Lecture 3 Flashcards
How many mg in 2% lido carp
34 mg
How many mg epi in 1:100k epi carp
0.018 mg
Where are amides/local anesthetics metabolized?
Liver
Two drugs that cause higher conc of LA in pt
Propanolol
Cimetidine
Early overdose symptoms of LA
Tachycardia and hypertension, Metallic Taste, confusion, sweating, tinging of lips
Late signs of overdose of LA
Bradycardi and hypotension, decrease CP, Loss of consciousness
Vasoconstrictors: use
Helps w/ Hemostasis
Keeps LA localized
Reduces endogenous release of catecholamines
Two vasoconstrictors we use and which is more potent
Epi - Most potent
Levonordefrin
Epi what receptors
A1, B1, B2
A1 effects
Inc BP (vasoconstriction)
B1 effects
Inc HR and cardiac contraction
B2 Effects
Vasodilation in bronchioles
Summary of A1, B1, B2
A1- Inc BP
B1- Inc HR
B2- Dec BP
When to use combined A and B blockers
Pts with more cardiovascular needs
Non-Selective B blocker causes:
Hypertension and bradycardia
Caution w/ pts on SNRI and Tricyclics
Keep epi around because blocking reuptake so could theoretically exaggerate response to epi
Blocking A1 causes
Hypotension and tachycardia
Parkinson’s Meds?
COMT Inhibitors - Tolcapone and Entacapone! - EXAGGERATED response to Epi
Recommend max epi dose in healthy aduly
0.2 mg = 11 carps
Max epi for CV compromised pt
0.04 mg = 2.2 carps
Endogenous secretion of epi in stressed patient
up to 0.28 mg/minute!
NSAIDS can cause issue with
Asthmatic or COPD patients –> everything goes down lipoxygenase pathway and production of leuktotrienes
NSAIDs adverse effects
GI problems, renal problems, platelet problems, exacerbation of asthma, CNS things like dizziness, tinnitus
NSAIDS have adverse interactions with these drugs
Oral hypoglycemics Warfarin Digoxin Lithium Cyclosprine Tacrolimus
NSAID + warfarin
Inc bleeding
NSAID + Oral hypoglycemic
Hypoglycemia
NSAID + Tacrolimus or Cyclosporine
Inc renal toxicity
NSAID + Digoxin or Lithium
Inc their levels! Beware of toxic levels!
Necessary to break down opioids
CYP 2D6
Opioids interact w/
Antihistamines and depressants–> excessive sedation
Anticholinergics and Imodium–> constipation
Antihypertensives–> hypotension
What to use on pts whom opioids don’t work on
NSAIDs!
Can also give Dilauded or Demerol but very very rare
Erythro and Clarithro -mycin Adverse interactions
Inc blood levels of Warfarin, Digoxin, Triazolam, Corticosteroids, cyclosporine
Penicillin and Metronidazole
Inc anticoagulation in pts on Warfarin
Metronidazole and Coumadin
Inhibits metabolism of Coumadin
Penicillin and Coumadin
Penicillin dec Vit K synthesis in Gut - so synergistic with warfarin
Rifampin Adverse interaction
Decreases oral contraceptive levels
Tetracycline adverse interaction
Inc lithium levels
Metronidazole interaction
Severe nausea/vomiting w/ alcohol
Adverse SE’s of antibiotics in general
Decreased gut flora
Decreased hydrolysis of metabolites
Decreased parent drug resorption
Decrease enteroheptic circulation
