Lecture 10 (Exam 2) - MAGA Brooke's Deck Flashcards
What enzyme catalyzes the synthesis of prostaglandins?
COX (Cyclooxygenase)
Slide 33
This form of COX is responsible for gastric protection, hemostasis, and renal function…
COX-1
Slide 33
Hemostasis (produces thromboxane)
Renal function (IDK)
COX-1 or COX-2?
Ubiquitous,
“physiologic”
Inhibition of this enzyme is responsible for many adverse effects
COX-1
Slide 33
COX-1 or COX-2?
Pathophysiologic, expressed at sites of injury, not protective
COX-2
Slide 33
COX-2 is responsible for which symptoms?
Pain, inflammation, and fever
Slide 33
What are the three main properties of NSAID drugs?
Analgesic
Anti-inflammatory
Antipyretic
Slide 34
Are drugs below non-specific or COX-2 selective? What GI symptom may occur?
Ibuprofen, naproxen, aspirin, acetaminophen, and ketorolac
Non-Specific
Increased gastric irritation with these drugs
Slide 34
Multimodal includes S____-a ____ acting anesthetics agents and O______ sparing components.
short acting; Opioid sparing.
slide 2
Celecoxib (Celebrex), Rofecoxib (Vioxx), Valdecoxib (Extra), Parecoxib (Dynastat) are all examples of what?
COX-2 Selective NSAIDs
Slide 34
Do COX-2 selective NSAIDs effect platelets?
NO
Slide 35
Because COX-2 selective NSAIDs have no effect on platelets, that increase the chance of what two disease processes?
MI and CVA
Slide 35
COX-2 selective and COX-nonspecific inhibitors have _____________ analgesia
Comparable
Slide 35
What was the first COX-2 inhibitor that decreases PG synthesis?
Celecoxib (Celebrex)
Slide 36
What is the dosage for Celebrex?
200 to 400 mg PO QD
Slide 36
Celebrex reaches its peak in…
3 hours
Slide 36
Define non-opioid anesthesia. List some alternatives to treat pain.
PT & OT, Chiropractic care, acupuncture, massage, yoga, weight loss, cold/heat, OTC medications, TENS unit…etc.
slide 11-12
What is the pain response pathway? (5)
slide 17
(this was in the pain pathway slide set too)
What are the 2 classes of opioids?
1) Phenanthrenes (L-isomers have opioid activity; morphine, codeine)
2) Benzylisoquinolones (Lack opioid activity; Papaverine, noscapine)
slide 19
What drug class does Ondansetron fall into?
It is the first 5-HT3 antagonist
-It was approved for CINV
-Responsiveness decreased by variations in the CYP2D6 activity!
(Slide 51)
Ondansetron is equivocal to what two drugs?
Droperidol & Metoclopramide
(Slide 51)
What are the side effects of Ondansetron?
- HA
- Constipation and
- Some QT prolongation
(Slide 51)
What is the duration & dose of Ondansetron? How about pediatric dose?
Duration/plasma half life is 4 hours!
Dose: Adults: 4 mg IV (up to 8 mgs)
Dose: Pediatrics: 0.1 mg/kg IV
(Slide 51)
What is the MOA of Corticosteroids?!
Why are Corticosteroids used with 5-HT3 (Ondansetron) & droperidol?
Hint: It was studied in CINV!
MOA is unknown: It works on glucocorticoid receptors in Nucleus Tractus Solitarius (NTS)!
Corticosteroids increase effectiveness for 5 HT3 antagonists and droperidol!
(Slide 52)
What is the dose for Dexamethasone (Decadron)?!
What is the MOA of Dexamethasone (Decadron)?
8 to 10 mgs
MOA: Anti-inflammatory; inhibition of phospholipase and cytokines and stabilization of cellular membrane.
(Slide 53)
What is the delay of onset of Dexamethasone (Decadron)?
Are there any adverse effects of a single dose of Dexamethasone (Decadron)?
Delay in onset is 2 hours! Efficacy persists for 24 hours!
With diabetics one dose will not throw off their blood sugar levels.
If you push it to fast you are going to give them Spicy Butthole 🥵and your patient will be mad!
(Slide 53)
According to the TXWES medication guide, what are the single doses/frequency for Acetaminophen (Ofirmev), Ketorolac (Toradol), & Ibuprofen (Caldor). What is are their Max daily?
Slide 62
A 50 y/o, 60 kg female patient received a Lidocaine initial dose of 1 mg/kg with a subsequent infusion of 1.5 mg/kg/hour for 1.5 hours. How much total Lidocaine in mgs did she receive in the PACU?
60kg x 1 mg/kg = 60 mg
60 kg x 1.5 mg/kg = 90 mg (1 hour)
(60 kg x 1.5mg/kg = 90 mg)/2 = 45 mg (30 minutes)
60+90+45 = 195 mg total!!!
(Slide 59)
What kind of properties does propofol have?
Analgesic properties
Slide 42
Ketamine inhibits N_____ activation.
NMDA
Slide 42
(We do not need to know TEAMHealth Formula in this slide)
What is the induction dose of Ketamine for IV and IM?
0.5-1.5 mg/kg/IV
4-8 mg/kg IM
Slide 43
What is the maintenance dose of Ketamine for IV and IM?
0.2-0.5 mg/kg IV analgesia
4-8 mg/kg IM
Slide 43
What is the subanesthetic (analgesic dose) of ketamine?
0.2 -0.5 mg/kg IV
Slide 43
What is Post op sedation and analgesia dose for ketamine?
1-2 mg/Kg/hour (pediatric cardiac surgery)
Slide 43