Exam 3 Flashcards
1
Q
what is the BEST drug for cerebral protection (CRMO2 and CBF decreased)
A
pentothal
2
Q
what is the best drug for cardiomyopathy
A
etomidate
3
Q
patients with _____ catecholamines should NOT be given ___________ (septic, critically ill patients)
A
LOW
ketamine
4
Q
drugs which do NOT cause apnea have a HIGHER risk for laryngospasm risk (2)
A
etomidate
methohexital
5
Q
which is the ONLY drug which can be used solely for TIVA (due to amnestic, analgesic properties)
A
ketamine
6
Q
what 2 things should you pretreat with ketamine
A
robinul (for secretions)
versed (for dissociation)
7
Q
true or false
all drugs are lipid soluble in the body
A
true
(water soluble outside)
8
Q
which 2 drugs do NOT depress CV or respiratory
A
ketamine
etomidate
9
Q
if you have an elderly patient, give an _________dose
Example range: 150-300mg, give the elderly ____mg
A
100mg
10
Q
elderly patients have _________ circulation times and take __________ to go to sleep
A
longer time
11
Q
methohexital vs. pentothal
methohexital is:
__________ lipid soluble
__________ half-life
__________ recovery
A
LESS lipid soluble
shorter half life
faster recovery
12
Q
etomidate ___________ seizure threshold
A
lowers it (MORE likely to have seizures)
13
Q
propofol ____________ seizure threshold
A
raises it (LESS likely to have seizures)
14
Q
which drugs should NOT be used for acute polyphoria (2)
A
barbiturates
etomidate
“BarbEE”
15
Q
Emesis (greatest to least)
A
Etomidate > ketamine > pentothal/methohexital > propofol
16
Q
Hemodynamics: Cardiac (most safe to least safe)
A
Etomidate > methohexital > pentothal > ketamine > propofol
17
Q
CSHT (shortest to longest)
A
Etomidate > propofol > ketamine > sufentanil > versed > methohexital > pentothal
18
Q
barbiturates, which drug is MOST potent
A
methohexital
19
Q
which drug should be used for LMA
A
propofol (decreased risk of laryngospasm)
20
Q
Greater % drug BOUND = _________ diffusion
A
slower diffusion
21
Q
Greater % drug UNboud = _________ diffusion
A
faster diffusion
22
Q
which drug causes euphoria
A
propofol
23
Q
which drug is best for asthma patients (B2 agonist)
A
ketamine
24
Q
which drugs CAUSE pain on injection (3)
A
propofol
etomidate
methohexital (maybe)
25
which drugs cause increased excitatory/myoclonic activity (2)
methohexital (hiccups)
etomidate
26
which drug causes hiccups
methohexital
27
which drugs cause resp depression (2)
LESS likely for laryngospasm
avoid these drugs with COPD
propofol
barbiturates
28
which drug is good for minimizing emergence delirium
precedex
29
how long is propofol good for
6 hours
30
true or false
pentothal is UNSTABLE once reconstituted
true
(6 days at room temp; 2 weeks fridge)
31
which drug is bacteriostatic
pentothal (due to high pH)
32
which drug is NOT approved for general anesthesia by itself
precedex
33
which drug can be used with propofol during a TIVA so that a patient does NOT become apneic
precedex
34
MOA:
HYPERpolarization (cell becomes more negative) with efflux of K out of the cell
DECREASED norepi release due to presynaptic receptors (results in vasodilation)
INHIBITION of adenylyl cyclase, results in decreased cAMP, results in decreased calcium
precedex
35
ketafol
maintains BP
maintains spontaneous ventilation
reduces vomiting
increases sedation to reduce hallucinations
reduces risk of seizures
36
advantages of TIVA (4 main ones)
no PONV
malignant hyperthermia patients
bronchs (cannot be a closed system)
good for transport
37
what is the best indicator of patient awareness for TIVA
movement
(make sure you have at least one twitch on TOF)
38
CSHT propofol: <3 hours
10 minutes
39
CSHT propofol: >3 hours
25 minutes
40
CSHT propofol: >8 hours
40 minutes
41
CSHT remifentanil
always 4 minutes
42
which 2 anti-emetic drugs do you NOT redose
decadron
scopolamine
43
what is the only opioid that you titrate
remifentanil
44
what are the receptors that affect the vomiting center (6)
Histamine/H1
Serotonin 5HT3
Dopamine
Ach/muscarinic
Neurokinin 1
GABA
Substance P
45
what receptor (1) affects the vagal and enteric system
serotonin 5HT3
46
what receptors affect the vestibular system (motion sickness)
Ach/muscarinic
Histamine/H1
"HACH" sounds like "ahhhh"
47
what receptors affect the CTZ
serotonin 5 HT3
opioid receptors
dopamine
"SOD"
48
termination of effect
redistribution to muscle cells
49
what does the increase in BP for ketamine come from
increase in catecholamines
(that is why its not good to use if you have low catecholamines)
50
inhalation/volatile anesthetic
machine check is done
with a TIVA, remember safety processes
51
when reducing a drug during TIVA,
if NO response, reduce by ____%
reduce 20%
52
when reducing a drug during TIVA,
if there IS a response, ________ and increase by _____
bolus
increase by half
53
which patient population is contraindicated with dopamine blockers
parkinson's
54
which drug causes adrenocortical suppression
avoid with __________ patients
etomidate
addison's disease
very sick patients
55
which patient population is contraindicated for reglan
intestinal obstruction
56
what is the biggest negative with antihistamines
sedation
57
what is the best thing about 5HT3 blockers
minimal side effects
because only targeting one receptor
58
how long does scopalamine last
72 hours
59
what are the non-specific NSAIDS
COX 1
o Ketorolac
o Ibuprofen
o Naproxen
o Aspirin
60
what are the selective NSAIDS
COX 2
Celebrex
61
what are the side effects of COX 1 (non-selective) (3)
Decreased platelet aggregation
Decreased renal function
Increased GI toxicity risk
62
what is the negative side effect with COX 2 (selective)
increased CV risk
63
what are the benefits with COX 2 (selective) (3)
o Decreased pain, inflammation, fever
o Decreased GI toxicity
o No platelet effects
64
what patients are CONTRAindicated for NSAIDS (5)
nasal polyps
elderly
hypovolemia
CKD renal issues
history of gastric ulcers
65
what is major contraindication for aspirin
nasal polyps
66
what is the dose for IM ketamine
4-8 mg/kg
67
aspirin is eliminated after the life of the ____________
other NSAIDS are eliminated after the life of the _______
aspirin=life of platelet (7 days)
IRreversible!
other NSAIDS= life of drug
68
what is the protamine dose based on
heparin that is in CIRCULATION
(otherwise, overdose would be given)
69
Target-Controlled Infusion Systems (TCIs)
based on the pharmaco___________ model
for _________ patients
pharmacokinetic model
healthy patients, so be careful
70
initiation phase= ___________ pathway
initiation = EXtrinsic
71
amplification phase = __________ pathway
amplification = INtrinsic
72
propagation phase = __________ pathway
propagation = common
73
INITIATION:
vessel damage, leads to tissue factor ____, which binds to _____, which leads to _____, which leads to ___________
initiation phase
tissue factor= III
binds to VII
which leads to Xa
which leads to thrombin (which leads to amplification)
74
Vessel damage, leads to tissue factor (III), which binds to VII, which leads to Xa, which leads to thrombin
initiation
75
AMPLIFICATION:
____________ activates amplification of: ____________, ___, and ____
thrombin activates: platelets, V, XI
think: "platelets loveeee 5 and 11"
76
Thrombin activates amplification of: platelets, V, XI
amplification
77
COMMON:
____, ___, _________: activates ___
thrombin activates: platelets, ___, _____, this leads to ______-____ complex
______-____ complex switches reaction to “____se pathway” (which is 50x more efficient at Xa generation)
Increased ____ leads to large amounts of increased _________
VIII, IX, calcium: activates X
thrombin activates: platelets, V, VIII, this leads to VIIIa-IXa complex
VIIIa-IXa complex becomes Xase pathway
Increased Xa leads to large amounts of increased THROMBIN
78
VIII, IX, calcium leads to activation of X
Thrombin leads to activation of platelets, V, VIII leads to VIIIa-IXa complex
VIIIa-IXa complex switches reaction to “Xase pathway”
Increased Xa leads to large amounts of increased thrombin
common
79
IV induction agents
Enhancing/increases/agonizes the ______ inhibition properties
Inhibiting/stops/antagonize the _______ excitatory synapses
agonizes GABA
antagonizes NMDA
80
redistribution is the _______ phase
alpha
81
pentothal %
2.5%
25 mg/ml
82
the more drug bound, the __________ the diffusion
slower
83
Increases the DURATION of GABA
and
Directly MIMICS GABA at its receptor
and
activates glutamate, adenosine, nAch receptors
barbiturates
84
directly mimicking GABA at its receptor causes __________ channels to open
chloride
85
which drug (1) causes histamine release
(BOTH anaphylaxis and anaphylactoid)
pentothal
86
barbiturates, NORMOvolemic:
__________ decrease in BP
__________ in HR
MINIMAL decrease in BP (peripheral vasodilation)
increase in HR (reflexively)
87
barbiturates, HYPOvolemic or beta blockade:
__________ decrease in BP
___ _________ in HR
DRASTIC LARGE decrease in BP
no change in HR
88
true or false:
for PENTOTHAL, slowing the rate of administration (giving incrementally)
does NOT improve the decrease in BP or increase in HR
instead, it ultimately causes a larger dose
true
89
Decreased Vt
and
Decreased RR
(2) drugs
barbiturates (pentothal)
and
propofol
90
barbiturates shift the CO2 response curve to the ______
right
allows for a greater amount of CO2 to build up before the body decides to breathe
91
cerebral vaso___________: decreases CMRO2 and CBF
vasoconstriction
92
when does pentothal provide cerebral protection
INCOMPLETE cerebral ischemia (CBP, hypotension, circulatory arrest)
NOT cardiac arrest
93
which drugs cause tolerance (2)
ketamine, pentothal
94
which drug (1) causes hangover
pentothal
95
which drug requires a hard flush, due to precipitate
pentothal
96
for 1/2 lives, multiply by ____x to get TOTAL
multiply by 4
97
methohexital %
1%
10 mg/ml
98
what are CONTRAindications for methohexital (2)
retrobulbar block (due to hiccups)
acute intermittent porphyria
99
unique, carboxylated imidazole-containing compound
Water-soluble: acidic pH
Lipid-soluble: physiologic pH
etomidate
100
etomidate %
.2%
2 mg/ml
101
Mimics inhibitory effects of GABA, thereby causing increasing AFFINITY for GABA
depresses reticular activating system (RAS)
etomidate
102
disinhibition of subcortical structures that normally suppress extrapyramidal motor activity
excitatory activity
103
true or false:
etomidate decreases CMRO2, CBF
true
EVERY drug EXCEPT ketamine
104
Decreased Vt
and
increased RR
etomidate
think, "fast and shallow breathing when youre sick"
105
Inhibition of conversion of ____________ to cortisol
Decreases ________ and _____________ levels for 4-48 hours after dose
cholesterol to cortisol
cortisol and aldosterone
106
metabolism by plasma esterases, extremely fast (5x faster than pentothal)
etomidate
107
caution with seizure patients
etomidate
108
alpha2 adrenergic agonist (8x more selective than clonidine)
precedex
109
true or false
precedex has a LONGER duration than propofol
true
110
true or false
precedex only works in the spinal cord and pontine locus ceruleus
true
111
precedex given as a fast, bolus can cause
vasoCONSTRICTION (hypertension!)
and
bradycardia
112
what are risk factors to greater hypotension (5)
hypovolemic
elderly
diabetic
high sympathetic tone (stress, sick, septic)
LV dysfunction
113
what is a CONTRAindication for precedex
heart block (due to decrease in HR)
114
cyclodextrin
sedative/hypnotic
propofol
115
propofol provides "some" analgesia (pain relief) for ___________, _______ pain
neuropathic, chronic pain
116
metabisulfite
(propofol)
generic brand
117
disodium edetate + NaOH
(propofol)
diprivan
118
increased pain; not approved
(propofol)
ampofol
think, "i have an amp of pain"
119
decreased pain but increased genital burning; not approved
(propofol)
aquavan
think, "aqua water in peeing"
120
propofol %
1%
10 mg/ml
121
GABAA receptor AGONIST: leads to inhibition of GABAA and hyperpolarization of cell membranes
propofol
122
Uptake: lungs and liver (cytochrome P450)
In lungs, most of drug goes back into circulation after 1st pass
propofol
123
Decreased HR, SVR, CO, BP
propofol
124
Increased incidence with oculocardiac reflex (eye surgery)
"5 and dime"
propofol related bradycardia
treat with robinul after 2nd occurence
125
metoclopramide
reglan
gastric motility
126
glycopyrrolate
robinul
reduces secretions
127
propofol causes broncho_____________
bronchoconstriction
(still okay to use with asthma)
128
true or false
resp depression IS dose-dependent for propofol
true
129
HPV is maintained
DOWNward shift of hypoxic response curve
propofol
130
Propofol with no anti-emetic = _________ with anti-emetic
volatile
131
anti-pruritic
anti-convulsant
anti-oxidant
anti-emetic
propofol
132
unused propofol should be discarded within ___ hours
6 hours
133
decreased IOP
propofol
134
true or false:
PROPOFOL
autoregulation and PaCO2 is NOT affected
true
135
Helps support SSEPs and MEPs (evoke potentials)
Seizure-like, but NOT seizure myoclonic movements
propofol
136
benign GREEN urine
phenol
137
benign CLOUDY urine
uric
138
>75 mcg/kg/min for >24 hours in the ICU
initially tachycardia, then bradycardia
causes metabolic/lactic acidosis
propofol infusion syndrome
139
true or false:
PROPOFOL and KETAMINE inhibit platelet aggregation
true
140
Antagonist, non-competitively binds to NMDA receptors to block it
Inhibits glutamate (excitatory transmitter)
S + R isomers: R is better for less side effects
interacts with ALL opioid receptors
-Anti-muscarinic
-Anti-nicotinic: analgesia
-Na+ channels: local anesthetic
ketamine
141
anti-muscarinic
parasympathetic nervous system; visceral organs
leads to bronchodilation and sympathomimetic activity
142
anti-nicotinic
NMJ
analgesia
143
what are risk factors for emergence delirium (4)
>15 years old
female
high dose
personality disorders
144
ketamine "cocktail"
midazolam + glycopyrrolate (robinul)
145
which drug has an active metabolite that contributes to prolonged analgesia
ketamine
146
what are CONTRAindications for ketamine (8)
CAD*
Pulmonary HTN (due to increased myocardial O2 demands)
LOW catecholamines* (critically ill patients should be given etomidate)
Neuraxial techniques
Tachycardia
Psychologic reactions
Neurosurgery (increased ICP due to cerebral vasodilation)
Eye procedures (nystagmus)
147
which is the best drug for OB, congenital heart issues, asthma
ketamine
148
hyperalgesia + increased shivering
remifentanil
149
which drug should you NEVER bolus
remifentanil
150
NSAIDS
________ Vd
________ protein bound
SMALL Vd
HIGHLY protein bound (slow diffusion)
151
which patients will have a LARGER effect of drugs that are HIGHLY protein bound
hypoalbumin (malnourished, elderly)
152
best NSAIDS drug to use for decreasing CV risk
Naproxen
153
what are CONTRAindications for NSAIDS (4)
HYPOvolemia (increases renal toxicity risk)
nasal polyps
allergic rhinitis
asthma
154
true or false
NO antidote for NSAIDS or ASA
true
treat with:
Hydration
Alkalinize urine
Charcoal
Hemodialysis
155
symptoms of toxicity from NSAIDS
N/V
Abdominal pain
CNS depression
Metabolic acidosis
Renal failure
Agitation
Hyperventilation
Coma
156
A-OK
Atropine: 1 mg (vagolysis)
Ondansetron: 8 mg (block serotonin receptors, vagolysis)
Ketorolac: 30 mg (block thromboxane production; blocks platelet aggregation)
157
what is acetaminophen metabolite
NAPQI
depletes antioxidant glutathione, directly damages liver cells
158
why is aspirin "separated" from other NSAIDS
(2 reasons)
it has CV and cerebrovascular benefits
it IRREVERSIBLY inactivates COX1
159
aspirin irreversibly inactivates ______: leading to inhibited platelet ______________
wait at least ___ days
inactivates COX1
inhibits platelet aggregation
7 days
160
what NSAID is metabolized by liver + plasma esterases
aspirin
161
ERAS
_____________ of NPO
combo of _____________ + _________ + ____________
elimination of NPO (instead, carb loading)
acetaminophen + NSAID + gabapentin
162
ERAS is opioid __________
sparing
163
TIVA _________________ functional vital capacity + catecholamines
decreases FVC, reduces catecholamines
this leads to increased costs :(
164
should TIVA be given as an infusion or a bolus
an infusion!
to minimize side effects
165
extrinsic + instrinsic pathways
based on "in _______"
in vitro
dated
166
heparin (unfractionated)
1 unit = ___ ml, prevents blood from clotting for___ hour after combining with __________
1 unit = 1 ml
prevents blood from clotting for 1 HOUR after combining with CALCIUM
167
MOA
Binds to antithrombin, this leads to enhanced binding with thrombin
heparin (unfractionated)
168
Platelet count <100,000 or 50% drop
Heparin-dependent antibodies trigger platelet aggregation, leading to thrombocytopenia
Treatment: heparin alternative (direct thrombin inhibitors, Xa inhibitor)
Heparin-Induced Thrombocytopenia (HIT)
169
MOA
alkalotic, combines with acidic heparin; acid/base reaction
protamine
170
how much protamine is needed per 100 units
1 mg per 100 units
171
what are risks with protamine (2)
heparin rebound (2-3 hours after)
due to FAST protamine clearance
anaphylaxis
172
LMWH __________ affected by temp, renal and hepatic disease, protein binding, patient variability
heavily affected
173
LMWH drug
lovenox (enoxaparin)
174
true or false
NO reversal for LMWH + NOACs
true
175
what type of monitoring for warfarin
INR (2-3) adjusts for non-standardization between commercial preparation
PT
176
which anticoagulant requires frequent lab monitoring
warfarin
177
reversal for WARFARIN (3)
Vitamin K
PCCs
FFP
178
Newer Oral Anticoagulants (NOACs)
direct ____________ inhibitors
direct _____ inhibitors
thrombin + Xa inhibitors
179
eliquis + xarelto
Xa inhibitors (NOACs)
180
pradaxa + angiomax
thrombin inhibitors (NOACs)
181
advantages of NOACs (3)
o No need for routine lab monitoring*
o Rapid onset
o Therapeutic range within hours
182
monitoring for NOACs (2)
aPTT
TT (thrombin time)
183
NOACs
LOW risk of blood loss
d/c 1 day before, resume 1 day after
184
NOACs
HIGH risk of blood loss
d/c 5 days before
185
NOACs
ELECTIVE procedures
Consider patient specific risks/benefits*
186
NOACs
ER procedures
delay as long as possible
187
Life-threatening hemorrhage: use ______ or recombinant _____
PCCs or VIIa
188
MOA
Antagonist that binds to P2Y receptor, this inhibits platelet activation + aggregation
thienopyridines (platelet inhibitors)
think "thienoPYridines"
189
thienopyridines drugs (2)
plavix (clopidogrel)
brilanta (ticagrelor)
190
MOA
Increases cyclic AMP, this leads to decreased platelet function
dipyridamole (platelet inhibitors)
191
MOA
Binds to platelets, this inhibits function
dextran (platelet inhibitors)
192
MOA
Bind and inhibit fibrinogen receptor, this leads to decreased platelet aggregation
Platelet Glycoprotein IIb/IIIa Antagonists (platelet inhibitors)
193
MOA
ACTIVATES plasminogen into plasmin, this INCREASES clot breakdown
thrombolytics
194
example of thrombolytic
tPA
195
true or false
use PCI (percutaneous cath lab) if available, instead of tPA (thrombolytic)
true
196
risks with thrombolytics/tPA (2)
intracranial hemorrhage
angioedema (ACE inhibitors)
197
MOA
BLOCKS conversion of plasminogen to plasmin, this leads to DECREASED clot breakdown/lysis
antifibrinolytics
198
true or false
antifibrinolytics are NOT procoagulants*
true
199
______________ are the opposite of thrombolytics (tPA)
antifibrinolytics (TXA)
200
Reduces risk of death due to bleeding, regardless of the cause
Decreased blood loss, decreased blood products, no risk of thrombi
antifibrinolytics (TXA)
201
3 types of antifibrinolytics
TXA
aminocaproic acid (amicar)
aprotinin
202
CONTRAindications to antifibrinolytics (4)
o Hypersensitivity to antifibrinolytics
o Thrombus history
o Color vision deficit
o Renal impairment
203
must give antifibrinolytic (TXA) ____ hours post-injury
<3 hours
204
MOA
Analog of vasopressin, stimulates endothelial von Willebrand factor
Desmopressin (DDAVP)
205
MOA
Binding site for IIb/IIIa receptors on platelets
Helps to create platelet aggregation (clotting)
Substrate of thrombin, XIIIa, plasmin
fibrinogen
206
low fibrinogen (low clotting) should be treated with (2)
more fibrinogen
or
cryoprecipitate
207
recombinant proteins (5)
o Fibrinogen
o PCCs
o VIII
o IX
o XIII
208
MOA
VIIa + tissue factor, leads to increased thrombin, which leads to hemostasis (clot formation)
Recombinant Factor VIIa (NovoSeven)
209
Very expensive (average dose $7000)
Recombinant Factor VIIa (NovoSeven)
210
Factors II, VII, IX*, X
Similar to FFPs, but is faster + less volume for the patient
Prothrombin Complex Concentrates (PCCs)
211
Good for urgent reversal (within hours)
(warfarin, hemophilia B)
PCCs
212
* Tests that are becoming more prevalent
* Help to pinpoint the issue with a patient
* Provides better treatment
TEG and ROTEM (Thromboelastography)
213
Used on the surgical field for pro-coagulation
o Fibrin sealants (thrombin + fibrinogen)
o Topical thrombin
o Surgicel
Topical Hemostatics
214
electrolyte imbalance that can occur with antiemetics (4)
Alkalosis
Hypochloremia
Hyponatremia
Hypokalemia
215
PONV
HIGH/Positive risk factors
o POST-op opioids (AFTER surgery)
o General anesthesia
o Volatile anesthetics, nitrous oxide
o Female
o History of PONV/motion sickness
o Non-smoker
o Younger age (<50)
o Surgery (ENT, strabismus, abdominal, gyn, thoracic)
216
PONV
MILD/Conflicting risk factors
o Menstrual cycle
o ASA physical status
o Muscle relaxant antagonists
o Level of anesthetist’s experience
217
NOT/Disproven risk factors
o BMI
o Anxiety
o NG tube
o O2
o Peri-op fasting
o Migraine
218
N/V
make sure patient is _________volemic
NORMOvolemic
219
N/V
If prophylaxis FAILS
DONT give the same drug as before, use a DIFFERENT drug class
220
N/V
If prophylaxis worked, then 6 hours later patient has PONV:
Give SAME drug
221
o Low Risk: ____ drugs
o Moderate Risk: ____ drugs
o High Risk: ____________ approach
o Low Risk: 0-1 drugs
o Moderate Risk: 1-2 drugs
o High Risk: multimodal approach
222
PDNV
Females are worse until day ___, then it equalizes
day 4
223
POV
occurs in _____________
pediatrics
2x as likely to vomit as adults
224
what is the greatest risk factor for POV
TYPE of surgical procedure
225
highest risk procedures for POV for peds (4)
hernia repair
tonsillectomy
strabismus
genital repair
226
age of greatest risk for POV
age 3-13
227
vomiting center is located in the BRAINSTEM in the __________ medullary ____________ formation
lateral medullary reticular formation
228
Floor of the 4th ventricle
(Outside BBB)
Chemoreceptor Trigger Zone (CTZ)
229
Motion sickness
vestibular system
230
Gag and retch response
Irritation of the Pharynx (vagus nerve)
231
Mucousa of the GI tract
Stomach stretch
Vagal and Enteric Afferents
232
Stress and anticipatory vomiting
CNS
233
CTZ: which receptors
Dopamine
Serotonin 5HT3
Opioid receptors
234
vestibular system: which receptors (2)*
Muscarinic (Ach)
Histamine (H1)
235
Vagal and Enteric Afferents: which receptor*
Serotonin 5HT3
(then stimulates CTZ)
236
what are the 7 receptors that contribute to vomiting center*
o Ach/muscarinic
o Histamine/H1
o Serotonin 5HT3
o Dopamine
o Substance P
o GABA
o Neurokinin 1
237
Decreasing DOPAMINE input at the chemoreceptor trigger zone as well as anxiety
Decreases ADENOSINE reuptake leading to decreased synthesis, release, and postsynaptic action of dopamine at the CTZ
benzodiazepines
238
Anticholinergic (Ach/muscarinic) + H1 blocker
antihistamines
239
Anxiety
Anticipatory vomiting
benzodiazepines
240
Motion sickness
Blocks oculoemetic reflex, this blockage leads to no vomiting
antihistamines
241
Benadryl
Dramamine
Bonine
Phenothiazines
antihistamines
242
Inhibition of DOPAMINE (dopamine antagonist) and
inhibition of Ach (muscarinic) receptors
phenothiazines (antihistamine)
phenergan, compazine
243
what are the 2 phenothiazines (antihistamine)
phenergan, compazine
244
Anticholinergic (Ach/muscarinic) + antihistamine + 5HT3 blocker
Blocks transmission to the medulla of impulses from overstimulation of vestibular apparatus (motion sickness)
Crosses BBB (lipid soluble)
scopalamine
245
Motion sickness
sedation
scopalamine
246
Dopamine blockade (alpha blockade)
Causes vasodilation due to peripheral alpha blockade (leading to decrease in BP)
Butyrophenones (Droperidol, Inapsine)
247
side effects of Butyrophenones (Droperidol, Inapsine) (4)
Dissociative state, extremely sedating
"LOCKED IN"
Prolonged QT interval (torsades with very high dose); black box warning
Extrapyramidal effects
Hypotension
248
MOA
Dopamine blockage in CTZ
Cholinergic stimulus to GI tract (increased gastric and small intestine motility)
Metoclopramide (Reglan)
249
MOA
Endogenous vasoactive substance and neurotransmitter (causes emesis and pain), cerebral stimulant
Stored in the enterochromaffin cells of the GI tract
Serotonin 5HT3
250
MOA
BLOCKS peripheral receptors on the intestinal vagal afferents (GI tract)
BLOCKS central receptors in the vomiting center + CTZ (vagal stimulation)
Serotonin 5HT3 Receptor Antagonists
251
Vomiting/emesis only*
NO EFFECT on nausea
NO EFFECT on motion sickness
NO EFFECT on any other receptors (dopamine, histamine, adrenergic, muscarinic)
Serotonin 5HT3 Receptor Antagonists
252
N/V
Give at the END of the case
zofran (5 HT3 blockers)
253
MOA
Possibly inhibits prostaglandin synthesis centrally and endorphin release (?)
corticosteroids (decadron)
254
Give right after induction
decadron (corticosteroids)
255
MOA
Substance P: natural ligand in the neurokinin receptor in the vagus nerve
Affects CTZ
aprepitant (NK1 blocker)
256
N/V
interacts with:
Coumadin
Calcium channel blockers
Anticoagulants
Seldane
Hismanal
aprepitant
257
o OB patients with hypotension and N/V
o Give at the end of C-section
ephedrine
258
Pulmonary disease/OSA: avoid ___________ drugs
antihistamines/sedation drugs
259
large Vd=_________ distribution=_____ protein binding
large Vd, widely distributed, low protein binding
(large + low)
260
decreases MAC >90%
precedex
261
ketamine __________ peripheral reuptake of catecholamines
INHIBITS peripheral reuptake of catecholamines
262
ketamine is a direct myocardial _____________
direct myocardial DEPRESSANT
263
THERAPEUTIC aPTT range
45-90 seconds
264
THERAPEUTIC ACT range
350-400
265
heparin:
IV onset ________
SQ onset ________
IV: immediate
SQ: 1-2 hours
266
warfarin:
elimination 1/2 _____- _____ hours
peaks _____- _____ hours
therapeutic ________ days
elimination: 24-36 hours
peaks: 36-72 hours
therapeutic: 5 days
267
normal fibrinogen levels
200-400 mg/dL
(pregnancy is HIGHer)
268
which anti-emetics have dopamine and should be used with caution with parkinsons?
reglan
butyrophenones (droperidol, inapsine)
phenothiazines (compazine, phenergen)
"PBR, elderly like PButteR"
