Final Review Flashcards
Which generation of Cephalosporins will cross the BBB?
Cephalosporins 3rd Generation
What generation of Cephalosporins will treat Meningitis?
Cephalosporins 3rd Generation
What is an example of a 3rd generation cephalosporin?
Ceftrixone/Rocephin
How are the 2nd generation cephalosporins eliminated?
All by the kidneys
What is an example of the 2nd generation cephalosporin?
Cefoxitin/Mifoxin
Which generation of cephalosprorins are inexpensive and exhibit low toxicity?
1st generation cephalosprorins
Cephalosproins - About 95% of patients allergic to penicillin form what conjugate? (hint: this is the major antigenic determinant)
Penicilloyl-protein conjugate
The remaining allergic patients form 6-aminopenicillic acid and benzylpenamaldic acid (minor antigenic determinants)
Cross-Reactivity cephalosporins and PCN are rare, although they share a common (BLANK) ring
B-Lactam Ring
How long before the surgical incision should the prophylactic antimicrobial be administered? According to SCIP-1
SCIP-1 recommends that prophylactic antimicrobials should be administered IV 1 hour before surgical incision
According to SCIP-2, the ABX chosen should be appropriate for what two things?
Type of surgery and patient characteristics
SCIP-7 states that anesthesia contributes to what?
SCIP-7 Anesthesia contributes to “normothermia”
Hypothermia will result in peripheral vasoconstriction, decreased wound oxygen tension and recruitment of leukocytes, favoring infection and impaired healing.
PCN interferes with the synthesis of (BLANK), which is an essential component of the cell wall
Interfere with synthesis of PEPTIDOGLYCON which is an essential component of cell wall
PCN decrease s the availability of an inhibitor of (BLANK) such that the uninhibited enzyme can then destroy (lyse) the structural integrity of bacterial cell walls
Decrease the availability of an inhibitor of MUREIN HYDROLASE such that the uninhibited enzyme can then destroy (lyse) the structural integrity of bacterial cell walls
Cell membranes of resistant gram-negative bacteria are in general resistant to penicillin’s because (what)?
Cell membranes of resistant gram-negative bacteria are in general resistant to penicillin’s because they prevent access to sites where synthesis of peptidoglycan is taking place
Large doses of Clindamycin can cause what?
Large doses can inducce NMB in the absence of a non-depolarizer
What are the SE of clindamycin?
Pseudomembranous colitis, diarrhea, skin rash
You need an echo before someone takes Doxorubin, why?
CausesCardiomyopathy- dose related increased plasma concentrations of troponin T (late), CHF, LV dysfunction***(
Why are we considered with someone taking Bleomycin?
Pulmonary toxicity- dose related 4% patients*****
SE include Cough, dyspnea, rales, fibrosis, infiltrates
Mgt: FIO2 <30%, SpO2 >90%, decrease fluids
What are the clinical signs of Red Man Syndrome?
Clinical signs: flushing, erythema, and pruritus. Affects upper body, neck and face > lower body. Myalgia, dyspnea and hypotension.
What is Red Man Syndrome?
Not a true allergy. Dose dependent infusion reaction. Vancomycin can act on mast cells and releases histamine.
What is the management of Red Man Syndrome?
Management: stop infusion administer an antihistamine and restart at a lower rate when symptoms subsides.
SE of vanco are what?
- Hypotension
- Cardiac arrest
- Histamine release
- Red Man Syndrome
- Erythema
- Bronchospasm
- Arterial hypoxemia/ low SPO2
- Ototoxocity & nephrotoxicity with given with aminoglycoside*
What happens when you give Vanco and succs?
can result in NMB (will act like a Phase II neuromuscular blockade)
What are the SE of Gentamicin?
- Ototoxicity**
- Vestibular and auditory
- Nephrotoxicity
- Skeletal muscle weakness
- Contraindicated in Myasthenia Gravis patients
- Potentiation of non-depolarizing neuromuscular blocking drugs*
What are the SE of Aminiglycoside?
- Ototoxicity**
- Vestibular and auditory
- Nephrotoxicity
- Skeletal muscle weakness
- Contraindicated in Myasthenia Gravis patients
- Potentiation of non-depolarizing neuromuscular blocking drugs*
Calvulanic Acid MOA?
Bind irreversibly to the β-lactamase enzymes, which are produced by many bacteria, thus inactivating these enzymes and rendering the organisms sensitive to β-lactamase–susceptible penicillins
Why are cephalorsporins used? (not asking what they treat)
The are cost effective
Patient on Bleomycin, what should the intraop FiO2 be?
FIO2 <30%, SpO2 >90%, decrease fluids
Patient on Mitomycin, what should the intraop FiO2 be?
Low FiO2 perhaps < 40%
Induces pulmonary fibrosis w/ hyperoxia and thoracic radiation. Limit the inspiratory pressure to not more than 30 mmHg, limit the tidal volume to not more than 8 ml/kg to avoid barotrauma and volutrauma.
What is Serotonin syndrome?
Cluster of autonomic, motor and mental status changes resulting from excess 5-HT
What happens when you give Meperidine with someone taking an MAOi?
Administration of meperidine to a patient treated with MAO inhibitors may result in an excitatory (type I) response (agitation, headache, skeletal muscle rigidity, hyperpyrexia) or a depressive (type II) response characterized by hypotension, depression of ventilation, and coma*****
How is Mannitol eliminated?
Its only means of clearance from the plasma is by glomerular filtration**
HCTZ SE?
a. Hypo K, Cl, and metabolic alkalosis with chronic HTN usage
b. Increase risk of digitalis Toxixity
c. Cardiac Dysrhythmia due to Hypo K and Hypo Mag
d. Hyper Ca
e. Potentiate NMB
f. Increase Lithium levels
g. Glucose intolerance
h. Increase lipedema
i. Poss cross reactivity with sulfa allergy due to structure
What is the clinical use of Spironolactone?
HTN with Thiazide diuretics in pt with low renin state or metabolic syndrome
Refractory HTN
iPromotes diuresis in liver cirrhosis, nephrotic syndrome, and heart failure
Decreases cardiac morbidity and mortality
What is the SE of Spironolactone?
Hyper K esp with impaired renal function esp with spironolactone
Nonspecific mineralocorticoid receptor antagonist
Spironolactone and ACE inhibitor can exacerbate K
Block androgen and progesterone receptor leading to gynecomastia and breast tenderness
MOA of Thiazide?
i. Inhibit the Na+-Cl− cotransporter in the cortical portion of the ascending loop of Henle and the distal convoluted tubule, inhibiting reabsorption of 5% to 10% of the filtered sodium
ii. Enhanced distal delivery of Na+ results in increased excretion of potassium into the renal tubules, resulting in an increase in the urinary excretion of Na, Cl, and K ions.
iii. In addition, thiazide diuretics stimulate the reabsorption of Ca in the distal convoluted tube
Acetazolaminde is used to Tx what?
Reduces intraocular pressure/ Glaucoma**
Altitude sickness**
Lithium SE
i. Polydipsia and Polyuria most common SE
ii. Hypothyroid- Women
iii. SA Node dysfunction (Pt with SSS contraindicated)
iv. Hand tremor w/ Beta antagonist
v. EPS Effects Rare
vi. T wave inversion- rare
vii. Acne & Psoriasis
viii. Cognitive dysfunction
What happens with anesthesia and someone who is taking Lithium?
i. Decreased anesthesia requirements
ii. High levels of Lithium may delay recovery from CNS depressant effects of barbiturates
iii. Depolarizing and non-depolarizing blocking drugs may be prolonged
What kind of diet does a patient need to be on if they are taking an MAOi
Tyramine free diet due to SE HTN*
What is Anticholinergic Syndrome?
AMS Mydriasis Flushed Skin Dry skin Dry mucous membranes
What is the black box warning for the SSRI?
SUICIDAL TENDENCIES IN CHILDREN and ADOLESCENTS
What is Neuroleptic Malignant Syndrome?
Normal pupils, drooling, pallor, lead-pipe rigidity, hyporeflexia, alert mutism, coma
What is the MOA of MAOi?
Block the enzyme that metabolizes biogenic amines, increasing the availability of these neurotransmitters in the CNS and peripheral autonomic nervous system**
What is the MOA of Spirionolactone?
Prevent the synthesis and the activation of the aldosterone-dependent basal cell Na+-K+-ATPase pump.
Both mechanisms result in decreased Na+ reabsorption without the increased K+ secretion that would otherwise occur
What will Spironolactone and ACEi do, if given together?
Spironolactone and ACE inhibitor can exacerbate K
Amitriptyline SE
causes ANTICHOLINERGIC- esp at high doses
Amitriptyline causes highest risk of
- Dry mouth, blurred vision, Tachy, urinary retention, delayed gastric emptying
- Elderly more sensitive to anticholinergic effects and anticholinergic delirium at normal doses
- Anticholinergic toxicity if given w/ other anticholinergic meds ( diarrhea and insomnia meds OTC)
Baclofen SE
Sedation, confusion, skeletal muscle weakness
How much will lipid lowering drugs lower LDL?
Lowers LDL 20-60%**
Most studies suggest (which drugs?) should be continued during the perioperative period, the risk of myopathies is small and the benefits outweigh the risks**
Statins
SE of Statins
i. Liver toxicity (elevation of transaminases) in a dose related fashion
ii. Rhabdomyolysis increases in proportion to dose and plasma concentration
iii. Factors that inhibit statin catabolism, age, hepatic or renal dysfunction, perioperative periods & untreated hypothyroidism
iv. CYP3A inhibitors can increase statin levels in blood causing harmful side effects
v. Drugs likely to be administered during anesthesia, including succinylcholine, have NOT been shown to increase the incidence of statin-induced myopathy.
Clinical uses for Caffeine?
i. Neonates apnea of prematurity
ii. Post-dural headache
iii. Common cold
MOA of caffeine in infants?
Primary apnea of prematurity by stimulating medullary respiratory centers by increasing the sensitivity of these centers to carbon dioxide*
What are the adverse SE of Phenytoin?
Adverse side effects of phenytoin such as nystagmus, diplopia, vertigo and ataxia are likely when the plasma concentration of drug is >20 µg/mL
Phenytoin induces what drugs?
Induces lipid soluble drugs carbamazepine, valproic acid, ethosuximide, anticoagulants, and corticosteroids
Neurotoxic effects
If someone is on Phenytoin, what should you be concerned with someone taking an oral contraceptive?
Oral contraceptive ineffective.
If someone is on Phenytoin, what should you keep in mind when you use a paralytic?
Need higher doses of non-depolarizing muscle relaxants
What does Dozapram do to Minute ventilation?
Centrally acting analeptic that selectively “increases minute ventilation” by activating the carotid bodies***
What is the dose for Datrolene?
2.5MG/KG IV,UNTIL SYMPTOMS SUBSIDE OR A CUMULATIVE DOSE OF 10MG/KGIV IS REACHED.
What is the SE of Datrolene?
Review labs for liver dysfunction
Poss Hepatotoxicity***
MOA for Dantrolene?
Binds to the ryanodine calcium channel and reduces Ca efflux from the sarcoplasmic reticulum counteracting the abnormal intracellular Ca levels accompanying MH
What receptor does cocaine inhibit?
Inhibits NE reuptake
High abuse potential due to euphoric effects caused by inhibition of catecholamine uptake specially dopamine
What is the MOA of Phenobarbital? (effects which two things)
Partly through potentiation of the postsynaptic actions of the inhibitory neurotransmitter GABA and inhibition of the excitatory postsynaptic actions of glutamate
Prolong Cl channel opening limits the spread of seizure activity and increase seizure threshold
What is the drug of choice for Status Epilepticus?
Diazepam
First line drug for status epilepticus and LA induced seizures
can be given IV or rectal
MOA for Sulfonylurea
i. Sulfonylurea receptors are found on pancreatic and cardiac cells.
ii. These drugs inhibit adenosine triphosphate–sensitive potassium ion channels (now known as the sulfonylurea receptor-1) on pancreatic β cells.
iii. As a result, there is an influx of calcium and stimulation of exocytosis (release) of insulin storage granules.
iv. Although sulfonylureas decrease insulin resistance, this effect is minor, if at all, in decreasing blood glucose concentrations.
SE of Dantrolene
Review labs for liver dysfunction
Poss Hepatotoxicity***
What is the Tx for DI?
i. DDAVP or Vasopressin V2
ii. Chlorpropamide (sulfonylurea hypoglycemic agent)
iii. Carbmazepine (anticonvulsant)
iv. Thiazide diuretics
DoA for Levothyroxine?
Long ½ life 7- 10 days
MOA for Mineralocorticoid (aldosterone), where does it work in the renal tubular system?
Evokes distal renal tubular reabsorption of Na in exchange for K ions
Receptors present in distal renal tubules, colon salivary glands and hippocampus
Protects volume status via the Renin-angiotensin-aldosterone system
What happens in Cushing Syndrome? (Glucocorticoid Excess)
i. Excess glucocorticoid hormones (Cortisol) from overproduction of adrenal cortex or exogenously administered
ii. ACTH dependent causes pituitary adenoma and ectopic secretion of ACTH non pituitary tumor
iii. ACTH independent causes adrenal tumor, adrenal carcinoma
iv. Iatrogenic causes supraphysiologic doses of glucocorticoids for arthritis, allergies and asthma- most common cause
DoA of T3
Rapid onset and short duration
Used for long term replacement
Aldosterone is a Mineralcorticoid that has no glucocorticoid action***.
It is released by the kidneys in response to what?
Released by the kidney in response to hypovolemia, SNS, hypotension and hyponatremia.
Aldosterone is a Mineralcorticoid no glucocorticoid action.***
SE of Cushings
Red cheeks, moon face, Buffalo hump, thin skin, high B.P., pendulous abdomen, red striation, poor wound healing
Patients taking greater than (what dose of prednisone) or its equivalent for more than 3 weeks have a suppressed HPA axis.* (will prob get stress dose)
20 mg per day of prednisone
Patients taking less than (what dose of prednisone) or its equivalent can be considered not to have suppression of their HPA axis.* (prob not get a stress dose)
5 mg per day of prednisone
What is the Tx for SIADH
Treatment**
Fluid restriction 0.9% normal saline 800-1000 ml per day
If patient symptomatic of Na 115-120 mEq/L consider hypertonic saline
What are the two Posterior pituitary hormones?
a. Arginine Vasopressin (AVP)/ADH
b. Oxytocin
What is the Acromegaly hormone?
a. Hypersecretion of GH usually caused by GH secreting pituitary adenoma 99% of the time
b. Somatotropin
What is the Tx for Conn Syndrome?
Treatment
- Surgical removal of adenoma
- Medical Management
- K supplement
- HTN drugs
What are the manifestations for Conn Syndrome?
HYPERsecretion of aldosterone from an adrenal adenoma independent of stimulus*
Manifestations
iSystemic HTN with coexisting HYPOkalemia
What is the pre op considerations for Metformin?
Serious SE Lactic acidosis***
For this reason, some have recommended discontinuing metformin 48 hours or longer before elective operations
