Box 3 Meds

Question 1

Labetalol (Normodyne, Trandate) Class

Answer 1

Non-selective beta adrenergic blocker (w/ some alpha 1-blocking properties)

Question 2

Labetalol (Normodyne, Trandate) MOA

Answer 2

Competitive beta receptor antagonist & prevent actions of catecholamine and other beta agonists

Question 3

Labetalol (Normodyne, Trandate) Dosage

Answer 3

IV: 0.1-0.5 mg/kg (20-80 mg bolus q 10)

Question 4

Labetalol (Normodyne, Trandate) characteristics

Answer 4

O: 5 min or less

P: 5-15 min

D: 2-6 hrs

Question 5

Labetalol (Normodyne, Trandate) E/M

Answer 5

M: conjugation w/ glucuronic acid (hepatic)

E: renal

H/t: 5-8 hrs

Question 6

Labetalol (Normodyne, Trandate) considerations

Answer 6

Provides b blockade in a 7:1 ratio IV but 3:1 PO

Elimination prolonged in liver dz but unchanged in renal

Contra: bronchospasm, 1 degree HB, cardio genic shock, obs. airway dz, severe bradycardia

Question 7

Metoprolol (Lopressor, Troprol XL) Class

Answer 7

Selective B1-adrenergic antagonist (cardioselective)

Question 8

Metoprolol (Lopressor, Toprol XL) MOA

Answer 8

Prevents inotropic & chronotropic response to B-adrenergic stimulation.

Question 9

Metoprolol (Lopressor, Toprol XL) Dosage

Answer 9

IV: 1-15 mg

PO: 50-400mg

Question 10

Metoprolol (Lopressor, Toprol XL) characteristics

Answer 10

O: 1-5 min

P: 20 min

D: 5-7 hrs

Question 11

Metoprolol (Lopressor, Toprol XL) E/M

Answer 11

Undergoes first pass hepatic met. so only 40% reaches circulation

h/t: IV 3-7 hrs
PO tartrate: 2-3 hrs
PO succinate: 5-7 hrs

Question 12

Metoprolol (Lopressor, Toprol XL) considerations

Answer 12

Caution w/ high doses in ch obstructive airway and hypoglycemic

Contra: AV HB, acute cardiac failure caused by tachycardia, hypovolemic pts w/ compensatory tachycardia (can cause resistant hypotension)

Question 13

Neostigmine (Prostigmin) class

Answer 13

Anticholinesterase inhibitor

Question 14

Neostigmine (Prostigmin) MOA

Answer 14

Inhibits AChE so that ACh accumulates at NMJ & competes w/ nondepolarizing NMB for unoccupied nicotinic ACh receptors

Question 15

Neostigmine (Prostigmin) dosage

Answer 15

Most common 40-70 mcg/kg

MAX: 5mg

Question 16

Neostigmine (Prostigmin) E/M

Answer 16

Renal excretion 50%

Question 17

Neostigmine (Prostigmin) considerations

Answer 17

MUST have at least 1 twitch first.

To minimize muscarinic CV effects, an anticholinergic (glycopyrrolate 7-15mcg/kg) should be coadministered

Caution in brady, bronchial asthma, epilepsy, arrhythmia, peptic ulcer, peritonitis, mechanical obs of intestines

Question 18

Robinul (Glycopyrrolate) class

Answer 18

Systemic cholinergic antagonist

Question 19

Robinul (glycopyrrolate) MOA

Answer 19

Blocks effects of ACh at parasympathetic sites.

Reduces rate of salivation by preventing stimulation of ACh receptors

Question 20

Robinul (glycopyrrolate) Dosage

Answer 20

IV: 7-15 mcg/kg

Question 21

Robinul (glycopyrrolate) characteristics

Answer 21

O: IV 2 min; IM/subq 15-30 min

P: 30-45 min

D: 2-4 hrs

Question 22

Robinul (glycopyrrolate) E/M

Answer 22

Feces (15%), urine (85%)

Question 23

Robinul (glycopyrrolate) considerations

Answer 23

Unlikely to pass BBB, GIT, or placenta d/t ionization (insoluble in lipids)

Mod increase in HR (

Question 24

Robinul (glycopyrrolate) supply

Answer 24

0.2mg/ml or 0.4mg/ml

Question 25

Zofran (ondansetron) class

Answer 25

Antiemetic (5-HT3 serotonin receptor antagonist)

Question 26

Zofran (Ondansetron) MOA

Answer 26

Serotonin is released in sm. Intestine stimulating vagal affronts through 5-HT3 receptors initiating vomiting. 5-HT3 antagonist block these receptors preventing N/V Do not treat N caused by vestibular stimulation

Question 27

Zofran (Ondansetron) dosage

Answer 27

IV 4-8 mg over 2-5 min before ind & after procedure Peds: PO 0.15 mg/kg; IV 0.05-0.15mg/kg (max 4mg)

Question 28

Zofran (Ondansetron) characteristics

Answer 28

O: 30-60 min P: 1-1.5 hrs D: 4-6 hrs

Question 29

Zofran (Ondansetron) E/M

Answer 29

M: CYP 450 E: renal H/t: 3-4 hrs

Question 30

Zofran (ondansetron) considerations

Answer 30

Prolonged QT Serotonin syndrome possible S/E headache & diarrhea Contra: hypermagnesemia (can cause torsades)

Question 31

Zofran (Ondansetron) supply

Answer 31

4mg/2ml

Question 32

Neostigmine (Prostigmin) characteristics

Answer 32

O: 5-10 min P: D: 45-90 min