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Anesth Pharm > Exam 1: Preop Meds > Flashcards

Exam 1: Preop Meds Flashcards

1
Q

Histamine Induces

A

contraction of smooth muscles in airways, secretion of acid in the stomach, release of NT in the CNS: ACh, Norepi, 5 HT

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2
Q

Drugs that induce Histamine release

A

Morphine, mivacurium (Mivacron), protamine, atracurium (isomer of Nimbex)

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3
Q

Treatment of Histamine Release

A

Must be treated with H1 and H2 antagonist.

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4
Q

Why must both H1 and H2 antagonist be given

A

Hit both receptors so you don’t have the effects from one of the receptors still active.

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5
Q

Histamine effects on H1

A

Hyperalgesia and inflammatory pain (insect stings). Allergic rhino-conjuctivitis symptoms

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6
Q

Histamine effects on H2

A

Elevates CAMP (B1 like stimulation). Increases acid/volume production

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7
Q

H1/H2 Receptor activation leads to

A

hypotension d/t NO release, capillary permeability, flushing, prostacyclin release, tachycardia

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8
Q

H1 antagonist receptor locations

A

Vestibular system, airway smooth muscle, cardiac endothelial cells

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9
Q

H1 receptor antagonists general effects

A

Motion sickness, possible protection against bronchospasm, provides some cardiac stability (indicated in anaphylaxis)

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10
Q

H1 antagonists side effects

A

Blurred vision, urinary retention, dry mouth, drowsiness 1st gen

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11
Q

List H1 antagonists

A

1st gen: diphenhydramine (Benadryl), promethazine (Phenergan)

2nd gen: cetirizine (Zyrtec), loratadine(Claritin)

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12
Q

Diphenhydramine (Benadryl) uses

A

Antipruritic
Pre medication for Allergy to ivp dye or shellfish

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13
Q

Diphenhydramine (Benadryl)
Dose and E 1/2

A

Dose: 25-50 mg IV
E 1/2: 7-12 hours

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14
Q

Promethazine (Phenergan) use

A

Anti emetic

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15
Q

Promethazine (Phenergan)
Dose, onset and E 1/2

A

Dose: 12.5- 25 mg IV
Onset: 5 minutes
E 1/2: 9-16

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16
Q

Promethazine (Phenergan) black box warning

A

Respiratory arrest in <2 years old
Necrosis if infiltrated

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17
Q

H2 antagonist most common use

A

Duodenal ulcer disease/GERD

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18
Q

H2 antagonist action

A

Decreases hypersecretion of gastric fluid (H+)
Decreases gastric volume (less amount to be aspirated)
Decreases pH (less acidic gastric aspirate)

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19
Q

H2 antagonist side effects

A

HA, diarrhea, skeletal muscle pain. Weakened gastric mucosa d/t bacteria, (increased pulmonary infections candida Albicans)
Bradycardia increase serum creatinine by 15%

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20
Q

H2 antagonist drugs

A

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotide (Pepcid)

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21
Q

Tagamet dose

A

150-300 mg IV
1/2 dose for renal impairment

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22
Q

Cimetidine (Tagamet) metabolism

A

Met. By liver. Strongly inhibits CYP450.
Prolongs effects of many other drugs

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23
Q

Tagamet side effects

A

Brady, hypotension.
Increased prolactin levels
Inhibits dihydrotestosterone binding to androgen receptor (male breast growth)

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24
Q

Ranitidine (Zantac) metabolism

A

Hepatic metabolism, renal clearance.
Less inhibition of hepatic enzymes than Tagamet

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25
Q

Ranitidine (Zantac) dose

A

50 mg diluted to 20cc over 2 minutes
1/2 dose renal impairment

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26
Q

Famotidine (Pepcid) metabolism

A

Hepatic with no P450 interference

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27
Q

How does famotidine (Pepcid) differ from other H2 antagonist

A

Most potent
E 1/2: 2.5-4 hours

28
Q

Pepcid dose

A

20 mg IV

29
Q

What precaution must be taken when giving Pepcid

A

Phosphate levels. Pepcid interferes with phosphate absorption leading to potential hypophosphatemia

30
Q

How do PPIs work

A

They irreversibly bind to acid secretion pumps. This inhibits movement of protons across gastric parietal cells. Only works on pumps that are present. (New ones can be generated)

31
Q

Why does the onset of PPI limit its use in surgery

A

The onset of 5 days makes it ineffective to start day of surgery.

32
Q

PPI is most effective at

A

Decreasing gastric volume and acidity

33
Q

PPIs are more effective that H2 antagonists in what conditions

A

Healing esophagitis/ulcers
Relieving GERD symptoms
Best pharm tx for Zollinger-Ellison Syndrome

34
Q

PPI adverse effects

A

Bone fx, SLE, acute interstitial nephritis (extremely painful), C -Diff, vit B 12/Mag deficiency
Inhibits warfarin metabolism (increased bleeding risk)
Blocks enzyme that activates Plavix

35
Q

Examples of PPIs

A

Omeprazole (Prilosec)
Pantoprazole (Protonix)

Lansoprazole (Prevacid)
Dexlansoprazole (Dexilent)- good result but too expensive. Insurance won’t approve

36
Q

Omeprazole (Prilosec) dose

A

40 mg in 100 mL over 30 minutes

37
Q

Omeprazole (Prilosec) side effects

A

HA, Agitation, confusion. Since drug crosses BBB.
Abd pain, n/v, flatulence, small bowel bacterial overgrowth

38
Q

Pantoprazole (Protonix) dose

A

40 mg IV in 100 mL over 2-15 mins

39
Q

Studies show PPI are treatment of choice for

A

GERD/gastroduodenal ulcers, acute upper GIB (PPI infusion post EGD)

40
Q

Studies show Omeprazole is treatment of choice for

A

NSAID ulcerations

41
Q

Studies show H2 antagonists are drug of choice for

A

Aspiration pneumonitis concerns

42
Q

Particulate antacids properties

A

Aluminum or magnesium based. Aspiration contents still acidic

Examples: maalox and Mylanta

43
Q

Non particulate antacids

A

Neutralize acids
Ex: sodium citrate (Bicitra)

44
Q

Sodium Bicitra MOA

A

Prevents aspiration pneumonia NOT aspiration.
Increases intra gastric volume
Works immediately

45
Q

Sodium Bicitra dose

A

15-30 mL PO

46
Q

Metoclopramide (Reglan) dose

A

Dose: 10-20 mg IV over 3-5 mins (15-30 mins prior to induction)

47
Q

Domperidone is a dopamine blocker that is diff from reglan in that it

A

Does not cross BBB

48
Q

Droperidol (Inapsine) developed initially for

A

Schizophrenia and psychosis

49
Q

Adverse effects droperidol (Inapsine)

A

Strong D2 antagonist extrapyramidal symptoms, neuroleptic malignant syndrome

Avoid with other CNS depressants

50
Q

Droperidol (Inapsine) dose

A

Dose: 0.625-1.25 mg IV

51
Q

5HT3 receptors are located

A

They are ubiquitous: kidneys, colon, liver, lung, stomach.

High concentration in brain and GI tract

52
Q

5HT3 antagonists examples

A

Zofran
Kytril and Anzemet

53
Q

The first 5HT3 antagonist

A

Ondansetron (Zofran)

54
Q

Zofran side effects

A

QT prolongation
HA, diarrhea

55
Q

Zofran dose. Plasma 1/2 life

A

4-8 mg IV
Plasma half life: 4 hours

56
Q

Decadron dose

A

4 mg/8mg up to 12 and up if diff airway.

57
Q

Decadron onset

A

Delay in onset of 2 hours.
Efficacy persists for 24 hours

58
Q

Decadron timing of dose

A

Give 2 hours before closing d/t delay in onset

59
Q

Side effects of Decadron

A

Perioperative hyperglycemia with DM patients. (Minimal effect with 1 dose).

Perineal burning/itching with rapid IV admin.

60
Q

Anticholinergics drug

A

Scopolamine patch

61
Q

Scopolamine patch dose, onset, peak?

A

Dose: 1 patch
Onset: 4 hours
Peak: 8-24 hours

62
Q

Scopolamine side effects

A

Pupil dilation, sensitivity to bright lights

63
Q

Benefit of scopolamine compared to other anticholinergics

A

Sedation, antisialagogue, decreased motion sickness WITHOUT causing increased HR or relaxation of smooth muscles.

64
Q

SABA administration via inhaler

A

Inhaled for 5-6 seconds and hold breath for 5-6 seconds

65
Q

How much of inhaled SABA reaches lungs? How much does this decrease with ETT

A

12% reaches lungs.
ETT decreases the delivery by 50-70%

66
Q

Frequency of inhaled SABA

A

Q4H

67
Q

Side effects of beta agonist

A

Tremor, tachycardia, hyperglycemia (unlikely for 1 dose) transient decrease in arterial oxygenation.

Anesth Pharm (4 decks)

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