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Pharmacology 1 > Reversal Associated Dosages > Flashcards

Reversal Associated Dosages Flashcards

1
Q

Narcan (alternate name):

A

Naloxone

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2
Q

Narcan structure:

A

Derivative of Oxymorphone

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3
Q

Narcan MOA:

A

Competitive agonist of all opioid receptors
Greatest for Mu

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4
Q

Narcan Onset:

A

1-2 min

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5
Q

Narcan Duration of action:

A

30-60 min

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6
Q

Narcan PB:

A

50%

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7
Q

Narcan Metabolism:

A

Hepatic, Renal

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8
Q

Narcan IV adult Dose:

A

IV Adult: 0.4 - 2 mg
(repeat as needed)

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9
Q

Narcan IV peds Dose:

A

IV peds: 0.1 mg/kg (max 2mg)
(repeat as needed)

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10
Q

Narcan Side effects:

A
  1. Reversal of opioids
  2. increased resp drive
  3. increased BP
  4. N/V
  5. Arrythmias
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11
Q

Narcan Contraindications / cautions:

A
  1. Pulmonary edema
  2. Sudden death
  3. May need to re-dose
  4. Do not give fast
    5.
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12
Q

Sugammadex (alternate name):

A

Bridion

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13
Q

Sugammadex Structure:

A

Gamma cyclodextrin (selective relaxant-binding agent)

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14
Q

Sugammadex MOA:

A
  1. Hydrophobic cavity
  2. Encapsulates the steroid NMB (specifically roc)
  3. Forms a complex that cannot have an effect on receptors or acetylcholinesterase
  4. Highly water soluble
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15
Q

Sugammadex Onset:

A

1-2 min

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16
Q

Sugammadex duration of action:

A

2-16 h

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17
Q

Sugammadex PB:

A

0%

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18
Q

Sugammadex Metabolism:

A

Really excreted unchanged (80%)

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19
Q

Sugammadex IV dose:

A

IV: 2 mg/kg (TOF 2-4)
IV: 4 mg/kg (TOF 0-1)
IV: 16 mg/kg (1.2 mg/kg RSI reversal)

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20
Q

Sugammadex side effects:

A
  1. Bradycardia
  2. Nausea
  3. Headache
  4. Hepatic stable
  5. Potential asystole
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21
Q

Sugammadex Contraindications / cautions

A
  1. Birth control pills ineffective for 1 week
  2. Caution in renal disease
  3. Known hypersensitivity
  4. If need to reintubate, use a different NMB
  5. Ensure adequate reversal before extubation: head lift 5 secs, spontaneous ventilation, eye opening, hand grip, cough/gag reflex, leg raise
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22
Q

Glycopyrrolate (alternate name):

A

Robinul

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23
Q

Glycopyrrolate structure:

A

Anticholinergic
Quaternary ammonium

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24
Q

Glycopyrrolate MOA:

A
  1. Block muscarinic receptors
  2. Not nicotinic so that NMB can be antagonized while muscarinic effects are minimized
  3. blocks parasympathetic effects
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25
Glycopyrrolate Onset:
1-2 min
26
Glycopyrrolate duration of action:
2-4 h
27
Glycopyrrolate PB:
30%
28
Glycopyrrolate metabolism:
Limited hepatic, 80% unchanged renally
29
Glycopyrrolate IV dose:
0.6-1 mg (equal volume to anticholinesterase) 0.1-0.2 mg (antisalagouge, effect 2-4 x atropine)
30
Glycopyrrolate side effects (same as other anticholinergics):
1. Bronchodilation 2. Decrease PONV 3. Dry mouth 4. Pupil dilation 5. Increase HR
31
Glycopyrrolate Contraindications / cautions:
1. Give prior to anticholinesterase 2. Adjust dose if already tachycardic 3. Mix with equal volume of anticholinesterase 4. Tachycardia may be seen when administered with pyridostigmine b/c of its slow onset 5. Does not cross BBB 6. Overdose: mad as a hatter (confusion), blind as a bat (mydriasis), hot as a hare (no sweating), dry as a bone (dry mouth), red as a beet (flushing), full as a flask (urinary retention) (can’t see, pee, spit, or shit)
32
Atropine (alternate name):
Atropen
33
Atropine structure:
Anticholinergic Tertiary amine
34
Atropine MOA:
1. Competitively bind to the Ach receptor 2. prevents cGMP or cAMP mediated effects
35
Atropine Onset:
1-2 min
36
Atropine duration of action:
1-2 h
37
Atropine PB:
30%
38
Atropine Metabolism:
Liver 50%, renal 50% unchanged
39
Atropine IV dose:
IV: 15 mcg/kg (with equal volume anticholineasterase) or IV: 1-2 mg (with equal volume anti cholinesterase) (HR effects 2-4 x glycopyrrolate)
40
Atropine side effects (same as other anticholinergics):
1. Bronchodilation 2. Decrease PONV 3. Dry mouth 4. Pupil dilation 5. Increase HR
41
Atropine Contraindications / cautions:
1. Crosses BBB 2. Decreased baroreceptor sensitivity 3. High variability in HR 4. Does not increase HR in Heart transplant patients 5. Overdose: mad as a hatter (confusion), blind as a bat (mydriasis), hot as a hare (no sweating), dry as a bone (dry mouth), red as a beet (flushing), full as a flask (urinary retention) (can’t see, pee, spit, or shit)
42
Scopolamine (alternate name):
Hyoscine
43
Scopolamine structure:
Anticholinergic Tertiary amine Aromatic ester
44
Scopolamine MOA:
Competitive antagonist of peripheral and central muscarinic receptors
45
Scopolamine Onset:
4 h
46
Scopolamine duration of action:
3 days
47
Scopolamine PB:
30%
48
Scopolamine Metabolism:
CYP3A4, then conjugated and excreted by the kidneys
49
Scopolamine transdermal dose:
1.5 mg patch Releases 0.5 mg/day Stays on for 3 days
50
Scopolamine side effects (same as other anticholinergics):
1. Bronchodilation 2. Decreases PONV 3. Dry mouth 4. Pupil dilation 5. Increases HR
51
Scopolamine Contraindications / cautions:
1. Delirium 2. Sedation 3. Constipation 4. Blurred vision 5. Dizziness 6. Crosses BBB 7. Avoid in narrow-angle glaucoma (increases eye pressure) 8. Overdose: mad as a hatter (confusion), blind as a bat (mydriasis), hot as a hare (no sweating), dry as a bone (dry mouth), red as a beet (flushing), full as a flask (urinary retention) (can’t see, pee, spit, or shit)
52
Neostigmine (alternate name):
Bloxiverz
53
Neostigmine structure:
Anticholinesterase Quaternary Ammonia
54
Neostigmine MOA:
1. Inhibits acetylcholinesterase at NMJ 2. Increase Ach at the NMJ 3. Ach competes with NMB 4. reversal of nondepolarizing NMB
55
Neostigmine Onset:
5-15 min
56
Neostigmine duration of action:
1-2 h
57
Neostigmine PB
30%
58
Neostigmine Metabolism:
Hepatically & plasma esterase, Renally excreted
59
Neostigmine IV dose:
IV: 0.05-0.07 mg/kg MAX DOSE: 5 mg Ceiling effect at 0.07 mg/kg
60
Neostigmine side effects:
1. Cholinergic Crisis (DUMBELLS) 2. Diarrhea 3. Urination 4. Miosis 5. Bradycardia 6. Emesis 7. Lacrimation (tears) 8. Lethargy 9. Salivation
61
Neostigmine Cautions / contraindications
1. Always mix with anticholinergic 2. Must have 1-2 twitches on TOF 3. Previous allergic rxn 4. Use caution in pt with asthma 5. Does not cross the BBB
62
Physostigmine (alternate name):
antilirium
63
Physostigmine structure
Anticholinesterase Tertiary amine
64
Physostigmine MOA:
Inhibits acetylcholinesterase, thus allowing acetylcholine to increase at the NMJ
65
Physostigmine Onset:
5-10 min
66
Physostigmine duration of action:
30-60 min
67
Physostigmine PB:
30%
68
Physostigmine Metabolism:
Hepatically & plasma esterase, Renally excreted
69
Physostigmine IV dose:
IV: 15-60 mcg/kg
70
Physostigmine side effects:
1. Cholinergic Crisis (DUMBELLS) 2. Diarrhea 3. Urination 4. Miosis 5. Bradycardia 6. Emesis 7. Lacrimation (tears) 8. Lethargy 9. Salivation
71
Physostigmine Contraindications / cautions:
1. Used in central anticholinergic syndrome 2. Used for reversal of confusion following atropine/ scopolamine 3. Crosses BBB 4. Allergic reaction
72
Pyridostigmine (alternate name):
Mestinone
73
Pyridostigmine structure:
Anticholinesterase Quaternary ammonia
74
Pyridostigmine MOA:
1. Inhibit acetylcholinesterase at the NMJ 2. Allows for increased Ach at the NMJ to compete with NMB 3. results in the reversal of competitive nondepolarizing NMB
75
Pyridostigmine Onset:
10-20 min
76
Pyridostigmine duration of action:
1-2 h
77
Pyridostigmine PB:
30%
78
Pyridostigmine Metabolism:
Limited hepatic metabolism, 80% unchanged Renal
79
Pyridostigmine IV dose:
IV: 0.1 - 0.3 mg/kg
80
Pyridostigmine side effects:
1. Cholinergic Crisis (DUMBELLS) 2. Diarrhea 3. Urination 4. Miosis 5. Bradycardia 6. Emesis 7. Lacrimation (tears) 8. Lethargy 9. Salivation
81
Pyridostigmine Contraindications / cautions:
1. Always mix with anticholinergic 2. Must have 1-2 twitches on TOF 3. Previous allergic rxn 4. Use caution in pt with asthma 5. Does not cross the BBB
82
Flumazenil alternate name:
Romazicon
83
Flumazenil structure:
1, 4 imidazobenzodiazepine derivative
84
Flumazenil MOA:
Competitive benzodiazepine antagonist with high receptor affinity
85
Flumazenil Onset:
1-2 min
86
Flumazenil Duration of action:
30-60 min
87
Flumazenil PB:
50%
88
Flumazenil Metabolism:
Hepatic to inactive metabolites
89
Flumazenil IV dose:
1. IV Initial dose: 0.2 mg 2. IV Repeat dose: 0.3-0.5 mg Q 60 seconds (max 3 mg) 3. >5 mg w/o response = alternate reason for sedation
90
Flumazenil side effects:
1. Benzodiazepine reversal 2. Seizure 3. Nausea & Vomiting 4. Tachycardia 5. Hypertension
91
Flumazenil Contraindications / Cautions
1. Allergic Reaction 2. Arrhythmias 3. Withdrawal Symptoms 4. Dizziness/Lightheadedness 5. CAUTION: avoid with seizure patients on antiepileptics

Pharmacology 1 (12 decks)

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