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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
Q

most Heparin vials come in what increments

A

Most vials you will see for adult CPB will be 1000 units/mL

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26
Q

a loading dose of 30000 units is how many ml

A

30 ml

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27
Q

Neo-Synephrine action

A

Synthetic selective α1-adranergic agonist that causes vasoconstriction in arterioles

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28
Q

Neo-Synephrine duration

A

less than 5 minutes
•Titrated to effect
•Start with a test dose

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29
Q

Neo-Synephrine Dosing: IV bolus

A
  • 100 micrograms/mL
  • 200 micrograms/mL
  • 400 micrograms/mL
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30
Q

Neo-Synephrine Dosing: IV infusion

A

•10 or 15 mg in 250 mL IV fluid (40 to 60 micrograms/mL)

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31
Q

starting with 10 mg Phenylephrine in 1 mL vial– Add 49 mL Normosol and you get:

A

50 mL containing 10,000 mcg = 200 mcg/ML

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32
Q

Sodium Bicarbonate=

A
  • 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
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33
Q

Sodium Bicarbonate dosing equation

A

Dose (mEq) = 0.3 x Weight (kg) x BD (mEq/L)

*Or just “1 amp” (50 mEq)

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34
Q

Sodium Bicarbonate dosing for hyperkalemia

A

Adults: 50 mEq

•Peds: 1-2 mEq/kg

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35
Q

Sodium Bicarbonate dosing for hyperkalemia

A

Adults: 50 mEq

•Peds: 1-2 mEq/kg

36
Q

Lidocaine action

A

reduces cell membrane permeability for sodium and potassium which increases the stimulation thresholds in ventricles

37
Q

Lidocaine site of action

A

cell membrane

38
Q

Lidocaine duration of action

A

15 to 30 minutes post bolus

39
Q

Lidocaine Dosing

A

•IV bolus 1-2 mg/kg
–Usually 100 to 200 mg bolus at XC removal
•Not to exceed 300 mg/hr

40
Q

Magnesium Sulfate action

A

controls transmembrane electrolytes and energy metabolism

•Cardiac arrhythmias may occur during hypomagnesemia

41
Q

when could Hypomagnesemia occur on CPB

A
  • Poor pre op health
  • Albumin administration
  • Citrated blood product administration
42
Q

Magnesium Sulfate dosing

A
  • 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
Q

Calcium Chloride action=

A

Involved in myocardial contractility, blood clotting, neurotransmission and muscle contraction

44
Q

Calcium Chloride may be used for mixing with?

A

thrombin for platelet gel

45
Q

when would Calcium Chloride level drop on CPB

A

May be necessary to replenish before coming off CPB

Especially if citrated blood products given

46
Q

Calcium Chloride dosing: standard

A
  • 200 to 1000 mg slow IV

* Often 100 mg/mL concentration

47
Q

Calcium Chloride dosing: hyperkalemia

A
  • Adults: 0.5-1g CaCl2

* Peds: 20 mg/kg Calcium Gluconate

48
Q

Calcium Chloride is given when?

A

•Given post XC removal and before termination of CPB if levels are low

49
Q

Potassium Chloride=

A
  • The major intracellular ion
  • Necessary for normal cardiac contractions
  • HypERkalemia more of an issue than hypOkalemia
  • Cardioplegia
50
Q

Potassium Chloride cpg dose

A

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
Q

Potassium Chloride hypokalemia dose

A

Dose (mEq) = weight (kg) x 0.3 x K+ deficit

52
Q

how is Potassium Chloride given

A

GIVE IT SLOWLY especially if XC not on

53
Q

Potassium Chloride typical concentration

A

Usually 2 mEq/mL concentration

54
Q

Mannitol action

A

osmotic diuretic prevents reabsorption in the proximal tubule (also thought to be a free radical scavenger)

55
Q

Mannitol dosing during CPB

A

During CPB 0.5 to 1.0 g/kg
•Inspect carefully for precipitate or crystals.
•Use a filtered needle during administration

56
Q

Mannitol dosing for prime

A

Often given as 12.5 g vials in prime or during warming

57
Q

THAM (tromethamine) action

A

creates an alkaline environment by combining with hydrogen ions to form bicarbonate [buffer]

58
Q

THAM (tromethamine) dosing

A

Each 100 mL contains tromethamine 3.6g (30mEq)

Dose (mL) = 1.1 x wt (kg) x Base Deficit (mEq/L)

59
Q

Amicar (ε-aminocaproic acid) action

A

inhibits plasminogen activators to prevent conversion to plasmin
•Reduces bleeding caused by hyperfibrinolysis

60
Q

Amicar (ε-aminocaproic acid) dosing

A

Loading Dose: 5 g IV

Infusion: 1-1.25g/hr (30g/day max)

61
Q

Trasylol action

A

inhibits fibrinolysis and turnover of coagulation factors (serine protease inhibitor)

62
Q

Trasylol dosing

A

•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
Q

Thrombate III (antithrombin) action

A

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
Q

Thrombate III (antithrombin) dosing

A

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
Q

Thrombate III (antithrombin) dosing

A

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
Q

Benadryl (diphenhydramine) action

A

antihistamine, sedative, antiemetic, anticholinergic

•Given on CPB after suspicion of allergic reaction

67
Q

Benadryl (diphenhydramine) dosing

68
Q

Solu-Medrol (methylprednisolone) action

A

Intermediate acting glucocorticoid used on bypass to combat inflammation, often during circulatory arrest cases
•May cause hyperglycemia

69
Q

Solu-Medrol (methylprednisolone) dosing

A
  • 125mg – 1g
  • Sterile powder which must be mixed with the accompanying diluent
  • Use within 48 hours of mixing
70
Q

Forane action

A

ethers that modulate the GABAA receptor, used for induction and maintenance of anesthesia
•Potent vasodilators
•Pungent odor

71
Q

Forane dosing

A

Set vaporizer at 0.5% to 2% after initiation of gas flow

•Can be temporarily increased for blood pressure control

72
Q

what happens if you spill Forane on your pump

A

Spillage can cause structural degradation of plastic

73
Q

what should you have operating while using Forane

A

Scavenge oxygenator gas outflow when using anesthetic gas

74
Q

AMSECT Standard 6.8=

A

An anesthetic gas scavenge line shall be employed whenever inhalation agents are introduced into the circuit during CPB procedures.

75
Q

Short term exposure to Forane effects

A
  • Liver and kidney disease
  • Headache
  • Irritability
  • Fatigue
  • Nausea
  • Drowsiness
  • Compromised performance
  • Decreased vigilance
  • Slow reaction time
76
Q

Long term exposure to Forane effects

A
  • Miscarriage
  • Genetic damage
  • Cancer
  • Miscarriage and birth defects in the SPOUSES of exposed workers
77
Q

Albumin=

A
  • 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
Q

Albumin dosing standard

A

Varying concentrations 5%, 20%, 25%
•25% contains 250g of protein for every 1000mL
Some give when serum albumin

79
Q

Albumin dosing prime

A

12.5 to 25g in prime, or as needed

80
Q

albumin effects

A

Will increase circulating volume 3.5 times the volume injected, in an adequately hydrated individual

81
Q

Insulin action=

A

stimulates glucose utilization by muscle and fat, and acts on the liver to inhibit glycogenolysis and gluconeogenesis

82
Q

Insulin dosing standard

A
  • 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
Q

Insulin dosing for hyperkalemia

A
  • Adults: 25g Dextrose + 10 units Insulin

* Peds: 1-2 g/kg Dextrose + 0.3 units Insulin per gram of Dextrose

84
Q

glucose target range

A

110-180 mg/dL during cardiac surgery

85
Q

Dextrose “D-50” =

A

Concentrated carbohydrate in the form of dextrose in water used to treat hypoglycemia

86
Q

Dextrose “D-50” dosing=

Perf Tech 3 (15 decks)

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