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Perf Tech 3 > 12. Pharm- Exam 3 > Flashcards

12. Pharm- Exam 3 Flashcards

1
Q

Pharmacokinetics=

A

What the body does to the drug

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2
Q

Pharmacodynamics=

A

How a drug interacts with the body to produce its effects

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3
Q

First order kinetics=

A

elimination of a drug occurs at a constant fraction of drug remaining in the body per unit of time

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4
Q

Zero order kinetics=

A

when drug administration exceeds the body’s ability to clear it, leading to drug accumulation

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5
Q

what should be done To prevent drug accumulation

A

drug infusion rates should be adjusted according to patient response

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6
Q

what 4 things does hemodiltion cause

A
  • Reduction in circulating protein concentration
  • Reduction in RBC concentration
  • Reduction in concentration of free drug (unless your pump prime matches exactly)
  • Alterations in organ blood flow, affecting distribution and clearance
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7
Q

What happens if you add drugs to your prime BEFORE RAP or AFTER RAP??

A

lose drugs that are in that given prime that is removed

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8
Q

what 4 things does hypothermia cause

A
  • Fluid shifts from intravascular to interstitial space= Altered volume of distribution & Increased 3rd spacing
  • Vasoconstriction= Changes in organ perfusion
  • Reductions in enzyme-mediated biotransformation
  • Increased solubility of volatile anesthetics
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9
Q

Lungs being excluded from circulation effects what 3 drugs

A

Valium, propofol, opioids

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10
Q

Altered hepatic blood flow effects what 2 drugs

A

Fentanyl, propofol

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11
Q

Sequestration: Drugs may be taken up by various components of the CPB circuit. give 3 examples

A
  1. Coated tubing= lipophilic drugs stick to the circuit
  2. Oxygenators= takes the drug up invitro
  3. Hemofilters= sieving coefficient and protein binding
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12
Q

when Administering medications, what do you ensure

A
  • you have a physician’s order or standing protocol authorizing you to administer the medication
  • the patient is NOT allergic to the medication
  • you have the correct medication, the correct concentration and the correct dosage
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13
Q

when Administering medications, what do you inspect

A

expiration date, precipitates, and sterility

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14
Q

What is in your drug box? (8)

A
  • Heparin
  • Neo-Synephrine
  • NaHCO3
  • Lidocaine
  • MgSO4
  • Calcium
  • Potassium
  • Mannitol
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15
Q

Heparin Sodium is derived from what?

A

bovine lung tissue or porcine mucosa standardized for anticoagulant activity

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16
Q

Heparin Sodium’s potency is determined by what

A

a biological assay using a USP reference standard based on units of heparin activity per milligram

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17
Q

100 units Heparin Sodium= ____mg

5000 units= _____mg

A

1 mg

50mg

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18
Q

Heparin Sodium action

A

stops coagulation by potentiating antithrombin III and inhibiting the action of activated Factors IX and XI

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19
Q

Heparin Pharmacokinetics=

A

•Eliminated by kidneys
•Half life at CPB doses is 2 or more hours
–Prolonged by hypothermia and renal blood flow alterations

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20
Q

Heparin Side Effects=

A
  • Activation of t-PA and platelets
  • Boluses decrease SVR by 10 to 20%
  • Anaphylaxis rarely occurs
  • HIT and HITT
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21
Q

Heparin Loading Dosing

A

300 to 450 units/kg

Rarely need to exceed 35,000 to 40,000 units

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22
Q

how does Heparin distribute

A

Distributes primarily in plasma, so increasing dose with increasing body weight is only relevant to a certain point

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23
Q

the Heparin priming solutions should contain heparin at approximately what level

A

Priming solution should contain heparin at approximately the same concentration of the patient’s blood stream

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24
Q

target ACT is ? this is prolonged by what?

A

Target ACT controversial (300 to 480 seconds)

ACT is prolonged by hypothermia and hemodilution

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25
most Heparin vials come in what increments
Most vials you will see for adult CPB will be 1000 units/mL
26
a loading dose of 30000 units is how many ml
30 ml
27
Neo-Synephrine action
Synthetic selective α1-adranergic agonist that causes vasoconstriction in arterioles
28
Neo-Synephrine duration
less than 5 minutes •Titrated to effect •Start with a test dose
29
Neo-Synephrine Dosing: IV bolus
* 100 micrograms/mL * 200 micrograms/mL * 400 micrograms/mL
30
Neo-Synephrine Dosing: IV infusion
•10 or 15 mg in 250 mL IV fluid (40 to 60 micrograms/mL)
31
starting with 10 mg Phenylephrine in 1 mL vial-- Add 49 mL Normosol and you get:
50 mL containing 10,000 mcg = 200 mcg/ML
32
Sodium Bicarbonate=
* A sterile, nonpyrogenic, hypertonic solution of sodium bicarbonate (NaHCO3) in water for injection for administration by the intravenous route as an electrolyte replenisher and system alkalizer * Also used to treat hyperkalemia
33
Sodium Bicarbonate dosing equation
Dose (mEq) = 0.3 x Weight (kg) x BD (mEq/L) | *Or just “1 amp” (50 mEq)
34
Sodium Bicarbonate dosing for hyperkalemia
Adults: 50 mEq | •Peds: 1-2 mEq/kg
35
Sodium Bicarbonate dosing for hyperkalemia
Adults: 50 mEq | •Peds: 1-2 mEq/kg
36
Lidocaine action
reduces cell membrane permeability for sodium and potassium which increases the stimulation thresholds in ventricles
37
Lidocaine site of action
cell membrane
38
Lidocaine duration of action
15 to 30 minutes post bolus
39
Lidocaine Dosing
•IV bolus 1-2 mg/kg --Usually 100 to 200 mg bolus at XC removal •Not to exceed 300 mg/hr
40
Magnesium Sulfate action
controls transmembrane electrolytes and energy metabolism | •Cardiac arrhythmias may occur during hypomagnesemia
41
when could Hypomagnesemia occur on CPB
* Poor pre op health * Albumin administration * Citrated blood product administration
42
Magnesium Sulfate dosing
* 2 to 2.5 g initial bolus or 1.75 g/h infusion * On CPB, usually given as 2 to 4 grams at XC removal with Lidocaine * Often 0.5 g/mL concentration
43
Calcium Chloride action=
Involved in myocardial contractility, blood clotting, neurotransmission and muscle contraction
44
Calcium Chloride may be used for mixing with?
thrombin for platelet gel
45
when would Calcium Chloride level drop on CPB
May be necessary to replenish before coming off CPB | Especially if citrated blood products given
46
Calcium Chloride dosing: standard
* 200 to 1000 mg slow IV | * Often 100 mg/mL concentration
47
Calcium Chloride dosing: hyperkalemia
* Adults: 0.5-1g CaCl2 | * Peds: 20 mg/kg Calcium Gluconate
48
Calcium Chloride is given when?
•Given post XC removal and before termination of CPB if levels are low
49
Potassium Chloride=
* The major intracellular ion * Necessary for normal cardiac contractions * HypERkalemia more of an issue than hypOkalemia * Cardioplegia
50
Potassium Chloride cpg dose
15-30 mmol/L of solution delivered into the heart | •ie. 4 to 1 cdpg requires 5 times the delivery strength in the cardioplegia bag
51
Potassium Chloride hypokalemia dose
Dose (mEq) = weight (kg) x 0.3 x K+ deficit
52
how is Potassium Chloride given
GIVE IT SLOWLY especially if XC not on
53
Potassium Chloride typical concentration
Usually 2 mEq/mL concentration
54
Mannitol action
osmotic diuretic prevents reabsorption in the proximal tubule (also thought to be a free radical scavenger)
55
Mannitol dosing during CPB
During CPB 0.5 to 1.0 g/kg •Inspect carefully for precipitate or crystals. •Use a filtered needle during administration
56
Mannitol dosing for prime
Often given as 12.5 g vials in prime or during warming
57
THAM (tromethamine) action
creates an alkaline environment by combining with hydrogen ions to form bicarbonate [buffer]
58
THAM (tromethamine) dosing
Each 100 mL contains tromethamine 3.6g (30mEq) | Dose (mL) = 1.1 x wt (kg) x Base Deficit (mEq/L)
59
Amicar (ε-aminocaproic acid) action
inhibits plasminogen activators to prevent conversion to plasmin •Reduces bleeding caused by hyperfibrinolysis
60
Amicar (ε-aminocaproic acid) dosing
Loading Dose: 5 g IV | Infusion: 1-1.25g/hr (30g/day max)
61
Trasylol action
inhibits fibrinolysis and turnover of coagulation factors (serine protease inhibitor)
62
Trasylol dosing
•Test dose: 1 mL at least 10 min before loading •Loading dose: 200 mL (280mg) over 20-30 min •Infusion dose: 50 mL/hr •Pump prime dose: 200 mL *May artificially prolong ACT results
63
Thrombate III (antithrombin) action
inactivates thrombin and activated forms of clotting factors IX, X, XI, and XII which results in inhibition of coagulation •The anticoagulant effect of heparin is enhanced with Thrombate III in patients with antithrombin III (AT-III) deficiency
64
Thrombate III (antithrombin) dosing
Dose [(IU) = (desired-baseline AT-III level) x kg] / 1.4 •Each vial will contain approximately 500 IU •Use within 3 hours of reconstitution
65
Thrombate III (antithrombin) dosing
Dose [(IU) = (desired-baseline AT-III level) x kg] / 1.4 •Each vial will contain approximately 500 IU •Use within 3 hours of reconstitution
66
Benadryl (diphenhydramine) action
antihistamine, sedative, antiemetic, anticholinergic | •Given on CPB after suspicion of allergic reaction
67
Benadryl (diphenhydramine) dosing
10-50 mg
68
Solu-Medrol (methylprednisolone) action
Intermediate acting glucocorticoid used on bypass to combat inflammation, often during circulatory arrest cases •May cause hyperglycemia
69
Solu-Medrol (methylprednisolone) dosing
* 125mg – 1g * Sterile powder which must be mixed with the accompanying diluent * Use within 48 hours of mixing
70
Forane action
ethers that modulate the GABAA receptor, used for induction and maintenance of anesthesia •Potent vasodilators •Pungent odor
71
Forane dosing
Set vaporizer at 0.5% to 2% after initiation of gas flow | •Can be temporarily increased for blood pressure control
72
what happens if you spill Forane on your pump
Spillage can cause structural degradation of plastic
73
what should you have operating while using Forane
Scavenge oxygenator gas outflow when using anesthetic gas
74
AMSECT Standard 6.8=
An anesthetic gas scavenge line shall be employed whenever inhalation agents are introduced into the circuit during CPB procedures.
75
Short term exposure to Forane effects
* Liver and kidney disease * Headache * Irritability * Fatigue * Nausea * Drowsiness * Compromised performance * Decreased vigilance * Slow reaction time
76
Long term exposure to Forane effects
* Miscarriage * Genetic damage * Cancer * Miscarriage and birth defects in the SPOUSES of exposed workers
77
Albumin=
* Concentration of proteins derived from human blood * Increases plasma volume or serum albumin levels * May not be consented for by Jehovah's Witnesses patients
78
Albumin dosing standard
Varying concentrations 5%, 20%, 25% •25% contains 250g of protein for every 1000mL Some give when serum albumin
79
Albumin dosing prime
12.5 to 25g in prime, or as needed
80
albumin effects
Will increase circulating volume 3.5 times the volume injected, in an adequately hydrated individual
81
Insulin action=
stimulates glucose utilization by muscle and fat, and acts on the liver to inhibit glycogenolysis and gluconeogenesis
82
Insulin dosing standard
* 100 units/mL * 10-20 units IV on CPB * Never shake vial, roll in your hands to mix * Use 1 mL syringe or dedicated insulin syringe
83
Insulin dosing for hyperkalemia
* Adults: 25g Dextrose + 10 units Insulin | * Peds: 1-2 g/kg Dextrose + 0.3 units Insulin per gram of Dextrose
84
glucose target range
110-180 mg/dL during cardiac surgery
85
Dextrose “D-50” =
Concentrated carbohydrate in the form of dextrose in water used to treat hypoglycemia
86
Dextrose “D-50” dosing=
10-25g

Perf Tech 3 (15 decks)

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