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ICU > 2- pharm > Flashcards

2- pharm Flashcards

1
Q

comparing ativan, versed, and xanax for PK

A

Midazolam (Versed) – fast onset, short duration

Lorazepam (Ativan) – slowest onset, longest acting

Diazepam (Valium) – difficult to use for sedation, least commonly used

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2
Q

propofol side effects

A

respiratory and CV depression,
apnea,
hypotension,
↑ triglycerides,

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3
Q

propofol PK

A

rapid onset and short duration

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4
Q

Propofol infusion syndrome

A

rare adverse effect after prolonged infusion, or with catecholamines or steroids

–> cardiac failure, bradycardia, rhabdomyolysis, severe metabolic acidosis, renal failure, and is often fatal

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5
Q

Etomidate used for

A

sedative, anesthetic; used for rapid sequence intubation

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6
Q

advantages/disadvantages of etomidate

A

Advantages – rapid onset (< 60 sec), reliable kinetics, cardiovascularly stable

Disadvantages – inhibits adrenal steroidogenesis by inhibiting 11-B-hydroxylase → ↓ response to ACTH

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7
Q

MOA Dexmedetomidine (Precedex) –

A

alpha2 agonists in locus ceruleus and spinal cord; sedates by upregulating endogenous sleep promoting pathways and analgesia through spinal cord pathways

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8
Q

precedex used for

A

for brief post-op sedation;

ventilator weaning difficulties

alcohol withdrawal to help them be less agitated

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9
Q

advantages/disadvantages to precedex

A

Advantages – no respiratory depression

Disadvantages – bradycardia, vasodilation

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10
Q

how does fentanyl compare to morphine

A

lipid soluble,
100x more potent than morphine,
more rapid onset,
no histamine release

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11
Q

ketamine MOA

A

phencyclidine analog; sedative and dissociative anesthetic

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12
Q

ketamine effects

A

potent bronchodilator;

may cause hypertension, hypertonicity, hallucinations, nightmares;

psychotic effects can be limited by treating with benzos or using lower dose

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13
Q

ketorolac advantages/disadvantages

A

o Advantages – no respiratory depression

o Disadvantages – renal failure, thrombocytopenia, gastritis; ↑ in critically ill

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14
Q

paralytic uses

A

facilitate mechanical ventilation, intubation, preventing ↑ ICP, decreasing metabolic demands, decreasing lactic acidosis in tetanus and NMS

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15
Q

disadvantages to paralytics

A

no analgesia or sedation, prevent neuro exams, ↑ risk of DVTs, pressure ulcer, and nerve compression,

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16
Q

Post-parayltic syndrome –

A

acute myopathy with flaccid paralysis, ↓ DTRs, normal sensation, and ↑ CPKs that persists after paralytic is gone; ↑ risk in combination with high dose steroids

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17
Q

depolarizing vs polarizing agents

A

Depolarizing agents - succinylcholine

Polarizing agents – pancuronium, vecuronium, rocuronium, atracurium

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18
Q

advantages/disadvantages succinylcholine

A

A: Rapid onset, short acting

D: ↑ K, ICP, IOP

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19
Q

advantages/disadvantages Pancuronium

A

A: Inexpensive, long acting

D: Tachycardia

20
Q

advantages/disadvantages Vecuronium

A

A: Less CV effects

D: Bradycardia

21
Q

advantages/disadvantages: Atracurium

A

A: Hoffman elimination

D: Rash, histamine release

22
Q

advantages/disadvantages Rocuronium

A

A: No hemodynamic effects

D: Expensive

23
Q

dose effects of dopamine- medium vs high

A

Medium dose – 5-10 mcg/kg/min; stimulates B > A causing modest positive inotrope and ↓ BP

High dose – 10-20 mcg/kg/min; stimulates A > B causing vasoconstriction

24
Q

disadvantages of dopamine

A

– tachyarrhythmias; may impair mesenteric perfusion more than NE

25
Q

dobutamine MOA

A

strong B1 agonist, mild B2 agonist; dose at 5-15 mcg/kg/min

Effects – ↑ SV → ↑ CO and possibly ↓ SVR

26
Q

uses dobutamine and adverse effects

A

Uses – RHF, LHF, septic shock

ADR – tachyarrhythmias

27
Q

amrinone, milrinone MOA

A

PDE inhibitors

positive inotrope and vasodilator, systemic and pulmonary; little effect on HR

28
Q

uses and adverse effects of amrinone, milrinone

A

Uses – CHF

Disadvantages – arrhythmogenic, thrombocytopenia

29
Q

Norpinephrine (Levophed, leave them dead) MOA

A

potent A and B

Effects – vasoconstriction, but spares brain and heart

30
Q

Uses and adverse effects of NE

A

Uses – septic shock (increases SVR)

Disadvantages – ↓ kidney perfusion (but least of all A agents), reflex vagal bradycardia

31
Q

phenylephrine MOA

A

strong, pure A agent;

Effects – vasoconstriction with minimal ↑ in HR or contractility

32
Q

Uses and adverse effects of phenylephrine

A

switch to this from NE if pt has tachycardia

adverse: reflex bradycardia, does not spare brain or heart, BP at the expense of perfusion

33
Q

epinephrine MOA

A

B and A agonist

Effects – similar to NE, but more mesenteric ischemia, more effects on inflammation and metabolic rate

34
Q

epi uses and adverse effects

A

Uses – anaphylaxis

Disadvantages – arrhythmogeic, coronary ischemia, renal vasoconstriction, ↑ metabolic rate

35
Q

Ephedrine

A

releases tissue stores of epinephrine;

longer lasting but less potent than epinephrine;

used mostly by anesthesiologists

36
Q

vasopressin effect

A

released in response to hypovolemia, ↑ osmolarity, causes vasoconstriction of vascular smooth muscles using V1 receptors

37
Q

vasopressin use

A

septic shock in addition to NE since most patients quickly become physiologically deficient in vasopressin

38
Q

labetalol MOA

A

a1 and non-selective B blocker

↓ SVR and BP without causing tachycardia; does not ↑ ICP

39
Q

labetalol dose for HTn emergencies and dissection

A

20 mg bolus, 2 mg/min infusion

40
Q

nitroglycerine effect low vs high dose

A

o Low doses – < 40 mcg/min; venodilation

o High doses - > 200 mcg/min; arteriolar dilation

41
Q

nitroglycerine PK

A

o Rapid onset, short duration, tolerance

42
Q

nitroglycerine Disadvantages

A

tolerance;

inhibits platelet aggregation

↑ ICP, headache

43
Q

Nitroprusside MOA and PK

A

balanced vasodilator, rapid onset, short elimination time; 0.2-10 mcg/kg/min

44
Q

Nitroprusside uses

A

HTN emergency, severe CHF, aortic dissection

45
Q

nitroprusside disadvantages

A

cyanide poisoning- ↓ CO, lactic acidosis, seizures; accumulates in renal and hepatic dysfunction

↑ ICP

ICU (6 decks)

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