Different cases Flashcards
What is the MOA for caffeine?
nonselective inhibition of adenosine receptors and phosphodiesterase resulting in accumulation of cAMP and calcium with effects of smooth muscle relaxation and/or muscle/cardiac/CNS excitation. Also B1 and B2 adrenergic stim from catecholamine release
When are the primary uses of caffeine?
cath lab to stim tachy and ID origin
supplement
post dural puncture headache.
What are the doses of caffeine?
250mg at start/throughout/end of case as supplement.
For post dural puncture it is 1-2 doses of 500mg
What is the MOA of octreotide?
potent inhibitor of growth hormone, glucagon, and insulin. Decreases splachnic blood flow and inhibits release of serotonin, gastrin, vasoactive intestinal peptide, motilin, secretin, and pancreatic polypeptide
What are the uses of octreotide?
acromegaly, treating symptoms of metastatic carcinoid tumors, vasoactive intestinal peptide tumors (treat diarrhea)
What’s the toxic dose of octreotide?
there isnt one. no side effects either.
What are the doses of octreotide?
small procedure: 100mcg sq preop then 50-100mcg throughout the case.
major surgery 100-200mcg sq preop, possibly gtt or 500-1000mcg boluses iv
What is the MOA of Flolan?
direct vasodilation of pulm arteries and systemic arterial vascular beds, inhibits platelet aggregation
What is Flolan used for?
primary pulm htn
What are some considerations for flolan?
Don’t abruptly stop: short 1/2 life and can cause complications/death
Admin in dedicated iv with 0.22 micron filter
C/I with CHF (decrased LV function) b/c cant keep up with right heart
What is the MOA of methylene blue?
inhibits nitric oxide cGMP pathway by inhibiting guanylate cyclase in endothelium and reduces nitric relaxation of vessels.
What is Methylene blue used for?
to improve hypotension, hypoxia, and methemoglobinemia. increases MAP and SVR while decreasing pressor requirements. Also used as dye to check anastomosis in urology.
When is indocyanine green used?
when surgeon under microscope looking at vasculature
What is the dose of IC green?
0.5mg/kg over 6-10 sec
What can you expect after admin IC green?
transient drop in pulse ox sats
What is Onyx glue used for?
embolization on AVM and aneurysms,
What does the onyx glue do?
non-adhesive liquid embolic agent made of ethylene-vinyl copolymer, dimethyl sulfoxide and tantalum to show contrast under fluoro: after delivery material transforms into solid polymer
What are the side effects of onyx glue?
PAINFUL, can cause bad breath and skin odor.
What does a tocalytic do and what are examples?
stop uterine contractions: magnesium and endometh…
How does oxytocin/pitocin work?
oxy receptors in uterus, increase cAMP and intracellular Ca
What does methergine act on?
D1 antagonist
What does carboprost (hemabate) act on?
prostacyclin
When is carboprost C/I?
asthma and HTN due to bronchoconstriction
Is txa 1st line in maternal hemorrhage kit?
No.
When is methergine C/I?
HTN/preeclampsia, HAART
When can you use inhaled TxA?
to treat airway bleeding after CT-guided mass ablation. need atomizer and filters so need RT to help
How is thymoglobulin administered to kidney transplant patients?
through 0.22 micron filter via CENTRAL ACCESS
How is Campath (alemtuzumab) admin, and what for?
SQ injection, for induction med of standard risk recipients
How is Basiliximab (simulect) admin?
IV, central not required
What chemo meds are given in HIPEC?
mitomycin, cisplatin
Describe HIPEC.
Hyperthermic Intraperitoneal Chemotherapy; not curative, mainly palliative. put chemo in belly and shaken x90 min. used for intestinal, uterine, abdominal cavity CA.
What are anesthetic considerations in HIPEC.
treat acidosis, chemo precautions, keep temp <38.5 b/c chemo is heated, so use ice packs and all the things
What is the primary toxicity of cisplatin?
ototoxicity/nephrotoxicity
When/why do you use sodium thiosulfate?
gtt when they infuse chemo and through end of case, given by anesthesia to mitigate chemo toxicity
What is the MOA of sodium thiosulfate?
neutralizing agent for cisplatin (thought to be done in kidney
What is the concentration of dex in kids?
dilute to 4 mcg/mL
What can be used for ear tubes?
nasal fentanyl 2mcg/kg and dex
What can you premed kids with?
midazolam, ketamine, tylenol (beware of sugar if on ketogenic diet can’t use)
When can you premed kids?
2-6yo
What can’t mitochondrial disorders have?
propofol
Why do you need to be cautions in succ with kids?
potential for undiagnosed muscular dystrophy but still often used in laryngospasm
