Exam IV Important

Question 1

Celecoxib (Celebrex)

(COX 2 slective inhibitor)

S/E & C/I

Answer 1

-Bronchoconstriction (hold in asthma)

-HTN

-DIC in peds w/ RA

-Contains Sulfa

Question 2

Ketorolac (Toradol)

(COX inhibitor)

S/E & C/I

Answer 2

-Bronchoconstriction (hold in asthma)

-kidneys

-bleeding

-impairs bone healing (controversal in ortho cases)

Question 3

Acetaminophen (Tylenol)

(COX inhibitor)

S/E & C/I

Answer 3

*minimal anti-inflammatory effects

*active metabolite - acetylimidoquinone

-liver

*max 4g/day

Question 4

Ibuprofen (Caldolor)

(COX inhibitor)

S/E & C/I

Answer 4

-CV & GI RISKS (BOX WARNING)

-C/I in CABG

-thrombotic risk

-Must be diluted (100mLs w/ 400mg & 200mLs w/ 800mg)

Question 5

MOA of Corticosteroids

Answer 5

-Inhibits phospholipase A2 (usually makes arachidonic acid)

so that

-prevents the release of arachidonic acid (which usually makes COX 1 & 2)

so that

-decreases cytokines & prostaglandins (which are made from COX 1 & 2)

Question 6

One dose of steroids can cause HPA suppression from ____ days to ____ weeks.

Answer 6

4days - 5weeks

Question 7

Normal endogenous steroid production is approx. ___ mg of hydrocortisone per day

Answer 7

20mg hydrocortisone

Question 8

Methadone hydrochloride

(opioid agonist)

S/E & C/I

Answer 8

-D-isomer antagonizes NMDAr & inhibits serotonin & NE uptake

-L-isomer binds to opioid receptor

-Prolongs QT (VT/Torsades)

*Take EKG pre-tx, 30days after, & annually

*D/c if QT > 500ms

*Risk of dependence, tolerance & addiction

Question 9

When something that doesn’t usually cause pain, causes pain.

Answer 9

Allydonia

Question 10

When a “pinch” feels like a “gun-shot”

Answer 10

Hyperalgesia

Question 11

Esmolol decreases what 3 things?

Answer 11

-anesthesia requirements

-opioid requirements

-PONV

Question 12

Lidocaine decreases ______ use post-op

Answer 12

Opioid use

Question 13

Name the 4 predictors of actue post-op pain

Answer 13

-pre-op pain

-pt fear r/t outcome

-pts who catastrophize pain

-expected post-op pain

Question 14

Chronic opioid user comes in for surg:

Buprenorphrine

Hold or give?

Answer 14

Give

Question 15

Chronic opioid user comes in for surg:

Methadone

Hold or give?

Answer 15

Give

Question 16

Chronic opioid user comes in for surg:

Naltrexone

Hold or give?

Answer 16

Hold

*opioid antagonist

Question 17

Chronic opioid user comes in for surg:

Naloxone

Hold or give?

Answer 17

Hold

*opioid antagonist

Question 18

Chronic opioid user comes in for surg:

Nalbuphine (Nubain)

Hold or give?

Answer 18

Hold

*opioid agonist-antagonist

Question 19

(t/f) intrathecal/epidural opioids are adequate for baseline opioid therapy

Answer 19

False

Question 20

What is the prime target of addictive drugs

Answer 20

Mesolimbic DA system

Question 21

Where are the DA producing neurons located

Answer 21

Ventral Tegmental Area (VTA)

Question 22

Name the steps of pupilary reflex arch

Answer 22

1. opioid blocks GABBA
2. Edinger-Westphal nucleus is stimulated
3. PNS stimulation of cilliary ganglion
4. Oculomotor n. causes miosis

Question 23

What was the first synthetic opioid

Answer 23

Meperidine

Question 24

How do you get from morphine to codeine

Answer 24

Replacing the morphine alcohol group w/ an ether

Question 25

(t/f) Tolerance develops to the Pupillary reflex arch

Answer 25

False

Question 26

Best agents for cough suppression

Answer 26

Codeine & Heroin

*also Dilaudid