Pharmacology Flashcards
TXWES REFERENCE GUIDE (158 cards)
1
Q
BENZOS
Dose (IV, PO), Onset, Duration:
Diazepam
Valium
A
Valium
0.1mg/kg IV
Onset 1-5mins ⏐Duration 2-6h
0.2mg/kg PO
2
Q
BENZOS
Dose, Onset, Duration:
Lorazepam
Ativan
A
Ativan
0.04mg/kg ⏐ Onset 1-5mins ⏐Duration 6-10h
3
Q
BENZOS
Dose, Onset, Duration:
Midazolam
Versed
A
Versed
1-5mg or 0.01-0.05mg/kg ⏐Onset 1-5mins ⏐Duration 15-80min
4
Q
BENZOS
Dose, Onset, Duration:
Flumazenil
Romazicon
A
Romazicon
0.2mg ⏐ Onset 1-5mins ⏐Duration 30mins!!! (may need redose to outlast BZD)
Repeat 0.1 q 1min –> MAX 3mg
BENZO REVERSAL
5
Q
OPIOIDS
Dose (intraOp, postop), Onset, Duration:
Morphine
A
1-10mg IntraOp
5-20mg PostOp
Onset 10-20mins ⏐ Duration 4-5h
6
Q
OPIOIDS
Dose, Onset, Duration:
Fentanyl
A
1.5-3mcg/kg
Onset 30-60sec ⏐ Duration 1-1.5h
7
Q
OPIOIDS
Dose, Onset, Duration:
Sufentanil
A
0.3-1mcg/kg
Onset 30-60sec ⏐ Duration 1-1.5hr
Infusion: 0.5-1mcg/kg/hr (close to intraop dose)
8
Q
OPIOIDS
Dose, Onset, Duration:
Remifentanil
A
LOAD: 0.5 - 1mcg/kg OVER 1 MIN!
Onset 30-60sec ⏐ Duration 6-8min
gtt: 0.125-0.375 mcg/kg/min
9
Q
OPIOIDS
Dose, Onset, Duration:
Meperidine
Demerol
A
Demerol
12.5mg (Shivering)
Onset 5-15min ⏐ Duration 2-4h
10
Q
OPIOIDS
Dose (intra, postop), Onset, Duration:
Hydromorphone
Diluadid
A
Dilaudid
1 - 4mg IntraOp
1.5 - 4mg PostOp (basically the same)
Onset 5-15min ⏐ Duration 2-4hr
11
Q
OPIOIDS
Dose, Onset, Duration:
Naloxone
Narcan
A
Narcan
40-80mcg ⏐ Onset 1-5 min⏐ Duration 30min
Opioid REVERSAL
12
Q
INDUCTION MEDS
Dose (induction, sedation gtt, TIVA gtt), Onset, Duration:
Propofol
A
1.5-2.5mg/kg Induction
25-100 mcg/kg/min Sedation
100-300 mcg/kg/min TIVA
Onset 30-60sec ⏐ 1-8mins
13
Q
Induction
Dose, Onset:
Etomidate
A
0.3mg/kg ⏐ Onset 1 min
14
Q
Induction
Dose (induction, IV analgesia), Onset, Duration:
Ketamine
A
0.5-1.5mg/kg Induction
0.2-0.5 mg/kg IV Analgesia
Onset 1 min⏐ 10-20min
4 - 8 mg/kg IM
15
Q
Induction Dose
Dose, Onset, Duration:
Midazolam
Versed
A
Versed
0.1-0.2mg/kg Induction
Onset 30-60sec ⏐ Duration 5-10min
*may precede dose w/ Fentanyl 50-100mcg
16
Q
Dose (Bolus and Infusion):
Dexmedetomidine
Precedex
A
Precedex
Bolus 0.5-1mcg/kg over 10mins
Infusion 0.2 - 0.7 mcg/kg/hr
Usually on-hand 200mcg/2ml > mix with 48cc NS ⇒ 4mcg/ml
17
Q
Inhalation
MAC, VP, Blood:Gas Co.:
Sevoflurane
A
Ultane
MAC 1.8
VP 157
Blood:gas Coefficient 0.69
18
Q
Inhalation
MAC, VP, Blood:Gas Co.:
Desflurane
A
Suprane
MAC 6.6
VP 669
Blood:gas Coefficient 0.42
19
Q
Inhalation
MAC, VP, Blood:Gas Co.:
Isoflurane
A
Forane
MAC 1.17
VP 238
Blood:gas Coefficient 1.46
20
Q
Inhalation
MAC, VP, Blood:Gas Co.:
Nitrous Oxide
A
MAC 104
VP 🚀 38,770 gas
Blood Coefficient 0.46
21
Q
Muscle Relaxants
Dose, Onset, Duration:
Succinylcholine
Anectine
A
Anectine
1-1.5 mg/kg
Onset 30-60sec ⏐Durations 5-10min
22
Q
Muscle Relaxants
Dose, Onset, Duration:
Cisatricurium
Nimbex
A
Nimbex
0.1 mg/kg
Onset 2-3min ⏐ Duration 40-75min
Hoffman Elimination
23
Q
Muscle Relaxants
Dose, Onset, Duration:
Vecuronium
Norcuron
A
Norcuron
0.1 mg/kg
Onset 2-3min⏐ 45-90min
24
Q
Muscle Relaxants
Dose (1st & 2nd), Onset, Duration:
Rocuronium
Zemuron
A
Zemuron
0.6 mg/kg Onset 2-3mins
1.2 mg/kg Onset 1.5 mins
Duration 35-75mins
25
# Muscle Relaxants
Dose, Onset, Duration:
**Pancuronium**
| Pavulon
Pavulon
0.1 mg/kg
Onset 2-3min ⏐Duration 60-120min
## Footnote
[Common]: 2mg/mL
26
# Muscle Relaxants Reversals
Dose, Onset, Duration, Anticholinergic buddy:
**Neostigmine**
0.04-0.07 mg/kg
Onset 5-10min ⏐ Duration 60min
| **Glycopyrrolate 0.2mg/ml of Neo to avoid bradycardia**
27
# Muscle Relaxants Reversals
Dose, Onset, Duration:
**Sugammadex**
2-16 mg/kg (depends on TOF & PTP)
Onset 1 - 4min ⏐ Duration 1.5 - 3hrs
28
# REGIONAL MEDS
Amide/Ester?
Regional MAX dose (mg/kg) w/ & w/o EPI?
**Lidocaine**
Amide
Max
w/o Epi: 5 mg/kg
w/ Epi: 7 mg/kg
29
# REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
**Prilocaine**
Amide
Max
w/o Epi: 6 mg/kg
w/ Epi: 8.5 mg/kg
30
# REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
**Mepivicaine**
Amide.
Max
w/o Epi: 5 mg/kg
w/ Epi: 7 mg/kg
31
# REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
**Bupivicaine**
Amide.
Max
w/o Epi: 2.5 mg/kg
w/ Epi: 2.5 mg/kg
| EPI DONT MAKE NO DIFFERENCE! 😅
32
# REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
**Ropivicaine**
Amide.
Max
w/o Epi: 3 mg/kg
w/ Epi: 4 mg/kg
33
# REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
**Procaine**
Ester.
Max
w/o Epi: 7 mg/kg
w/ Epi: 8.5 mg/kg
34
# REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
**Chloroprocaine**
Ester.
Max
w/o Epi: 6 mg/kg
w/ Epi: 14 mg/kg
35
# REGIONAL MEDS
Amide/Ester?
MAX dose (mg/kg) w/ & w/o EPI?
**Tetracaine**
Ester.
Max
w/o Epi: 3 mg/kg
w/ Epi: 3 mg/kg
| EPI MAKES NO DIFFERENCE 😅
36
# CSE LABOR ANALGESIA
Epidural (%) & Spinal (mg) doses?
**Bupivicaine**
Epidural: 0.0625-0.125%
Spinal: 1.25 - 2.5 mg
37
# CSE LABOR ANALGESIA
Epidural (%) & Spinal (mg) doses?
**Ropivicaine**
Epidural: 0.08 - 0.2%
Spinal: 2.5-4.5 mg
38
# CSE LABOR ANALGESIA
Epidural (%) & Spinal (mL) doses?
**Lidocaine + Epi**
Epidural: 2% in 5cc bolus
Spinal: N/A
| No spinal dose.
39
# CSE LABOR ANALGESIA
Epidural & Spinal doses? (mcg)
**Fentanyl**
Epidural: 50-100 mcg
Spinal: 10-25 mcg
40
# CSE LABOR ANALGESIA
Epidural & Spinal doses? (mcg)
**Sufentanil**
Epidural: 5 - 10 mcg
Spinal: 1.5 - 5 mcg
41
# CSE LABOR ANALGESIA
Epidural (%) & Spinal (mg) doses?
**Morphine**
NO epidural dose.
Spinal: 0.1 - 0.2 mg
42
# ANTIEMETICS
Dose, Onset, Duration:
**Droperidol**
| Inapsine
0.625mg⎪O: 1-5min⎪D: 2-3hrs
43
# ANTIEMETICS
Dose, Onset, Duration:
**Promethazine**
| Phenergan
6.25 - 25 mg⎪O: 1-5mins⎪D: 4-6hrs
44
# ANTIEMETICS
Dose, Onset, Duration:
**Ondansetron**
| Zofran
4mg⎪O: 10mins⎪D: 4-9hrs
45
# ANTIEMETICS
Dose, Onset, Duration:
**Dexamethasone**
| Decadron
4mg⎪O: 10-30mins⎪D: 2-10hrs
46
# ANTIEMETICS
Dose, Onset, Duration:
**Metoclopramide**
| Reglan
10-20mg⎪O: 10mins⎪D: 2hrs
47
# ANTIEMETICS
Dose, Onset, Duration:
**Scopolamine**
Patch⎪O: 2-4hrs⎪D: 72hrs
| Non-hairy area - dont touch eyes after handling --> can cause mydriasis.
48
# ANTIEMETICS
Dose, Onset, Duration:
**Propofol**
| Diprivan
Antiemetic Dose
10-15mg IV followed by 10**mcg**/kg/**min**
49
List some PONV risk factors.
Female, <40yrs, Hx of PONV or Motion Sickness, vertigo, non-smokers
*Surgeries:* Laparotomy, Laparoscopy, Major Breast, Strabismus, Intraocular, Middle Ear, Tonsils, Adenoids, Neuro (intracranial), Gynecologic, Testicular, Scrotum, Kidney stones
50
If I have 0 PONV risk factors, what is the chance I will have PONV?
10%
| This requires NO prophylactic drugs.
51
If I have 3 PONV risk factors, what is the chance I will have PONV?
What drugs will you treat your patient with?
> 60% chance.
Give at least 3 treament drugs: 5HT blocker, steroid, propofol + TIVA??
52
My patient requires 2 pre-treatment drugs for PONV; I gave zofran and decadron before her surgery.
How many risk factors do you think she has?
What are her chances of developing PONV based on this info?
2 risk factors = 40% chance of developing PONV
53
My chance of PONV is 20%.
How many risk factors do I have?
What drug(s) will you give me?
I have 1 risk factor and you should give me a 5HT-blocker like zofran :)
54
# NON OPIOID ANALGESICS
Dose & daily MAX dose.
**Acetaminophen**
| Ofirmev
1000mg q 4-6hr
MAX: 3-4g qd
55
# NON OPIOID ANALGESICS
Dose & daily MAX dose.
**Ketorlac**
| Toradol
15-30mg q6h
Max: 60-120mg qd
56
# NON OPIOID ANALGESICS
1x Dose & daily MAX dose.
**Ibuprofen**
| Caldor
200-800mg q6h
Max: 3200mg qd
57
List some symptoms of LAST.
| Local Anesthetic Systemic Toxicity
* Analgesia, lightheadedness
* tinnitis
* tongue/circumoral numbness
* tingling of mouth, funny/metallic taste
* SZ, LOC
* respiratory arrest, cardiovascular arrest.
58
Explain the lipid rescue for LAST.
In addition to CPR -
* BOLUS 20% intralipids 1.5mL/kg over 1min
* ⇒ Infusion 0.25mL/kg/min
* Circulate lipids w/ CPR
* Repeat bolus q3-5 mins UP TO 3ml/kg total dose until ROSC.
* ⬆ infusion to 0.5mL/kg/min if BP declines - continue infusion until hemodynamically stable.
*MAX DOSE: 8ml/kg
## Footnote
If you dont have 20% lipids immediately handy - give what you have until you obtain the 20%.
59
List the formula for Celcius ⇉ Farenheit
°F = [(9/5) x °C) + 32]
60
If my patient's temp is 96.8°F, what is it in °C?
94°F?
96.8ºF ⇉ 36°C
94ºF ⇉ 34.5°C
61
What is the formula for Farenheit ⇉ Celcius?
°C = [(5/9) x (°F - 32)]
62
If my patients temp is 38°C, what is it in °F?
40°C?
38°C ⇉ 100 °F
40°C ⇉ 104 °F
63
A nice pattern to help do quick temp conversions.
1. If you start at 95°F - celcius is 35.
2. As you increase in 0.9°F, each °C goes up by 0.5°
:)
64
# AIRWAY CLASSIFICATION
Describe a Mallampati 1.
PUSH
Pillars, Uvula, Soft/Hard Palate, and fauces
65
# AIRWAY CLASSIFICATION
Describe a Mallampati 2.
USH
Uvula, Soft/Hard Palate, and fauces
66
# AIRWAY CLASSIFICATION
Describe a Mallampati 3.
uSH
Base of uvula, Soft/Hard Palate
67
# AIRWAY CLASSIFICATION
Describe a Mallampati 4.
H
Hard Palate only
68
# AIRWAY CLASSIFICATION
List the Cormack-Lehane view grade: Full view of entire glottic opening.
Grade 1
69
# AIRWAY CLASSIFICATION
List the Cormack-Lehane view grade:
Neither glottis nor epiglottis seen.
Grade 4.
70
# AIRWAY CLASSIFICATION
List the Cormack-Lehane view grade:
Only epiglottis seen.
Grade 3.
71
# AIRWAY CLASSIFICATION
List the Cormack-Lehane view grade:
Only posterior portion of glottic opening.
Grade 2.
72
# ASA Class
A patient with an ASA I would exhibit what?
Normal healthy patient
73
# ASA Class
A patient with an ASA II would exhibit what?
Mild systemic disease (no functional limitations)
74
# ASA Class
A patient with an ASA III would exhibit what?
Severe systemic disease (some functional limitations)
75
# ASA Class
A patient with an ASA IV would exhibit what?
Severe systemic disease with constant threat to life
76
# ASA Class
A patient with an ASA V would exhibit what?
Moribund (near death) patient not expected to survive without surgery
77
# ASA Class
A patient with an ASA VI would exhibit what?
Brain dead patient, organs procured
78
List the normal blood gas values:
pH
PaO₂
PaCO₂
pH: 7.35-7.45
PaO₂: 90-100
PaCO₂: 35-45
79
List the normal blood gas values:
HCO₃⁻
BE
SaO₂
HCO₃⁻: 22-26
BE: -2 to 2
SaO₂: 95-98%
80
Formula for VO₂
10 x kg(3/4) = VO₂
81
Formula for VCO₂
8 x kg(3/4) = VCO₂
82
What does this formula describe?
[FiO₂ x (Pb - PH₂O)] - PaCO₂ / 0.8
Alveoar Gas/Air Equation
## Footnote
https://youtu.be/vrjK4gxa-48
83
Formula for *arterial* O₂ content/dL
(Hgb x 1.34 x SaO₂) + (PaO₂ x 0.003)
84
PBW (predicted body weight) equation for a male.
50 + 0.91(cm height - 152.4)kg = male PBW
## Footnote
PBW is used to determine your tidal volume (5 - 8cc/kg).
85
PBW (predicted body weight) equation for a female
45.5 + 0.91 (cm height -152.4)kg = female PBW.
## Footnote
PBW is used to determine your tidal volume (5 - 8cc/kg).
86
Formula for MAP.
What is the normal adult range?
[SBP + (2xDBP) / 3]
or
[DBP + 1/3(SBP-DBP)]
Normal range: 70-105mmHg
87
Normal CO
4-8 L/min
88
Formula for CI
Normal range for CI?
(CO / BSA)
2.5 - 4 L/min
89
Normal CVP range?
2-6 mmHg
90
Normal PCWP?
What does PCWP measure?
8-12 mmHg
Helps measures LA pressure, along with L heart function (mitral valves & LV filling pressure).
91
Normal PVR?
(pulmonary vascular resistance)
50 - 350 dynes/cm/sec⁻⁵
92
Normal SVR?
700 - 1400 dynes/cm/sec⁻⁵
93
Normal EF?
55-70%
94
Normal mPAP? sPAP? dPAP?
mPAP: ~15mmHg
sPAP: 15-30 mmHg
dPAP: 5-15 mmHg
95
Formula for Shock Index
(HR / SBP)
## Footnote
>1 = increased M&M & chance of Mass Transfusion protocol (MTP)
96
EBV of premature infant
95mL/kg
97
EBV of full-term infant
85mL/kg
98
EBV of infant - 12mo
80mL/kg
99
EBV of male adult/child
75mL/kg
100
EBV of female adult/child
65mL/kg
101
EBV of morbid obese (BMI >40)
60mL/kg
102
Allowable blood loss (ABL) formula
[(EBL x initial Hct) - (EBV x Hct allowable)] x3
Hct allowable = 30%
103
# Fluid Replacement Equivalent
Crystalloids
3ml / 1ml EBL
104
# Fluid Replacement Equivalent
Colloids
1ml / 1ml EBL
105
# Fluid Replacement Equivalent
Whole Blood
1ml / 1ml EBL
## Footnote
*same as colloids
106
# Fluid Replacement Equivalent
PRBC
0.5ml / 1ml EBL
## Footnote
PRBC Hct = 70%
107
# Fluid Replacement Equivalent
How much EBL is in a fully soaked 4x4 gauze? Raytech?
4x4 ≈ 10 mL
Raytech ≈ 20 mL
108
# Fluid Replacement Equivalent
How much EBL is in a fully soaked 'lap' sponge?
100-150cc
109
What is the 4-2-1 rule for maintenance fluids?
1st 10kg = 4cc/kg/hr
2nd 10kg = 2cc/kg/hr
Every kg >20 = 1cc/kg/hr
110
How do you accomodate for an NPO deficit with maintenance fluids?
(maintenance rate x #hrs NPO)
111
What are the estimated evaporated losses?
(minimal, moderate, severe)
Minimal = 0 - 2 mL/kg/hr
Moderate = 2 - 4 mL/kg/hr
Severe = 4 - 8 mL/kg/hr
112
BMI formula(s)
## Footnote
1in = 0.025meters
113
Healthy BMI range
18.5 - 25
114
Overweight BMI
25 - 30
115
Obese BMI
30+
116
Morbidly obese BMI
>35-40
117
Super morbidly obese
>55
118
List the IBW formulas.
(male, female)
Male: (cm Ht - 100)=kg
Female (cm Ht - 105)=kg
## Footnote
1in = 2.5cm
119
Dose of ephedrine for HoTN?
Main receptor(s)?
5mg
⍺ & β agonist
## Footnote
[common] = 5mg/mL
120
Dose of Neosynephrine for HoTN?
Main receptor(s)?
100mcg
⍺ agonist
## Footnote
[common] = 10mg/mL
121
Labetalol dose for HTN?
Main receptor?
5mg
β (and ⍺) antagonist
## Footnote
[common] = 5m/mL
122
Esmolol dose for HTN?
Main receptor?
10mg
β1 antagonist
## Footnote
[common] = 10mg/mL
123
Hydralazine dose?
Main receptor?
5mg
Directly vasodilates on the smooth muscle of the arterioles.
## Footnote
[common] =20mg/mL
124
# LABS
Hct (male, female)
male: 42-52 g/dL
female: 37-47 g/dL
125
# LABS
Hgb (male, female)
male: 14-18 g/dL
female: 13-16 g/dL
126
# LABS
WBCs
4k-11k microL
127
# LABS
Plts
150k-450k microL
128
# LABS
K+
3.5-5 mEq/L
129
# LABS
Mg
1.5-2.5 mEq/L
130
# LABS
Ca++
8.5-10.5 mg/dL
131
# LABS
iCa++
**4.8 - 5.3 mg/dL** (easy to remember bc it's 1/2 of normal Ca++ level)
or
**1.1 - 1.3 mmol/L** (used often)
132
# LABS
Phos
1.8 - 2.6 mEq/L
133
# LABS
Cl-
100-108 mEq/L
134
# LABS
BUN
&
Creatinine
BUN: 10-20 mg/dL
Creatinine: 0.6-1.3 mg/dL
135
# LABS
Albumin
3.5-5.5 g/dL
136
# LABS
PT
11-14 sec
## Footnote
WEPT (warfarin, extrinsic, PT level)
137
# LABS
INR
1
## Footnote
Normal INR on Warfarin: 2-3
138
# LABS
PTT
21-34 sec
## Footnote
On heparin = varies (~60-100 secs) depending on your coag goals!
139
# LABS
ACT
| Activating Clotting Time
80-120 secs
> 160-180sec for ECMO
| > 400sec for CPB
## Footnote
Used for large heparin doses.
140
# LABS
FSP
| Fibrin Split Products
<10 µ/dL
| Fragments from dissolved clots. Used often for DIC
141
# LABS
Fibrinogen
160-450 mg/dL
| (the netting that covers the clot)
142
# LABS
Plasminogen
62-130%
| Plasminogen makes Plasmin. Plasmin degrades fibrin (or clots)
143
# LABS
FDP
| Fibrin Degredation Products
<10 µ/mL
| basically FSP but resulted in different units.
144
# LABS
D-Dimer
<250 ng/dL
| Only detectable if you are currently breaking down lots of clots.
145
# LABS
TSH
T3
T4
TSH: 0.4 µ units/mL
T3: 90 -230 ng/dL
T4: 13 - 15 µ/dL
| Control metabolism, temp, mood, weight, neuro fxn, & muscle strength.
## Footnote
T3 = MORE active, 7%, majority made in cells.
T4 = main circulating thyroid hormone, 93%, can be converted to T3 using iodinase.
146
# LABS
AST
ALT
<35 IU/L
## Footnote
Liver function - ALT more specfic to liver, AST involves other organs including the liver.
147
# LABS
Fill in the blanks for the lab model:
148
# LABS
Fill in the blanks:
149
# LABS
Fill in the blanks:
150
List triggers for MH.
Volatile Anesthetics & SCh
151
List signs of MH crisis
* tachycardia, tachypnea
* **rapidly increasing ETCO2**
* muscle rigidity, masseter spasm
* hyperthermia
* skin mottling
152
List the treatment regimen for MH.
1. STOP THE TRIGGER
2. 100% O₂ hyperventilation
3. Dantrolene 2.5mg/kg IV (repeat 5-10mins; MAX 10mg/kg)
4. Actively cool pt
5. correct hyperkalmia and metabolic acidosis
6. Monitor labs and maintain UO >2cc/kg/hr (hydration, mannitol, lasix) *watch for rhabdo*
153
What is the dose of Dantrolene for MH?
2.5mg/kg IV (repeat q5-10mins prn)
## Footnote
MAX 10mg/kg
154
# PEDI ETT
How can you determine the ETT length?
(Tube size x 3)
155
# PEDI ETT
List the ETT sizes:
Preemies (≤ 1kg)
Preemies (1-2.5kg)
Term Neonate
2.5
3
3.0 - 3.5
156
# PEDI ETT
List the ETT sizes:
6mo-1yr
1-2yr
3.5 - 4.0
4.0 - 4.5
157
# ETT SIZING
How do you determine ETT size for >2yrs?
[(age + 16) / 4]
or
[(age / 4) + 4]
158
# PEDI LMA SIZES
List the size & max cuff air volume:
0-5kg
5-10kg
10-20kg
20-30kg
>30kg
Adult
1 (4cc)
1.5 (7cc)
2 (10cc)
2.5 (14cc)
3 (20cc)
4 (30cc)
