Brainscape's Knowledge GenomeTM

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


See full index

620 Advanced Pharmacology > Herbal Remedies, IV Dyes & Electrolytes > Flashcards

Herbal Remedies, IV Dyes & Electrolytes Flashcards

1
Q

True or False: Are all supplements benign

A

False.

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

True or False: If you eat a well balanced meal you should also take a multivitamin supplement

A

False.

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

Complimentary therapy

A

The addition of non-conventional therapies to accepted treatments

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

Alternative therapy

A

The use of nonconventional therapies in lieu of accepted treatments.

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

Complementary and Alternative Medicine (CAM)

A

Integrative health or integrative medicine.
This is when complementary approaches are incorporated into mainstream healthcare.

  • Visits to CAM practitioners exceed those to primary care physicians
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the three reasons why we care if CAM is onboard during surgery?

A
  1. commonly used herbal medications exhibit direct effects on the cardiovascular system & coagulation systems
  2. some CAMs interfere with conventional medications that are commonly given in the post-op period
  3. CAM in the perioperative period is increasingly being described as reducing post-op nausea/vomiting, & pain.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 3 major categories of CAM?

A
  1. Natural products: herbs, vitamins/minerals, and probiotics. “dietary supplements”
  2. Mind-body practices: yoga, chiropractic/osteopathic manipulation, meditation, & massage therapy, acupuncture, relaxation techniques.
  3. Traditional healers: ayruredic medicine, Traditional Chinese, naturopathy and functional medicine.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pharmacological effects of Echinacea

A
  • Purple cone-flower root

Effects: activation of cell-mediated immunity

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

Perioperative concerns with Echinacea?

A
  • Allergic reactions
  • Decreases effectiveness of immunosuppressants
  • Potential for immunosuppression with long term use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Should you discontinue Echinacea before surgery?

A

No data;

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pharmacological effects of Ephedra?

A

Increases HR and BP through direct and indirect sympathomimetic effects*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Perioperative concerns with Ephedra?

A
  • Risk of MI and Stroke from tachycardia and HTN**
  • Ventricular arrhythmias with Halothane
  • Long-term use depletes endogenous catecholamines and may cause intra-operative hemodynamic instability
  • Life threatening interaction with MAOIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Should you discontinue Ephedra before surgery?

A

Yes. Discontinue 24hr prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pharmacological effects of Garlic

A
  • Inhibits platelet aggregation (may be irreversible)**
  • Increases fibrinolysis
  • Equivocal antihypertensive activity (controversial)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Perioperative concerns with Garlic

A
  • May increase risk of bleeding - especially combined with other medication that inhibit platelet aggregation**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Should you discontinue Garlic before surgery?

A

Yes. 7 days prior **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pharmacological effects of Ginger

A
  • Antiemetic

- Anti-platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Perioperative concerns with Ginger

A
  • May increase risk of bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Should you discontinue Ginger before surgery?

A

No data

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pharmacological effects of Gingko

A
  • Inhibits platelet- activating factor (inhibits platelet function)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Perioperative concerns with Gingko

A
  • May increase risk of bleeding, especially when combined with other medications that inhibit platelet aggregation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Should you discontinue Gingko before surgery?

A

Yes. Discontinue 36 hrs prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pharmacological effects of Ginseng

A
  • Lowers BG
  • Inhibits platelet aggregation (may be irreversible)
  • Increased PT/PTT in animals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Perioperative concerns with Ginseng

A
  • Hypoglycemia
  • May increase risk of bleeding
  • May decrease anticoagulant effects of warfarin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Should you discontinue Ginseng before surgery

A

Yes. Discontinue 7 days prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pharmacological effects of Green Tea

A
  • Inhibits platelet aggregation**

- Inhibits Thromboxane A2 formation**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Perioperative concerns with Green Tea

A
  • May increase risk of bleeding

- May decrease anticoagulant effect of warfarin** (so does ginseng)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Should you discontinue Green Tea before surgery

A

Yes. 24 hrs prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pharmacological effects of Kava

A
  • Sedation

- Anxiolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Perioperative concerns with Kava

A
  • May increase sedative effect of anesthetics
  • Increase in anesthetic requirements with long term use (unstudied)

(Metabolized by CYP450)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Should you discontinue Kava before surgery

A

Yes. 24 hrs prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Pharmacological effects of Saw Palmetto

A
  • Inhibits 5 alpha-reductive

- Inhibits cyclooxygenase

33
Q

Perioperative concerns with Saw Palmetto

A
  • May increase risk of bleeding
34
Q

Should you discontinue Saw Palmetto before surgery

A

No data

35
Q

Pharmacological effects of St. John’s Wort

A
  • Inhibits neurotransmitter reuptake

- MAO inhibition is unlikely

36
Q

Perioperative concerns with St. John’s Wort

A 
- Induction of cytochrome P450 enzymes 
= affects: 
	- cyclosporine
	- warfarin
	- steroids
	- protease inhibitors
May affect:
	- benzodiazepines
	- calcium channel blockers
- Decreased serum digoxin levels
- Delayed emergence
37
Q

Should you discontinue St. John’s Wort before surgery

A

Yes. 5 days prior

38
Q

Pharmacological effects of Valerian

A
  • Sedation
39
Q

Perioperative concerns with Valerian

A
  • May increase sedative effects of anesthetics
  • Acute withdrawal after long term use: M&M increase (morbidity & mortality)**
  • May increase anesthetic requirements w/ long term use
40
Q

Should you discontinue Valerian before surgery

A

No data.

41
Q

Summary of Herbal effects on anesthesia through what 3 mechanisms

A
  1. Direct effects - intrinsic pharmacological effects
  2. Pharmacological interactions (i.e. alteration of the action of conventional drugs at effector sites)
  3. Pharmacokinetic interactions (alteration of ADME)
42
Q

What are the 4 G’s that inhibit platelet function**

A
  1. Gingko
  2. Ginseng
  3. Garlic
  4. Green Tea
43
Q

True or False: Preop discontinuation of all herbal medicines eliminates complications related to their use

A

False. Discontinuation might not eliminate complications

44
Q

Withdrawal of which herbal medicine can increase morbidity & mortality?**

A

Valerian

45
Q

If your patient presents on the day of surgery for an elective procedure and are non compliant about discontinuing herbal supplements, what should you do?

A

Anesthesia can usually proceed safely at the discretion of the anesthesia provider

46
Q

What is the ASA guideline for herbal supplements?

A

Discontinue two weeks before surgery since there is no official standard or guideline for preop herbal meds

47
Q

Other herbal medicines in the top 10 list with no reports of ADRs or risks but should be d/c’d 2 weeks before

A
  • Soy
  • Isoflavones
  • Grape seed extract
  • Milk thistle
  • Boldo (peumus boldus)
  • Danshen
  • Papaya
48
Q

CoenzymeQ10

A
  • Promoted as an antioxidant
  • Structurally related to Vit K
  • Interacts with Warfarin**
  • Endogenous CoQ10 can prevent the membrane transition pore from opening, b/c it counteracts several apoptotic events, such as DNA fragments, cytochrome c release, & membrane potential depolarization
49
Q

Glucosamine & Chondroitin Sulfate

A
  • Widely used for joint disorders & accepted as OA management
  • Glucosamine does interfere w/ Warfarin & w/ some diabetes animal studies
  • Should be discontinued 2 two weeks prior to surgery
50
Q

Pharmacological effects of Fish Oil-omega 3 fatty acid supplement

A
  • Reduce the incidence of may chronic diseases that involve inflammatory processes, including CV ds., IBS, Cancer, RA, & neurodegenerative illness
  • Meta analysis concluded that it does not decrease M&M, cardiac death, sudden death, MI or stroke
51
Q

Perioperative concerns with Fish Oil-omega 3 fatty acid

A
  • Increased risk of bleeding
52
Q

Should you discontinue Fish Oil before surgery

A

Yes. D/c 2 weeks before surgery

53
Q

What is a Prebiotic?

A

A non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth & activity of one or a limited number of bacteria in the colon that have the potential to improve host health

54
Q

What is Probiotic

A

A live microbial feed supplement that beneficially affects the host by improving the intestinal microbial balance

55
Q

Acupuncture has promising indications for what?

A

PONV prevention

  • the main spot is the P6 or PC6
  • tapping a small needle cap over the P6 point (between the palmeris longs and flexor carpi radialis tendons, 4 cm proximal to the distal wrist crease and 1 cm below the skin)
56
Q

What are the main concerns with IV dyes?

A
  • Can cause allergic reactions
    • itching, hives, anaphylactoid & anaphylactic
    • more commonly in asthmatics & hx of allergy w/ multi. Comorbidities
    • Antigen fixates itself onto mast cells or basophils
      = release of histamine & tryptase = inhibit coagulation, dilate blood vessels, release complement or even stimulate IgE reaction
  • Extravasation of the intravenous contrast media agent
57
Q

ICM induced renal impairment can be reduced by using ?

A

Low-osmolality contrast media & extracellular volume expansion

58
Q

High-osmolar contrast media (HOCM)

A
  • Contains FEW dissolved particles and iodine atoms.

- Causes a fluid shift from the cell to the vein with the ICM

59
Q

Low-osmolar contrast media (LOCM)

A
  • Also known as Non-ionized contrast media
  • Contains a GREATER number of dissolved particles with iodine.
  • This one is closely iso-osmolar inducing less fluid shift from the cell
  • More costly so therefore not used as often
60
Q

Which ICM has lower reactions?

A

LOCM can still have reactions but fewer occur compared to HOCM

  • reactions can occur from a half hour to up to a week after administration
61
Q

Your diabetic patient is undergoing a CT w/ contrast, what education should you provide?

A
  • Diabetic patients taking Metformin must withhold the medication b/c of the risk of lactic acidosis (mainly if diabetic neuropathy)
  • 24 hrs before ICM and hold for 48 hrs after
62
Q

Who should never receive ICM?

A

Pregnant patients are an absolute contraindication

63
Q

To avoid renal issues with ICM how should you prepare your patient?

A

Hydrate them adequately starting 1 hr before the CT and continue for 24hrs afterward

64
Q

Patients who are at risk for anaphylactoid reactions with ICM should receive what as pretreatment?

A
  • Corticosteroids: methyprednisolone, or prednisone (PO or IV)
  • Severe previous reactions give
    • H1 blocker: Benadryl, Diphenhydramine, & - H2 blocker: Cimetidine or ranitidine
65
Q

What is the most frequently used agent that causes anaphylactoid reactions? How much does it take to cause this reaction?

A

IV Contrast Media

- takes as little as 1 mL for a patient to have these reactions

66
Q

Hyponatremia

A
  • Occurs in the presence of low serum osmolality (< 285 mOsm/kg)
  • Usual issue is elevated total body water (not enough sodium)
  • Causes:
    • Hypotonic fluids
    • Irrigation (glycine & sorbitol) w/ TURP or hysteroscopy
      (= these solutions prevent dispersal of electrical current when mono polar cautery is used.)
    • Mannitol use with renal dysfunction
67
Q

Hyponatremia signs and symptoms (

A
  1. Nausea/vomiting
  2. Visual disturbances
  3. Muscle cramps
  4. Weakness
  5. Bradycardia
  6. May develop increased ICP = mental status changes
  7. If Na is at 120 mEq/L now at risk for seizures
68
Q

Hypernatremia

A
  • Less common than hypo
  • Always associated with hypertonicity
  • Can present with low, normal, or high total body sodium content
  • Increases your MAC
  • Delay surgery if pt has > 150 mEq/L
69
Q

Potassium basics

A

Normal 3.5 - 5 mEq/L

- 2% is extracellular

70
Q

Hypokalemia

A
  • a low K = significant body depletion of K (GI loss/diarrhea), renal loss, trans cellular shifts, or inadequate intake
  • GI Loss:
    • Overuse of laxatives
    • Acute colonic pseudo-obstruction
  • Produces ECG changes:
    • ST segment & T wave depression
    • Prolonged QT
    • U waves
    • Cardiac arrhythmias - afib
    • PVCs
  • Impairs cardiac contractility
71
Q

Hypokalemia signs and symptoms

A
  • ST segment & T wave depression
  • Prolonged QT
  • Onset of U waves
  • Cardiac arrhythmias: PVCs and afib
  • Muscle weakness: including respiratory
    = sensitive to muscle relaxants
72
Q

Hyperkalemia signs & symptoms

A
  • Symptoms start to show @ 5.5 mEq/L
  • Profound weakness
  • Cardiac conduction abnormalities
  • Enhanced automaticity & repolarization irregularities
  • PEAKED T WAVE**, widening P wave, lengthening PR segment
73
Q

Anesthesia concerns with Hyperkalemia

A
  • Do not give succinylcholine will cause K+ to increase by 0.5 mEq/L
  • If you have a patient coming in with an acute stroke, burn, or spinal cord injury avoid Sux after 24 hrs
74
Q

Treatment for Hyperkalemia

A
  • Calcium chloride
  • Calcium gluconate
  • Kaexylate
  • Dialysis
75
Q

Hypocalcemia Causes

A
  • Hypoparathyroidism
  • Hyperphosphatemia
  • Vitamin D deficiency
  • Malabsorption
  • Rapid blood transfusion
  • Pancreatitis
  • Rhabdomyolysis
  • Fat embolism
76
Q

Hypocalcemia Treatment

A
  • Calcium chloride or gluconate IV
    • chloride provides more Ca than gluconate
    • gluconate less irritating
77
Q

Magnesium basics

A

Serum Mag = 1.3 - 2.2 mEq/L

78
Q

Hypomagnesemia

A
  • QT prolongation (Torsades de Pointes)
  • Muscle weakness tremors
  • Twitches
  • Numbness
  • Paresthesia
  • Confusion
  • Drowsiness
  • Seizure
  • increased susceptibility to muscle relaxants
    • may remain weak after surgery, can include respiratory insufficiency
79
Q

Hypermagnesemia

A
  • Very uncommon
  • Usually caused by renal dysfunction or excessive intake with is often iatrogenic
  • Typical symptoms occur at 4 - 6 mEq/L

620 Advanced Pharmacology (9 decks)

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