Advanced Pharmacology

Question 1

What is the onset of action for IV/IO administrated drugs

Answer 1

Onset: 30-60s

Question 2

What is the onset of action for ETI administered drugs?

Answer 2

onset: 2-3min

Question 3

Time of onset for IM and SC drug administration?

Answer 3

IM: 10-20Min
SC:15-30min

Question 4

What is the “loading dose” for fentanyl in a patient presenting with severe pain? (IM/IV/IO)

Answer 4

-0.5-1.0mcg/kg to a max single dose of 100mcg. q-5 to a total of 300mcg

Question 5

What is the intranasal dose for fentanyl?

Answer 5

-1.5 to 2.0mcg/kg.

Max single dose 100mcg

Max cumulative dose of 300mcg

Question 6

When should ketamine be considered after fentanyl use?

Answer 6

-pain insufficiently managed after a total of 1-3mg/kg.

• High opioid tolerance?
• Patient request

Question 7

What is the paediatric max single and cumulative dose of fentanyl IN/IV/IO

Answer 7

Max single IN: 100mcg

Max single IV/IO: 50mcg

Max cumulative dose: 200mcg

Question 8

What is the SC dose for morphine?

Answer 8

0.1mg/kg SC or 2.5-5mg SC

May repeat every 10-30 min based on blood pressure >100mmHg

Question 9

Describe the analgesic dose for Ketamine

Answer 9

IV/IO: 0.3mg/kg
-may repeat 1/2 (0.15mg/kg) after 5 min

IM-0.5mg/kg, may repeat 0.3mg/kg after 45 minutes

Question 10

Describe the procedural sedation dose for ketamine

Answer 10

IV/IO: 0.1-0.5mg/kg slow push every 60 seconds to effect.

CONSIDER starting at 0.5mg/kg and use subsequent 0.25mg/kg doses as needed

Question 11

Describe an induction dose of ketamine based on shock index

Answer 11

If SI is <1 use 2mg/kg

If SI is >1 use 1mg/kg

Half of induction dose every 10-15min as required

Question 12

What are the doses for IM and IV/IO midazolam?

Answer 12

IV/IO 2-5mg

IM 5-10mg

MAX 30mg

Question 13

What is the pediatric dose for midazolam?

Answer 13

IN 0.2mg/kg, max of 10mg

IV/IO 0.1mg/kg or max of 5mg

IM: 0.2mg/kg IM

Question 14

Describe phase 0 of action potential

Answer 14

• Depolarization phase

- Rapid influx of Na+ and Ca+

Question 15

what is the resting membrane potential of a cardiac myocyte?

Answer 15

-90mv

Question 16

Describe Phase 1 of action potential

Answer 16

Phase 1 consists of a transient efflux of K+

Question 17

Describe phase 2 of action potential

Answer 17

Phase 2 is the plateau phase, the efflux of K+ is balanced by the influx of Ca+

Question 18

Describe phase 3 of action potential

Answer 18

Phase 3 is the depolarization phase with an Efflux of K+

Question 19

Describe phase 4 of resting membrane potential

Answer 19

Consistent leak of K+

Question 20

Describe class one of Vaughn Williams classification

Answer 20

• Sodium channel blockade
• Reduces phase 0 slope and peak of action potential
• broken up into 1A, 1B, 1C (moderate, weak, strong) Lido is 1B

Question 21

Describe class 2 of VW

Answer 21

• Beta Blockade

- Block sympathetic activity; reducing HR and conduction.

Question 22

Describe class 3 of VW

Answer 22

• Potassium channel blockade (Amio)

- Delays repolarization phase and increases action potential duration and the effective refractory period

Question 23

Describe class 4 of VW

Answer 23

Blocks L-type Ca+ channels, calcium channel blockers are most effect at the SA and AV nodes causing reduced HR and conduction.

Question 24

Describe MOA for Amioderone

Answer 24

Mainly a class 3 agent but has 1,2,4 class properties.

-Amio primarily blocks potassium channels lengthening the refractory period in all cardiac tissues

Question 25

Name three “Inoconstrictors”

Subset 1

Answer 25

Norepinephrine
Epinephrine
Dopamine

Question 26

Name two vasoconstrictors

Answer 26

Phenylephrine
Vasopressin (ADH)
subset 2

Question 27

Name three inodilators

Answer 27

Dobutamine
Milrinone

subset 3

Question 28

Name 3 Vasodilators

Answer 28

Nitroglycerin
Nitroprusside
Nesiritide

Subset 4

Question 29

What are the three stages of anaesthesia

Answer 29

Induction
Maintenance
Emergence