Drug box 5

Question 1

Methergine Name

Answer 1

Methylergonovine Maleate

Question 2

Methergine Classification

Answer 2

Ergot Derivative

Question 3

Methergine Contraindication

Answer 3

IV administration is NOT recommended because of sudden hypertensive and cerebrovascular accidents., CAD; Breastfeeding.

Question 4

Methergine Dose and Route

Answer 4

Dose: 0.2mg
Route: IV & IM

Question 5

Methergine Mechanism of Action (MOA)

Answer 5

Acts directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of rhythmic contractions.

Question 6

Methergine Elimination

Answer 6

Hepatic metabolism and excretion

Question 7

Methergine Onset

Answer 7

IV;Immediate, IM: 2-5 minutes, PO: 5-10 minutes

Question 8

Methergine Duration

Answer 8

20-30 mins

Question 9

Famotidine name

Answer 9

Pepid

Question 10

Famotidine Classification

Answer 10

H2 (Histamine) receptor antagonist

Question 11

Famotidine contraindication

Answer 11

Pregnancy: drug will be present in breast milk and can cross the placenta and blood brain barrier. (use cimetidine for pregnancy). Renal failure increases the elimination half life therefore decreased dose is recommended. Decrease dose in patients with acute burns. Decrease dose in elderly related to increased elimination half-life up to twofold in elderly patients. Famotidine interferes with phosphate absorption and can lead to hypophosphatemia in chronic uses.

Question 12

Famotidine dose

Answer 12

20mg iv or 20-40mg po

Route: Rapid oral absorption: 50% hepatic first pass effect: Can be given IV

Question 13

Famotidine MOA

Answer 13

Famotidine competitively and selectively antagonizes/blocks histamine from binding to the H2 recepto

Question 14

Famotidine Elimination

Answer 14

elimination half life 2.5-4 hours: combination of hepatic metabolism (principal mechanism for oral route) and renal. Renal clearance is typically 2-3x > creatinine clearance (extensive renal tubular secretion). Only 10-20% of the drug would be cleared by hemodialysis. Hepatic dysfunction does not have a significant effect on elimination.

Question 15

Famotidine Onset

Answer 15

rapid iv

Question 16

Famotidine Peak

Answer 16

1-3.5 hr

Question 17

Famotidine Duration

Answer 17

10 hrs

Question 18

Valium name

Answer 18

Valium, diazepam

Question 19

Valium classification

Answer 19

Benzodiazepine/Anticonvulsant/Anxiolytic

Question 20

Valium contraindication

Answer 20

Glaucoma; During or within 14 days of MAOI therapy

Question 21

Valium dose and route

Answer 21

4.) Dose
0.5-1mg/kg IV for induction of anesthesia
0.1mg/kg IV to abolish seizures
Flood pg 179-180 ebook
5.) Route
PO, IV, IM

Question 22

Valium MOA

Answer 22

GABA receptor agonist

Question 23

Valium Elimination

Answer 23

Liver

Question 24

Valium Onset

Answer 24

po 30- 60min
IM 15-30 min
IV 1-5 min

Question 25

Valium Peak

Answer 25

1-2 hrs

Question 26

Valium Duration

Answer 26

iv 15min-1hr | po up to 3 hrs

Question 27

Valium misc

Answer 27

Miscellaneous Reversal Flumazenil Reduces requirements of volatile anesthetics.

Question 28

Dilaudid name

Answer 28

Hydromorphone

Question 29

Dilaudid classification

Answer 29

Semisynthetic Opioid

Question 30

Dilaudid contraindication

Answer 30

Hypersensitivity to morphine, acute/severe asthma, Increase ICP, pregnancy, severe respiratory depression, paralytic ileus, pruritus

Question 31

Dilaudid Dose and Route

Answer 31

Dose: Adult Analgesia: 0.5-1 mg (Miller’s Anesthesia Vol 2 pg. 2992) Epidural Cont. Infusion: 0.1-0.2 mg/hr (Miller’s Anesthesia Vol 2 pg. 2992) ** 7-8 times more potent than morphine Route: IV, PO

Question 32

Dilaudid MOA

Answer 32

Mu1 and Mu2 agonist

Question 33

Dilaudid Elimination

Answer 33

Elimination is via hepatic conjugation. Unlike morphine, it lacks the active metabolite M6G, therefore, administration is safe in renal patients

Question 34

Dilaudid Onset

Answer 34

15-30 min

Question 35

Dilaudid peak:

Answer 35

30-90min

Question 36

Dilaudid Duration

Answer 36

4-5 hr

Question 37

Pancuronium name

Answer 37

Pavulon

Question 38

Pancuronium classification

Answer 38

Nondepolarizing skeletal muscle relaxant

Question 39

Pancuronium contraindiation

Answer 39

MG, Bromide Hypersensitivity & pts unable to handle tachycardia.

Question 40

Pancuronium dose and route

Answer 40

Dose-0.04-0.1mg/kg | Route: IV

Question 41

Pancuronium MOA

Answer 41

Steroidal, potent long-acting neuromuscular blocking drug with both vagolytic and butyrylcholinesterase-inhibiting properties

Question 42

Pancuronium Elimination

Answer 42

40% to 60% is cleared by the kidney; 11% is excreted in the bile; 15% to 20% is metabolized, mainly by deacetylation in the liver.

Question 43

Pancuronium Onset

Answer 43

1-3 min

Question 44

Pancuronium Peak

Answer 44

2.9 Minutes

Question 45

Pancuronium Duration

Answer 45

40-65 min

Question 46

Pancuronium Misc

Answer 46

Miscellaneous-reverse with anticholinesterase | Bottle- 1mg/ml in 10ml vial

Question 47

Glucophage name

Answer 47

Metformin ( Generic)

Question 48

Glucophage classification

Answer 48

Biguanide

Question 49

Glucophage contraindication

Answer 49

Should not be prescribed in patients with lactic acidosis, acute kidney injury, GI intolerance, and acute hepatic disease.

Question 50

Glucophage route

Answer 50

po

Question 51

Glucophage MOA

Answer 51

Decreases hepatic glucose production and increases peripheral insulin sensitivity.

Question 52

Glucophage Elimination

Answer 52

Renal

Question 53

Glucophage Onset

Answer 53

1-3 hrs

Question 54

Glucophage peak

Answer 54

2 hrs

Question 55

Glucophage duration

Answer 55

17 hrs

Question 56

Glucophage misc

Answer 56

The most serious side effect is lactic acidosis. For this reason, some have recommended discontinuing metformin 48 hours or longer before elective operations

Question 57

Hemabate name

Answer 57

carboprost tromethamine

Question 58

Hemabate classification

Answer 58

Oxytocic Synthetic prostaglandin

Question 59

Hemabate contraindication

Answer 59

Hypersensitivity, Acute pelvic inflammatory disease, active cardiac, pulmonary, renal, or hepatic disease.

Question 60

Hemabate dose/ route

Answer 60

Dose- Initial dose of 250mcg IM. Can give successive doses 15-90 minutes apart for a total of up to 2mg or 8 total doses. Route: IM

Question 61

Hemabate MOA

Answer 61

binds to prostaglandin E2 receptor and stimulated uterine contraction

Question 62

Hemabate Elimination

Answer 62

Metabolized by lungs and liver. excreted via kidneys

Question 63

Hemabate Misc

Answer 63

Stimulation of smooth muscle can cause diarrhea, vomiting, hypertension. Can be used for abortions in fetuses aged 13-20 weeks

Question 64

Bicitra name

Answer 64

Sodium Citrate and Citric Acid

Question 65

Bicitra classification

Answer 65

Nonparticulate neutralizing buffer

Question 66

Bicitra contraindication

Answer 66

- Severe renal impairment (oliguria, azotemia, anuria) - Addison’s Disease - Severe heart disease - Heat cramps - Acute dehydration - Adynamic episodica hereditaria

Question 67

Bicitra dose and route

Answer 67

Dose: Adults: 15 ml diluted in 15 ml of water administered within 60 minutes of surgery Children: 5 – 15 ml diluted in 5 – 15 ml of water Route: PO

Question 68

Bicitra MOA

Answer 68

converted to bicarbonate in the body to increase blood pH (raises blood pH by 2.5 in most patients)

Question 69

Bicitra Elmination

Answer 69

kidneys

Question 70

Bicitra Onset

Answer 70

2-10min

Question 71

Bicitra duration

Answer 71

60-90min (30mins per dr hammon)

Question 72

Bicitra misc

Answer 72

- Useful for patients at high risk of aspiration; given to increase blood pH in treatment of metabolic acidosis and buffering pH of gastric secretions to prevent aspiration pneumonitis associated with intubation and anesthesia - S/E: metabolic alkalosis and saline laxative effect