deck_1516053 Flashcards
1
Q
Herbal Supplements: are they regulated by FDA?
A
NOpe
2
Q
Herbal Supplements: is there rigorus testing such as with Rx meds?
A
nope
3
Q
Herbal Supplements: are the adverse effects all know?
A
nope
4
Q
Herbal Supplements: should be stoped how long prior to Sx
A
2 weeks
5
Q
Herbal Supplements: what is the most popular herbal remedy in currently in the US
A
Echinacea
6
Q
Herbal Supplements: Echinacea is beleived to improve immune system by how?
A
modulation of cytokine signaling
7
Q
Herbal Supplements: Echinacea is used for tx of what?
A
viral, bacterial, and fungal infections (especially URI)
8
Q
Herbal Supplements: Echinacea Chronic use can resut in what?
A
immunosupression and hepatic faiuler
9
Q
Herbal Supplements: Echinacea what are some periop considerations?
A
avaoid hepatotoxic drugs avoid in immunosupressed pts (transplant)
10
Q
Herbal Supplements: Echinacea other names
A
purple coneflower coneflower American coneflower
11
Q
Herbal Supplements: Ephedra other names?
A
ma Huang Herbal ecstasy Cloud 9 (sounds bad ass)
12
Q
Herbal Supplements: Ephedra Sale is restricted in the US to Chinese Herbal Medicine only d/t adverse effects r/t dietary suppliments. what are some of those SE
A
Palpatations HTN Tacjycardia Stroke Seizures Cardiomyopathy MI Dysrhythmias Acute hepatitis psychosis death
13
Q
Herbal Supplements: Ephedra it contains what alkaloids?
A
ephedrine pseudoephedrine methylephredrine nor-pseudo-ephedrine
14
Q
Herbal Supplements: Ephedra has direct effect on ____ and ___ receptors and can indirectly increase the release of norepi for presynaptic neurons
A
alpha beta
15
Q
Herbal Supplements: Ephedra Used for what 3 things
A
Weight loss CNS stimulant Asthma
16
Q
Herbal Supplements: Ephedra periop considerations
A
when combined with other sympathomimetics can cause HTN Dysrhythmias Hyperthermia CV instability
17
Q
Herbal Supplements: Garlic also called what?
A
Allium sativum
18
Q
Herbal Supplements: Garlic has been used for centuries to treat what?
A
CV disease DM Infections Tumors
19
Q
Herbal Supplements: Garlic the _____ in garlic is beleived to decrease thromboxane formation and alter arachidonic metabolism
A
Cysteine
20
Q
Herbal Supplements: Garlic since it decreases thromboxane formation it can inhibit what?
A
platelet aggregation
21
Q
Herbal Supplements: Garlic can potentiate the anti-platelet effects of what drugs (2)?
A
Aspirin NSAIDs
22
Q
Herbal Supplements: Garlic preop considerations
A
Assess bleeding risk D?C 7 days b4 sx
23
Q
Herbal Supplements: Ginger also called what?
A
Ziingiber officinale
24
Q
Herbal Supplements: Ginger used to treat what?
A
Arthritis GI d/o Vertigo antiemetic
25
Herbal Supplements: Ginger the active component ______ is thought to inhibit prostaglandin and leukotriene sysnthesis
Gingerol
26
Herbal Supplements: Ginger is also thought to inhibit ________ synthatase, thus decreasing platelet agregation
thromboxane
27
Herbal Supplements: Ginger may ________ the effect of medications with anticoagulation properties
potentiate
28
Herbal Supplements: Ginger periop considerations
assess for bleeding Avoid in combination w/ other anticoagulants
29
Herbal Supplements: Gingko Biloba is thought to do what?
protect vascular walls and nerve cells
30
Herbal Supplements: Gingko Biloba is thought to protect vascular walls and nerve cells by acting as a _____-___ scavengers and ________ platelet activating factor
free-radical scavenger inhibiting
31
Herbal Supplements: Gingko Biloba was approved in Germany for the tx of ______
dementia
32
Herbal Supplements: Gingko Biloba is also beleived to decrease blood viscosity and improve blood flow to tissues and is used to treat _____
PVD
33
Herbal Supplements: Gingko Biloba periop considerations
Assess bleeding Avoid w/ NSAIDs, Aspirin, Warfarin D/C 36 hours prior to sx
34
Herbal Supplements: Ginseng used in traditional Chinese medicine for what? (3 main things)
immunomodulation Mood enhancement aphrodisiac
35
Herbal Supplements: Ginseng has mild sympathomimetic effect and may interact with what enzyme? tremors and mania have beenreported
Monoamine Oxidase Enzyme (MAO)
36
Herbal Supplements: Ginseng does what to BGL
Hypoglycemia
37
Herbal Supplements: Ginseng does what to platelet aggregation
interferes
38
Herbal Supplements: Ginseng periop considerations
Monitor BGL May increase bleeding (Assess) D/c 7 days prior to sx
39
Herbal Supplements: Herbal Diuretics what are 5 types
Dandelion Green tea Goldenseal Saw Palmetto Berries Spearmint
40
Herbal Supplements: Herbal Diuretics the MOA is uncertain but it is thought to interfers with the _____ system
RAAS
41
Herbal Supplements: Herbal Diuretics do to the diuretic effects significant ____ and _____ disturbances are associated with their use?
fluid and electrolyte
42
Herbal Supplements: Herbal Diuretics periop considerations
monitor fluid and electrolytes correct prior to sx
43
Herbal Supplements: KAVA another name
Piper methysticum
44
Herbal Supplements: KAVA derived for the dried root of the ___ plant family
pepper
45
Herbal Supplements: KAVA what is it used for
anxiolytic and Sedative effects
46
Herbal Supplements: KAVA the anxiolytic and seditive effect are mediated by potentiation of what?
GABA Gamma-aminobutyric acid
47
Herbal Supplements: KAVA potentiated effects of what drugs
barbs Benzos
48
Herbal Supplements: KAVA SE are seen in what organ
hepatotoxicity (LIVER)
49
Herbal Supplements: KAVA Perioperative considerations
may reduce MAC Avaoid hepatotoxic drugs D/C 24hrs prior to sx
50
Herbal Supplements: St. John's Wort Another name
Hypericum perforatum
51
Herbal Supplements: St. John's Wort is widely used in western societies as what?
antidepressant for mood disorders
52
Herbal Supplements: St. John's Wort similar to more convential antidepressents , and it's effects are thought to be b/c of thr inhibition of _______, ______, and _______ re-uptake by neurons
Serotonin Noorepinephrine Dopamine
53
Herbal Supplements: St. John's Wort found to be equal to _______antidepressants (drug class) in the treatment of mild to moderate depressive d/o
tricyclic
54
Herbal Supplements: St. John's Wort periop considerations
can lead to serotonergic syndrome may increase metabolism of Drugs (d/t potent inducer of CYP450) reduces anticoagulation effect of drugs Sedative properties may prolong anesthestic drugs D/C 5 days b4 sx
55
Herbal Supplements: Valerian another name?
Valeriana Officnialis
56
Herbal Supplements: Valerian has been used as what?
Anxiolytic sedative
57
Herbal Supplements: Valerian produces dose dependent sedation and hypnosis, possiably d/t inhibition of _____ breakdown and re-uptake
GABA
58
Herbal Supplements: Valerian acutly stopping will cause what?
withdrawl
59
Herbal Supplements: Valerian periop considerations
Decrease MAC Benzo like withdrawl if sudden stop
60
Illicit Drug Use: what are signs that indicate illicit drug use?
Track marks thrombotic veins Phlebitis Tattoos ablation of venous return (unilateral edema) Sub Q abcess
61
Illicit Drug Use: Opthalmologic Changes opiods
constriction (miosis)
62
Illicit Drug Use: Opthalmologic Changes Amphetamines
Dilation (Mydriasis)
63
Illicit Drug Use: Opthalmologic Changes PCP
Nystagmus
64
Illicit Drug Use: malnourishment is usually seen in what obusers opiod or amphetamines?
Amphetamines
65
Illicit Drug Use: Poor dentation is usually associated with abusers of what drugs
Amphetamines
66
Illicit Drug Use: nasal perforation is isually from what drug abuse
Cocaine
67
Illicit Drug Use: S/S of withdrawl (abstinence)
HTN Tachycardia Abdominal pain Cramping Diahrrea Tremors anxiety irritability Lacrimation Mydriasis algid sweating yawning
68
Illicit Drug Use: suspection of Drug abuse should be followed up with what?
urine drug screen
69
Illicit Drug Use: Marijuana other names
pot hash grass weed THC
70
Illicit Drug Use: Marijuana obtained from what plant
Cannabis Sativa
71
Illicit Drug Use: Marijuana What is the active ingrediant
Delta-9-tetrahydrocannabinol (THC)
72
Illicit Drug Use: Marijuana effects
possible antiemetic analgesia anticonvulsant appatite stimulant
73
Illicit Drug Use: Marijuana 1/2 life
56 hours for occasional users 28 hrs for chronic users
74
Illicit Drug Use: Marijuana why is the tissue half life so long? (1 weeks)
d/t sequestering in adipose tissue
75
Illicit Drug Use: Marijuana complete elimination of a single dose may take up to how many days
30 days
76
Illicit Drug Use: Marijuana metabolized by the _____ into more than 20 metabolites (most w/ psychoactive properties)
Liver
77
Illicit Drug Use: Marijuana frequent use can lead to what?
cognative impairment Shorted memory span Confusion altered time perception Dulled reflexes diff with ADLs
78
Illicit Drug Use: Marijuana low or moderate doses _______ sympathetic activity and ________ parasympathetic activity. which results in what?
increases decreases tachycardia and increased CO
79
Illicit Drug Use: Marijuana High doses ______ sympathetic activity but not parasympathetic activity, leading to what
inhibit Hypotension & bradycardia
80
Illicit Drug Use: Marijuana combination with other sedatives (ETOH, Benzo) may enhance _____ Depression
CNS
81
Illicit Drug Use: Marijuana effects on CV Myocaridal depression and and HR BP and HR drugs What drugs should you avoid
increased Myocadial depression and tachycardia Potentiates BP and HR drugs Avoid drugs that increase HR (ketamine, panc, atropine, ephedrine)
82
Illicit Drug Use: Marijuana respiratory effects
Upper airway irritability Cough/bronchitits/ COPD/ bronchospasm Upper airway edema
83
Illicit Drug Use: Marijuana some reccomend administration of what drug as prophylaxis from airway edema and irritation prior to GA
Dexamethasone
84
Illicit Drug Use: Opioids S/S of opioid craving
lacrimation Rhinorrhea yawning Piloerection
85
Illicit Drug Use: Opioids S/S of opiod overdose
Slow RR Increased TV Miotic pupils
86
Illicit Drug Use: Opioids s/s of withdrawl
restlessness insomnia mydriasis tachycardia tachypnea HTN Dysphoria Unconciousness
87
Illicit Drug Use: Opioids when does withdrawl occur? when does it peak?
4-6 hours post last intake peaks 48-72 hours
88
Illicit Drug Use: Opioids treatment for withdrawl
Opioids Methadone Clonidine
89
Illicit Drug Use: Opioids what drugs do you want to avoid, bc they can cause withdrawl
Nubain Narcan
90
Illicit Drug Use: Opioids Anesthestic considerations Acute opiiod intoxication does what to MAC
decreases
91
Illicit Drug Use: Opioids Anesthestic considerations Chronic opioid abuse does what to MAC
increases it
92
Illicit Drug Use: Opioids Anesthestic considerations why do abusers usually have exaggerated pain post op?
decreased pain tolerance decreased productionof endogenous opioids (endorphins, Enkephalins) increased post op Opioid requirement
93
Illicit Drug Use: Cocaine extracted from the leaves of what plant?
Erythroxylon coca
94
Illicit Drug Use: Cocaine available in what hydrochloride forms
powder granules crystals
95
Illicit Drug Use: Cocaine alkalinizide form (highly addictive) is called what
Crack rock free base
96
Illicit Drug Use: Cocaine When Smoked injected, snorted or ingested orally inhibits _________ uptake of sympathomimetic NT (AKA NE, Serotonin, Dopamine)
Presynaptic
97
Illicit Drug Use: Cocaine produces a pwerful euphoria lasting ____-___ min as a result of free catecholamines stimulation
5-30 min
98
Illicit Drug Use: Cocaine blood flow to arteries in areas like the ___ & ____may be compromised as the vessels vasoconstrict or vasospasm temporarily, severly compromising oxygenation and supply; this may lead to irreversable brain damage, stroke, and MI
Heart and brain
99
Illicit Drug Use: Cocaine metabolism _____ _____ across lipid membranes d/t low molecular weight and High lipid solubility
Easilly diffused
100
Illicit Drug Use: Cocaine metabolism metabolised to water soluble metabolites abd excreted in _____
urine
101
Illicit Drug Use: Cocaine metabolism biological 1/2 life?
0.5-1.5 hr
102
Illicit Drug Use: Cocaine metabolism ______ cholenesterases metabolizes 75-90% of cocaine into ____ INACTIVE metabolites, which can be detected 15-60 min after intacke! Also name the metabolites
Plasma 2 ecgonine methyl ester & Benzolecgonine
103
Illicit Drug Use: Cocaine metabolism _____ cholinesterase metabolizes 10% of cocaine into ______, an ACTIVE metabolite that produce similar actions as cocaine
LIver norcocaine
104
Illicit Drug Use: Cocaine metabolism Plasma cholinesterase deficiences results in greater liver cholinesterase metabolism whch can ______ the effects of cocaine and increase the risk of complications
Prolong
105
Illicit Drug Use: Cocaine metabolism only 1-1.5% is cleared unmetabolized in the urine allowing ots detection only ___ hours after its use
3-6
106
Illicit Drug Use: Cocaine Anesthesia considerations: although rare acute aortic dissection can occur, perhaps a consequence of abrupt, sever HTN, from ______ release
catecholamine
107
Illicit Drug Use: Cocaine Anesthesia considerations: Why must you be careful with regional
Cocain induced thrombocytopenia can occur form cocaine use
108
Illicit Drug Use: Cocaine Anesthesia considerations: why may HTN occur with regional
peripheral vasoconstriction
109
Illicit Drug Use: Cocaine Anesthesia considerations: Regional Ephdrine resitant Hypotension may occur. what drug may correct this
Phenylephrine
110
Illicit Drug Use: Cocaine GETA What drugs are contraindicated to treat Severe HTN an dCardiac arrhythmias
BBs
111
Illicit Drug Use: Cocaine GETA why is hydralazine good for HTN in these ots?
vasodilation effects and decreased SVR (watch for tachycardia relfex)
112
Illicit Drug Use: Cocaine GETA VAAs and especially _______ may produce arrhythmias
Halothane
113
Illicit Drug Use: Cocaine GETA why is ketamine avoided
CNS stimulat effects- increases catecholamines
114
Illicit Drug Use: Cocaine GETA why shoud etomidate be avoided
myoclonus seizures hyperreflexia
115
Illicit Drug Use: Cocaine GETA what may happen to SCh duration and why?
prologation d/t depletion of cholinesterase by cocaine metabolism
116
Illicit Drug Use: Cocaine GETA what drug may delay cocain induced seizure activity and increase the cumulative doses of cocaine necessary to produce seizures
Dexmedetomidine
