Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

5230 > GI Drugs, Anticoagulation > Flashcards

GI Drugs, Anticoagulation Flashcards

1
Q

Drugs that decreased lower esophageal sphincter tone

A 
Atropine
Glycopyrrolate 
Dopamine
Nipride
Thiopental
TCAs
Beta adrenergic stimulants
Inhaled anesthetics
Opioids
Propofol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Drugs that increase lower esophageal sphincter tone

A 
Reglan
Edrophonium
Neostigmine
Histamine
Succinylcholine
Pancuronium
Metoprolol
Alpha adrenergic stimulants
Antacids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Metoclopramide mechanism of action, indication, contraindications, and dose

A

Mild dopamine receptor blocking effect
Cholinergic stimulation of GI tract, accelerates gastric emptying/decreases gastric volume, increases LES tone
Anti-emetic (antagonizes dopamine receptors in CTZ)
Contraindication: Parkinson’s disease, SBO, extrapyramidal symptoms
Dose: 10-20mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bicitra mechanism of action, side effects

A

Mechanism of action: Increases pH of gastric contents (but also increases gastric volume)
Side effects: Increased gastric volume, caution in patients with renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

H2 antagonists (“-idine” ex: Pepcid, zantac) mechanism of action

A

Competitively blocks H2 receptors on parietal cells (decrease acid secretion)
-Doesn’t affect gastric fluid currently present, moreso given for emergence prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

H1 vs H2 receptor affects

A

H1: Decrease HR, Bronchoconstriction
H2: Increase HR, bronchodilation, secretion of gastric acid, CNS stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Droperidol mechanism of action, contraindication, dose

A 
Dopamine antagonist (inhibit CTZ), anti-psychotic, alpha antagonist (vasodilation)
*Black box warning for prolonging QT (need 12 lead before giving)
-Contraindications: Parkinsons, pts with prolonged QT
Dose:  .625 mg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

5-HT3 receptor antagonists (Zofran), dose

A

Blocks serotonin receptor centrally and peripherally
-Central receptors: Present at vomiting and CTZ centers
-Peripherally: Initiate vomiting reflex
Dose: 4-8 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

H1 antagonist (Benadryl, Dramamine)

A

Block H1 and muscarinic cholinergic receptors in vestibular system (best for motion sickness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Corticosteroids for PONV, contraindication, dose

A 
Decadron, uncertain mechanism of action
-Inhibit prostaglandin synthesis? Less inflammation
-Increase release of endorphins
Side effect: Increased blood sugar
Dose: 4-8 mg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chemotactic trigger zone (CTZ)

A

Area in postrema of brain stem

  • Has dopamine, serotonin, histamine, muscarinic acetylcholine, and opiate receptors
  • Gives messages to vomiting center
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Vomiting center

A

Receives input from the chemotactic trigger zone and vagus nerve
-Can be stimulated by opioids (dose dependent, lower initial doses) and then inhibited by high dose opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risk factors for PONV

A 
History of PONV
Female
<50 years old
High doses of intraop or postop opioids
Surgery >1 hour
Laparoscopic procedures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Overall coagulation steps (3) and which class of medications works during the different steps

A

1: Primary hemostasis: adhesion, activation, aggregation -> platelet plug formation
- Meds: Anti-platelet
2: Secondary hemostasis: Actions of coagulation factors -> stable clot formation
- Meds: Anti-coagulant
3: Regulation of coagulation: Fibrinolysis/clot breakdown by plasmin
- Meds: Thrombolytic/fibrinolytic medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Average life span of platelet

A

7-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Antiplatelet medications (overall MOA, 4 types)

A

Overall: Prevent platelet activation and aggregation

  • COX inhibitors
  • Phosphodiasterase inhibitors
  • ADP receptor antagonists
  • Glycoprotein IIb/IIIa receptor antagonists
17
Q

COX inhibitors

A 
COX=enzyme for prostaglandin synthesis
-Inhibit production of thromboxane A2 (essential in plt activation/aggregation)
ASA-irreversible inhibition
NSAIDS-reversible inhibition
Selective COX 2: Celebrex
18
Q

Phosphodiasterase inhibitor

A

Dipyridamole
Inhibit phosphodiesterase->increased cAMP
-Blockade in uptake of adenosine
-Prostacyclin release from endothelium (vasodilate)
-Decreased response to ADP (essential for platelet activation/aggregation)

19
Q

ADP receptor antagonist

A

Indirect (Plavix)
-Given in inactive form (prodrug), require liver metabolism into active metabolite
-Irreversible inhibition of ADP mediated platelet activation
-Stop 7-10 days preop
Direct (Ticagrelor, cangrelor)
-Administered in active form
-Reversible inhibition when discontinued

20
Q

BP IIb/IIIa receptor antagonists

A

Direct inhibition of platelet aggregation
Ex: Abciximab
Contraindicated if surgery within 4-6 weeks

21
Q

Anticoagulant medications

A

Inhibit coagulation factors (in circulation and being produced)

  • Vitamin K antagonist
  • Glycosaminoglycans
  • Pentasaccharides
  • Direct thrombin inhibitors
  • Activated protein C
22
Q

Vitamin K antagonist (ex, MOA, monitoring)

A

Warfarin
Vitamin K vital for production of factors II, VII, IX, X
-Doesn’t inhibit factors already in circulation (why onset time is so long)
Monitoring: PT/INR

23
Q

Unfractionated heparin (Ex, MOA, complication, monitoring)

A

Glycosaminoglycan (anti-coagulant)
Inhibits factors II, IX, X, XI, XII
IIa and Xa are inactivated in a 1:1 ratio
Heparin induced thrombocytopenia: Immune mediated, heparin forms complex with platelet factor 4, generates IgG antibodies -> plt activation, thrombus formation, platelet consumption
Monitoring: PTT

24
Q

Low-molecular weight heparin (Ex, MOA, benefits, monitoring)

A

Exogenous heparinoid
Lovenox
Inactivates factors II and X in a 1:4 ratio
Less protein binding->more consistent pharmacokinetics, greater bioavailability, longer elimination half-life, daily dosing
Decreased risk of HIT
No monitoring

25
Q

Thrombolytic medications

A

TPA
Plasminogen activators convert plasminogen to plasmin -> dissolves fibrin and other plasma proteins/coagulation factors
-Better at dissolving newly formed clots than older ones

26
Q

Protamine

A

Emergent reversal for heparin and LMWH
Dose: 1mg heparin : 100 units heparin in circulation
Side effects: Histamine release -> hypotension, pulmonary vasoconstriction -> RV failure, reaction if allergic to fish

27
Q

TXA

A 
Anti-fibrinolytic 
Binds to plasminogen, prevents conversion of plasminogen to plasmin
Most effective early post op
Half-life: 2-3 hours
Serum levels therapeutic 3 hours after 
Route: IV or topical soak

5230 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions