Clinical Pharm Flashcards

Question

What is the concentration of Dexmedetomidine?

Answer 1

100 mcg/mL (2 mL vial) DILUTE to 4 mcg/mL

Answer 2

GABA-A agonist Increases frequency of channel opening (most GABA agonists increase time of opening)

Answer 3

1 mg/mL 5 mL vial

Answer 4

IV analgesic dose: 1-2 mg IV induction: 0.1-0.4 mg/kg IV sedation: 0.01-0.1 mg/kg PO sedation (children): 0.5-1.0 mg/kg (50% PO bioavailability)

Answer 5

IV onset: 30-60 seconds PO onset: 15 minutes Duration: 20-60 minutes

Answer 6

Liver/intestine (P450) Active metabolite: 1-hydroxymidazolam - rapidly conjugated to inactive compound except in liver failure

Answer 7

Sedation: minimal effects Induction: decreased BP/SVR Resp depression potentiated with opioids Decreased CMRO2/CBF Anterograde amnesia Anticonvulsant Anxiolysis No analgesia

Answer 8

Competitive GABA-A receptor antagonist

Answer 9

0.2 mg IV titrated in 0.1 mg q 1 min Redosing may be required as duration is shorter than some benzos

Answer 10

Low solubility = less likely to be taken up into the blood/more available agent for brain/alveoli = faster onset

Answer 11

Alveolar concentration required to block autonomic response to painful stimulus (= 1.5 MAC)

Answer 12

MAC in which patient opens eyes 0.4-0.5 during induction 0.15 during recovery

Answer 13

- Protein interactions within the brain/spinal cord. - Stimulate inhibitory receptors or inhibit stimulatory receptors - In brain GABA-A - In SC NMDA, glycine, and sodium channels

Answer 14

- Decreased MAP - Decreased contractility - Decrease SVR - Iso/Des increase HR - N2O increases MAP/SVR (SNS activation) - Preserved CO

Answer 15

- Decreased CMRO2/Increased CBF = increased ICP/CBV - Isoelectric state at 1.5-2.0 MAC - N2O increased CMRO2 and CBF

Answer 16

Na+ channel blockade = decreased nerve conductance

Answer 17

Pseudocholinesterase (Increased DOA with pseudocholinesterase deficiency)

Answer 18

Hepatic/P450

Answer 19

Onset: pKA Potency: Lipid solubility Duration of action: Protein binding

Answer 20

Max dose: 2.5 mg/kg Max total dose: 175 mg

Answer 21

Max dose w/epi: 3 mg/kg Max total dose w/epi: 200 mg

Answer 22

Max dose: 4.5 mg/kg Max total dose: 300 mg

Answer 23

Max dose w/epi: 7 mg/kg Max total dose w/epi: 500 mg

Answer 24

Autonomic, pain, temperature, touch, deep pressure, motor C, A delta, A Beta

Answer 25

T10: 10-15 mg T4: 12-20 mg

Answer 26

Onset: 4-8 min Duration: 130-220 min (2-3.5 hrs) Duration + epi: +20-50% (3 - 5 hrs)

Answer 27

Dose, baricity, position

Answer 28

Initial: 1-2 mL/segment to be blocked Top-up: 50-75% of initial dose

Answer 29

Concentration: 2% Onset: 10-20 min Duration: 60-120 min

Answer 30

Concentration: 0.1-0.75% Onset: 10-20 min Duration: 140-220 min

Answer 31

Concentration: 0.0625-0.5% Onset: 15-20 min Duration: 160-220 min

Answer 32

Nicotinic acetylcholine receptors (nAChRs) - prejunctional on the presynaptic nerve - postjunctional on the motor endplate of the muscle

Answer 33

2 ACh molecules bind to the 2 alpha subunits of the receptors

Answer 34

- Nerve injury leads to creation of extrajunctional fetal nicotinic receptors at the NMJ - These receptors are much more sensitive to succinylcholine and remain open longer allowing increased K+ to exit the cell

Answer 35

Block binding of ACh to pre and post-synaptic receptors at the NMJ

Answer 36

Succinylcholine binds to the alpha subunits of the nAChR and depolarizes cell causing muscle contraction (sodium in/potassium out), continued binding = muscle paralysis

Answer 37

Bradycardia (children)/tachycardia (adults) Histamine release? Potassium release Increased IOP/ICP/IGP MH Fasciculations Post-op myalgia

Answer 38

Acetylcholinesterase/NMJ

Answer 39

Plasma cholinesterase/pseudocholinesterase

Answer 40

Atypical pseudocholinesterase Heterozygous succ duration: 20-30 min Homozygous succ duration: 4-8 hours Dibucaine test (amide LA that inhibits normal plasma cholinesterase, no effect on atypical PCHe)

Answer 41

Onset: 30 seconds DOA: 5-10 min

Answer 42

muscular dystrophy, guillain-barre, MS, ALS, huntington chorea, myasthenia gravis

Answer 43

Measure of potency = dose at which there is a 95% reduction in twitch height Higher ED95 = lower potency/faster onset (d/t more molecules to fill NMJ)

Answer 44

Intubating dose is 2-3x the ED95

Answer 45

ED95: 0.04 Intubating dose: 0.1 mg/kg

Answer 46

Onset: 5 min Duration: 45 min

Answer 47

Onset: 5.2 min Duration: 45 min

Answer 48

ED95: 0.3 mg/kg Intubating dose: 0.6 -1 mg/kg (normal adult 80-100 mg)

Answer 49

Onset: 1.5 minutes Duration: 40 minutes

Answer 50

ED95: 0.3 mg/kg Intubating dose: 1.0 mg/kg

Answer 51

10 mg/ml (200 mg/20 mL)

Answer 52

10 mg/mL (50 mg/5 mL)

Answer 53

Hoffman (organ independent) Active metabolite: Laudanosine (causes seizures, but small quantity)

Answer 54

Organ independent base-catalyzed reaction dependent on normal pH/temp. Slower with acidosis/hypothermia

Answer 55

Benzylisoquinolinium - end is -curium - undergo hoffman elimination

Answer 56

None 70% liver elimination unchanged

Answer 57

Aminosteroids

Answer 58

Hypermagnesemia (decreased Ach release from presynaptic nerve) Hypocalcemia (decreased Ach release from presynaptic nerve) Hypokalemia (decreased resting membrane potential)

Answer 59

Neuromuscular blockers

Answer 60

Inhibits acetylcholinesterase to increase the concentrations of ACh at the NMJ

Answer 61

.05 mg/kg (common adult dose = 2.5-3.5 mg)

Answer 62

Onset: 5-15 min Duration: 45-90 min

Answer 63

Cholinergic (muscarinic) effects - SLUDGE + bradycardia

Answer 64

No - quaternary

Answer 65

0.05 mg/kg (common adult dose = 2.5-3.5 mg)

Answer 66

No - quaternary amine

Answer 67

Glycopyrrolate 0.01-0.02 mg/kg (or .2 mg/1 mg Neo) ## Footnote Ex: 2.5 mg Neo, 0.5 mg glyco

Answer 68

Blocks acetylcholine from binding to muscarinic receptors

Answer 69

0.1-0.2 mg

Answer 70

Binds/encapsulates aminosteroid NDNMBs

Answer 71

AMINOSTEROID NDNMBs (roc, vec, panc)

Answer 72

1:1 molar ratio between sugammadex/muscle relaxant, dose is calculated on degree of block TOF 2/4 = 2 mg/kg TOF 0/4 = 4 mg/kg 3 min after ROC admin (dose less than 1.2 mg/kg) = 16 mg/kg

Answer 73

Bradycardia Decreased effectiveness of hormonal contraceptives up to 7 days

Answer 74

Analgesia, bradycardia, respiratory depression, euphoria, physical dependence, itching, constipation

Answer 75

Analgesia, stops shivering, dysphoria, delirium, hallucinations

Answer 76

Bind to opioid receptors in the CNS/spinal cord/periphery and block transduction and perception of pain

Answer 77

Competitively agonizes mu, kappa, and delta receptors

Answer 78

1-4 mcg/kg (give 20-40 mcg at a time) Concentration: 0.4 mg/mL (could dilute in 10 cc and give 1 mL = .04 mg/mL (40 mcg/mL)

Answer 79

Ach antagonist, competes with Ach at smooth muscle muscarinic receptor sites

Answer 80

Yes, it is a tertiary amine, can cause mild sedation

Answer 81

Drug of choice for symptomatic bradycardia Not effective: Second degree type 2 block, third degree block

Answer 82

0.5 mg q 3-5 minutes (max 3 mg/6 doses)

Answer 83

Onset: 30-60 sec Duration: 30-60 min

Answer 84

10-20 mcg/50-100 mcg

Answer 85

IVP: 25-100 mcg (0.5-1.0 mcg/kg) Sole surgical agent: 50-100 mcg/kg

Answer 86

Onset: 5 min Duration: 30-60 min

Answer 87

0.25-0.30 mg

Answer 88

0.5-1 mg q hr (in recovery)

Answer 89

Onset: 10 min Duration: 3 hours

Answer 90

- Organ independent metabolism - Ultra fast onset - Only used as IV gtt

Answer 91

Onset: 1 minute Duration: 3-10 min after drip turned off

Answer 92

Induction: 1-3 mcg/kg over 1 min Gtt: 0.5-1 mcg/kg/min

Answer 93

- Quick onset - Most potent opioid - Usually gtt

Answer 94

Induction: 0.1-0.3 mcg/kg Gtt: 0.2-0.5 mcg/kg/hour (0.2 = normal)

Answer 95

Selective B1 blockade

Answer 96

2-5 mg q 5 min (max 15)

Answer 97

Onset: < 5 min Duration: 5-8 hours

Answer 98

Bradycardia, bronchoconstriction

Answer 99

B1/B2 blocker and selective A1 blocker

Answer 100

7:1 IV, 3:1 oral

Answer 101

10-20 mg q 10 minutes max: 300 mg

Answer 102

Onset: 5 min Duration: 4 hours

Answer 103

Selective B1 blocker

Answer 104

Temporary tachycardia/HTN Often given pre-induction

Answer 105

IVP: 0.5 mg/kg (often 100-150 mg given pre-induction) gtt: 50-300 mcg/kg/min

Answer 106

Onset: 2 minutes Duration: 10-30 minutes

Answer 107

Plasma hydrolysis

Answer 108

Hydralazine

Answer 109

Beta Blocker (BB)

Answer 110

Vasodilator - activates g cyclase to produce ARTERIOLAR relaxation

Answer 111

10 mg (0.1-0.2 mg/kg)

Answer 112

Onset: 10-20 min Duration: 3-6 hours

Answer 113

Alpha agonist

Answer 114

Concentration: 100 mcg/mL (1 mg/10 mL) Dose: 40-60 mcg (.5 mL)

Answer 115

Onset: rapid Duration: up to 20 min

Answer 116

Indirect and direct alpha/beta agonist

Answer 117

5-10 mg (up to 50 mg)

Answer 118

Hypotension Has been used for bronchoconstriction

Answer 119

Epinephrine is 250x more potent

Answer 120

Onset: 3-5 min Duration: 10-15 min

Answer 121

Direct alpha/beta agonist

Answer 122

B2 > B1 > alpha

Answer 123

1:1000 = 1 mg/mL 1:10000 = 0.1 mg/mL (100 mcg/mL)

Answer 124

1 mg (this would be using 1:10000 epi)

Answer 125

1-16 mcg/min or 0.1-1 mcg/kg/min Concentration: 4 mcg/mL (1 mL in 250 bag - this would be using 1:1000 epi)

Answer 126

5-20 mcg (0.5-2 mL) q 2-5 min

Answer 127

Take 1 mL of code syringe epi = 100 mcg/mL Add to 9 mL NS = 10 mcg/mL

Answer 128

Duration: 5 min Onset: < 1 min

Answer 129

Calcium channels in cardiac cells modulate force of contraction also cause smooth muscle contraction

Answer 130

250 mg-1 g

Answer 131

Onset: 5-15 min Duration: 4 hrs

Answer 132

Class 3 anti-arrythmic (potassium channel blocker) Prolongs phase 3 of cardiac action potential = prolonged PR, QRS, QT = decreased BP/HR/PVR

Answer 133

Ventricular arryhtmias VF/VT PVCs

Answer 134

2nd/3rd degree block

Answer 135

Pulseless: 300 mg bolus, then 150 mg W/pulse: 150 mg bolus then gtt

Answer 136

Binds to antithrombin 3, inactivating other clotting factors

Answer 137

Onset: immediate Duration: 20-60 min (SQ), 3-5 hrs (IV)

Answer 138

Onset: 1 min Duration: 30 min

Answer 139

Therapeutic: 5000 U SQ Bipass: 400 U/kg

Answer 140

Neutralizes effect of heparin through electrostatic binding

Answer 141

1 mg/100 U heparin

Answer 142

B2 agonist, relaxes bronchial smooth muscles

Answer 143

0.5 mL of 0.5% solution (2.5 mg)

Answer 144

Pseudohypokalemia, tachycardia, HTN

Answer 145

Onset: < 5 min Duration: 4-6 hrs

Answer 146

Glucocorticoid steroid reduces inflammation, improving pain, nausea not well understood

Answer 147

PONV prophylaxis: 4-8 mg Airway edema: 0.5 mg/kg

Answer 148

Onset: 10-30 min Duration: 36 hours

Answer 149

H2 receptor antagonist, stops release of H+ from gastric parietal cells

Answer 150

Onset: < 1 hr Duration: 0.5-4 hours

Answer 151

5HT3 antagonist, blocks serotonin at the chemoreceptor trigger zone Does not cause other CNS effects

Answer 152

Onset: rapid Duration: 6-12 hours

Answer 153

QT prolongation - EKG monitoring recommended

Answer 154

Antidopaminergic effects at the CTZ, relieving nausea Also causes sedation by depressing CNS

Answer 155

0.5-1 mg IV pre-induction Concentration: 5 mg/mL (in 1 mL solution)

Answer 156

CI in Parkinson's patients Increased mortality for elderly patients with dementia-related psychosis Prolongs QT - TdP

Answer 157

Onset: seconds Duration: 4 hours

Answer 158

0.625 mg IV pre-induction

Answer 159

Onset: 3-10 min Duration: 2-4 hours

Answer 160

CNS - calming Vascular dilation - can cause hypotension Augments ventilator response to hypoxemia by blocking dopamine inhibition at carotid body (this is good for COPD patients who require carotid body drive for ventilation)

Answer 161

Loop diuretic, inhibits reabsorption of Na, Cl, K, Ca, H2O, PO3 in the loop of Henle = diuresis

Answer 162

0.5 mg/kg (5-40 mg = usual range)

Answer 163

Ototoxicity, hypotension, hypokalemia, hypomagnesemia

Answer 164

Onset: <1 hr Duration: 6-8 hours

Answer 165

Gastrokinetic agent + dopamine receptor antagonist, stimulates GI motility, increased GE sphincter tone, relaxes pylorus

Answer 166

Standard dose = 10 mg (5 mg in elderly)

Answer 167

Parkinson's Seizure disorder GI obstruction

Answer 168

Onset: 1-2 min Duration: 1-3 hours

Answer 169

NSAID, inhibits COX-1 and COX-2 = anti-inflammatory, analgesic

Answer 170

30 mg < 65 yo with normal kidney function 15 mg > 65 (I think studies now show 15 mg is appropriate in everyone)

Answer 171

Onset: 10 min Duration: 4 hours

Answer 172

10 mg morphine

Answer 173

Maybe increases bleeding time (ASK surgeon first) Decreases prostaglandins causes renal arteriole constriction = decreased RBF (avoid in hypovolemic patients/Cr >1)

Answer 174

Kidney injury Hypovolemia Bleeding Nasal polyps Asthma Rhinitis

Answer 175

Not fully understood, maybe inhibits Cox, but minimal anti-inflammatory effects, metabolized and crosses BBB to act on brain and SC and provide analgesia

Answer 176

1000 mg > 50 kg 15 mg/kg < 50 kg Max: 4 g/day

Answer 177

Liver issues - caution with alcoholism/malnutrition Taken other medications containing Tylenol

Answer 178

Ofirmev onset: 5-10 min Acetaminophen onset: < 1 hr Duration of both: 4-6 hours

Answer 179

Natural hormone, simulates smooth muscle contractions

Answer 180

20 u/1L NS (run this wide open after cord is clamped, followed by second bag slowly)

Answer 181

Acts directly on smooth muscle of uterus to increase tone, rate, amplitude

Answer 182

Risk of severe HTN/CVA (why it isn't given IV)

Answer 183

Synthetic prostaglandin that mimics PGF2 alpha, stimulating uterine contractions

Answer 184

250 mcg IM q 15 min

Answer 185

Caution with asthmatics, may cause severe bronchospasm DO NOT give IV

Answer 186

Generally preserve CO

Answer 187

0.5-20 mcg/kg/min

Answer 188

Inodilator Primarily B1 agonist (increased contractility/rate)

Answer 189

Caution with asthmatics, may cause severe bronchospasm. DO NOT give IV.

Answer 190

Generally preserve CO

Answer 191

0.5-20 mcg/kg/min

Answer 192

Inodilator; Primarily B1 agonist (increased contractility/rate), also B2 (vasodilator), some alpha 1

Answer 193

2.5 mg/kg IV, repeat 1 mg/kg PRN, Max: 10 mg/kg

Answer 194

Binds to the ryanodine receptor, depresses excitation-contraction coupling in skeletal muscle decreasing intracellular calcium concentration.

Answer 195

250 mg vial, reconstitute in 5 mL = 20 mg/mL

Answer 196

5 mcg/mL (1:200,000)

Answer 197

3 mL of 1.5% lidocaine (15 mg/mL) w/ 1:200,000 Epi (5mcg/mL) = 45 mg of lidocaine and 15 mcg of epi

Answer 198

Analgesia infusion: 0.1-0.5 mg/kg

Clinical Pharm Flashcards

(248 cards)