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Oral Boards cold > Drugs > Flashcards

Drugs Flashcards

1
Q

What are the disadvantages of using etomidate on induction?

A

Inhibitor of endogenous steroid synthesis thru inhibition of 11-beta hydroxylase
Does not block sympathetic response to tracheal intubation (need beta blocker or opioid too)
PONV
Myoclonus

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2
Q

What antibiotics cover for pseudomonas ?

A 
Piperacillin/tazobactam
Cefepime
Imipenem/meropenem
Cipro 
Moxi 
Levofloxacin
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3
Q

What antibiotics due gram negative coverage?

A

Gentamicin
Tobramycin
Amikacin

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4
Q

What antibiotics for gram positive coverage?

A

Cefazolin for skin flora

Linezolid or vanc for MRSA

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5
Q

What about anaerobic coverage?

A

Metronidazole

Clindamycin

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6
Q

What is AMICAR?

A

Anti fibrinolytic

Decreases plasminogen to plasmin so that it cannot break up fibrin clot

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7
Q

What are the American Red Cross transfusion guidelines for platelets?

A

They do not have to ABO or Rh compatible.
They should be when possible.

You should consider anti-Rh globulin when you have given Rh+ platelets to a female patient who is Rh - to avoid erythroblastosis fetal is in the future

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8
Q

What are the transfusion guidelines for FFP ?

A

Must be ABO compatible

Do not have to cross matched or Rh compatible

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9
Q

What is the transfusion threshold for patients that are hemodynamically stable ?

A

7 g/DL

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10
Q

What is the transfusion threshold for patient undergoing orthopedic, cardiac surgery or pre-existing cardiac disease?

A

8 g/DL

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11
Q

What are the transfusion guidelines for someone with sickle cell preoperatively?

A

Transfuse to Hgb of 10 g/DL (use leukocyte reduction!)

If at 8.5 g/DL and on hydroxyurea, undergoing high risk surgery - consult heme

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12
Q

For an untreated SCD patient, what are the preop guidelines?

A

Avoid transfusion to greater than 10 g/DL due to risk of hyper viscosity

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13
Q

When do you give platelets preoperatively?

A

When platelet count is less than 50K if bleeding may be an issue.
Do NOT have to do this for minor surgeries or vaginal deliveries

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14
Q

What are the transfusion thresholds for a patient with multiple trauma or CNS injury?

A

< 100K

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15
Q

What is FFP deficient in?

A

Factor V and VIII

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16
Q

What does cryoprecipitate contain?

A 
Concentrated levels of fibrinogen (150 mg in 5-20 ml of plasma)
Factor VIII (80 IU) 
VWF
Factor XIII
Fibronectin
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17
Q

What are the transfusion guidelines for cryoprecipitate?

A

Do not need to be ABO compatible
Do not need to be Rh compatible
CMV testing and leukocyte reduction are not required

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18
Q

What is the advantage of using propofol over a barbiturate in a patient with liver disease?

A

Propofol has a high extraction ratio, does not depend on hepatocytes,

Barbiturates are highly bound to albumin, in liver disease you will have low albumin causing increased FF of barbiturates so longer duration or action. Additionally barbs rely on P450 system for metabolism which is impaired in liver disease

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19
Q

Why are the differences of LMWH compared to unfractionated heparin?

A 
Stronger inhibitors of factor Xa
Lower risk of osteopenia 
Smaller molecular structure
Less release of vwf (better for patients with NSTEMI or unstable angina)
Lower incidence of HIT
Longer half life so less frequent dosing
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20
Q

What are the indications for erythropoietin administration?

A

Reduce need for RBC transfusions for patients with Hgb > 10 g/DL but less than 13 who are high risk for periop blood loss

Need to give daily for 10 days before surgery, DOS, and 4 days after
Or 4 doses administered 21, 14, and 7 days before surgery and DOS.

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21
Q

What is platelet transfusion threshold for major elective surgery?

A

Less than 50K

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22
Q

What is the therapeutic range for patients with mechanical valves of warfarin?

A

2.5-3.5

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23
Q

What herbal medicine inhibit platelet aggregation

A 
Bilberry
Bromelain
Dong Quoi
Feverfew
Fish oil
Flaxseed oil
Garlic
Ginger
Ginkgo 
Grape seed extract
Saw palmetto
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24
Q

What herbals inhibit clotting?

A

Chamomile
Dandelion
Dong Quoi
Horse chestnut

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25
Q

What do you do if you suspect ABO incompatibility?

A

Stop the transfusion
Support!
Aggressive transfusions of platelets, FFP and cryogenic to counteract consumptive coagulopathy

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26
Q

What is the cause of TRALI?

A

Donor anti-HLA antibodies to plasma components of blood (FFP or platelet) causing complement activation

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27
Q

What do you suspect with hypotension and hyperthermia after giving platelets?

A

Sepsis from bacterial contamination

Stop transfusion! Start antibiotics and supportive measures

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28
Q

Why is Isoflurane best for liver cases?

A

Preserves splanchnic blood flow

Vasodilates hepatic vessels

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29
Q

What is in the preservation fluid for a liver transplant?

A

Potassium
Lactobionate and raffinose - prevent cell swelling
Hydroxyethyl starch - increase oncotic pressure
Allopurinol and glutathione - reduce oxygen free radicals
Adenosine - promote ATP production

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30
Q

At what dose and duration of prednisone are patients considered HPA suppressed?

A

20 mg/day for over 3 weeks

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31
Q

What are the periop guidelines of steroid administration for someone who is suppressed and undergoing major surgery?

A

Give daily dose plus 100 mg IV hydrocortisone before incision
Then give infusion of 200 mg of hydrocortisone over 24 hour in D51/2NS
Then taper

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32
Q

What are the periop guidelines of steroid administration in patient undergoing minor surgery who are suppressed?

A

Give 50 mg IV before incision
Then 25 mg IV q8h X 24 hours
Then taper over 1-2 days to daily dose

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33
Q

What are the periop guidelines of steroid administration in patient undergoing moderate surgery who are suppressed?

A

Give 50 mg IV before incision
Then 25 mg IV q8h X 24 hours
Then taper over 1-2 days to daily dose

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34
Q

What are the alternative anticoagulants in HIT?

A

Argatroban
Bivalirudin
Lepirudin

MOA: direct thrombin inhibitors

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35
Q

What is the loading dose of bivalirudin and maintenance dose?

A

1 mg/ kg loading dose
2.5 mg/kg/ hr infusion

Half-life of 25 minutes
Renally cleared
Can still use ACT
No reversal agent - can use PCC, FFP

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36
Q

What is the difference in lepirudin and bivalirudin?

A

Lepirudin has a longer half life of 80 minutes and

Bivalirudin is safer, more evidence behind it

37
Q

What is HIT?

A

IgG mediated antibody reaction to Plt factor 4 and heparin complexes resulting in arterial thrombosis and TCP
Happens within 4-14 days of heparin administration

38
Q

What it type 1 HIT?

A

Drop in platelets without thrombosis

Not immune mediated

39
Q

What are the problems if someone takes ephedra?

A

Increased circulating levels of norepinephrine, decreased stores –> may have hypotension refractory to vasopressors due to receptor down regulation

40
Q

What are the problems if someone takes St John’s wort?

A

Delayed emergence due to hypericin (GABAergic)

41
Q

What drugs do you want to avoid if a patient is on MAOi?

A

Ephedrine
Meperidine
Methylene blue

42
Q

What is the difference between NMS and serotonin syndrome?

A

Serotonin syndrome symptoms are clonus and hyperreflexia

NMS has rigidity but hyperreflexia

43
Q

When should removal of a neuraxial catheter happen after discontinuation of IV heparin?

A

2-4 hours

44
Q

How long should you wait to start IV heparin after epidural placement?
Subq heparin?

A

1 hour

Can do immediately for subq because peak drug effect is 2 hours

45
Q

What is low dose LMWH and how long do you need to wait to place neuraxial?

A

Lovenox 30-40 mg subq BID or q day
Dalteparin 5,000 u q day

Wait 12 hours for removal or placement
Restart 2 hours after removal

46
Q

How long do you need to hold ticlodipine for neuraxial?

A

14 days

47
Q

How long do you need to delay neuraxial for clopidogrel or prasugrel?

A

7-10 days

48
Q

How long do you delay restarting Plavix or prasugrel after neuraxial?

A

At least 6 hours

49
Q

How long do you delay for ticagrelor to do neuraxial?

To restart?

A

5-7 days

6 hours

50
Q

How long do you wait if they’re on abciximab? What is abciximab?

A

24-48 hours

It’s a G2b/3a inhibitor

51
Q

When is it safe to do neuraxial after eptifibitide or tirofiban? What are these?

A

4-8 hours

g2b/3a inhibitors

52
Q

What are ticlodipine, prasugrel, clopidogrel, ticagrelor?

A

P2Y12 receptor inhibitors

Thienopyridine derivatives

53
Q

What is the safe time to wait for neuraxial placement or removal if the patient is on antifibrinolytics?

A

No one knows

Can monitor fibrinogen to guide management

54
Q

How long do you wait for neuraxial placement or removal with direct thrombin inhibitors (pradaxa, lepirudin, argatroban, bivalirudin)?

A

5 days

Wait 6 hours to redose after catheter removal

55
Q

What is the safest time for neuraxial with fondapari nix and apixaban or rivaroxaban? What are these drugs?

A

72 hours

Resume after 2 hours

Factor Xa inhibitors

56
Q

What drugs should you avoid in renal failure?

A 
Pancuronium
Glycopyrrolate 
Atropine
Ketamine
Meperidine
Morphine
Diazepam
57
Q

What does cyclosporine do to NMB?

A

Potentiation of effect of atracurium and vecuronium

58
Q

What does azathioprine do to muscular blockade?

A

Competitive antagonism

59
Q

What can bromocriptine cause?

A

Gastroparesis

60
Q

What is the mechanism of action of bromocriptine?

A

D2 agonist

Inhibits release of prolactin and GH

61
Q

What is the mechanism of action of octreotide?

A

Somatostatin analogue
Inhibits release of lots of hormones including GH
Can shrink pituitary adenoma size

62
Q

What are the signs of lithium toxicity?

A 
Polyuria
AV block, widened WRS
Seizure
Hypotension
Skeletal muscle weakness
Ataxia
Sedation
63
Q

What we the anesthetic considerations for someone taking lithium?

A

Prolongation of neuromuscular blockade
Reduces MAC requirement
Drugs that increase lithium levels: thiazides, ACEi, NSAIDs
Can cause vasopressin resistant diabetes insipidus
Use sodium solution to prevent renal reabsorption of lithium (exchanged in proximal tubule for Na)

64
Q

Which drugs can raise lithium levels?

A

ACEi
NSAIDs
Thiazides

65
Q

What does PTU do?

A

Stops synthesis of thyroid hormone
Decrease the conversion of T4 to T3

Takes 6-8 weeks to work!

66
Q

What does iopanic acid do?

A

Inhibits thyroid hormone release
Inhibits conversion of T4 to T3 (can reduce T3 levels within 6-12 hours by 50-75%)

Should be given within 1 hour of PTU in thyroid storm
Don’t give preop unless euthyroid already

67
Q

What is the treatment for hypocalcemia from thyroidectomy?

A

10 ml of 10 % calcium gluconate over 10 minutes
Treat hyperkalemia and hypomagnesemia
Get EKG to monitor for symptoms

68
Q

Why would you not use aspirin to treat fever due to thyrotoxicosis

A

Because it displaces thyroid hormone from binding proteins in the blood

69
Q

What are the catecholamine depleting agents you can use in thyroid storm?

A

Reserpine

Guanethidine

70
Q

What are the contraindications ft cell saver?

A

Hemoglobin apathy
Amniotic fluid
Contamination with meds, methyl methacrylate, bone chips, urine,
Pheochromocytoma
Cancer (can do is process, wash and use a leukodepletiom filter)
Sepsis

71
Q

What are the complications of cell saver?

A

Hemolysis
Systemic contamination
Nephrotoxicity (high levels of free hemoglobin)
Coagulopathy
Pulmonary injury 2/2 leukocyte activation
Gas embolism
Fever

72
Q

What drugs are safe to give with porphyria?

A 
Ketamine
Propofol
NMBs
Opioids
Volatile
73
Q

What anesthetic drugs are known to induce the P450 system?

A

Thiopental
Ketorolac (Toradol)
Etomidate
Methohexital

74
Q

What is hematite used for?

A

Increasing the pool of heme and thereby decreasing the activity of ALA synthetase in porphyria crisis

75
Q

What drugs should be given based on IBW on induction and maintenance?

A

Vecuronium
Rocuronium
Remifentanil

76
Q

Why is diltiazem used over verapamil?

A

Because it produces significantly less myocardial depression

77
Q

How does epinephrine treat anaphylaxis?

A

Alpha vasoconstriction
Beta bronchodilation
Increases intracelluar cAMP thereby restoring membrane permeability and decrease of vasoactive mediators

78
Q

What is the dose of epi for anaphylaxis without complete cardiac collapse?

A

10 Mcg IV

79
Q

What is the dose of epi in anaphylaxis with cardiac collapse?

A

100 Mcg - 1 mg

80
Q

What is antithrombin III?

A

Serine protease that binds thrombin, factor X, XI, XII and XIII and enhances Anticoagulation

Heparin binds this and increases its activity 1000X

81
Q

At what dose is developing cyanide toxicity is low with nitroprusside?

A

Less than 0.5 mg/kg/hr

82
Q

What are the risks of giving Rh + blood to a male patient if Rh type is unknown?

A

Delayed transfusion reaction

Alloimmunization - would type after surgery and administered Rhogam within 72 hours if Rh negative

83
Q

Do platelets have to ABO compatible?

A

If they are apheresis platelets, then YES because they are suspended in plasma containing anti- and B antibodies

84
Q

Can you give a FFP with AB blood type to a patient with unknown blood type?

A

Yes, because this plasma does not have antibodies to A or B

85
Q

Would you proceed with a surgery after traumatic needle placement of an epidural?

A

Yes, if they were not going to be fully heparinization

If fully heparinization - must wait for 24 hours

86
Q

What should you do if the INR is less than 4.5 and there needs to be urgent reversal?

A

Consider vitamin K 2.5 mg po

87
Q

What should you do if there is life-threatening bleeding and INR is < 4.5?

A

Hold warfarin
Vitamin K 10 mg IV over 30 minutes
4 units of FFP or Kcentra

88
Q

What should you do if INR is between 4.5-10 and needs urgent reversal?

A

Vit K 2.5 mg po

1 mg IV

89
Q

What should you do if INR is over 10 and you need urgent reversal?

A

Vit K 1-2 mg IV over 30 minutes

Repeat every 6-24 hours as needed

Oral Boards cold (10 decks)

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