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Clinical Pharmacology Flashcards

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1
Q

Diazepam (Valium):
Dose?
Onset?
Duration?

A

Dose - 0.1 mg/kg IV, 0.2 mg/kg PO
Onset - 1-5 mins
Duration - 2-6 hours

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2
Q

Lorazepam (Ativan):
Dose?
Onset?
Duration?

A

Dose - 0.04 mg/kg (Post-Op = 1-4 mg)
Onset - 1-5 mins
Duration - 6-10 hours

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3
Q

Midazolam (Versed):
Dose?
Onset?
Duration?

A

Dose - 1-5 mg (0.05 mg/kg)
Onset - 1-5 mins
Duration - 15-80 minutes

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4
Q

Flumazenil (Romazicon)
Dosing?
Onset of action?
Duration?
Contraindications?

A

Dose - 0.2 mg IV, repeat 0.1 mg q 1 min
MAX - 3 mg
Onset - 1-5 mins
Duration - 30 mins
Contraindications: Seizure disorders

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5
Q

List the benzodiazepines in order from most potent to least potent:

A

Lorazepam > Midazolam > Diazepam

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6
Q

Morphine
Dosing: Intra-Op/Post-Op
Onset:
Duration:

A

Dosing: Intra-Op (1-10 mg)/Post-Op (5-20 mg)
Onset: 10-20 mins
Duration: 4-5 hours

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7
Q

What are Morphine’s two active metabolites?

A

Morphine-3-Glucoronide and Morphine-6-Glucuronide

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8
Q

Morphine can decrease _________ with high doses

A

PVR

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9
Q

Morphine has a prolonged half-life in which patient populations?

A

Elderly, liver failure, and renal failure

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10
Q

Fentanyl (Sublimaze)
Dosing:
Onset:
Duration:
Infusion:

A

Dosing: 1.5-3 mcg/kg induction dose, 1-5 mcg/kg for first hour of surgery
Onset: 30-60 seconds
Duration: 1-1.5 hours
Infusion: 3-6 mcg/kg/hour (Turn it off 60 mins before breathing)

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11
Q

T or F: Fentanyl is dosed on ideal body weight

A

True

IBW Formula
[Women = 45 + (2.3 x inches over 5 ft)]
[Men = 50 + (2.3 x inches over 5 ft)]

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12
Q

Sufentanil (Sufenta)
Dosing:
Onset:
Duration:
Infusion:

A

Dosing: Intra-Op (0.3-1 mcg/kg)
Onset: 30-60 seconds
Duration: 1-1.5 hours
Infusion: 0.5-1 mcg/kg/hr

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13
Q

Why would you choose Sufenta over other opioids like Fentanyl?

A

It’s CV stable

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14
Q

Remifentanil (Ultiva)
Dosing:
Onset:
Duration:
Infusion:

A

Dosing: Loading Dose (0.5-1 mcg/kg over 1 min)
Onset: 30-60 seconds
Duration: 6-8 mins
Infusion: 0.125-0.375 mcg/kg/min

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15
Q

Remifentanil is used for what cases?

A

Neuro, carotid endarterectomy, eye blocks, TIVA

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16
Q

There is up to _______ (percentage) decrease in MAC when using a Remifentanil drip

A

70% reduction

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17
Q

Meperidine (Demerol)
Indication:
Dosing:
Onset:
Duration:

A

Indication: Post-Op Shivering
Dosing: 12.5 mg
Onset: 5-15 mins
Duration: 2-4 hours

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18
Q

Demerol has affinity for which receptors?

A

Mu, kappa, and delta

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19
Q

Demerol is structurally similar to which drugs?

A

Atropine and local anesthetics

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20
Q

This active metabolite of Meperidine acts as a CNS stimulant and can result in seizure activity

A

Normeperidine

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21
Q

Meperidine blocks reuptake of serotonin and is contraindicated with what?

A

MAOIs

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22
Q

Hydromorphone (Dilaudid)
Dosing:
Onset:
Duration:

A

Dosing: Intra-Op (1-4 mg), Post-Op (1.5-4 mg)
Onset: 5-15 mins
Duration: 2-4 hours

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23
Q

Naloxone (Narcan)
Dosing:
Onset:
Duration:

A

Dosing: 40-80 mcg
Onset: 1-5 mins
Duration: 30 mins (May need to redose)

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24
Q

After giving Narcan, you may see _________ stimulation related to reversal of analgesia

A

Cardiac (HTN/tachycardia)

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25
**Propofol (Diprivan)** Induction: Maintenance: Onset: Duration:
Induction: 1.5-2.5 mg/kg Maintenance: 25-100 mcg/kg/min (sedation), 100-300 mcg/kg/min (TIVA) Onset: 30-60 seconds Duration: 1-8 mins
26
Children need an (increased/decreased) Propofol dose
Increased
27
Elimination half life of Propofol
0.5-1.5 hours (30-90 minutes)
28
What are some pros to using Propofol over other induction agents?
Bronchodilator Anti-nausea properties Suppresses the SNS response to laryngoscopy
29
**Etomidate (Amidate)** Induction: Onset:
Induction: 0.3 mg/kg Onset: 1 min
30
Etomidate is a carboxylated imidazole, when the ring is open it is _________ The ring closes when the drug enters the body and it becomes ___________
Open = Water soluble Closed = Lipid soluble
31
Adrenocortical suppression lasting 4-8 hours is a rare problem with which induction drug?
Etomidate
32
Which induction agent has the highest incidence of PONV?
Etomidate (Vomitdate)
33
**Ketamine (Ketalar)** Induction: Maintenance: Onset: Duration:
Induction: 0.5-1.5 mg/kg Maintenance: 0.2-0.5 (Analgesia), 4-8 mg/kg IM given to calm a child Onset: 1 min Duration: 10-20 mins
34
Ketamine depresses the neuronal function of the cortex and the thalamus, however, it stimulates the ________ system
Limbic (Behavior/emotions)
35
At higher doses of Ketamine, what is a major concern?
Emergence Delirium
36
What does Ketamine do to the following (increase or decrease): SVR? HR? CO? SNS outflow? Epi/Norepi uptake?
Increases all
37
Before giving Ketamine, what should you give?
Glycopyrrolate (Ketamine increases salivary secretions)
38
**Dexmedetomidine (Precedex)** Loading Dose: Infusion:
Loading Dose: 1 mcg/kg over 10 mins Infusion: 0.2-0.7 mcg/kg/hr
39
Precedex works on which receptors?
Alpha2-A (Sedation, hypnosis) Alpha2-B (Vasoconstriction, antipshivering, analgesia) Alpha2-C (Learning, startle response)
40
Drug and alcohol withdrawal is well offset with this drug...
Precedex
41
**Methohexital (Brevital)** Induction dose: Indications:
Induction dose: 1.5 mg/kg Indications: Electroconvulsive therapy, cardio version, mapping seizures, rapid procedures '
42
**Sevoflurane (Ultane)** MAC: Blood:Gas Vapor Pressure
MAC: 1.8 Blood:Gas = 0.69 Vapor Pressure: 157
43
**Desflurane (Suprane)** MAC: Blood:Gas Vapor Pressure
MAC: 6.6 Blood:Gas = 0.42 Vapor Pressure: 669
44
**Isoflurane (Forane)** MAC: Blood:Gas Vapor Pressure
MAC: 1.17 Blood:Gas = 1.46 Vapor Pressure = 238
45
**Nitrous** MAC: Blood:Gas Vapor Pressure
MAC: 104 Blood:Gas = 0.46 Vapor Pressure = Very high (38,770)
46
MACawake MACbar
MACawake = 0.3-0.5 MACbar = 1.7-2.0
47
Highest MAC at what age?
6 months
48
Which factors increase anesthetic requirements?
Chronic ETOH Infants Red hair Hypernatremia Hyperthermia
49
Factors that decrease anesthetic requirements?
Acute ETOH Elderly Hyponatremia Hypothermia Anemia Hypercarbia Hypoxia Pregnancy
50
Drug of choice for obese patients (Due to its low solubility) Airway irritant, increases HR, absorbs quickly, needs a special heated vaporizer
Desflurane
51
Good for pediatric induction, but can cause emergence delirium in kids
Sevoflurane
52
Very lipid soluble, very suitable for long cases where extubation is not expected
Sevoflurane
53
Which gas do you absolutely NOT use in neuro and most bowel cases?
Nitrous
54
**Succinylcholine (Anectine)** Dose: mg/ml: Onset: Duration:
Dose: 1-1.5 mg/kg Supplied: 20 mg/ml Onset: 30-60 seconds Duration: 5-10 mins
55
**Cisatracurium (Nimbex)** Dose: mg/ml: Onset: Duration:
Dose: 0.2 mg/kg Supplied: 2 mg/ml Onset: 2-3 mins Duration: 40-75 mins
56
**Vecuronium (Norcuron)** Dose: Supplied: Onset: Duration:
Dose: 0.1 mg/kg Supplied: 1 mg/ml Onset: 2-3 mins Duration: 45-90 mins
57
**Rocuronium (Zemuron)** Dose: Supplied: Onset: Duration:
Dose: 0.6 mg/kg (1.2 mg/kg = RSI dose) Supplied: 10 mg/ml Onset: 2-3 min (RSI dose = 1.5 min) Duration: 35-75 mins
58
**Pancuronium (Pavulon)** Dose: Supplied: Onset: Duration:
Dose: 0.1 mg/kg Supplied: 2 mg/ml Onset: 2-3 mins Duration: 60-120 mins
59
Which paralytic is the drug of choice for renal failure?
Cisatracurium (Nimbex)
60
What are the commonly used reversal agents (anticholinesterase inhibitors)?
Edrophonium (Peds), Neostigmine, Pyridostigmine, Physostigmine
61
**Neostigmine (Prostigmine)** Dose: Onset: Duration: Anticholinergic:
Dose: 40-70 mcg/kg (0.04-0.07 mg/kg) Onset: 5-10 mins Duration: 60 mins Anticholinergic: Glycopyrrolate (0.2 mg per mg of Neostigmine)
62
**Sugammadex (Bridion)** Dose: Onset: Duration:
Dose: 2-16 mg/kg Onset: 1-4 mins Duration: 1.5-3 hours
63
**Glycopyrrolate (Robinul)** Dose: Onset: Duration: Supplied:
Dose: 1:1 with neostigmine (3 mL of Neostigmine = 3 mL of Glyco) Onset: 2-3 mins Duration: 2 hours Supplied: 0.2 mg/mL
64
**Ephedrine** dose
5-10 mg (Usually supplied as 50 mg/mL)
65
**Neosynephrine** dose
50-100 mcg (Usually supplied as 10 mg/ml)
66
**Hypertension Drugs:** Labetolol Esmolol Hydralazine
Labetolol: 5-25 mg (Tachycardia and HTN) Esmolol: 10 mg (DOC for JUST tachycardia) Hydralazine: 5-10 mg (HTN + Bradycardia)
67
**Droperidol** Dose: Onset: Duration:
Dose: 0.625 mg Onset: 1-5 mins Duration: 2-3 hrs
68
**Promethazine (Phenergan)** Dose: Onset: Duration:
Dose: 6.25-25 mg Onset: 1-5 mins Duration: 4-6 hrs
69
**Ondansetron (Zofran)** Dose: Onset: Duration:
Dose: 4-8 mg Onset: 10 mins Duration: 4-9 hrs
70
**Dexamethasone (Decadron)** Dose: Onset: Duration:
Dose: 4-16 mg Onset: 10-30 mins Duration: 2-10 hr
71
**Metoclopramide (Reglan)** Dose: Onset: Duration:
Dose: 10-20 mg Onset: 10 min Duration: 2 hrs
72
**Scopolamine** Onset: Duration:
Onset: 2-4 hr Duration:72 hours
73
**Propofol** for N/V dose:
10-15 mg IV followed by 10 mcg/kg/min
74
**Non-Opioid Analgesics** Acetaminophen(Offirmev) Ketorolac (Toradol) Ibuprofen (Caldor)
Acetaminophen(Offirmev) - 1000 mg q4-6h (MAX 3-4 g) Ketorolac (Toradol) - 15-30 mg q4h (60-120 mg qday MAX) Ibuprofen (Caldor) - 200-800 mg q6h (3200 mg qd MAX)
75
Signs/Symptoms of LAST?
Analgesia, lightheadedness, tinnitus, tongue/circumoral numbness, seizures, unconsciousness, respiratory arrest, CV arrest
76
Lipid rescue for LAST:
20% Intralipids - BOLUS 1.5 ml/kg over 1 min, then start a drip at 0.25 mL/kg/min
77

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