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Anesthesia Pharmacology > Exam 2 - Multimodals for GETA > Flashcards

Exam 2 - Multimodals for GETA Flashcards

1
Q

What enzyme catalyzes the synthesis of prostaglandins?

A

COX (Cyclooxygenase)

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2
Q

This form of COX is responsible for gastric protection, hemostasis, and renal function…

A

COX-1

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3
Q

COX-1 or COX-2?
Ubiquitous, “physiologic”, inhibition is responsible for many adverse effects

A

COX-1

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4
Q

COX-1 or COX-2?
Pathophysiologic, expressed at sites of injury, not protective

A

COX-2

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5
Q

COX-2 is responsible for which symptoms?

A

Pain, inflammation, and fever

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6
Q

What are the three main properties of NSAID drugs?

A

Analgesic
Anti-inflammatory
Antipyretic

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7
Q

Type of NSAID?
Ibuprofen, naproxen, aspirin, acetaminophen, and ketorolac

A

Non-Specific
Increased gastric irritation with these drugs

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8
Q

Celecoxib (Celebrex), Rofecoxib (Vioxx), Valdecoxib (Extra), Parecoxib (Dynastat) are all examples of what?

A

COX-2 Selective NSAIDs

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9
Q

Compare COX-2 selective to Nonspecific NSAIDS

A
  • Comparable analgesia
  • No effect on platelets
  • Increase in MI and CVA
  • Dosage ceiling
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10
Q

What was the first COX-2 inhibitor that decreases PG synthesis?

A

Celecoxib (Celebrex)

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11
Q

What is the dosage for Celebrex?

A

200 to 400 mg PO QD

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12
Q

Ofirmev properties?
MOA?
Dosing?

A
  • Analgesic/antipyretic, no anti-inflammatory properties
  • Reduces prostaglandin metabolites
  • 1000 mg q4-6h, max 4000 mg qd
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13
Q

Toradol MOA?

A

Inhibits PG synthesis by inhibiting both COX-1 and COX-2

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14
Q

What are the contraindications for ketorolac?

A
  • Severe renal impairment
  • Risk for bleeding
  • CAD
  • CABG
  • Pregnancy
  • Decrease dose in elderly
  • NSAID allergy
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15
Q

Ketorolac properties include:

A
  • Potent analgesic
  • Moderate anti-inflammatory
  • May potentiate opioid antinociception (increased analgesic effects)
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16
Q
A
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17
Q

Ibuprofen:
MOA
Contraindications
Dose
Peak
Excretion

18
Q

Lidocaine is what type of local anesthetic?

19
Q

Dosing for lidocaine?

A

1-2 mg/kg IV initial bolus
1-2 mg/kg/hr drip

20
Q

At what plasma dose of lidocaine do you get analgesia?

A

1-5 mcg/mL

21
Q

At what plama dose of lidocaine do you get tinnitus, muslce twitching, hypotension, and myocardial depression?

A

5-10 mcg/mL

22
Q

What happens at a plasma lidocaine dose of 10-15 mcg/mL?
15-25 mcg/mL?
>25 mcg?

A

10-15 - Seizures and unconciousness
15-25 - Apnea and coma
> 25 - CV depression

23
Q

How does magnesium cause anti-nociceptive effects?

A

NMDA antagonist - potentiates opioids

24
Q

Magnesium regulates what 4 things?

A
  • Ca access into the cell and actions within the cell
  • Neurotransmission
  • Cell signaling
  • Enzyme function
25
Q

What are the two contraindications to magnesium?

A

Myasthenia gravis and renal failure

26
Q

What drug was the first 5HT-3 antagonist?
Dose?
Peds dose?

A

Ondansetron
4-8 mg IV
Peds: 0.1 mg/kg IV

27
Q

MOA of antinausea of corticosteroids?

A

Unknown… may effect gluccocorticoid receptors in nucleus tractus solitarius
Increases effectiveness of 5HT 3 antagonists and droperidol

28
Q

Decadron MOA?
Dosing?

A

Dose: 8-10 mg
MOA: Anti-inflammatory - inhibts phospholipase and cytokines and stabilization of the cellular membrane

29
Q

When should decadron be given?

A

At the start of the case, onset is delayed 2 hours

30
Q

A 50 y/o, 60 kg female patient received a Lidocaine initial dose of 1 mg/kg with a subsequent infusion of 1.5 mg/kg/hour for 1.5 hours. How much total Lidocaine in mgs did she receive prior to PACU?

A

60kg x 1 mg/kg = 60 mg
60 kg x 1.5 mg/kg = 90 mg (1 hour)
(60 kg x 1.5mg/kg = 90 mg)/2 = 45 mg (30 minutes)

60+90+45 = 195 mg

31
Q

What is dexmedetomidine MOA?

A

Highly selective, specific (pontine locus coeruleus), and potent ⍺2 agonist
7-10x more selective than clonidine

32
Q

Antagonist of dexmedetomidine?

A

Atipamezole

33
Q

Uses for dexmedetomidine?

A
  • Concious sedation
  • GETA
  • TIVA
34
Q

Precedex dosing for TIVA/GETA?

A

Bolus 0.5 mcg/kg over 10 minutes
0.1 - 1.5 mcg/kg/min infusion

35
Q

Epidural and regional dosing of precedex?

A

Epidural: 2 mcg/kg
Regional: 0.5 mcg/kg with lidocaine

36
Q

Spinal dosing for precedex?

A

3 mcg as combo
5 mcg with fentanyl
25 mcg alone

37
Q

If dexmedetomidine is available as 200mcg/2 mL, how much dilutent is needed to make 4 mcg/mL?

38
Q

Gabapentin MOA?

A
  • Structural analogue of GABA (does not bind to gaba)
  • Binds voltage gates Ca+ channels - enhancing decending inhibition and inhibiting excitatory neurotransmitter release (glutamate)
39
Q

Gabapentin dosing?

A

300-1200 mg PO 1-2 hrs pre-op

40
Q

Gabapentin contraindications?

A
  • Myasthenia gravis
  • Myoclonus
  • Reduce dose in elderly

Anesthesia Pharmacology (15 decks)

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