CNPT2 Exam 4 Drugs

Fentanyl brand

Fentanyl brand

Abstral, Duragesic, Fentora

Fentanyl class

Opioid analgesic

Fentanyl use

Pain

Fentanyl MOA

Opioid agonist at the mu receptor

Fentanyl dose

IV: 50-100 mcg loading dose with 25-50 mcg/hr titrated to patient need, transdermal patch: 25-100 mcg/hr

Fentanyl contraindications

Do not use in opioid naive patients

Fentanyl BBW

Life threatening respiratory depression, addiction, misuse, abuse, risk of concomitant use with benzodiazepines or other CNS depressants

Dexmedetomidine brand

Precedex

Dexmedetomidine class

Sedative

Dexmedetomidine use

Sedation

Dexmedetomidine MOA

Selective alpha 2 adrenergic agonist, inhibits norepinephrine release, peripheral alpha 2b-adrenoceptors

Dexmedetomidine dose

ICU sedation: 1 mcg/kg IV over 10 minutes followed by 0.2-0.7 mcg/kg/hr maintenance, procedural sedation: 1 mcg/kg IV over 10 minutes with 0.6 mcg/kg/hr maintenance

Dexmedetomidine contraindications

None

Dexmedetomidine BBW

None

Ketamine brand

Ketalar

Ketamine class

General anesthetic

Ketamine use

Anesthesia

Ketamine MOA

Noncompetitive NMDA receptor antagonist that blocks glutamate

Ketamine dose

IM: 4-10 mg/kg, IV: 0.5-2 mg/kg

Ketamine contraindications

None

Ketamine BBW

None

Lidocaine brand

Lidoderm, Xylocaine

Lidocaine class

Analgesic anesthetic

Lidocaine use

Anesthesia

Lidocaine MOA

Local antiarrhythmic class IB

Lidocaine dose

Topical 4.5 mg/kg/day divided in 4 doses or apply 5% patch to painful area for 12 hours every day

Lidocaine contraindications

Use with caution in patients with known drug sensitivities

Lidocaine BBW

Fatal events have occured with high blood levels from topical exposure and is more likely in young children

Midazolam brand

Nayzilam, Versed

Midazolam class

Benzodiazepine

Midazolam use

Sedation, agitation, end of life, seizures

Midazolam MOA

Binds to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron, essentially enhances the inhibitory effects of GABA on neuronal excitability. Impact on GABA-A and not GABA-B receptors

Midazolam dose

Preop sedation: 0.1-0.35 mg/kg over 20-30 seconds, seizures: 5 mg nasal spray as a single dose in one nostril; may repeat dose in 10 minutes in alternate nostril based on response and tolerability

Midazolam contraindications

None

Midazolam BBW

Has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical settings

Naloxone brand

Evzio, Narcan

Naloxone class

Opioid antagonist

Naloxone use

Opioid overdose

Naloxone MOA

Pure opioid antagonist that competes and displaces opioid at receptor sites

Naloxone dose

IV/IM/SQ: initial 0.4-2 mg repeated q2-3 min up to 10 mg total, intranasal: 1 spray (4 mg) as a single dose in one nostril, may repeat in 3-5 min if respiratory depression persists

Naloxone contraindications

None

Naloxone BBW

None

Propofol brand

Diprivan

Propofol class

General anesthetic

Propofol use

Anesthesia, RSI

Propofol MOA

Short acting lipophilic IV general anesthetic, results in CNS depression through GABA-A agonism and glutamatergic activity through NMDA receptor blockade

Propofol dose

Initial IV: 5 mcg/kg/min (or 0.3 mg/kg/hr) increase by 5-10 mcg/kg/min (or 0.3-0.6 mg/kg/hr) every 5-10 min until desired sedation level is achieved, maintenance: 5-50 mcg/kg/min (0.3-3 mg/kg/hr)

Propofol Contraindications

Hypersensitivity to eggs, soybeans, soy production, caution with hypertriglyceridemia

Propofol BBW

None