ZOFRAN

 (ONDANSETRON)

2mg/ml

5HT3 ANTAGONIST

Dose:   4mg (0.1mg.kg child)

Onset:  <30min

Peak:   2hrs

Duration: 12-24hrs

Elimination: Hepatic

*5HT3 receptors are found peripherally on vagal nerve terminals and centrally in the CTZ.

*Used for PONV and Chemotherapy induced N/V

SCOPOLAMINE

(HYOSCINE)

0.4mg/ml

ANTIMUSCARINIC

Dose:   0.3-0.6mg

Onset:  10min

Peak:   20-60min

Duration: 2hrs

Elimination: Hepatic/Renal

*Used for motion sickness but can produce undesirable S.E.

(Scopolamine will blick Mr. B.B. SLUDGE) 

*Antisialagogue effects: helps prevent laryngospasm

*3x more potent than Atropine

*less likely to change HR

*Tertiary amine (crosses BBB): may be used for sedation

*Obtained from the plant family of Solonacae (deadly nightshade)

METACLOPRAMIDE

(REGLAN)

5mg/ml

D2 ANTAGONIST

Dose:   5-20mg

Onset:  1-3min

Peak:   5min

Duration: 1-2hrs

Elimination: Hepatic/Renal

*Used in the prophylaxis and treatment of PONV 

*At higher concentrations blocks 5HT3 receptors

*Higher doses are effective in managing chemotherapy-induced N/V

*Exerts prokinetic effects     

*Increases LES sphincter tone

*Enhances gastric and small bowel motility

*High doses are associated with a high incidence of dystonic reacations and EPS

DROPERIDOL

(INAPSINE)

2.5mg/ml

D2 ANTAGONIST

Dose:   0.625-2.5mg

Onset:  3-10min

Peak:   30min

Duration: 2-4hrs

Elimination: Hepatic/Renal

*Higher doses (50-75mg/kg) result in delayed emergence and sedation (due to alpha adrenergic blockade)

*May cause EPS, restlessness, anxiety, and dysphoria (may want to give with Versed)

*Dec/2001 Black Box warning against QT abnormalities  (If you use, must have continuous ECG for at least 2hrs) 

NITROGLYCERIN

(NTG)

 5mg/ml

NITRIC OXIDE

MIX:   50mg/250ml   CONC:  200mcg/ml

IV Push Dose: 25-50mcg

Infusion:  0.1-7mcg/kg/min

Onset: 1-2min

Peak:  1-5min

Duration: 3-5min

Elimination: Hepatic/Renal

*Used as a vasodilator to treat Angina, MI, CHF

*Primary effect is to increase peripheral venous capacitance by decreasing preload  

*In its pure form NTG is explosive

*Low concentrations of NTG perdominantly vasodilate veins

*Restores bloodflow to the subendocardial regions of the heart

*Reduce MVO2     *Prolonged exposure will cause tolerance

*Nitrates DO NOT directly alter contractility (inotropy) or HR (chronotropy) -- is a reflexive response

*Side Effects: H/A, dizziness, weakness, hypotension

SODIUM NITROPRUSSIDE

(SNP)

10mg/ml

NITRIC OXIDE

MIX: 50mg/250ml     CONC:  200mcg/ml

IV Push Dose:  0.5-1mcg/kg/min

Infusion Dose: 0.1-10mcg/kg/min

Onset: 30-60sec

Peak:   1-2min

Duration: 1-10min

Elimination: Hepatic

*A direct inorganic vasodilator.  It is inorganic b/c it does not contain C-H bonds.

*Uses: 1.Rapid & short acting reduction in BP (IV use ONLY with continuous monitoring) 2. Hypertensive emergencies  3. Acute aortic dissection (important: administer b-adrenergic antagonist with SNP) 4. To decrease MVO2 after acute MI

*1 OxyHgB + 1 SNP= 1 MetHgB + 5 CN + 1 NO

*Rhodanase is the enzyme in the liver that is responsible for converting thiosulfate and cyanide to thiocyanate

*SNP dilates both arterioles and venules

*Reduces both ventricular perload and afterload

*May cause cyanide and thiocyanate toxicity, Methemoglobinemia