Base Drug List Basics Flashcards
Pre Program Drug List Need to Know
Propofol
Induction Agent
Diprivan
Diisopropylphenol: binding to GABAa receptors to increase GABA affinity for GABAa receptors
10 mg/ml
1.5-2.5 mg/kg
IV
Onset: 15-30 secs
DOA: 2-8 mins
MAC: Bolus 10-30 mg or Infusion 25-75 mcg/kg/min
TIVA
75-150 mcg/kg/min
Decrease dose for older age, hypovolemia/vasodilation, mycocardial dysfunction
May need more in you healthy patients or those with cross tolerance
M+M
Maintenance Infusion: 50-200 mcg/kg/min
Sedation Infusion: 25-100 mcg/kg/min
Etomidate
Induction Agent
Amidate
Carboxylated imidazole: depresses Reticular Activating System and mimics inhibitory effects of GABA
2 mg/ml
0.1-0.4 mg/kg
IV
Onset: 5-15 secs
DOA: 3-8 mins
Ketamine
Induction Agent
Ketalar
Phencyclidine: Inhibit NMDA channels, dissociative from thalamus
5-100 mg/ml
1-2.5 mg/kg
IV
Onset: 15-30 seconds up to 1 minute
DOA: 10-20 mins (elimination time 2-3 hours)
MAC
0.25-0.5 mg/kg
TIVA
SAME AS FOR MAC, DECREASE PROPOFOL IF USING
M+M
Maintenance: 10-20 mcg/kg/min
Analgesia or Sedation: 2.5-15 mcg/kg/min
IM
Onset: 3-5 mins
DOA: 12-30 mins
Induction: 3-5 mg/kg
Midazolam
Sedative
Versed
Benzodiazepine: Bind to GABAa sites increases chloride ion channel opening
1, 5 mg/ml
1-2 mg
0.025-0.06 mg/kg (NEALSIVMAN)
IV
Onset: 1-3 mins, Peak at 5 mins
DOA: 30-60 mins, Elimination half-time = 1-4 hours
MAC (concerns)
Issues with use as sole agent- patient still likely to move, prolonged amnesia
Issues with mixing- synergistically potentiates effects of other sedatives and opioids
IM
Onset: 15 mins
DOA: less than 2 hrs
Premedication: 0.07-0.15 mg/kg
M+M
Induction: 0.1-0.4 mg/kg
Sedation: 0.01-0.1 mg/kg
Oral
Onset: 20 mins
DOA: 1-6 hrs
0.25-1 mg/kg
Peds: 0.5 mg/kg
Intranasal
0.2-0.3 mg/kg
Buccal
0.07 mg/kg
Sublingual
0.1 mg/kg
Lorazepam
Sedative
Ativan
Benzodiazepine: Bind to GABAa sites increases chloride ion channel opening
2, 4 mg/ml
0.05 mg/kg
IV
Onset: 1-3 mins
IM
Onset: 15-30 mins
Oral
Onset: 20-30 mins
DOA: 6-8 hrs
Premedication: 0.05 mg/kg
Precedex
Sedative
Dexmedetomidine
Alpha-2-agonist: decrease in sympathetic activity, analgesia from release of norepinephrine at spinal cord
200 mcg/2 ml
0.2-1 mcg/kg
IV
Onset: less than 5 mins
DOA: 60-120 mins
MAC
Potential for a Loading Dose: 0.5-1 mcg/kg over 10 minutes
0.2-1.2 mcg/kg/HOUR
TIVA
SAME AS FOR MAC, DECREASE PROPOFOL IF USING
M+M
Induction: 1 mcg/kg over 5-10 mins
Maintenance: 0.2-1.4 mcg/kg/h
Nasal
Induction: 1-2 mcg/kg
Peds
Nasal (Premed): 1-2 mcg/kg
Oral (Premed): 2.5-4 mcg/kg
Diazepam
Sedative
Valium
Benzodiazepine: Bind to GABAa sites increases chloride ion channel opening
5 mg/ml
0.05-0.2 mg/kg
IV
Onset: 1-3 mins
DOA: 1-3 hrs
Sedation: 0.04-0.2 mg/kg
Oral
Onset: 15-60 mins
DOA: 12+ hrs
Premedication: 0.2-0.5 mg/kg
Fentanyl
Pain Medication
Sublimaze
Opioid: Bind to Mu, Kappa, and delta receptors resulting in pain receptors not working
50 mcg/ml
25-50 mcg
IV
Onset: 1-3 mins
DOA: 30-60 mins
Intraoperative: 2-50 mcg/kg
Postoperative: 0.5-1.5 mcg/kg
MAC and TIVA
Generally Boluses
Morphine
Pain Medication
Morphine
Opioid: Bind to Mu, Kappa, and delta receptors resulting in pain receptors not working
10 mg/ml
2.5-5 mg
IV
Onset: 5-10 mins
DOA: 2 hrs
TIVA
20-30 mins or longer before emergence if significant post-pain is expected
M+M
Postoperative: 0.03-0.15 mg/kg
IM
Onset: 10-30 mins
DOA: 2 hrs
Postopertative: 0.05-0.2 mg/kg
Sufentanil
Pain Medication
Sufenta
Opioid: Bind to Mu, Kappa, and delta receptors resulting in pain receptors not working
50 mcg/ml
0.05-0.2 mcg/kg
IV
Onset: 1-3 mins
DOA: 30 mins
TIVA
0.2-1 mcg/kg/hr
Longer TIVA procedures or significant pain potential
M+M
Intraoperative: 0.25-20 mcg/kg
Infusion: 0.1-1 mcg/kg/hr
Remifentanil
Pain Medication
Ultiva
Opioid: Bind to Mu, Kappa, and delta receptors resulting in pain receptors not working
2 mg/ml
0.25 mcg/kg
IV
Onset: 60-90 seconds
DOA: ultrashort, context sensitive halftime ~3 mins
MAC
Boluses of 1 mcg/kg over 30-90 seconds (before LA infiltration)
Infusions 0.05-0.1 mcg/kg/min (5 min before LA infiltration)
Cut in Half dosage if using Versed as well
TIVA
Induction: 0.5-1 mcg/kg for induction
Maintenance: 0.1-0.25 mcg/kg/min
M+M
Loading: 0.05-2 mcg/kg/min
Intraoperative: 1 mcg/kg
Maintenance/Postop/Sedation: 0.05-0.3 mcg/kg/min
Meperidine
Pain Medication
Demerol
Opioid: Bind to Mu, Kappa, and delta receptors resulting in pain receptors not working
25, 50 mg/ml
12.5-25 mg
Onset: 3-6 mins
DOA: 2-3 hrs
Hydromorphone
Pain Medication
Dilaudid
Opioid: Bind to Mu, Kappa, and delta receptors resulting in pain receptors not working
1,2 mg/ml
0.25-0.5 mg
IV
Onset: 5 mins
DOA: 5 hours
TIVA
20-30 mins or longer before emergence if significant post-pain is expected
M+M
Postoperative: 0.01-0.02 mg/kg
IM
Onset: 5-20 mins
DOA: 2-3 hrs
Postoperative: 0.02-0.04 mg/kg
Naloxone
Pain Medication/Reversal
Narcan
Opioid Antagonist: antagonist at u receptors
0.4 mg/ml
1-4 mcg/kg
IV
Onset: ~60 seconds
DOA: 30-45 mins
1-4 mcg/kg (40 mcg every 60 secs)
Ondansetron
Antiemitc
Zofran
5-HT3 antagonist: 5-HT3 receptor mediates vomiting and is found in the GI tract and the brain area postrema
2 mg/ml
4 mg
Onset: 5-10 minutes, 30 minutes peak effect
Inapsine
Antiemitic
Droperidol
Butyrophenones: Dopamine antagonist, blocks dopamine receptors that contribute to the development of PONV
2.5 mg/ml
15 mcg/kg
Metoclopramide
Antiemetic
Reglan
Cholinomimetic: facilitates acetylcholine transmission at selective muscarinic receptors and centrally as a dopamine receptor antagonist
10 mg/ml
10 mg
Promethazine
Antiemetic
Phenergan
Phenothiazine: anticholinergic agent and antihistamine
25 mg/ml
6.25-25 mg
Succinylcholine
Muscle Relaxant
Anectine/Quelicin
Depolarizing MR: will bind to the NMJR and they mimic ACH causing the receptor to depolarize but these agents do not allow the NMJR to repolarize until the agent eventually falls off
20 mg/ml
1-2 mg/kg
IV
Onset: 30 secs
DOA: 5-10 mins
Rocuronium
Muscle Relaxant
Zemuron
Non-depolarizing MR: bind to the NMJR and the prevent the depolarization of that receptor by endogenous ACH
10 mg/ml
0.6-1.2 mg/kg
IV
Onset: 60-90 secs
DOA: 30-90 mins
Intubation: 0.45-0.9 mg/kg
Infusion: 5-12 mcg/kg/min
IM
Infant: 1 mg/kg
Child: 2 mg/kg
Vecuronium
Muscle Relaxant
Norcuron
Non-depolarizing MR: bind to the NMJR and prevent the depolarization of that receptor by endogenous ACH
1 mg/ml
0.08-0.12 mg/kg
IV
Onset: 3-5 mins
DOA: 30-60 mins
Intubation: 0.08-.12 mg/kg
Infusion: 1-2 mcg/kg/min
Pancuronium
Muscle Relaxant
Pavulon
Non-depolarizing MR: bind to the NMJR and the prevent the depolarization of that receptor by endogenous ACH
1, 2 mg/ml
0.1-0.2 mg/kg
IV
Onset: 2-3 mins
DOA: 60-120 mins
Intubation: 0.08-0.12 mg/kg
Cisatracurium
Muscle Relaxant
Nimbex
Non-depolarizing MR: bind to the NMJR and the prevent the depolarization of that receptor by endogenous ACH
2 mg/ml
0.08-0.12 mg/kg
IV:
Onset: 3-5 mins
DOA: 20-40 mins
Intubation: 0.1-0.15 mg/kg
Infusion: 1-2 mcg/kg/min
Edrophonium
Reversal Agent
Enlon
Cholinesterase inhibitor: prevent the breakdown of acetylcholine by blocking the enzyme called cholinesterase, allows for the action potential threshold to be reached so a new impulse can be triggered in the next neuron
10 mg/ml
0.5-1 mg/kg
IV
Onset: 1-2 min
DOA: less than 10 mins
Anti-cholinergic to avoid bradycardia
Glycopyrrolate: 0.007 mg per 1 mg of edrophonium
Atropine: 0.014 mg per 1 mg of edrophonium (recommended)
