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Flashcards in Emergency Drugs Deck (17):

What is phenylephrine?

  • Alpha 1 agonist
    • mostly directly acting
  • venoconstriction >arterial constriction
  • less potent than NE
  • Longer lasting
  • treat hypotension in OR
  • Increases MAP, SBP, DBP, SVR
  • Decreases HR, CO
    • barorecptor mediated drop in HR


Dose of phenylephrine?

  • 50-200 mcg IV
  • continuous infusion 20-50 mcg/min
  • Standard concentration in vial 10 mg/mL
  • Standard concentration for admin
    • 100 mcg/mL
    • Needs double dilution or in 100 mL NS
      • Doublt dilution: mix 9 mL saline with 1 mL 10mg/mL phenyl, discard 9 mL, draw up new 9mL NS


Overview of ephedine?

  • Synthetic non-catecholamine
  • indirect acting- stimulates B and alpha adrenergic receptors
  • treat hypotension in OR due to various reasons
  • CV effects similar to epinephrine, longer lasting
  • SVR effected minimally
  • CV effects mostly due to increased contractility
    • increased map, sbp, dbp, hr, coronary bf
    • Decreased renal, splanchinic BF
  • (if you've given whole syringe, it's time to move on)


Dose of ephedrine?

  • Dose 5-25 mg IV
  • Tachyphylaxis is common with this agent- due to indirect effect and occupying of receptors
  • Dilute once
    • 1mL of 50 mg/mL + 4 mL saline= 10 mg/mL
    • 1 mL of 50 mg/mL in 9 mL saline= 5 mg/mL


Atropine overview?

  • Anticholinergic-antagonizes effect of ACh at cholinergic post ganglionic muscarinic receptors
  • Muscarinic receptors are present in heart, salivary glands, smooth muscle of GU and GI tract
  • No/minmal effect at nicotinic receptors
  • tertiary amine- naturally occuring, alkaloid of belladonna plant
  • resembles cocaine in structure, has mild analgesic activity
  • combines reversibly with muscarinic receptors and prevents ACh from binding to thses sites
    • competitive inhibitors


Dose of atropine? Side effects?

  • Drug of choice for treatin intra op bradycardia
  • 2 standard concentrations
  • Dose:
    • 15-75 mcg/kg IV 
    • 0.4-1 mg (max dose 3 mg)
  • Other effects
    • antisialagogue, bronchodilation, mydriasis, decreased GI motility and acid production, bronchodilation, sedation


What is glycopyrrolate 


  • Similar to atropine
  • Quaternary ammonium- does not easily cross BBB so no sedative effects
  • Usees similar to atropine, similar effects, more potent antisialagogue, less potent increase HR
  • Dose: 0.2-0.4 mg IV
  • Combine with AChe drugs for reversal (0.05-0.07 mg/kg)
    • 1 cc of robinul for each cc of reversal drawn


What is lidocaine?

  • Amide local anesthetic
  • Prevents transmission of nerve impulses by inhibiting the passage of sodium ions through voltage gated sodium channels in nerve membrane
  • slows rate of depolarization such that the threshold potenital is not reached, and longer action potential is not propagated
  • In cardiac conduciton and myocardial muscle reduces intracellular sodium activity and intracellular Ca activity
    • reduction of arrhythmogenic transient depolarization
    • reduction of contractility by decreasing inward sodium current
  • Overdose can cause CNS toxicity/sz


Dose for lidocaine?

  • Used for local anesthetic activity
  • numbness of veins for propofol (30mg) and ablating response to laryngoscopy (1mg/kg)
  • Used as anti-dysthmic- suppresses ventricular dysrhythmia
    • 2mg/kg followed by infusion 1-4 mg/min


What is succinylcholine

Depolarizing muscle relaxant

  • Attaches to alpha subunits of nicotinic cholinergic receptor and mimic action of ACh, depolarizing the post junctional membrane
  • hydrolysis of SCh is lsower than ACh resulting in sustained depolarization of receptor ion channels


Dose succinylcholine? DOA, used for? Causes?

  • Dose 0.5-1.5 mg/kg
  • DOA 3-5 min
  • Used for emergency airway situations (0.5 mg to break laryngospasm)
    • RSI 1-1.5 mg/kg
  • Can cause: dysrhtyhmia (bradycardia, arrest- acts at cardiac muscarinic receptors mimics ACh, hyperkalemia, myalgias, increase GI pressure, ICP nad IOP


Overview labetalol?

  • Non selective beta blocker as well as alpha blcokade
  • B: alpha 7:1
  • Bolus of 10 mg typical
    • can repeat in 10 min
  • HTN emergency IV dose 40-80 mg
  • DOA 2-18 hrs
  • Make sure pt has adequate HR, do not give to asthmatics


What is esmolol/

Beta 1 selective agent at small doses

  • Onset 2 min
  • E1/2 t 9 minutes
    • metabolized by non-specific plasma esterases found in cytosol of RBC
  • Bolus dose 500 mcg/kg
  • in OR, typically 10-15 mg then dose according to resposne


When should we be cautious with administration of succinylcholine?

  • Especially cautious in paralyzed pt because they can have upregulation of ACh receptors, so admin of succinylcholine can cause hyperkalemia from efflux of K from cell. 
  • Caution in renal disease
  • caution in children- chance of undiagnosed muscular dystrophy


Important emergency drugs to alway have ready to go on cart

  • Succinylcholine
  • atropine
  • ephedrine
  • phenylephrine
  • optional
    • IV lidocaine
    • LTA
    • pt speicifc pre meds
    • preop sedation/meds
    • induction agent
    • NMB agent
    • narcotics needed during case
    • abx per surgeon request


Ped emergency doses to have ready to go?

  • Succinylcholine standard conc in 3 cc syringe
  • atropine standard concentration in 1 cc syringe
  • succinylcholine 2 cc= 40 mg and atropine 1cc= 0.4 mg in 3 cc syringetogether for final concnetraiton of
    • atropine 0.13 mg/cc and suc 13.3 mg/cc
  • Ephedrine burst a jet in med drawer, un opened



  • Machine check
  • Suction and emergency equipment
  • Monitors checked
  • Airway equipment
    • laryngoscope, appropriate ETT, oral and nasal airways, tongue depressor, laryngoscope, appropriate Mac Miller blades with lights checked. LMA, NGOG tube, esophageal stethoscope
    • eye tape, lub ETT tube tape
  • IV
    • IV kids reayd to go
  • Drugs