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SRNAPharmacology I > ANTACIDS (no questions)/PROKINETIC > Flashcards

ANTACIDS (no questions)/PROKINETIC Flashcards

1
Q

Mendelson’s syndrome: aspiration definition

A

Aspiration is the inhalation of gastric or oropharyngeal contents into the lungs

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2
Q

Mendelson’s syndrome aka

A

Peptic-aspiration pneumonia and is chemical pneumonitis causes by aspiration during anesthesia

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3
Q

Pulmonary aspiration of gastric contents will most likely cause

A

some degree of pulmonary complication

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4
Q

The severity of pulmonary complication will vary depending on the

A

volume of the fluid aspirated and the pH of the aspirate

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5
Q

Prevention of aspiration

PIG RIA the patient means what?

A

Performing an awake intubate or awake extubation
Increase pH of the gastric contents (antacids)
Give pro kinetics agent

Rapid sequence intubation with cricoid pressure
Inserting an NG tube
Allow adequate NPO time

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6
Q

widely accepted for defining aspiration

A

25mls or greater and or a pH of <2.5 wiIl cause aspiration pneumonitis.
Gastric ph is above 2.5
Gastric volume is 25ml

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7
Q

ASPIRATION risk factors

A 
Elderly 
Obese
Pregnant
Hx of CVA
emergency surgery 
Huntington's Chorea 
Parkings
Cancer of esophageal
Hiatal hernai
Bil vocal cold paralysis 
GI disorder
High ASA score (3 or greater)
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8
Q

Prokinetic agents

A

agents that enhance coordinated GI motility and transit of material in the GI tract

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9
Q

Prokinetic agents effects (4)

A

Increased GI motility
Increase peristaltic contractions
Increase/accelerates gastric emptying
Increase Lower esophageal sphincter (LES) tone

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10
Q

Cisapride effects

A

oral agent gastric motility
NASTY drug
Enhance the release of ACH at the myenteric plexus and is a 5-HT4 receptor agonist (G-Metoclopramide coupled receptors).

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11
Q

Restricted use of Cisapride

A

routine use can lead to Vfib and torsade

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12
Q

Domperidone actions

A

block D1 and D2 receipts with antiemetic properties

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13
Q

Domperidone facilitates

A

facilities smooth muscle activity by inhibiting dopamine at the D1 receptors.

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14
Q

MetoCLOPARMIDE is a

A

Dopamine antagonists acts as a GI pro kinetic drug

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15
Q

MOA of metocloplamide

What would block the effect of reglan

A
  1. Selective cholinergic stimulation of the GI tract by enhancing the response to Ach of tissue in the upper GI tract primarily via 5-HT4 receptor agonists
  2. Dopamine 2 receptor antagonism in the GI tract.

Any muscarinic antagonists will BLOCK the effect of reglan

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16
Q

Metoclopramide - Antiemetic drug through action of

A

dopamine 2 antagonist

17
Q

side effects of Metoclopramide

A

Can cause acute dystonic reaction

18
Q

Metoclopramide pharmacokinetics

A 
Protein binding low
Bioavailability 80%
half life 5-6hours
Minimal hepatic metabolism
Phase II conjugation
19
Q

Excretion is

A

Kidneys

cut in half for kidney issues

20
Q

Contraindications for Metoclopramide*** (4)

A
  1. Any patients with SBO
  2. Parkingson’s disease
  3. Pheochromocytome
  4. Seizure disorders
21
Q

Clinical uses of Metoclopramide for anesthesia

A

Pulmonary aspiration
prevent N/V
tx of diabetes gastroparesis
Small bowel intubation

22
Q

Prevention of postop N/V

A

10-20 mg IV

23
Q

Pediatric post of NV

A

0.1-0.2 mg/kg IV every 6- 8hours

24
Q

Adverse effects of Metoclopramide

A

Abdominal cramping (worse with IV administration)
Hypotension, tachycardia
EPS –>

25
Q

• Metoclopramide inhibits plasma cholinesterase (aka: Butyrylcholinesterase) activity

A
  • Prolonged action of succinylcholine and mivacurium

* Prolonged action of ester local anesthetics

26
Q

Metoclopramide effects:

A

CNS depressants such as sedatives and hypnotics
• May increase the risk of sedation when used in combination
• Opioids
• May increase the risk of sedation when combined
• Opioid-induced inhibition of gastric motility may not be reversible with metoclopramide (Narcotics antagonize metoclopramide effects on GI motility)
• Phenothiazine and butyrophenone agents

27
Q

• Metoclopramide will antagonize the clinical effects of

A

parkinson’s medications

28
Q

Metoclopramide and Monoamine oxidase inhibitors or tricyclic antidepressants

A

• The finding that metoclopramide releases catecholamines in patients with essential hypertension suggests that it should be
used cautiously, if at all, in patients receiving monoamine oxidase inhibitors or tricyclic antidepressants

29
Q

Erythromycin causes

A

DIARRHEA

30
Q

Erythromycin is a _______ and causes (3)

A

A macrolide antibiotic that

  • increases LES tone
  • enhances intraduodenal coordination
  • stimulates gastric and small bowel contractility (promotes emptying of gastric contents)
31
Q

Prokinetic mechanism of action of erythromycin is due to multiple mechanisms (2)

A

• Cholinergic stimulatory properties – Erythromycin facilitates cholinergic transmission in the GI tract
• Erythromycin mimics the effects of motilin in the GI tract by
binding to motilin receptors in the stomach and duodenum

32
Q
  • Metabolism and drug-drug Interactions

* Erythromycin is

A

metabolized by liver CYP 3A system

33
Q

Erythromycin is also a potent __________of the CYP 3A subfamily and other CYP 450 enzyme systems, thus co-administration of erythromycin and a drug primarily metabolized by any of these
CYP 450 enzymes can be associated

A

INHIBITOR

  • with elevations in this drugs plasma concentrations that could increase or prolong both the
    therapeutic and adverse effects of these other drugs
34
Q
  • Erythromycin + verapamil or diltiazem –

* Remember, prodrugs are the exception to the rule

A

increased risk of bradycardia, hypotension, and lactic acidosis

35
Q

• Erythromycin + alfentanil or midazolam –

A

increased serum concentrations of alfentanil or midazolam

36
Q

Erythromycin on QT

A

Prolonged

37
Q

Most common side effects of ORAL erythromycin are

A

GI symptoms such as diarrhea, abdominal cramping/pain, nausea and vomiting
(oral based products)
• GI symptoms are dose related!!!

SRNAPharmacology I (29 decks)

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