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Flashcards in Dosing Deck (88):
1

sodium citrate

non-particulate antacid
Onset: 15-20 minutes
Met: metabolized as Na+ Bicarb in kidneys
30mL PO 15-30 min preop

2

hydromorphone

(derivate of morphine, semi-synthetic opioid)
.5-2mg IV Q 2-6 hrs
2-4 mg PO q 4-6

3

Albuterol

selective B2 agonist- short-acting (2 isomers R and S)
Onset: <5min
E1/2T: 4hrs
DOA: 4hrs (Sx relief 8hrs)
Met: liver
50% unchanged in urine
100mcg/puff; 2 puffs q4-6hrs DO NOT EXCEED 16-20 puffs
nebulizer 2.5-5 mg in 5ml NS

4

Ipratropium

Anticholinergic; Quaternary amine- salt derivative of atropine
Onset: 30-90 min
DOA: 4 hrs
Met: Highly polar- not well absorbed- partial hydrolysis
40-80mcg puff MDI; rinse mouth. 2-4 puffs 2X/day nebulizer

5

Ketorolac

(NSAID)
Onset: 10 min, E1/2T 5 hrs (prolonged in elderly), DOA 6 hours, PB: 99%, Liver conjugation, Renal excretion (60% unchanged)
30mg IV q6h
max daily= 120mg, do not use for more than 5 days

6

Digoxin

Antiarrhythmic:
(cardiac glycoside) class 5 agent
Onset: 5-30mins
Vd large, PB: weak, Elim: 90% unchanged in urine
Decrease dose in elderly
0.5-1mg IV over 12-24 hrs
NARROW therapeutic window: 0.5-2ng/mL

7

Oxytocin

Endogenous post. pit. hormone
Onset: rapid
E1/2T: 5 min
DOA: 1 hr

up to 40 mU/min for post partum uterine atony
Labor induction: 1-2 mU/min gtt- increase q15min by 1-2 mU/min until contractions 2-3 min apart

8

ketamine

(non-barbiturate induction agent, phencyclidine derivative)
induction dose- 1-2mg/kg, maintenance 1-2 mg/kg/hr
IM- 4-6mg/kg

9

vecuronium
(norcuron)

(intermediate acting steroid type NDNMB)
intubating dose: .1 mg/kg

10

Protamine

Heparin antidote- derived from salmon semen. also has weak anticoagulant properties on its own
Onset: 5 min
DOA: 20 min, it clears faster than heparin
Met: reticuloendothelial system
**based on amount of heparin given. 1mg/100units of heparin

11

mivacurium (mivacron)

(short acting NDNMB)
.2 mg/kg IV
topoff .02 mg/kg every 5-15 minutes

12

Diltiazem

Ca+ Channel Blocker- (non-dihydropyridine Class IV anti-arrhythmic)
Onset: rapid (<3 min)
E1/2T: 4-6hrs
PB: 70-80%
Met: extensive liver
Elim: 30% unchaned in urine
0.25-.35 mg/kg over 2 minutes
10mg/hr IV infusion

13

Diphenhydramine (benadryl)

H1 antagonist, 1st generation
Crosses BBB
Onset: 30 min
Peak: 2-3hrs
E1//2T: 2-8hrs
DOA: 4-6hrs
PB: high
Met: sig 1st pass effect, liver via CYP2D6, pulm & renal metabolism
10-50mg IV q6-8hrs

14

Ondansetron (Zofran)

Anti-emetic (serotonin antagonist)
Onset: 30min
E1/2T: 3-4hrs, DOA: 4-8hrs
Met: liver
Elim: renal excretion
4-8mg IV

15

nalbuphine (nubain)

(opioid agonist-antagonist)
.1-.3 mg/kg IV (have ceiling effect)

16

phenobarbital

(oxybarbiturate, anticonvulsant)
status epilepticus loading dose: IV 10-20mg/kg IV then 5 mg/kg Q 15-30 minutes until seizure controlled or max dose of 30mg/kg reached
maintenance: 1-5 mg/kg/day in divided doses

17

alfentanil

(phenyl-piperidine synthetic opioid agonist)
pain: 10-20 mcg/kg
induction: 50-200 mcg/kg IV

18

Glucagon

Synthetic analog of endogenous glucagon; use for sphincter of Odi spasm and BB OD
Onset: rapid
E1/2T: 5 min
DOA: 1 hr
Met: enzymatic degradation in liver, kidney and tissue into inactive metabolites
1-5mg IV or 5mcg/kg/min, 0.3 mg IV (SOO)

19

Mannitol (6 carbon hexose sugar)

Osmotic diuretic
Onset: 15 min
DOA: 2hrs
E1/2T: 1hr
100% excreted by kidney unchanged and not reabsorbed
0.25-1g/kg over 30- 60min

20

Nitroprusside

Vasodilator:
(direct peripheral arterial vasodilator; non-selective relaxation of venous and arterial smooth muscle)
Onset: immediate E1/2T: <10 min
Met: iron electron binds to nipride -> cyanide ions -> cyanide methgb. Transfer of iron to SNP -> methgb and unstable SNP, 5 cyanide ions released. Oxyhgb oxidizes nipride -> 1 cyano methgb and 4 thicyanates.
Elim: kidneys clear slowly 2-7 days
.3-10 mcg/kg/min, increased risk of toxicity over 2 mcg. max dose should not be used longer than 10 minutes

21

Cefazolin

Antimicrobial:
(B-lactam; Cephalosporin: 1st gen, broad spectrum)
E1/2T 2hrs, PB 80%, Renal excretion unchanged (80-100%) in kidney
1-2 g IV 30 min preop

22

sevoflurane

(fluorinated methyl isopropyl ether)
VP 160
B:G .69
MAC 2.05

23

morphine

(natural opioid agonist)
preop/postop: 2.5-15 mg IV
intra-op: 0.1-1 mg/kg

24

Promethazine (Phenergan)

Anti-emetic (H1 antagonist phenothiazine)
Onset: 3-5min, E1/2T: 9-16hrs, DOA:4-6hrs, PB: high
Met: CYP450 to inactive metabolites
7-25mg IV

25

Nitroglycerine

Vasodilator:
(Organic nitrate- works on venous capacitance vessels)
Onset: immediate, E1/2T: 1.5min, DOA 3-5min, PB:60%
Met: rapid <1% excreted unchanged in urine.
Metabolite: nitrate metabolite produced capable of producing methemoglobin by oxidation of ferrous to ferric ion in Hgb (treatment= methylene blue 1-2mg/kg IV)
Initial: 5-10mcg/min
Titrate: 5-200mcg/min

26

Dopamine

(Endogenous catecholamine, adrenergic agonist stimulates all receptors)
Onset: rapid, E1/2T 1 min, DOA 5-10 min
Met and elim= MAO and COMT
75% met. to inactive, 25% NE
D1 receptor stim: 1-3 mcg/kg/min "renal dose"
beta 1: 3-10 mcg/kg/min
alpha receptor: >10mcg/kg/min

27

Metoprolol

Beta Antagonist:
(Beta 1 selective antagonist)
Onset: 5 min, E1/2T 3-4hrs, DOA 7 hrs. Met: liver. Elim: renal excretion
5mg IV

28

sufentanil

(phenyl-piperidine synthetic opioid agonist)
bolus: .1- 1 mcg/kg IV
minor pain: 1-2 mcg/kg IV
mod pain: 2-8 mcg/kg IV
sole anesthetic: 8-50 mcg/kg
* >2mcg/kg not compatible with immediate post op extubation

29

Furosemide

Loop diuretic
Onset: 2-10 min
DOA: 2 hrs
E1/2T: <1hr
PB:90%
Met: liver, 50% kidney, 30% excreted unchanged in bile
0.1-1 mg/kg IV

30

glycopyrrolate

(synthetic quaternary ammonium, anticholinergic) onset 2-3 minutes
reversal: .01-.02 mg/kg IV
.1-.2 mg anti-sialagogue and bradycardia

31

Nifedipine

Ca+ Channel Blocker- (dihydropyridine- Class IV anti-arrhythmic)
Onset: rapid (<3 min), E1/2T: 3 hrs, PB:90%
Met: liver
Elim: renal clearance 70-80%
5mcg/kg IV

32

Hydrocortisone

Corticosteroid
E1/2T: 1-2hrs
Met: liver 70%, 30% unchanged in urine
PB: 90%
Many regimens- follow institution's policy: 25mg IV + what they are taking. 50-75 mg for mod surgery, 100-150mg IV for major surgery
normal amount: 10-20mg/day avg requirement
extreme physiologic stress 50-150 mg/day

33

Epinephrine

(endogenous catecholamine; nonselective adrenergic agonist)
Onset: 1-2 min, E1/2T 30 sec, DOA 5-10 min, poor lipid solubility, Met and elimin= MAO, COMT, reuptake, diffusion
1mg q3-5min for ACLS
1-2mcg/min B2
4-5mcg/min B1
10-20 mcg/min A and B

34

Labetalol

Beta Antagonist:
(Non-selective beta and alpha 1 antagonist)
Onset: 5 min, E1/2T: 5-8 hrs, DOA: 4 hrs, PB: 50%. Met: conjugation of glucuronic acid. Elim: liver and kidneys
5-20mg q5-10mins
max dose: 300mg

35

scopolamine

(tertiary amine, anticholinergic) onset 10 minutes
preop: .3-.6 mg IV Q 4-6 hours
may delay awakening from GA because its a strong sedative effect

36

Phenylephrine

(Synthetic non-catecholamine, direct acting, selective A1)
Onset: <1 min, DOA 5-20min, Met and Elim: MAO to phenolic conjugates & excreted via urine (90%)
PB: High, 90%
50-200mcg IV
Maint: 20-50mcg/min
Double dilute to 100mcg/cc

37

isoflurane

(halogenated methyl ethyl ether)
VP 240
B:G 1.4
MAC 1.15

38

Heparin

Anticoagulant: DVT prophylaxis, PE tx, ACS
Onset: rapid
E1/2T: 1 hr
Met: liver and 50% unchanged in urine
a lot of non specific protein binding, highly polar large molecular weight
5000 units SQ for prophylaxis q8-12hrs
D/C infusion 4-6 hrs prior to surgery and check PTT levels
dosing very variable among pts. titrate!

39

pancuronium (pavulon)

(long acting NDNMB)
intubatinf dose .1mg/kg

40

lidocaine

(amide local anesthetic)
rapid onset, 2 active metabolites, cauda equina syndrome,
max dose 4mg/kg, with epi max dose 7mg/kg
spinal 30-100 mg
ACLS max dose 1mg/kg
lipid solubility 4, low potency
pKa 7.9
protein binding 65
duration moderate

41

Isoproterenol

(Synthetic catecholamine, B1 > B2, min alpha, cardiac pacemaker)
Onset: rapid, DOA 5-10 min, E1/2T 3-5min, Met and Elim:COMT in liver and pulm, 50% unchanged in kidney
0.5-10mcg/min

42

Ranitidine

H2 Blocker (blocks H2 receptors in gastric parietal cells, decreasing gastric secretion) crosses BBB
Onset: 1 hr
E1/2T: 2 hrs
Met: 30% liver
Elim: 70% unchanged in urine
50mg IV over 15-30 min preop

43

phenytoin

(anticonvulsant, anti-arrhythmic class 1B)
10-15 mg/kg

44

Vasopressin

(Exogenous antidiuretic peptide. vasopressor)
E1/2T: 10-20 min.
Tissue peptidase metabolism, urinary excretion
40 unit push- cardiac arrest
20 units IV- esophageal varices
0.04 units/min- sepsis

45

physostigmine

(tertiary amine, anticholinesterase)
15-60 mcg/kg IV every 1-2 hours
-used for atropine and scopalamine toxicity, not used for reversal!)

46

Dantrolene

Muscle relaxant:
(Direct, centrally acting)
Onset: <5min, DOA 3 hrs, E1/2T 10-15hrs, met: liver to 5-hydroxydantrolene (30-50% potency), elim: liver and kidneys
Bolus: 2.5 mg/kg IV followed by Maint: 2mg/kg IV q5min to max dose 10mg/kg

47

desflurane

(fluorinated methyl ethyl ether)
VP 669
B:G .42
MAC 6.0

48

Verapamil

Ca+ Channel Blocker- (non-dyhydropyridine, Class IV anti-arrhythmic)
Onset: rapid (<3 min)
E1/2T: 6-12hrs
PB: 90%
Met: liver met w/ active metabolite norverapamil
Elim: 70% unchanged in kidneys and bile
2.5-5mg IV (max of 20) over 1-3min

49

remifentanil

(phenyl-piperidine synthetic opioid agonist with ester linkage)
induction: .5-1 mcg/kg over 60 seconds
infusion: 1-2 mcg/kg/min

50

neostigmine

(quaternary ammonium, anticholinesterase) onset 3-5 mins
.05-.07 mg/kg give with glyco .01 mg/kg

51

N20

(inorganic gas)
VP: 38,770
B:G .47
MAC 104%

52

Ephedrine

(Synthetic Non-catecholamine, direct and indirect adrenergic agonist)
Onset: rapid, DOA 1 hr, E1/2T 3 hrs, Met and Elim: resistant to MAO, 40% unchanged in urine
5-25 mg IV

53

Methylprednisone

Corticosteroid
E1/2T: 2-4hrs
Met: liver 70%, 30% unchanged in urine
PB: high
10-250mg IV

54

Hydralazine

Vasodilator:
(phthalazine derivative) Onset: 5-20min, Peak:10-20min, E1/2T: 3 hrs, DOA: 6hrs
Met: hep 1st pass
Elim: 14% urine unchanged
PB: 90%
2.5-10mgIV

55

Propanolol

Beta Antagonist:
(non- selective beta 1 and 2 antagonist)
Onset: 5 min, DOA: 4hrs, High PB, Vd, lipid solubility, extensive pulm uptake. Met: liver via CYP450. Elim: urine
1mg/min
max dose: 3-6mg

56

regular Insulin

Pancreatic hormone- structurally identical to endogenous insulin
Onset: rapid
E1/2T: 5-10 min
DOA: 30-60 min
1 units regular insulin will decrease BS 40-50 units
average daily requirement of insulin is 40 units

57

Dexamethasone

Corticosteroid. very high glucocorticoid action, no mineralcorticoid
E1/2T: 2-4hrs
Met:liver 70%, rest unchanged in urine and feces
4-10mg IV

58

acetaminophen

anti-pyretic, analgesic, central anti-prostaglandin effect
not a true opioid
1g IV over 15 minutes, oral 325-650 mg PO every 4-6 hours, max dose 4g/day

59

butorphanol (stadol)

(opioid agonist-antagonist)
.01-.04 mg/kg IV (have ceiling effect)

60

Adenosine

Antiarrhythmic: class 5
(endogenous nucleotide)
DOA 20-30 seconds
E1/2T: <10 sec
Elim: carrier-mediated uptake- nucleotide is met by cell enzymes & then elim by plasma and vascular endothelial cells
6 mg IV rapid bolus, can repeat with 6-12 mg in 3 minutes

61

Procainamide

Antiarrythmic: Afib, Vtach
(Class 1A- Na+ channel blocker)
**Analog of Procaine
Onset: immediate, E1/2T: 3 hrs, PB: low
Active Met: liver acetylation -> n-acetyl procainamide (NAPA) with E1/2T: 6-8hrs
Elim: 25% unchanged in urine
1-4mg/min

62

Bupivicaine

(amide local anesthetic)
max dose 2.5mg/kg
spinal max dose .75% 15-20 mg
lipid solubility-30, highly potent
pKA 8.1
PB- 95
duration-long
moderate onset, long DOA, diff nerve block, high Pb, good for epidural, spinal, PNS, CV toxic

63

Milrinone

Vasodilator:
(bypyridine inotropic/vasodilator agent with phosphodiesterase inhibitor activity)
Onset:5-20min, Peak:5min, E1/2T: 2 hrs
Elim: 80% urine unchanged
0.375-0.75mcg/kg/min

64

Octreotide

Somatostatin analog- inhibits production and release of GH, glucagon, insulin. used to treat carcinoid crisis and control of esophageal varices
Onset: rapid
E1/2T: 2.5hrs
Met: liver, 32% excreted unchanged
PB: moderate
25-100 mcg prn for carcinoid crisis
50mcg/hr for esophageal varices

65

etomidate

(non-barbiturate induction agent)
induction -.3mg/kg maintenance 10 mcg/kg/min with N20 and opioid

66

Amiodarone

Antiarrhythmic:
Class III (potassium channel blocker) with class I, II and IV properties
Metabolite: active metabolite (longer acting than amio)
Met: CYP 45
Elim: bile
PB: high, Vd: high, E1/2T: 10-100 days
bolus 150-300mg IV over 5 minutes
1mg/min x6 hours then .5mg/min x18 hours

67

Esmolol

Beta Antagonist:
(Beta 1 selective antagonist- class 2 anti-arrhythmic)
Onset: rapid, DOA 10-15 minutes. E1/2 t 9 mins. Met: plasma esterase in RBCs. Elim: urine excretion.
50-300 mcg/kg/min
or .5mg/kg IV

68

flumazenil

(benzo receptor antagonist)
.2 mg IV, wait 2 minutes to peak, then .1 mg Q 1 minute
max 3 mg

69

lorazepam

(benzo)
pre-op- 50 mcg/kg PO
IV- 1-4 mg (max 4 mg)

70

edrophonium

(quaternary ammonium, anticholinesterase) onset rapid
.5-1 mg/kg with atropine .01mg/kg

71

pyridostigmine

(anticholinesterase, quaternary ammonium)
.2mg/kg with glyco .01mg/kg

72

rocuronium (zemuron)

(short/intermediate acting NDNMB)
.6-1.2 mg/kg intubating dose
(higher end dosing can be used for RSI)

73

atropine

(tertiary amine, anticholinergic) onset 1 minute
reversal: .01 mg/kg IV
bradycardia: .4-1mg IV
PEA: 1mg Q 3-5 minutes

74

narcan

(N-alkyl derivative of oxymorphone, pure non selective competitive opioid antagonist)
.2 mg IV/IM/SC Q 2 minutes, max dose 10mg
(titrate slowly, try lowest dose possible)
(DOA is 30-60 minutes which is less than most opioids so may have to redose)

75

dexmedetomidine

(selective alpha 2 agonist)
1mcg/kg bolus over ten minutes then .2-1mcg/kg/hr infusion

76

succinylcholine

(depolarizing muscle relaxant)
laryngospasm dose: 10-40 mg IV or .3mg/kg
IV intubation dose 1-1.5mg/kg

77

diazepam

(benzo)
induction- .5-1 mg/kg IV,
premed- 10-15 mg oral, .2mg/kg IV

78

propofol

(non-barbiturate induction agent, 2,6 di-isopropophenyl)
induction 1-2.5 mg/kg, maintenance 100-300 mcg/kg/min
amnestic dose- 10 mg, 25-100 mcg/kg/min

79

Norepinephrine

(direct acting endogenous catecholamine; adrenergic agonist)
Onset: rapid, E1/2T 2.5min, DOA 5-10 min, Met and elmin=MAO, COMT in blood, liver, kidney. Metabolite: VMA
4-16mcg/min

80

midazolam

(benzo)
IV sedation 1-2.5 mg IV (max 5mg)
induction- .1-.2 mg/kg over 30 seconds

81

atracurium
(tracrium)

( intermediate acting NDNMB)
intubating dose: .5mg/kg
topoff .05mg/kg every 45 minutes

82

fentanyl

(phenyl-piperidine synthetic opioid agonist)
preop: 25-100 mcg
analgesia: 1-2 mcg/kg IV

83

meperidine

(phenyl-piperidine synthetic opioid agonist)
IV 5 mg Q 5 minutes
IM/SC/PO: 50-150 mg
shivering: 12.5-50 mg IV

84

Terbutaline

B2 agonist- short-acting
Onset: inhaled= immediate, subQ=6min
E1/2T: 11hrs
DOA: 2hrs
Met: liver 50% unchanged in urine
200mcg/puff, 16-20 puffs/day
.25 mg SQ (SQ administration resembles the response of epi)

85

cisatracurium
(nimbex)

(intermediate acting NDNMB)
intubating dose: .2mg/kg

86

Dobutamine

(Synthetic cathecholamine, sympathomimetic, B1 selective agonist)
Onset: 1-2 min, DOA: 5-10min
Met and elim: MAO, COMT, reuptake, diffusion.
Inactive metabolite.
2-10mcg/kg/min
<5mcg/kg/min= B1
>5mcg/kg/min= weak A1

87

Clonidine

Vasodilator:
(alpha 2 adrenergic agonist- decreases symp outflow from vasomotor centers in brainstem)
E1/2T:9-12hrs, DOA: 24-72hrs, PB:20-40%
Met: 50% via liver
Elim: 50% urine unchanged
0.2-0.3mg/day

88

metoclopramide

Anti-emetic:
(dopamine antagonist- structurally similar to procainamide)
Onset: 3-5 min, E1/2T: 2-4hrs, DOA: 1-2hrs
Elim: 40% unchanged in urine
10-20 mg IV over 3-5min, 15-30min prior to induction
.15mg/kg in peds or parturients