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Medica/tion ChartMedications in the Anesthesia CartDrug:Mech of action & Receptor:Onset:Duration of action:Normal Dose:Uses:Risks:Other:Alupent(metaproterenol sulfate)* SympathomimeticStimulates ?2 receptors, resulting in relaxation of bronchial smooth muscle. Selective ?2-adrenergic receptor agonistInhalation:1 min.Inhalation:3-6 hrs.MDI:Inhal. x 2-3 q 3-4 hrs. PRN (0.65mg/spray)**MAX:12 inhalations/24 hrsNebulizer: Inhal x 5-15 of 5% soln. (0.3ml/dose) Kids: Rx not recommendedBronchodilator to Tx:- bronchospasm r/t asthma, chronic bronchitis, emphysemaHTN, hypoTNTachy, palpitationsHypo-K↑ BP followed by a substantial ↓ in BP. Severe paradoxical bronchoconstriction.Drowsiness, coughN/V, tremor, HA nervousness, vertigoInsomniaCaution: isch. Heart, HTN, arrhyth., ↑ thyroid, DM,Seizures, RF, liver dxContra:pt w dysrhyth hypersensitivity, tachy r/t dig tox.Interactions: other Sympaths., MAOI’s, BB. Category CAtracurium Besylate(Tracrium)* Non-depolarizing NMBACompetes for cholinergic receptors at the motor end plate. Nicotinic receptors Reversal: Anticholinesterase Rx w/ Atropine or Glycopyr.IV: <3 min.IV: 20-35 min.Elim: Ester hydrolysis & Hoffman elim. - Temp & pH dep.Intubation: IV: 0.3-0.5mg/kg (add’l doses at 10-50% of intub. dose).monitor: w/ nerve stimulator to min. OD.Facilitate tracheal intubation, Improve surgical working conditions during general anesthesia (produces skeletal muscle relaxation), used to facilitate mechanical ventilation in critically ill. HypoTN, vasodilationST, SBHypovent./apneaBroncho/larynospasmDyspnea, urticariaHistamine SE rare at recommended doses.Prolonged infus. ↑ seizure risk.Active Metabolite: Laudanosine can cause CNS stim. (give 10X the normal dose) Caution: hx of asthma & anaphylax.Interactions: NM block ↑ w/: animogl. abx, LA, Mg, lithium, ganglionic blockers, hypothermia, hypo-K, resp acidosis, Succs, Volatile, loops,MG, adrenocort. dysf.Req ↓ & w/: VolatilesRecurrent paralysis w/ quinidine.Reversal effects ↓ w/: theophylline, paresis, anticonvul. Rx, burn pt.Category CAtropine Sulfate*AnticholinergicCompetitively antagonizes Ach at Muscarinic receptor.IV: 45-60 secETT:10-20 secIM: 5-40 min.Inhal: 3-5 minIV/IM: antichol 1-2 hr antisialog 4hr.Inhalation: antichol 3-6 hrs.Elim: Hepatic & RenalACLS & Brady: IV/IM/SC 0.5-1mg, q 3-5 min x 3Kids: 10-20 mcg/kgPre-Op: IV/IM 0.4-1 mgBronchodilation: Inhal 0.025 mg/kg q 4-6 hrs. (2.5 mg max)Emergence: IV 0.015 mg/kg with…Edroph: 10mcg/kgNeo: 0.05-1 mg/kgBrady, ACLS, pre-med to ↓ secretion, NMBA reversal /emergence, bronchospasm.Cholinergic crisis.OP poisoning.Resp. dep., CNS effects, dry mouth. ↓ GI motility & LES tone,GERD(↑ asp risk)UO retention.High doses: tachy, anhydrosis Low doses: BradyToxicity: tx w/ Benzo & physostigmine.Contra: obstruct. Uropathy/GI, NA glaucoma.Caution: additive effects w/ other Rx, Pts w/ tachy arrhyth, CHF, AMI, fever, GERD, GI infect.Antagonizes: Reglan & Antichol-ase Rxs. Crosses BBBCategory CCalcium Chloride3x ↑ Ca vs Ca gluc.*electrolyte & + inotropeNerve and muscle fxn/contraction, cell memb. & cap. perm., renal fxn, resp., coagulation.Ca channel receptors.IV: <30 sec.IV: 10-20 min.Elim: GI & RenalAdult: IV 500-1000 mgKids: IV 10-25 mg/kgGoal serum Ca: **8.5-10mg/dLACLS, hyper-K (w/ EKG changes), hyper-Mg, Lg. vol. Transf. (citrate),Ca antagonist OD. HTN, hypoTN, brady, Arrest, N/V, lethargy, hyper-Ca (weak, HA, fatigue, confusion, irregular HR).Arrhyth. w/ rapid IVPAntagonizes: CCB, Verapamil, Mg. ↑ Arrhyth: dig tox.Category CDexamethasone(Decadron)* Synthetic Glucocorticoid ↓ inflammation by inhibiting the migration of leukocytes and reversal of increased capillary permeability. Suppresses normal immune response.Glucocorticoid receptorsIV/IM:Anti-inflam. 2-5 min.IV/IM:Anti-inflam.36-54 hoursElim: Anti-inflammatory: IV/IM 0.5-25mg/day ↑ ICP/Cerebral edema:IV 10-50mg initially → IV/IM 4-20mg q 6 hrs x 5-7 days.Airway Edema: IV 10-25mg q 6 hrs x 5 PRN(at least 24hrs prior to intub.)Bronchospasm:Inhal 300mcg (3) 3-4 x day0.75mg Dex. = 20mg CortisolInflamm. diseases ↑ ICP/cerebral edema, Aspir. pneumo. Bronchial asthmaPrevent transplant rej.Replace. therapy w/ adrenalcortical insuff. Arrhyth, HTNCHF (susceptible pts)Seizure, ↑ICP, psychosis↑ Insulin req.↓ wound healing Petechiae, erythema. ↑ IOPH2O/Na retentionK depletionMyopathy, weaknessThromboembolism↑ risk of infection (↑ masking of S&S)Long-term: muscle wasting, spont. fx.Avoid NSAIS’sEnhance ?-agonistsAlters Counadin resp Caution: pt w/ HTN, CHF, emboli hx, MG, ↓ thyroid, cirrhosis, peptic ulcer, UC, diverticulitis, new GI anastomosis, psychosis, seizures, syst. fungal/viral inf.Contra: admin of live viral vaccines.Category CDigoxin(Digitalis)(Lanoxin)*Cardiac GlycosideDirectly inotropic effect d/t inhibitor of the Na-K ATPase pump. Indirect vagomimetic effect ↓ conduction through the SA node & prolongs conduction at AV node.IV: 5-30 min.PO: 0.5-2 hrs.IV/PO: 3-4 daysElim: RenalAdults: IV/PO 0.5-1mg divided: 50% → remaining in 25% x 4, then→IV/PO 0.125-0.5mg/dailyCreat Cl. 10-79 & >65 y/o:↓ daily dose: IV/PO <0.25mgMonitoring: K & Dig levels (must be 4-6 hr post dose; therep. takes up to 7 days)CHF, SVT+ inotrope - chronotrope↑ contractility↓ myocardial O2 consumptionNarrow therp. rangeCHB, arrhyth. (VT, VF, ect.)HA, psychosis, confs.N/V/D, gynecomastiaToxicity S&S: N/V, arrhyth., HA, ↑or↓ K (or normal), drowsy, Yellow-green haols. Interactions: Toxicity ↑ w/ ↓ K, ↓ Mg, ↑ Ca, ↑ serum CCB levels, enzyme inhibitors.↑ thyroid ↑ resistance↑ arrhyth w/ SuccsContra: VF, cardioversion w/ dig toxicity. Diphenhydramine(Benadryl)* AntihistamineAntagonizes histamine H1 receptors.H1 receptorsIV: 3-5 min.PO: <15 min.IV/PO: 4-6 hrsElim: HepaticIV/IM 10-50mg**MAX: 400mg/dayPO 25-50mg q 6-8 hrsAntiemetic, antivertigo, allergic rxn., EPS rxn (symptomatic), anticholPartially inhib. vasodil effects of histamine. Anaphylaxis after Epi.HypoTN, palp., PVC.Wheezing, tightness. Paradox. CNS stimul. (more in kids)Sedation, conf., blur. vision, tinnitus, tremors, seizures.Urine frequency or retention.Caution: Sedative effects are additive, MAOI’s potentiate antichol. effects, NA glaucoma, ↑ IOP, seizures, GI or bladder neck obst. lower resp dx (incl. asthma). Droperidol(Inapsine)* Neuroleptic- ButrophenoneAntagonizes dopamine, NE, & serotonin at the NT synapses, incl. the CTZ. Producing tranquilization, antiemetic effects.Dopamine, NE, & Serotonin receptors IV/IM: 3-10 min.IV/IM: 2-4 hoursElim: Hepatic & RenalPre-Op:IV/IM 2.5-10mgAntiemetic: IV 0.625-2.5 mgNeuroleptanesthesia:IV 0.2mg/kg with…Fentanyl 4mcg/kgEpidural: 1.25-2.5mgAnesth. pre-med - N/V Neuroleptic↓ potentiation and SE of Opioid epidural.HypoTN, ↓SVR,Tachy (↓ upstroke), prolonged QT.Prolonged CNS dep. w/ neuroleptanesth.EPS, drowsiness, hyperactivity.“Fear of death” w/ pre-op admin. R/o hypoTN enduced N/V before admin. Contra: Parkinson’sCaution: potentiates other CNS dep. Rx, ↓ effects of Epi,↑ threshold for Haloth. & Epi-induced arrhyth.Category CEdrophonium Chloride(Enlon)(Tensilon)(Reversol)* AnticholinesteraseInhibits hydrolysis Ach by competitively binding to acetylcholinesterase. improves intestinal/ skeletal muscle tone, increases secretions, salivation.Binds to acetylcholinesterase.Tx Chol. Crisis:Atropine: IV 10mcg/kg q 3-10 min PRNIV: 30-60 secIV: 5-20 min.Elim: Hepatic & RenalEmergence: Slow IVP 0.5-1mg/kg **MAX: 40mg with….Atropine 0.015mg/kgGlycopyrrolate 0.01mg/kgPSVT:Slow IVP 2mg q 1-2 min.MAX: 10mg w/ Atropine avail(1mg/kg if > 90% twitch depression when reversal is intiated).Reverse ND NMBADx of MG (↑ strength)DX & Tx PSVT- including WPW Short actingBrady, tachy, AV block, hypoTN↑ secretions, resp ditress, bronchosp.Anaphyl, allergic rxnSeizures, dysarthria HA, miosisN/V/G, ↑ peristalsisUrticaria, rashOD: cholinergic crisis NO effect on depol NMBA (Succs)Interactions: effects ↓ with amino abx, steroids, Mg, hypo-K, hypothermia, resp & metabolic acidosis. Caution: brady, asthma, arrhyth., peptic ulcers. Contra: peritonitis, GI or urinary obst. Category CEphedrine*Non-CatecholamineSympathomimeticMixed direct & indirect stimul. of the ɑ- & ?-adrenergic receptors by ↑ the activity of NE at post-synaptic α- and β-receptors.Alpha and Beta adrenergic receptorsIV: immed.IM: 2-5 min.IV/IM: 10-60 min.Elim: Hepatic & Renal Resistant to: MAO & COMTHypotension/ Bronchospasm: IV 5-25 mg IM/SC 25-50mg q 5-10 minPO 25-50mg q 3-4 hr PRN(PO for bronchospasm only)**MAX: 150mg/24 hrsVasopressorBronchodilator↑ CO, BP, HR, coronary BF, skeletal BFHTN, tachy, arrhyth.Pulm. edema Anxiety, tremors Insomnia (CNS stim.)Trans. hyper-K then results in hypo-K.Unpredictable effects: pt w/ depl. endrog NEVolatiles: co-admin ↑ arrhyth, ↑ MACPotentiated: w/ TCACaution: pt w/ HTN, ischemic heart dx. Category C- Min alt. uterine BFEpinephrine(Adrenaline)*Sympathommetic (Catecholamine)A1 ↑ vasoconstriction A2 relax smooth muscle B1 ↑ bronchodilation B2 ↑ myocardial contract. And HRAgonist: alpha 1, alpha 2, beta 1, beta 2. (response dose dep.)IV: 30-60 secSC: 6-15 minETT: 5-15 secInhal: 3-5 minIV: 5-10 minETT: 15-25 min.Inhal/SC: 1-3 hrs. Elim: MAO & COMTACLS: IVP 1mg q 3-5 min x2 (1:10,000 soln)Intra-Op: Infusion 2-20mcg/min. Anaphylaxis:IM/SC 0.1-0.5mg (1:1,000 soln.)Bronchodilation: Neb w/ O2: Dilute 1ml 2.25% racemic Epi OR 1% (1:100) Epi w/ 3ml NS, give 1-3 inhal q 5 min.ACLS, anaphylaxis, prolong LAPost-intubation & infectious Croup.HTN, tachy, angina, arrhyth., pulm edema. hypo-K, & transient hyper-K. Anxiety, HACerebral hemorrhage.↓ renal BF, ↓ UO. Caution: ↑ effects of TCA’s, ↑ arrhyth w/ volatiles & dig tox.Pt’s w/ HTN, CVD, DM, hyperthyroid. Contra: LA or reg. in digits, nose, ect..Category CEsmolol(Brevibloc)* Beta Blocker Cardioselective Selectively antagonizes Beta1 receptors prod. negative inotropic & chronotropic effects:↓ sinus HR, ↓ CO, ↓ BP.Beta1-adrenergic receptorsReversal: PacemakerAtropine IV 1-2mgIsoproterenol IV 0.02-0.15mcg/kg/minGlucagon IV 1-5mgIV: 1-2 min.IV: 10-20 min.Elim: EsterasesInduction: IV 25-100mg 2 min priorSVT:IV 500mcg/kg/1 min. → infus. 50-200mcg/kg/min (titrate)HTN:IVP 25-100mg q 5 min. PRNInfus. 50-300mcg/kg/min.SVT, peri/intra-op HTNAttenuate pressor response d/t intubation.HypoTN, bradyConfusion, N/VUrinary retention↑ Dig. levelsMask ↓ BGIV site rxn.High-dose: Antag. B2- Bronchospasm- ↓ BG↑ levels w/ co-admin: morphine, warfarin.Potentiates: myocar. dep. w/ inhal. or IV anesth.; NMB of Succs & Panc.Caution: AV-HB, non-tachy HF, COPDIncompatable: Bicarb Category CEtomidate (Amidate)Enhances the effects of GABA similar to barbs, propofol, and benzo’s.GABA receptor agonistIV: 30-60 secIV: 3-10 min.Elim: HepaticInduction: IV 0.1-0.4 mg/kgInfus 0.25-1mg/min.Induction Anesth. supplement- alt. to propofol/ Barbs esp. w/ CV instability. HypoTN, HTN Arrhyth., N/VHypovent., hyperventLaryngospasmhiccup, eye/muscle movements.Adrenocortical supp. ThrombophlebitisRapid IVP: ven.pain & myoclonus.↓w/ benzo/opioid pre-medInteractions: CV & CNS dep. ↑ w/ Narcs, sedatives, & volatilesCaution: pt w/ focal epilepsyCategory CFentanyl(Sublimaze)*OpioidActivates Mu1 & Mu2 opioid receptors. Reversal: NaloxoneIV/IM/SC: 0.2-0.4 mgIV: 30 secIM: <8 min.IV: 30-60 min.IM: 1-2 hrs.Elim: Hepatic & Pulm. Pre-Op & Analgesia:IM/IV 25-100 mcg Induction: IVP 5-40 mcg/kgIntra-Op: IV 2-20 mcg/kg Analgesia, pre-med., anesthesia.Resp. dep.(dose dep),Rigidity(high dose), Brady, HypoTN Urinary retentionN/VCaution: MAOI’sCategory C - Crosses placentaFlumazenil(Romazicon)*Benzo antagonist**Reversal Rx**Antagonizes the effect of benzos at the GABA receptor.GABA receptor antagonist.IV/ETT: 1-2 min.IV/ETT: 45-90 min.Elim: HepaticReversal/OD:IV 0.2-1 mg at a rate of 0.2 mg/min. q 20 min PRN**MAX: 3mg/hr Kids: 0.01mg/kg, PRN 45 sec → 6sec.x 4.**MAX: 1mgOther:ETT 1 mg/10ml NS (adult)Reversal of sedative effects of Benzo’s.- reverse NMBA first.N/V, confusion, HA, agitation, seizures.Arrhyth., tachy, brady, angina, HTN, flushing. Benzo OD: other Rx SE may emerge. Esp TCA’sCaution: Resedation may occur (up to 2 hrs. after reversal).More potent Benzo’s req ↑ dose Category CFurosemide(Lasix)* Loop DiureticInhibits reabsorp. of Na, Cl & K at the ascending medullary.Na-K-2Cl cotransporterAscending loop of HenleIV: 5-15 min.IV: 2 hrsPO: 6-8 hrsElim: RenalDiuresis:Slow IV/IM 5-40 mgPO 20-160mg/dayInfusion 4mg/min or ↓Kids: slow IV/IM 0.1-1mg/kgPO 1-2mg/kg dailyDiuretic, HTN, ↑ ICPCHF edema,Hepatic cirrhosisNephrotic syndromeCRF pts.Diuretic resistant pts↓ prod. of CSFDx acute oliguriaOrtho-hypoTNHypo-K, ↑ BG, ↑ uricHypo-Cl alkalosisOtotox. (rapid IVP)Tinnitus, vertigo N/V/D↓ clearance of: salicylates & lithium.Phototox. (1-2 weeks post exposure)Bladder spasmPancreatitisTCP, neutropenia, aplastic anemia.Diuretic of choice w/ acute CHFPeriph vasodil occurs before diuresisSafe w/o BBBContra: co-admin w/ aminoglycoside abx & ethacrynic acid, oliguria d/t hypovol. Potentiates:antiHTNHypo-K ↑ dig tox. & potentiates NMBA. Caution: ↓ effects if co-admin w/ NSAID’s & indomethacin, Liver dx. Category CGlycopyrrolate(Robinul) * Anticholinergic**Reversal Rx**Inhibits action of ACh at post-ganglionic PNS receptors in smooth muscle, secretory glands, CNS. Muscarinic receptorsIV: <1 min. IM/PO: 15-30 min.IV: Vagal block 2-3hr↓ secretions 7 hrsPO: Vagal block 8-12hrs.Elim: Renal & Hepatic Pre-med: IV/IM 0.1-0.2mgPO 1-2mg (dilute in 3-5ml of apple juice or soda).Emergence: IV 0.01mg/kg with…Neo IV 0.05mg/kgPyridostigmine IV 0.25mg/kg (0.2 mg Glyco. per 1mg Neo, or 5mg of Pyridostigmine)Pre-med (vagolysis) - ↓ secretions, relax bronch., ↓ GI tone/motility, ↓ LES tone, ↑ IOP. Reversal of NMBA Adjunct w/ peptic ulcer, & bronchospasm. Tachy, brady, palp.Confusion esp elderlyDizzy, HA, dry mouthUrinary hesit/retent.N/V, urticaria, ↑ IOPPoor PO absorptionvs. Atropine: ↓ tachy & ↓ secretions.DOESN’T cross BBBDevoid of sed. effectsSmall doses may prod. paradox brady.Caution: glaucoma, asthma, CAD, GI or urinary obst.Category BHeparin Sodium* AnticoagulantInhibits thrombosis by inactivating. factors: IX, X, XI, XII.Inhibites conversion of prothrombin to thrombin, forms complexes with thrombin to inactive. and prevent stable fibrin formation. Reversal: Protamine slow IV 1mg per 100U IV: immed.SC: 20-30 min.IV/SC: 1-3 hrs (1/2 life)Elim: HepaticIV Flush: 10-100 unitsProphylaxis: Low-dose: SC 5000U 2hrs pre-op → q 12 hrsFull-dose SC: IV 5000U & SC 10-20K U → SC 8-10K U q 8 hrs or 15-20K U q 12 hrs.Full-dose IV: IV 5000U → infusion 20-40K U/24 hrs.Bypass Surgery:IV 350-450U/kg Goal ACT : 400-480 secGoal aPTT: 1.5-2 x control (control normal: 25-35 sec)Prophylaxis/Tx of thrombus/emboliAnti-coag for BypassDx and Tx DIC↑ bleeding/ hemorrh. (monitor: plt, HCT, occult stool & urine). TCP, ↑ AST/ALT Injection site rxn.HypersensitivityPriapismErratic SC absorptionNO IM admin.↑ risk of bleed w/ co-admin of plt. aggreg. inhibitors. Caution: effects ↓ w/ Dig, Propran., Tetracyc., Nicotine, Antihistamine.Contra: TCP, non-DIC uncontrolled active bleed.Category C- NO cross placentaHydralazine(Apresoline)* Antihypertensive VasodilatorDirect relaxant effect on arteriolar smooth muscle. Interferes with Ca transport in vascular smooth muscle. ↓ BP & SVR↑ CO & SVIV: 5-20 min.IM: 10-30 min. PO: 0.5-2 hrsIV: 2-4 hoursIM/PO: 2-8 hrs.Elim: Hepatic (acetylation)Dilation:IV/IM 2.5-40 mgPO: 10-100mg 4 x daily(↑ dose w/ rapid acetylators)HTN↓ afterload w/ CHF HTN secondary to preeclampsia, eclampsia, primary pulmonary HTN.Tachy, hypoTN, angina, palpitationsDyspnea, congestionHA, dizzy, anxiety Periph neuritisN/V/D, urticariaSLE-like syndromeSplenomegaly Leukopenia, esinoph.AgranulocytosisNO ↓ in renal, uterine, or cereb. BF.Interactions: ↓ rxn to Epi, ↑ hypotn w/ MAOI’s, diuretics, dizoxide, anti-HTNs, ↑Desfl & Enflurane.Category CKeterolac (Toradol)* NSAIDInhibits prostaglandin synthesis. Casues analgesia, ↓ inflamm., ↓ plt aggregation & ↑ bleeding time, & antipyretic. IV: <1 min.IM: <10 min. IV/IM: 3-7 hrsElim: Renal & HepaticAnalgesic: IV/IM 30mg q 6 hrs. PRN**MAX: 120mg daily>65 y/o, RF, Kids, <50kg: IV 15mg q 6 hrs. PRNIM 30mgq 6 hrs PRN**MAX: 40mg dailyNOT recomm. as pre-med30mg = 9mg Morphine- w/ ↓ SEAnalgesia - mild to moderate painGI bleed, peptic ulcer↑ risk RF w/ ↓ renal fxn, HF, LF, elderly, on diuretics.Vasodil, pallor, angina, N/V/DDyspnea, asthmaDrowzy, dizzy, HA, sweating, euphoriaPuritis, urticarial.NO ↓ in MACUse limit: 5 daysNo effect on plt. count, PT, or PTT.Interactions: ↑ tox. of Lith. & methotrexateContra:ASA, NSAID, anti-coags, (↑ bleed) salicylates (↑ effects), Hx PUD & GI bleed, hypovol risk, any bleeding Hx or acute.Incomp: morphine, meperd., hydrolazinePromethazine. Category C- contra in L&DLabetolol( Normodyne )(Trandate)*AntihypertensiveBlocks adrenergic receptors at ɑ1, ?1, & ?2. IV: ɑ-? blockade ratio of 1:7PO:ɑ-? blockade ratio of 1:3Slows HR, decreases SVR, cardiac output, B/P. ɑ1, ?1, and ?2 receptorsIV: 2-5 min.PO: 20 min.-2hrs.IV: 2-4 hrs.PO: 8-24 hrs.Elim: Hepatic, Urine & FecesHTN:Slow IVP 2.5-20mg/2 min.(titrate to desired response)Infus 0.5-2mg/min.** MAX: 1-4mg/kgPO 100-400mg 2 x dailyHTN (dose dep. ↓)- w/o profound ↓ HRBronchoconstriction - prior hyper airway.DyspneaMaskes ↓ BGHypoTN, brady, CHF VT/VF, angina, HADrowsiness, vertigoParesthesia, tremorCognitive dep., rashNumbness, fatigueDizziness, diarrheaCholestasis, ↑ LFT’s.NO change in CBF or ICP.Interactions: ↑ bio-avail. w/ cimetidine, ↑ resist. to ?2 dilatorshypoTN ↑ w/ Volities.Contra: asthma, HF, >1sr deg. HB, cardio-shock, severe brady.Caution: abrupt d/c ↑ isch/MI risk w/ CAD.Lidocaine* Class Ib AntiarrhythmicBlocks Na Channel receptors.IV: 45-90 secLT: 10-15 secInfiltration: 0.5-1 min.IV: 10-20 min.LT: 30-50 min.Infiltration: 30-60 min.Elim: Hepatic & Pulm.Induction (attenuate): IV 1.5-2 mg/kg 2-3 min prior to intub/SuxLT 2 mg/kgLA: Topical 0.6-3 mg/kgInfiltration/periph NB 0.5-5 mg/kgAnti-Arrhythmic: Slow IVP: 1-1.5 mg/kg → 0.5 mg/kg q 2-5 min**MAX: 300mg/hrVentricular arrhyth. LA, epidural/spinal.Attenuate pressor resp. or Succs induced fasciculation.HypoTN, brady, arrhyth. CHB.Resp dep. SeizuresPotentiates SuccsCaution: hypovol., CHF, Shock, all heart blocks.Category BMagnesium Sulfate*mineralPresynaptic: regulates release of Ach at nerve endings, enzyme active., req. for ox. phos. (ATP).NMJ: ↓ Ach release, ↓ motor end plate Ach sensitivity, ↓ amplitude of MEP potential.Reversal: Ca Gluc. 5-10 mEq (10-20ml of 10%)- fluid loading & diureticIV: immed.IM: <1hr.IV: 30 min.IM: 3-4 hrs.Elim: Renal- maintain UO at 100ml q 4hrs.Hypo-Mg: (10-20% soln.)IV 10-15mg/kg/15 min→1g/hr.IM 10-15mg/kg q6 x 4PO 3g q 6 hrs. x 4Torsades: IV 1-2g over 30-60 sec q 5-15 min. PRNGoal plasma Mg:**1.5-2.2mEq/LToxemia/Eclampsia/Tocolysis:Slow IV 1-4g → Infus. 1-2g/hrTherapeutic plasma Mg: **4-6mEq/LHypo-Mg, toxemia/ eclampsia/tocolytic, epilepsy, nephritis.Torsades, AMI, hypo-K w/ arryth.Resp. dep., CNS dep., brady, hypo, CHB, wide QRS-I, vasodil., loss of deep tendon reflexes, flaccid paralysis. hypothermiaHypo-CaHigh dose: ↓ ABPPregnancy: transient ↓ uterine vasc. resist., ↑ uteroplacental BF. Potentiates: depol & non-dep NMBA, CSN dep w/ seds, narcs, & volatiles.Monitoring: assess patellar reflex before repeat dose.Contra: CHB & extensive heart damage.Life-threatening hyper-Mg can be Tx w/ Ca Gluconate.Metoclopramide( Reglan)* AntidopaminergicSensitizes GI smooth muscle to Ach causing ↑ motility of upper GI tract & ↑ LES tone. Antagonism of dopamine receptors & inhib of CTZ result in ↓ N/V. Dopamine receptor antagonist, selective cholinergic agonists.IV: 1-3 min.IM: 10-15 minPO: 30-60 min.IV/IM/PO: 1-2 hrs.Elim: RenalAspiration Risk:IV/IM 10mg/ 1-2 min. PO: 10mg 30 min. before meals & at bedtime. ↑ gastric emptying antiemeticTx DM gastroparesis, Tx symptomatic GERDHTN, hypoTN, arrhyth. ↑ catechol. releaseDrowsiness, anxiety insomnia, akathisia Minimal sedationEPS rareN/D, ↓ BGCaution: pt w/ HTN, MAOI’s, ↑ GI motility antagonized w/ Antichol Rx & Narcs. Potentiated: ↑ sedative effects ETOH, sedation-hypnotics, tranq, Narcs. Prolongs SucsContra: Parkinson’s, Peds, HTN crisis w/ PheoCC pt., GI bleed, epilepsy, GI obst/perf Category BNalbuphine(Nubain)* Synthetic Opioid agonist-antagonistBinds to opioid receptors within the CNS, narcotic agonist-antagonist. Mu, Kappa & Delta receptorsReversal: Narcan IV/IM/SC 0.2-0.4mg or ↑IV: 2-3 min.IM/SC: <15 min.IV/IM/SC: 3-6 hrs.Elim: HepaticAnalgesia/Sedation: IV/IM/SC 5-10mg Induction: IV 0.3-3mg/kg↓ dose: w/ elderly, hypovol., co-admin of Narcs & sedatives.Analgesic Potency: = to MorphineAntagonist Potency:1/4th of Nalorphine Analgesia (potent)AnesthesiaReverse resp dep. of Opioid agonists.↑ withdrawl S&S (w/ Narc-dep. pts)HTN, hypoTNTachy, brady.Resp dep, dyspnea, asthma.Sedation, confusionEuphoria, dysphoria.Cramps, dyspepsiaPuritis, burning. Urinary urgency↑ gallbladder painGood CV stabilityPotentiates: dep. effects of Narc. Rx, volatiles, sedative-hypnotics, phenothiazides.Category B- crosses placentaNaloxone(Narcan)**Reversal Rx**Competitively inhibits opiates at Mu, Delta, & Kappa receptor sites, & prevents or reverses the effects of opiate Opioid Mu, Delta, & Kappa receptorsIV/ETT: 1-2 min.IM/SC: 2-5 min. IV/IM/SC/ETT: 1-4 hrs.Elim: HepaticReversal/OD:IV/IM/SC 0.1-2mg q 2-3 min. PRNETT dilute 1:1 in NS**MAX: 10 mgKids: 10-100mcg/kgProphylaxis/SE Tx:IV/IM/SC 0.1-0.8 mgReversal of opioid Narcotic dep/sedation. Adjunt for other Rx OD’s, Narcotic SE prophylaxis/tx. Help reverse hemodyn. instability in septic & cardiogenic shock pts.↑ SNS activity (HTN, tachy, arrhyth, pulm. edema)N/V d/t rapid admin. HypoTN, trembling, seizures, sweating.Caution: Resedation may occur, pt w/ cardiac disease, pt/newborns physically dep on opioids → Acute Abstinence synd.Neostigmine(Prostigmine)* AnticholinesteraseInhibits hydrolysis of Ach by competing w/ Ach for attachment to Ach-esterase at the esteratic site.Causes ↑ AchBinds to Ach-esterase. Tx Chol. Crisis:Atropine: IV 10mcg/kg q 3-10 min PRNIV: <3 min.IV: 40-60 min.Elim: Hepatic & plasma esterasesST or SVT:IV 0.25-0.5mg (tx cause)Reversal of NMBA:Slow IV 0.05mg/kg with…Atropine: IV 0.015mg/kgGlycopyrrolate: IV 0.01mg/kgPost-Op Retention/Ileus: IM/SC 0.25-1mg q 4-6 hrs Reversal of non-depolarizing NMBA.Tx Myasthenia Gravis Tx post-op urinary retention & ileus.Adjunct Tx: ST or SVTBrady, tachy, AV block, hypoTN.↑ secretions, rep dep., BronchospasmSeizures, HAN/V/F, ↑ peristalsis↑ urinary frequencyAnaphylaxisOD: cholinergic crisis NMBA reversal ↓ w/: animoglyc abx, hypo-K, hypothermia, resp & metabolic acidosis.Caution: pt w/ brady, asthma, epilepsy, arrhyth., peptic ulcer. Contra: pt w/ peritonitis, bowel or urinary obstruction.Category CPentothal(sodium thiopental)*BarbiturateEnhances action of GABA receptors.Ultra short-actingNo analgesiaIV: 10-20 secIV: 5-15 minElim: Hepatic - slowInduction:IV 3-5mg/kgIntra-Op:IV 0.5-1 mg/kgBarb. Narcosis: IVP 8mg/kg → drip @ 0.05-0.35 mg/kg/min.Induction, to ↓ ICP, anticonvulsant, cerebral protection (Barb coma).↓ SVR, CO, BP, CPP.↓uterine BFN/V Resp dep.May ↓ plasma CortisolAnaphylaxisIncomp: Succs & Rx w/ acid pH.Contra: status asthmaticus, & all Porphyria’s. Caution: MAOI’s, HTN, Hypovol., cardiac ischemia, Septic. Category CPhenylephrine( Neosynepherine)*SympathomimeticActivates alpha-adrenergic receptors of the vascular smooth muscle.Causing vasoconstriction of the arterioles. Little ? effects.Alpha-adrenergic receptorsExtravasation: Phentolamine SC 5-10mg in 10ml NS IV: <1 min.IM/SC: 10-15 min.IV: 15-20 min.IM/SC: 0.5-2 hrs.Elim: HepaticHypotension during anesth.: IV 50-100mcg SC/IM 2-5mgInfusion 10-200mcg/min.Kids: IV 1-2mcg/kgPSVT:IV 0.5-1mg rapid, wait 1-1.5 min.→ if same, 2mg IV slowMaint SBP <160mmHgShunt Reversal:IV 50-100mcgPeriph vasoconstriction HypoTN.shock PSVT R-to-L shuntProlongs anesth. (LA’s)Reflex brady, palp., arrhyth., hypoTN, HTN, precordial painAcute pulm. edema, resp distress N/V, HA, anxiety cerebral hemorrhageHepatic necrosis Tissue necrosis↓ BF to: renal, skin, splanchnic & uterine.↑ PAP↑ pressor effects w/: oxytocics, bretylium, guanethidine, MAOI’s & other sympathomimetics. Caution: elderly, ↑thyroid, brady, partial HB, severe arteriosclerosis. ↑ arrhyth w/ volatilesContra: IV regional, LA of end organs. Category CPropofol(Diprivan)* Sedative HypnoticProduces sedative/ hypnotic effects via interaction with GABA.GABA receptor agonistIV: <40 secIV: 5-10 min.Elim: Hepatic - high Vol. distrib.- rapid elim.Induction: Slow IV 2-2.5mg/kg/ 30 secIntra-Op:IVP 25-50mgInfusion 100-200mcg/kg/min.Sedation: IVP 25-50mg (titrate slowly - desired effect slurred speech)Maintenance of anesthesia: 100-300 mcg/kg/min (typical ICU max dose is 50 mcg/kg/min)Induction/maintenance of anesthesia. - blunts resp. to intub.Chemotherapy or post-op N/V.HypoTN, ↓ SVR, apnea.↓: cerb. BF, MBR, ICP.HypoTN, HTN, fever arrhyth. tachy, bradyResp dep., apneaBroncho/larynospasmHiccups, HA, dizzy. confusion, euphoria. Seizures, clonic/ myoclonic movement.N/V, abd cramps.Pain at IV siteErythema, urticaria.Histamine release poss.: prod. anaphyl.Interactions: ↑ CNS & CV effects w/ Narcs, sed-hypnotics, Volatiles. ↓ resp. cl. w/ Afent/fentanyl. Caution: pt w/ ↑ ICP,Hx seizure/epilepsy, C-section, generic has ↑ allergic rxn.Contra: allergy to eggs &/or soybean oil. Category BProtamine sulfate* LMW ProteinCombinds with Heparin to form a stable complex devoid of anti-coag activity. Results in ↓ of anticoagulant activity of HeparinIV: 0.5-1 min.IV: 2 hrs.Elim: HepaticIV: slow 1mg neutralizes 90-115 units of Heparin> 30-60 min: give ? dose> 2 hrs: give ? dose**MAX: 50mg/10 min.Tx severe Heparin ODHypoTN, HTN, bradyPulm. HTN, dyspneaBronchospasmAnaphylaxis (or rxn)N/V, flushing, TCPHyperheparinemiaRapid IV:↑ histamine- anaphyl., hypoTNInteraction: ↑ effects of vasodilators.Incomp: PCN, CephloCaution: fish allergy, Insulin w/ protamine.Category CPuralube(Lubricant tears) * Eye LubricantForms an occlusive film on eye surface. Lubricates/protects eye from drying.Place small amount in the conjunctival sac PRNProtection/lubrication of eye during and following surgery Post removal of a foreign body.Temp. blurring post admin.Rocuronium Bromide(Zemuron)* Non-depolarizing NMBACompetes for cholinergic receptors at the motor end plate. Nicotinic receptors Reversal: Anticholinesterase Rx w/ Atropine or Glycopyr.IV: 1-2 min.IV: 15-120 min.(dose dependant)Elim: Renal & HepaticIntubation:IV 0.6-1.2mg/kg (add’l doses at 10-50% intub. dose).**base on actual body weightMonitor: w/ nerve stimulator to min. OD.Facilitate tracheal intubation. - esp. if can’t use Succs Rapid actingTachy, arrhyth. Hypovent./apneaBronchospasmPulm. HTNPruritis, rashEdema at IV siteHistamine SE rare Interactions: NM block ↑ w/: animogl. abx, LA, Mg, lithium, ganglionic blockers, hypo therrmia, hypo-K, resp acidosis, Succs, Volatile, loops,MG, adrenocort. dysf.Req ↓ & w/: VolatilesRecurrent paralysis w/ quinidine.Reversal effects ↓ w/ & theophylline, anticonvul. rx, burn pt, & paresis.Category CSodium Bicarbonate*BufferDissociates to form HCO3- & Na.Buffers excess H ions, promotes cell uptake of K.IV: 2-8 min.IV: 30-60 min.Elim: RenalACLS: IV 1mEq/kg, → 0.5mEq/kg q 10 min.Acidosis: IV (kg x mEq/L deficit x 0.3) /2Alkalization of urine:IV 48mEq, → 12-24mEq q 4 hrs.**1 AMP = 50mEqCorrect Metabolic acidosis, urinary alkalization, ACLS. Metabolic alkalosis, hypo-K Carpopedal spasm w/hypo-Ca pt.Incomp: Ca ↑ EtCO2Category CSodium Nitroprusside(Nipride) (Nitropress)*AntihypertensivePotent peripheral vasodilator at arterial & venous smooth muscle. Generates NO, which activates smooth muscle guanylate cyclase forming ↑ IC cGMP. To cause relaxation: cGMP inhibits Ca from moving into the cell. NO causes hyperpol. at K channels leading.cGMP also acts on myosin at the sarcomere.↓PVR, preload, afterload & ↑ CO.IV: 30-60 secIV: 1-10 min.Elim: HepaticPeripheral vasodilation: IV infusion: 10-300mcg/min. **MAX: 10mcg/kg/min for 10 min. HTN Crisis, HTN, controlled hypoTN, acute CHF, pre-heart transplant. HypoTN, tachy, circ. collapse, palpitations. ↑ ICP, HA, ↓ thyroid.N/V-retchingMethheme., Cyanide tox., thocy. tox. anti-plt effect. May ↑ V/Q mismatch↓ uterine BFCyanide Tox S&S: Tachyphylaxis, ↑ MvPO2, metab acidThiocy. tox S&S: (> 10mg/100ml)Sk. muscle weakness N/V, confusion. - lab req if inf >48hrs**Protect from lightCaution: RF ↑ tox risk, ↑ fetal cyanide risk if mother under gen. anesth.HypoTN poten. by: Volatiles, antiHTN , ganglionic BA, circulatory dep Rx.Contra: pt w/ compensatory HTN, inadequate cerebral BF.Vecuronium(Norcuron)* Non-depolarizing NMBA Competes for cholinergic receptors at the motor end plate. Nicotinic receptorsReversal: Anticholinesterase Rx (Neostigmine) w/ Antichol. (Atropine or Glycopyrrlate).IV: <3 min.IV: 25-30 min.Elim: Renal & HepaticIntubation:IV 0.08-0.1mg/kgIntra-Op: IV 0.01-0.0mg/kg initially Infusion 1-2 mcg/kg/minMonitor: w/ nerve stimulator to min. OD.Facilitate tracheal intubation. Hypovent./apneaProlonged paralysis w/ long-term infusion- RF, ↓K, ↓Ca, ↑Mg, amino abx, corticoster.Brady w/ co-admin of potent opioids.Histamine SE rare Interactions: NM block ↑ w/: animogl. abx, LA, Mg, lithium, ganglionic blockers, hypo therrmia, hypo-K, resp acidosis, Succs, Volatile, loops,MG, adrenocort. dysf.Req ↓ & w/: VolatilesRecurrent paralysis w/ quinidine.Reversal effects ↓ w/ theophylline. Category CVerapamil(Calan)(Isoptin)* CCBSelectively inhibits influx of Ca ions into cardiac & smooth muscle Antiarrhythmic effects are d/t inhibition of Ca influx through slow channels in pacemaker cells. AV conduction is slowed & the effective refractory period is prolonged. Calcium channel receptorsTx RVR with WPW: Procainamid, Lidocaine, cardioversion. Tx Brady or AV block: Isopro., CaCl, NE, Atropine, Pacing. IV: 2-5 min.PO: 30 min.IV: 30-60 min.PO: 3-7 hrs.(1/2 life)Elim: RenalPSVT, A-Fib or A-Flutter:IV 5-10 mg/ 2 min q 30 min PRNHTN:IV 2.5-10mg (titrate)PO 40-80mg (RR) 3 x daily Chronic A-Fib (on Digoxin):PO 240-320mg/day (RR)- taken in 3-4 divided dosesPSVT (NOT on Digoxin):PO 240-480mg/day (RR)- taken in 3-4 divided dosesTx SVT (PSVT)Temp. control of A-fib or A-flutter w/RVR not assoc. w/ accessory pathway. HTN, anginaMigraine prophylaxis↓: Contractility, HR, SVR, ABP, myocardial demand.HypoTN Brady, tachyWorsen HF w/ poor LV fxn pts.Bronchospasm LaryngospasmHA, dizzy, seizuresN/V, Abd painUrticaria, puritisInteractions: ↑ effects of ALL NMBA, CV dep effects are additive w/ Volatiles & Anti-HTN Rx’s, ↑ cardiac risk w/ co-admin of BB, ↑ cardiac dep effects of Bupiv. & LA’s, ↓ Lithium effects, ↓ cl. w/ cimetidine, levels ↑ w/ grapefruit.Enzyme InhibitorIncompatible: Bicarb & NafcillinCaution: pt on highly protein-bound Rx’s. Versed(Midazolam)*BenzoEnhances action of GABA receptors.GABA receptor agonist.Reversal: Flumazenil slow IV 0.2-1 mgIV: 0.5-1 min. IM: 15 min. PO: <10 min.IV/IM: 15-80 min.PO: 2-6 hr.Elim: RenalPre-Op: IM 2.5-10 mgPO 0.25-0.5mg/kg (kid)Conscious Sedation:IV 0.5-5 mgDeep sedation:Infusion 2-15 mg/hrInduction:0.25mg/kgIVP 1-2.5 mg PO 0.5 mg/kg Pre-med, sedation, induction, anxiolytic, amnesia, anticonvulsant.↓ RR, Possible ↓ BP ↓ dose >60yContra: NA glaucomaCategory D↓ MAC req.Other Meds not listed on the REQ sheetDrug:Mech of action & Receptor:Onset:Duration of action:Normal Dose:Uses:Risks:Other:Succinylcholine(Anectine)*DEPOL. NMBCombines w/ chol. receptors at the motor end plate to depol.-observed as fasciculations. Prod. flaccid paralysis.Reversal: Anticholinesterase Rx (Neostigmine) w/ Antichol. (Atropine or Glycopyrrlate).MH: Tx w/ Dantroline 2.5mg/kgIV: 30-60 secs.Peak:60 secsIV: 5 minsElim: plasma pseudochol-aseInduction:0.7-1mg/kg(1.5mg/kg w/ ND pre-tx)Neonates & Infants: 2-3mg/kgChildren:1-2mg/kgSleletal muscle relaxation InductionUltra-short actingMonitor w/ nerve stimul↓or↑ BP, ↓or↑ HR, arrhyth.↑ LES press. (Aspir.) Prolonged blockade w/: ↓K, ↓Ca, ↓ pseudochol-ase, phenelzine, BB, lidocaine, procainamide, reglan, , Mg, oxytosin, Volitiles, trimethaphan, Antichol-ase,pre-tx w/ Panc, MAOI’s, BCP.Blockade ↓ w/: pre-tx ND NMB.MH: ridgidity (esp jaw), tachy, tachypnea, unresp to ↑ Volatiles.Will ↑ K (0.5mEq in normal pt)Unpred resp w/: MGContra: severe burns, ↑ K, -lyte imbal., trauma, ↑ IOP, paraplegia, sp.cord injury.Histamine r not signif.Inconp. w/ Alkaline soln.Repeat dose: ↑ bradyPreg: ↑ sensitivity, NO effect on Uterus or other smooth muscle.Category CMethergine(Methylergonovine Maleate)* Semisynthetis Ergot AlkaloidAct directly on uterine smooth muscle: ↑ tone, rate, & amplit. of contractions.↓ 3rd stage of labor & ↓ bleeding IV: immedIM: 2-5 minsPeak:IV: <5 minIM: <30 minIV:.45 minsIM: 4-6 hrsElim: HepaticIV/IM: 0.2mg over 60 secsRepeat q 2-4 hrsTx postpartum uterine atony & bleeding↑or↓ BP, chest pain, dyspnea, ↑ CVP & PAP, tinnitus, HA, SZ, N/V/D, hematuria, extremity necrosisD/C w/ c/o: tingling in extremitiesVasoconstr. potent. w/: ephedrine, phynel., nicotineCaution: preeclampsia, HTN, heart disease.Avoid in pt w/: PVDLimits lactation, IS in breast milk. Metoprolol(Lopressor)*AntihypertensiveCardio-selective BBCan block ?2 in high dosesIV: immedPO: <15 minsPeak: IV 20 mins.IV/PO: 5-8 hrsElim: HepaticHTN & Angina: PO: 50-400mg dailyAMI: IV: 5mg q 2mins x 3HTN, SVT, AMI, anti-anginal, ETOH withdrawal↓ BP, arrhyth, rebound angina, bronchospasm, dyspnea, cough, N/V, TCP purpura, arthralgia. Mask S&S of ↓ BG↓ BP worse w/: Volatiles, ↓ catechol.Potentiates: ALL NMBA↑ levels: Dig & morphineRebound HTN w/ abrupt d/cContra: brady, HB >1°, cardio shockPropranololIndigo carmineMethylene Blue(Urolene Blue)Oxidation-reduction rxnIV: immedPeak: <1 hrVariesElim: RenalIV: 1-2mg/kg over minutesPO: 65-130mg q TIDTx Rx induced methemoglobinemia↑ HR, HTN, cyanosis, confustion, HA, N/V/D, abd painFalse ↓ in SaO2 <85% or false ↑ SaO2 >85%Hemolytic AnemiaHyperbilirubinemiaBLUE skin colorDiscolor. of UO & fecesContra: RF ptSolu-cortefancefDecadronOxytosinPhysostigminePromethazineZofranNitroglycerineNitrobid 2%Pepsid ................
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