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Anes 516: Pharmacology > Lecture 3: Subarachnoid Hemorrhage > Flashcards

Lecture 3: Subarachnoid Hemorrhage Flashcards

1
Q

Where do cerebral aneurysms normally occur? Why?

A

At or near bifurcation of the vessels d/t more vulnerable geometry

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2
Q

What is a syncopal episode?

A

Fainting

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3
Q

What are the components of propofol that can trigger allergies? (Do keep in mind that propofol was reformulated to reduce anaphylactic reaction.)

A

Egg lecithin + soybean oil

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4
Q

What part of propofol usually causes allergic reactions?

A

Diisopropyl group + phenol group

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5
Q

What is valsartan/diovan?

A

Antihypertensive medication; angiotensin II receptor blocker

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6
Q

Common name of acetylated salicyclic acid?

A

Aspirin

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7
Q

Hydrocodone dose?

A

5-10 mg q3-4 hours

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8
Q

Acetominophen is what class of drug? Dose?

A

NSAID; 10-15 mg/kg q4 hours

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9
Q

Naproxen: common name? Class? Dose?

A

Aleve; NSAID; 250 mg q4 day or 500 mg q2 day

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10
Q

What disease does novolin treat?
Dose?
Supplied?

A

Diabetes
6 units subcutaneously q12hr
Supplied 100 units/ml

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11
Q

Common name of glucophage? Class? What disease does glucophage treat?

A

Metformin
Biguanide
Diabetes

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12
Q

Nimotop’s generic name? Treats?

A

Nimodipine; Ca++ channel blocker that treats hypertension

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13
Q

Zocor’s generic name? Treats?

A

Simvastatin; treats high cholesterol

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14
Q

Colace treats what problem?

A

Colace is an anionic surfactant that decreases the surface tension of stool– a stool softener that treats constipation.

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15
Q

Mechanism of metformin?

A

Reduces glucose levels by decreasing hepatic glucose production and increasing insulin action in muscle and in fat

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16
Q

Mechanism of action of sulfonylureas:

A

Stimulate the insulin release from the Beta cells of the pancreas

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17
Q

Who shouldn’t take metformin?

A

Patients with a history of renal impairment, lactic acidosis, hepatic disease or cardiac failure

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18
Q

Which Ca++ channel blocker has the most widespread effect on all aspects of the heart?

A

Verapamil

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19
Q

Which Ca++ channel blocker has its main effect in slowing conduction of both SA and AV nodes?

A

Diltiazam

20
Q

Which Ca++ channel blocker improves neurological outcomes in patients where deficits secondary to vasospasm are present after cerebral aneurysm rupture and is also recommended to prevent vasospasm after cerebral aneurysm coiling?

A

Nimodipine

21
Q

Why do we prescribe aneurysm patients stool softeners after surgery?

A

We don’t want them to strain; that would increase ICP and cause aneurysm to burst.

22
Q

What class of drug is pepcid? What does it inhibit?

A

Histamine H2 receptor blocker; inhibits gastric acid production

23
Q

Pepcid results in what percentage drop in acid secretion?

A

70%

24
Q

On what type of secretion is pepcid most effective?

A

Basal acid secretion, which is responsible for nocturnal acid secretion

25
Q

Drug name of pepcid?

A

Famotidine

26
Q

When end organ function exists, surgical mortality for diabetic patients is _____ times higher than normal patients.

A

5x higher

27
Q

Which three patient groups demand perioperative tight control of blood sugar?

A

1) Pregnant patients
2) Patient undergoing cardiopulmonary bypass
3) Patient with global CNS ischemia

28
Q

What is a common complications during surgery in patients with diabetes?

A

Cerebral CNS insult

29
Q

Which type of diabetic patient is susceptible to ketoacidosis?

A

Type I diabetic

30
Q

NIDDM is defined as a fasting blood glucose:

A

> 125 mg/dl

31
Q

Which type of diabetic medication increases insulin binding to the insulin receptors on target tissue?

A

Sulfonylureas

32
Q

What effect does high glucose levels have on wound healing?

A

Decreased granulocytic function + collagen synthesis

33
Q

What is another word for ketoacidosis?

A

Hyperglycemia

34
Q

What glucose level is considered hypoglycemic? How do you treat hypoglycemia?

A

< 50 mg/dl

Treat with 50% dextrose, starting with 15 ml bolus.

35
Q

Under what circumstances would you have your patient on an IV insulin infusion during surgery?

A

If your patient is having a major surgery and has DM on insulin or DM poorly controlled w/ oral meds

36
Q

Why do you discard the first 50 ml of insulin infusion?

A

Insulin sticks to plastic tubing, so we use the first 50 ml to coat the system to prevent that.

37
Q

What is the physiological response during an asthma attack?

A

Mast cell release of histamine

38
Q

What is the pathology of an asthma attack?

A

Bronchoconstriction and airway inflammation

39
Q

In what way do B2 agonists treat asthma?

A

They activate muscarinic receptors in the lungs to cause bronchodilation by relaxing smooth muscle.

40
Q

Particle sizes of aerosolized spray in:
Mouth and oropharynx
Conducting and low airways
Alveolar level

A

1) 10 micrometer in mouth and oropharynx
2) 1-10 micrometer in conducting and low airways
3) Alveolar level

41
Q

What are the two types of aerosols?

A

1) Metered dose

2) Nebulizers

42
Q

Onset and duration of short-acting B2-agonists?

A

Onset: 1-5 min
Duration: 2-6 hours

43
Q

Onset and duration of long-acting B2-agonists?

A

Onset: > 20 minutes
Duration: 12 hours

44
Q

What are the two long-acting B2-agonists?

A

1) Salmeterol

2) Formoterol

45
Q

What steroid (glucocorticoid) is used to treat asthma?

A

Beclomethasone

46
Q

By what means do steroids have a bronchodilating effect?

A

They decrease mucosa edema and prevent the release of bronchoconstricting substances

47
Q

What are three possible complications of aneurysm coiling?

A

1) Aneurysm rupture
2) Thromboembolism
3) Vasospasm

Anes 516: Pharmacology (5 decks)

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