed 0.1 mg in a single dose (2-3 min intervals)

onset of action within 1 minute; 2 to the 4-hour duration of action
vagal blocking effects persist for 2 to 3 hours and the antisialagogue effects persist up to 7 hours

Question 15

Name two PONV drugs?

Answer 15

-Ondansetron (zofran)
-Metoclopramide (aka reglan)

Question 16

what is the concentration of Ondansetron ?

Answer 16

2 mg/ml (2 ml vial)
-4 – 8 mg single dose adult
-0.1 mg/kg pediatric dose
4 mg max

causes QT prolongation; normal QT 350-400ms

Question 17

what is the concentration of Metoclopramide?

Answer 17

5 mg/ml (2 ml vial)
-10 – 20 mg single dose adult
-2.5 – 5 mg 6–14 yrs old
-0.1 mg/kg <6 yr old

-Increases gastric emptying by increasing peristalsis
-dopamine antagonist - Don’t give with Parkinson
-Don’t give with bowel obstruction (SBO)
-Has CNS effects

Question 18

List all three Beta blockers

Answer 18

Esmolol 10 mg/ml (10 ml vial)
Beta1-specific antagonism

Labetalol 5 mg/ml (20 ml vial)
Alpha and beta antagonism

Metoprolol 1 mg/ml (5 ml vial)
Beta1-specific antagonism

Question 19

How does Esmolol work?

Answer 19

By blocking the adrenergic activity of epinephrine and norepinephrine
-It decreases inotropic contractility, heart rate, and conduction.
-onset is 60 - 120 sec and duration of action is
-extremely short, about 10 to 30 minutes

Question 20

How does Labetalol work?

Answer 20

For acute hypertensive events (emergent/urgent), the IV formulation is indicated and an initial dose of a 10- to 20-mg IV push, with repeat boluses administered every 10 minutes until the systolic blood pressure is within the desired range
onset of action within 2 - 5 minutes, peak effects at 5 - 15 minutes, duration of action up 3-6 hours

Question 21

how does Metoprolol work?

Answer 21

onset of action 5 min,, duration 5-8 hr

Question 22

Examples of Vasodilators ?

Answer 22

Hydralazine
20 mg/ml vial
-5 – 20 mg
-Max dose 40 mg

Question 23

How does Hydralazine work?

Answer 23

onset 5–20 minutes; BP-lowering effect lasts 2–6 hours
reduces peripheral vascular resistance (through IP3) and leads to a compensatory baroreceptor-mediated release of epinephrine and norepinephrine, which, as a result, increases venous return and cardiac output. Given hydralazine’s stimulation of the sympathetic nervous system, it consequently leads to tachyphylaxis and tachycardia. It is sometimes given with a beta-blocker or diuretic for better patient tolerance

Question 24

What is the concentration of etomidate?

Answer 24

Etomidate
2 mg/ml (10 ml vial)
-0.3 mg/kg induction GA

Adrenal suppression 6-8 hours - Caution if pt is septic, old, on high dose steroids
side effects: PONV, burns on injection
Great for cardiac patients - Hemodynamically stable

Question 25

Name Opioid reversal?

Answer 25

Naloxone
0.4 mg/ml vial
-Dilute to 0.04 mg/ml
-Titrate in 1 ml to emergence

Onset of action is rapid (1-2 minutes), duration of action 30-60min

Question 26

concentration Corticosteroid- Dexamethasone (aka decadron)?

Answer 26

4 mg/ml (1 ml vial)
-4 – 12 mg adult dose
-0.1 mg/kg for PONV pediatric dose
-0.25- 0.5 mg/kg for edema pediatric dose
-given to pt with croup

side effects:
-Peri-anal itching, Hyperglycemia (Less than 10 will be fine, Avoid in diabetes with super high BG)
-Used in regional blocks so know total dose
-Stick to 4 mg dose, 8 mg if difficult airway and you were messing around
-Takes 45 min to peak effect, long lasting

Question 27

IV NSAIDS- Ketorolac (aka toradol) ?

Answer 27

30 mg/ml (2 ml vial)
-30 mg adult dose (equivalent to 4mg of morphine)
-15 mg dose
≥65 years old
< 50 kg
-0.5 mg/kg pediatric dose
15 mg max dose
-60 mg adult IM dose

-NSAID contraindications: GI Bleeding, pregnant, asthma, kidney issues
-Don’t give with Samter’s triad: Asthma, Aspirin allergy, Nasal polyps
-onset 30 minutes, with maximum analgesia occurring within one to two hours, duration of analgesia is generally 4-6 hours

Question 28

What is Furosemide?

Answer 28

Diuretic
10 mg/ml (2 ml vial)
-10 – 40 mg dose

Edema - 20-40 mg IV/IM once
Acute Pulmonary Edema/Hypertensive Crisis/Increased Intracranial Pressure 0.5-1 mg/kg (or 40 mg) IV over 1-2 minutes; may be increased to 80 mg if there is no adequate response within 1 hour

Hyperkalemia in Advanced Cardiac Life Support (ACLS) 40-80 mg IV

Question 29

What do you know about Lidocaine?

Answer 29

20 mg/ml (5 cc syringe or vial)
-1-1.5 mg/kg dose

4.5 mg/kg with epi
7 mg/kg without epi

Question 30

What do you know about Diphenhydramine?

Answer 30

50 mg/ml syringe
-10 – 50 mg adult dose IV
-1 mg/kg pediatric (>10 kg)

maximum activity occurring in approximately one hour. The duration of activity following an average dose of Diphenhydramine hydrochloride is from four to six hours

Question 31

What is Calcium Gluconate used for ?

Answer 31

Give there is an increase in Mg or pt is hypocalcemia, given in trauma

100 mg/ml (10 ml vial)

-Severe symptomatic hypocalcemia (seizure, laryngospasm, tetany)
1-2 g over 10 mins
-Repeated in 10-60 mins until symptoms resolve

Question 32

Stye Sterile eye lubricant ingredients?

Answer 32

-Active Ingredients: Mineral Oil, White Petrolatum
-Inactive Ingredients: Microcrystalline Wax, Stearic Acid, Wheat Germ Oil

Question 33

what is Lidocaine jelly used for?

Answer 33

5 ml tube
Tube lubrication