Exam 1: 3 Feb Anesthesia Preop Medications Flashcards
What are the main concerns during anesthesia induction?
Addressing preoperative anxiety and preventing aspiration
Important factors include GERD, empty stomach, bronchospasms, and laryngospasm.
What is the role of histamine in anesthesia?
Histamine is endogenous, causes bronchospasm, and increases acid secretion in the stomach
This can lead to aspiration and severe complications.
What are H1 and H2 receptors responsible for?
H1 receptors are responsible for hyperalgesia and inflammatory pain; H2 receptors elevate cyclic AMP and increase acid volume production.
Name two histamine receptor antagonists discussed.
- Diphenhydramine (Benadryl)
- Promethazine (Finergan)
What are the side effects of H1 receptor antagonists?
- Blurred vision
- Urinary retention
- Drowsiness
What is the main use of proton pump inhibitors (PPIs)?
They are the drug of choice for GERD and ulcers, inhibiting long-term acid production.
What are the potential side effects of long-term PPI use?
- Bone fractures
- Lupus
- C. diff
- Vitamin deficiencies
What distinguishes particulate from non-particulate antacids?
Particulate antacids are more dangerous to aspirate.
What is the purpose of dopamine blockers in anesthesia?
They stimulate motility, increase lower esophageal sphincter tone, and prevent aspiration.
What is Zofran (ondansetron) used for?
It is a serotonin receptor antagonist effective in preventing nausea and vomiting.
Fill in the blank: The peak concentration of scopolamine occurs within _______ hours.
8 to 24
What are the side effects of beta agonists like albuterol?
- Tremor
- Tachycardia
- Hyperglycemia
What is the significance of timing medication administration in anesthesia?
Timing medication with inspiration maximizes effectiveness.
What is the structure of the upcoming test?
100 multiple-choice questions over two hours, no calculators allowed.
True or False: The use of inhalers can result in medication loss due to plastic obstructions.
True
What is the recommended time to apply a scopolamine patch preoperatively?
At least 4 hours prior to the start of the case.
What is the elimination half-time of promethazine (Finergan)?
9 to 16 hours
What is the main concern with administering dexamethasone for nausea?
Timing is crucial to maximize effectiveness and minimize side effects.
What is the role of sodium citrate (Bicitra) in anesthesia?
It is a non-particulate antacid that increases stomach volume and works immediately.
What should be ensured for effective drug delivery in the OR?
Effective ventilation and oxygenation post-administration.
What are the side effects of metoclopramide (Reglan)?
- Belly pain
- Cramping
- Sedation
- Potential for neuroleptic malignant syndrome
Describe the ABCs considered in medication choice.
Airway, Breathing, Circulation
What is the importance of reviewing historical context and drug names for the test?
To ensure comprehensive understanding.
What is the primary goal when treating histamine reactions?
To prevent hypotension, capillary permeability, and other severe side effects
What type of drug is commonly used to treat histamine reactions?
H1 receptor antagonist
What is an inverse agonist?
A drug that reverses some symptoms of a condition, often confused with antagonists
Where do H1 receptor antagonists work effectively?
- Vestibular system
- Airway smooth muscle
- Cardiac endothelial cells
What is a common side effect of first-generation H1 receptor antagonists?
Drowsiness
What is tachyphylaxis in relation to H1 receptor antagonists?
There isn’t a lot of tachyphylaxis, meaning effectiveness does not decline with continued use
Name a common first-generation H1 receptor antagonist.
- Diphenhydramine
- Promethazine
What is the elimination half-life of diphenhydramine?
7 to 12 hours
What should be monitored in elderly patients taking H1 receptor antagonists?
Steadiness on their feet to prevent falls
What is the typical IV dose range for promethazine?
12.5 to 25 milligrams
Which drug is known as a good rescue antiemetic?
Promethazine (Phenergan)
What are some common side effects of H2 receptor antagonists?
- Diarrhea
- Headaches
- Skeletal muscle pain
What conditions are H2 receptor antagonists commonly used for?
- Duodenal ulcers
- GERD
- Decreasing gastric acid secretion
What is the impact of reducing stomach acid with H2 receptor antagonists?
Decreased protective acid can lead to bacterial overgrowth
What is the generic name for Zantac?
Ranitidine
What is the primary mechanism of proton pump inhibitors (PPIs)?
Irreversibly bind to acid pumps
How long does it take for proton pump inhibitors to be fully functional?
Up to 5 days
What is an important consideration when using PPIs preoperatively?
They do not provide immediate relief for acid-related symptoms
True or False: H2 receptor antagonists should be used cautiously in patients with renal impairment.
True
What is a potential risk of promethazine in children under two?
Fatal respiratory arrests and bronchospasms
Fill in the blank: The elimination half-life of promethazine is ______ hours.
9 to 16
What is the effect of H2 receptor antagonists on prolactin levels?
Increases plasma levels of prolactin
What should be monitored when administering H2 receptor antagonists to male patients long-term?
Testosterone binding to androgen receptors
What is the primary use of diphenhydramine in anesthesia?
As an antipyretic for itching from opioids
What is a common misconception about over-the-counter medications?
That they are always safe due to their availability without a prescription
What are PPIs primarily used for?
Controlling acidity and decreasing volume in the stomach
PPIs (Proton Pump Inhibitors) are most effective for managing conditions like GERD and ulcers.
How do PPIs compare to H2 receptor antagonists?
PPIs are more effective than H2 receptor antagonists for reducing acidity and volume
PPIs are newer, more popular, and more expensive than H2 blockers.
What are some potential long-term side effects of PPIs?
Bone fractures, lupus, C. difficile infection, vitamin deficiencies
Long-term use of PPIs can lead to significant health issues.
What is a concern regarding PPIs and warfarin?
PPIs inhibit the metabolism of warfarin, potentially increasing INR
This can lead to an increased risk of bleeding if INR is not monitored.
What is a pro drug in the context of PPIs?
A medication that must be activated in the body to become effective
Prilosec is an example of a pro drug that inhibits acid pumps.
What is the significance of CYP metabolism for PPIs?
PPIs are metabolized by the CYP system, affecting interactions with other drugs
However, significant interactions with other CYP drugs are not commonly observed.
What is the preferred drug for immediate relief in acute situations?
H2 blockers are preferred for immediate relief
H2 blockers work faster in acute situations compared to PPIs.
What are the two types of antacids mentioned?
Particulate and non-particulate antacids
Particulate antacids include aluminum or magnesium-based products, while non-particulate antacids like sodium citrate are safer to use.
What can long-term use of alkaline antacids lead to?
Bacterial overgrowth and electrolyte imbalances
Long-term use can disrupt normal digestive processes and lead to complications.
What is the effect of sodium citrate as an antacid?
Neutralizes stomach acid and increases stomach volume
Sodium citrate is a non-particulate antacid used to minimize aspiration risk.
How long does the effect of sodium citrate last?
30 to 60 minutes
Its effectiveness diminishes quickly, requiring careful timing in administration.
What is a significant consideration when giving PPIs in a surgical context?
PPIs take time to inhibit acid pumps and may not provide immediate relief
In emergencies, H2 blockers may be more beneficial than PPIs.
True or False: PPIs can instantly relieve symptoms of acid reflux.
False
PPIs require continuous use to effectively manage acid production.
What is the primary reason for using H2 antagonists over PPIs in certain situations?
Cost-effectiveness and immediate action
H2 antagonists can be taken as needed, making them more practical for intermittent symptoms.
What might indicate that a drug crosses the blood-brain barrier?
Headache, agitation, confusion, drowsiness
These symptoms suggest that the drug has central nervous system effects.
What is the primary action of PPIs?
Inhibit proton pumps in the stomach to reduce acid production
This results in decreased acidity and volume in the stomach over time.
Fill in the blank: PPIs are the drug of choice for _____ and GERD.
ulcers
PPIs are effective for long-term management of ulcers and gastroesophageal reflux disease.
What is a potential risk of using particulate antacids?
Aspiration risk due to particles in the lungs
Non-particulate antacids are preferred to minimize this risk.
What is a consideration for trauma patients regarding gastric emptying?
Trauma patients are always considered to be full stomachs due to pain, trauma, and anxiety decreasing gastric emptying.
This is important for anesthesia management.
Which group of patients is also considered to have a full stomach?
Pregnant women over 12-16 weeks are considered full stomachs due to the baby compressing the stomach.
This can impact anesthesia considerations.
What is the role of dopamine blockers in gastric motility?
Dopamine blockers are prokinetic agents that stimulate gastric motility and help prevent aspiration by moving contents out of the stomach.
They increase the lower esophageal sphincter tone and relax the pylorus.
What are some examples of dopamine blockers mentioned?
- Reglan (metoclopramide)
- Domperidone
- Droperidol
These drugs have different side effects and efficacy.
What is a significant side effect of Reglan?
Reglan can cause sedation and extrapyramidal symptoms.
It crosses the blood-brain barrier, leading to these effects.
What condition can be mimicked by neuroleptic malignant syndrome caused by Reglan?
Neuroleptic malignant syndrome can mimic malignant hyperthermia.
This is critical in the context of anesthesia.
What is the FDA-approved use of Reglan?
Reglan is cleared by the FDA for diabetic gastroparesis.
It is a common first-line treatment for this condition.
What is the dosing recommendation for Reglan?
The typical dose is 10 to 20 mg over three to five minutes.
This dosing is important for effective treatment.
What are the risks associated with Domperidone?
Domperidone was removed from the US market due to risks of cardiac arrest.
It is still available in some countries.
What is the primary use of Zofran (ondansetron)?
Zofran is primarily used for chemotherapy-induced nausea and vomiting.
It is a 5-HT3 receptor antagonist.
What is a key characteristic of 5-HT3 antagonists like Zofran?
5-HT3 antagonists have almost no side effects and are effective in multiple areas of the body.
This makes them favorable in anesthesia.
What is the difference between Zofran and other antiemetics for motion sickness?
Zofran is not effective for motion sickness; scopolamine is preferred for that purpose.
Scopolamine is often used for its efficacy in preventing motion sickness.
True or False: Droperidol is related to Haldol.
True.
Droperidol was developed for schizophrenia and shares some side effects.
Fill in the blank: The drug _______ can cause QT interval prolongation.
Droperidol.
This can lead to Torsades de Pointes.
What is an expected side effect of dopamine antagonists related to muscle control?
Extrapyramidal symptoms, including jitteriness and discomfort.
Patients may mistake these for an allergic reaction.
What is the mechanism of action for serotonin in relation to nausea?
Serotonin is released from chromatin cells of the small intestine and stimulates 5-HT3 receptors, causing vomiting.
This mechanism is targeted by antiemetic drugs.
What is a common misconception about patients who report side effects from dopamine antagonists?
Patients may report side effects as allergies rather than recognizing them as expected effects.
This can lead to misunderstanding regarding medication use.
What is Zofran also known as?
Ondansetron
Zofran is the first of the five HT3 antagonists that came out.
Which drug is often preferred over Anzamet for efficacy?
Zofran
Zofran is preferred as it is more likely to provide effective relief with one dose.
What are common side effects of Zofran?
Headache and diarrhea
These side effects are generally not significant enough for patients to refuse treatment.
True or False: Zofran causes a significant QT prolongation.
False
Zofran does cause slight QT prolongation, but it is not significant compared to other drugs.
What is the typical plasma half-life of Zofran?
Four hours
This means Zofran should be administered close to the end of the surgical procedure.
What is the typical dosage range for Zofran?
4 to 8 milligrams
Both dosages are supported by literature, but the ideal dose is debated.
When should dexamethasone be administered during surgery?
Two hours before finishing
This timing allows dexamethasone to be effective for nausea and inflammation.
What is the primary mechanism by which corticosteroids prevent nausea and vomiting?
Decreasing endorphin release and exerting anti-inflammatory effects
This helps reduce pain, which can lead to less need for opioids and subsequently less nausea.
What is the common dosage for dexamethasone used for nausea and vomiting?
4 to 8 milligrams
Higher doses may be used for respiratory issues related to airway swelling.
What is the primary purpose of the scopolamine patch?
To prevent nausea and vomiting
Scopolamine is particularly effective for motion-induced nausea.
When should the scopolamine patch ideally be applied?
At least four hours pre-op
This allows the drug to start working before the patient is in surgery.
What is the release duration of the scopolamine patch?
Up to three days
Patients should be advised to remove the patch after three days.
What is the difference between scopolamine and other anticholinergics like atropine?
Scopolamine is better for nausea and sedation
Atropine and Robinul are more effective for increasing heart rate and managing secretions.
What should be monitored in patients with pulmonary issues before surgery?
Asthma stability and symptoms
Assessing the patient’s respiratory condition can prevent complications during anesthesia.
What is the initial step if a patient reports feeling tight or wheezy?
Administer albuterol
This can help alleviate respiratory distress before surgery.
Fill in the blank: The common drug used for nausea and vomiting in chemotherapy patients is _______.
Dexamethasone
What should be assessed for a patient before administering bronchodilators?
Fever, pneumonia, need for chest X-ray, and overall respiratory status
These assessments help determine the urgency and appropriateness of treatment.
What is the main purpose of administering albuterol?
To activate beta receptors, decrease calcium entry, and relax smooth muscles in the airway
Albuterol is a bronchodilator commonly used in asthma management.
What is the expected increase in FEV1 after using an albuterol inhaler?
Approximately 15% increase
This increase may not be sufficient during a severe asthmatic attack.
What are two methods of delivering bronchodilators in the operating room?
Metered Dose Inhaler (MDI) and nebulization
Both methods can be used depending on the patient’s needs and availability.
What are common side effects of beta agonists like albuterol?
- Tremor
- Tachycardia
- Hyperglycemia
- Transient decrease in arterial oxygenation
These side effects are related to catecholamine release.
True or False: Nebulizing bronchodilators can be done through an endotracheal tube.
True
This method allows for direct delivery of medication to the lungs.
Fill in the blank: The beta agonist can lead to a decrease in ________ due to increased contractility.
Venous return
Tachycardia can influence venous return dynamics.
What is the effect of bronchodilators on alveoli during an asthmatic attack?
They open constricted airways, improving ventilation and perfusion
This can temporarily enhance arterial oxygenation.
What alternative to albuterol might be chosen for an elderly patient with aortic stenosis?
Opened
Xopenex may have fewer side effects (especially no increase in HR) compared to albuterol.
What is the purpose of using a syringe with an inhaler for drug delivery?
To push medication directly into the endotracheal tube
This method aims to improve the efficiency of medication delivery.
What is the significance of timing when administering inhalers with inspiration?
To maximize the delivery of medication to the lungs
Timing with inspiration helps ensure the medication reaches the intended area.
What is the policy regarding calculators during exams in the operating room?
No calculators allowed
This is due to the potential for distractions and the unavailability of calculators in some clinical sites.
How many questions are expected from each lecture in the exam?
About 20 questions
This distribution ensures a balanced assessment across all topics covered.
What should students do if they finish their exam early?
Review and check for missed points
A brief review session is provided at the end of the exam.
