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Flashcards in important cards Deck (61):
1

atropine

(tertiary amine, anticholinergic) onset 1 minute
DOA 30-60 mins
E 1/2 t 1 hour
18% eliminated unchanged in urine
reversal: .01 mg/kg IV
bradycardia: .4-1mg IV
PEA: 1mg Q 3-5 minutes

2

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

3

Norepinephrine

(direct acting endogenous catecholamine; adrenergic agonist)
Onset: <1 min, E1/2T 1-2 min, DOA 5-10 min, Met and elmin=MAO, COMT in blood, liver, kidney. Metabolite: VMA
4-16mcg/min

4

alfentanil

(phenyl-piperidine synthetic opioid agonist)
onset rapid
DOA 30-60 mins
90% non ionized * highest!
E 1/2 t 1.5 hours
10-20x more potent than morphine
pain: 10-20 mcg/kg
induction: 50-200 mcg/kg IV

5

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

6

Dexamethasone

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

7

isoflurane

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

8

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

9

ketamine

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

10

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

11

edrophonium

(quaternary ammonium, anticholinesterase) onset rapid
DOA 1 hour
1/10 as potent as neostigmine
.5-1 mg/kg with atropine .01mg/kg

12

Dobutamine

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

13

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

14

flumazenil

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

15

lorazepam

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

16

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

17

desflurane

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

18

cisatracurium
(nimbex)

(intermediate acting NDNMB)
onset 3-5 mins
DOA 30 mins
E 1/2 T 20 mins
active metabolite: laudanosine
intubating dose: .2mg/kg

19

sufentanil

(phenyl-piperidine synthetic opioid agonist)
onset 1-3 mins
DOA 30-60 mins
E 1/2 t 2.5 hours
90% Pb, 20% non ionized
highest lipid solubility
weak active metabolite desmethylsufentanil
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

20

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

21

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

22

N20

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

23

metoclopramide

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

24

meperidine

(phenyl-piperidine synthetic opioid agonist), atropine sx, kappa and alpha 2 activity
onset <1 minute
DOA 3 hours
Pb moderate
% non ionized 7%
E 1/2 T 3 hours
moderate LS
1/10 as potent as morphine
active metabolite normeperidine
IV 5 mg Q 5 minutes
IM/SC/PO: 50-150 mg
shivering: 12.5-50 mg IV

25

glycopyrrolate

(synthetic quaternary ammonium, anticholinergic) onset 2-3 minutes
DOA 30-60 mins
E 1/2 T 1 hour
85% excreted unchanged in urine
reversal: .01-.02 mg/kg IV
.1-.2 mg anti-sialagogue and bradycardia

26

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

27

pancuronium (pavulon)

(long acting NDNMB)
onset 3-5 mins
DOA 2-3.5 hours
E 1/2 T 2 hours
80% excreted unchanged active metabolite 3-OH panc
intubating dose .1mg/kg

28

etomidate

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

29

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

30

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

31

morphine

(natural opioid agonist)
onset <5 mins
DOA 4 hours
Pb 30%
non ionized 20%
Ls 30%
active metabolite: morphine 6 gluconoride
preop/postop: 2.5-15 mg IV
intra-op: 0.1-1 mg/kg

32

rocuronium (zemuron)

(short/intermediate acting NDNMB)
onset 1-2 mins
DOA <30 or 30-60
Pb 50%
E 1/2 T 2 hours
.6-1.2 mg/kg intubating dose
(higher end dosing can be used for RSI)

33

hydromorphone

(derivate of morphine, semi-synthetic opioid)
onset 30 seconds
DOA 3 hours
Pb 10%
5x more potent than morphine
.5-2mg IV Q 2-6 hrs
2-4 mg PO q 4-6

34

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

35

sodium citrate

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

36

succinylcholine

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

37

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

38

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

39

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)

40

mivacurium (mivacron)

(short acting NDNMB)
onset 1-2 mins
DOA <30 mins
E 1/2 T 1 hour
metabolism: plasma esterases
.2 mg/kg IV
topoff .02 mg/kg every 5-15 minutes

41

sevoflurane

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

42

Dopamine

(Endogenous catecholamine, adrenergic agonist stimulates all receptors)
Onset: <1 min, E1/2T 1 -2 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

43

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

44

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

45

diazepam

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

46

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!

47

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

48

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

49

Phenylephrine

(Synthetic non-catecholamine, direct acting, selective A1)
Onset: <1 min, DOA 5-20min, E 1/2 T 2.5 hours Met and Elim: MAO to phenolic conjugates and excreted via urine (90%)
PB: High, 90%
50-200mcg IV
Maint: 20-50mcg/min
Double dilute to 100mcg/cc

50

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

51

remifentanil

(phenyl-piperidine synthetic opioid agonist with ester linkage)
onset 1-3 mins
DOA 5-10 mins
E 1/2 t 10 mins
Pb 60-90%
% non ionized 60%
moderate lipid solubility
100x more potent than morphine
induction: .5-1 mcg/kg over 60 seconds
infusion: 1-2 mcg/kg/min

52

neostigmine

(quaternary ammonium, anticholinesterase) onset 3-5 mins
DOA 1 hour
E 1/2 t 70 mins
*most potent
.05-.07 mg/kg give with glyco .01 mg/kg

53

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

54

midazolam

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

55

dexmedetomidine

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

56

fentanyl

(phenyl-piperidine synthetic opioid agonist)
onset 1-3 mins
DOA 30-60 mins
E 1/2 t 3-6 hours
Pb high
% non ionized 10%
3 weak active metabolites
100x more potent than morphine
preop: 25-100 mcg
analgesia: 1-2 mcg/kg IV

57

Ondansetron (Zofran)

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

58

atracurium
(tracrium)

( intermediate acting NDNMB)
onset 3-5 mins
DOA 30 mins
80% Pb
E 1/2 T 20 mins
active metabolite: laudanosine
intubating dose: .5mg/kg
topoff .05mg/kg every 45 minutes

59

Ephedrine

(Synthetic Non-catecholamine, direct and indirect adrenergic agonist)
Onset: rapid, DOA 1-1.5 hr (long!) , E1/2T 3 hrs, Met and Elim: resistant to MAO, 40% unchanged in urine
5-25 mg IV

60

Ranitidine

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

61

vecuronium
(norcuron)

(intermediate acting steroid type NDNMB)
onset 3-5 mins
DOA 30-60 mins
E 1/2 T 1 hour
Pb 60-80%
active metabolite: 3 desacetyl vec
intubating dose: .1 mg/kg